Spread of carbapenem resistant Enterobacteriaceae at tertiary care cancer hospital in Egypt

El-Mahallawy, Hadir A.; Zafer, Mai M.; Amin, Magdy A.; Ragab, Mai M.; Al-Agamy, Mohamed H.

doi:10.1080/23744235.2018.1428824

Cited by 27 publications

(31 citation statements)

References 9 publications

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“…Neither bla OXA-48 nor bla NDM genes, which are considered the predominant carbapenemases observed in our country, were detected. 23 These results are unlike the results described by other authors, which reported the existence of carbapenemase-producing Serratia . 24 Reporting carbapenemase production by Serratia species is very important as carbapenemase-encoding genes confer broad-spectrum antimicrobial resistance.…”

Section: Discussioncontrasting

confidence: 85%

First reported nosocomial outbreak of Serratia marcescens harboring blaIMP-4 and blaVIM-2 in a neonatal intensive care unit in Cairo, Egypt

Ghaith¹,

Zafer²,

Ismail³

et al. 2018

IDR

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IntroductionSerratia marcescens is a significant hospital-acquired pathogen, and many outbreaks of S. marcescens infection have been reported in neonates. We report a sudden breakout of S. marcescens harboring the blaIMP-4 and blaVIM-2 metallo-β-lactamase (MBL) genes that occurred from March to August 2015 in the neonatal intensive care unit of Cairo University Hospital, Cairo, Egypt.MethodsDuring the study period, 40 nonduplicate clinical isolates of S. marcescens were collected from blood culture samples. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was used to identify each isolate. Then, minimum inhibitory concentrations of different antibiotics were assessed by the Vitek 2 compact system. Screening of the MBL genes blaIMP, blaVIM, blaSIM-1, blaSPM-1, and blaGIM-1 as well as the carbapenemase genes KPC, NDM, OXA-48, SME-1, and SME-2 were evaluated. Pulsed field gel electrophoresis was preformed to detect the genetic relationship of the isolates.ResultsAnalysis showed that 37.5% of the S. marcescens clinical isolates were resistant to meropenem (minimum inhibitory concentrations ≥ 2 µg/mL), and blaIMP-4 and blaVIM-2 were the most prevalent MBL genes (42.5% and 37.5%, respectively). None of the other investigated genes were observed. Pulsed field gel electrophoresis typing revealed two discrete clones; 33/40 (82.5%) were pulsotype A and 7/40 (17.5%) were pulsotype B.ConclusionHere, we report for the first time the detection of MBL-producing S. marcescens isolates, particularly IMP-4 and VIM-2 recovered from inpatients with bacteremias from the intensive care unit at Cairo University Hospital.

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Section: Discussioncontrasting

confidence: 85%

First reported nosocomial outbreak of Serratia marcescens harboring blaIMP-4 and blaVIM-2 in a neonatal intensive care unit in Cairo, Egypt

Ghaith¹,

Zafer²,

Ismail³

et al. 2018

IDR

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“…Recent studies conducted by Al Tamimi et al . and ElMahallawy et al ., had reported (43%) and(49%), respectively with the MHT results [ 27 – 28 ]. In the current study, relatively low percentage of carbapenemase detection by MHT could be attributed to presence of class B carbapenemase including NDMs, VIMs and IMPs that requires zinc for their action[ 22 ].…”

Section: Discussionmentioning

confidence: 92%

“…Although, OXA-48 was initially identified in K . pneumoniae from Turkey, however since then OXA-48 producing enterobacterial strains has been widely spread as a source of nosocomial outbreaks in Mediterranean countries including Egypt as reported by many studies [ 27 , 29 , 30 ].This high level of OXA-48 among cancer patients is alarming due to difficulty in detection by reliable phenotypic methods, association with treatment failure and high rate of dissemination via transferable plasmids[ 31 ]. Also, the presence of NDM producers among our isolates should not be underestimated as they harbor multiple plasmid and chromosome mediated resistance genes, resulting in a MDR phenotype[ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Phenotypic screening and molecular characterization of carbapenemase-producing Gram-negative bacilli recovered from febrile neutropenic pediatric cancer patients in Egypt

et al. 2018

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AimInfections with carbapenem-resistant Gram-negative bacteria (GNB) are among the most frequent complications in the immunocompromised cancer patients because of their considerable morbidity and mortality. Therefore, the aim of the current study was to characterize the prevalence of carbapenemase-producing GNB recovered from febrile neutropenic pediatric cancer patients in Egypt.MethodsStandard methods were used for identification, sensitivity testing (Kirby-Bauer and broth microdilution method according to CLSI guidelines). Standard methods were applied for both phenotypic and genotypic detection of the carbapenemase-producing GNB.ResultsA total of 185 GNB were recovered from different clinical specimens, Escherichia (E.) coli (86; 46.48%), followed by Klebsiella spp. (71; 38.37%), Acinetobacter (A.) baumannii (7; 3.78%) and others including Pseudomonas spp., Enterobacter (Ent.) cloacae and Proteus spp. (21; 11.35%). It is a matter of concern that 116 out of 171 enterobacterial isolates (94.15%) showed resistance to three or more antimicrobial classes and were considered multidrug resistant. Additionally, the rate of carbapenem-resistance displayed a worrisome trend as 113 out of 171 enterobacterial isolates (66.08%) and 12 out of 14 non fermenting bacilli (85.71%) showed resistance pattern to at least one of the tested carbapenems. After performing a series of phenotypic tests for initial screening of potential carbapenemase producers, molecular characterization to the 29 extracted plasmids were subjected to PCR (using 5 common carbapenemase primers). The results revealed that blaOXA-48 was the most prevalent 17 (58.62%), followed by blaNDM 8(27.58%), then blaVIM 3 (10.3%) and blaKPC 2 (6.89%).ConclusionThese results are an alarming threat to public health that calls for urgent application of antimicrobial stewardship programs along with routine surveillance for controlling outbreaks.

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“…However, a similar study at MBRRH detected lower phenotypic prevalence of 12.6% [25]. Contrary to this, studies in North Africa and West Africa reported remarkably higher phenotypic resistance of > 50% and K. pneumoniae were the most prevalent isolates [26][27][28][29]. Furthermore, in a larger study which covered Gauteng, KwaZulu-Natal, Western Cape and Free State provinces in South Africa documented overwhelming phenotypic resistance of between 47-50% to Imipenem, Meropenem and Doripenem, 84%…”

Section: Discussionmentioning

confidence: 79%

“…Through molecular characterization, we detected carbapenem genotypic resistance frequency ranging from 32.4% at KIU-TH to 70.8% at MRRH and overall genotypic resistance prevalence of 43.2% in Uganda. In contrast, the overall genotypic prevalence was lower than that reported in Tunisia (86.3%) [33], Egypt (56%) [27], South Africa (86.0%), [31], India (76.3%) [34]. Among the ve genes which were detected by multiplex PCR, the most encountered gene was OXA-48like at a genotypic frequency of 36.4%.…”

Section: Discussionmentioning

confidence: 81%

Prevalence of Pathogenic Klebsiella Pneumoniae based on PCR Capsular Typing Harbouring Carbapenemases Encoding Genes in Ugandan Tertiary Hospitals

Ssekatawa

Byarugaba

Nakavuma

et al. 2020

Preprint

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Background: Klebsiella pneumoniae is an opportunistic pathogen that has been implicated as one of commonest cause of hospital and community acquired infections. The K. pneumoniae infections have considerably contributed to morbidity and mortality in patients with protracted ailments. The capacity of K. pneumonia to cause diseases depends on presence of an array virulent factors. Coexistence and expression of virulent factors and genetic determinants of antibiotic resistance complicates treatment outcomes. Thus, emergence of pathogenic MDR K. pneumoniae poses a great threat to the healthcare system. However, the carriage of antibiotic resistance among pathogenic K. pneumoniae is yet to be investigated in Uganda. We sought to investigate the carbapenem resistance profiles and pathogenic potential based on capsular serotypes of K. pneumoniae clinical isolates. Methods: This was a cross sectional study involving use of archived Klebsiella pneumoniae isolates collected between January and December, 2019 at four tertiary hospitals in Uganda. All isolates were subject to antimicrobial susceptibility assays to determine phenotypic antibiotic resistance, pentaplex PCR to detect carbapenemases encoding genes and heptaplex PCR to identify capsular serotypes K1, K2, K3, K5, K20, K54 and K57.Results: The study found an overall phenotypic carbapenem resistance of 23.3% (53/227) and significantly higher genotypic resistance prevalence of 43.1% (98/227). Over all, the most prevalent gene was blaOXA-48-like (36.4%), followed by blaIMP-type (19.4%), blaVIM-type (17.1), blaKP-type (14.0%) and blaNDM-type (13.2%). blaVIM-type and blaOXA-48-like conferred phenotypic resistance in all isolates and 38.3% isolates that harbored them respectively. Capsular multiplex PCR revealed that 46.7% (106/227) isolates were pathogenic and the predominantly prevalent pathotype was K5 (18.5%) followed by K20 (14.1%), K3 (7.1%), K2 (3.1%) and K1 (2.2%). Of the 106 capsular serotypes, 37 expressed phenotypic resistance; thus, 37 of the 53 carbapenem resistant K. pneumoniae were pathogenic.Conclusion: The high prevalence of virulent and antibiotic resistant K. pneumoniae among clinical isolates obtained from the four tertiary hospital as revealed by this study pose a great threat to healthcare. Our findings underline the epidemiological and public health risks and implications of this pathogen.

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Spread of carbapenem resistant Enterobacteriaceae at tertiary care cancer hospital in Egypt

Cited by 27 publications

References 9 publications

First reported nosocomial outbreak of <em>Serratia marcescens</em> harboring <em>bla</em><sub>IMP-4</sub> and <em>bla</em><sub>VIM-2</sub> in a neonatal intensive care unit in Cairo, Egypt

First reported nosocomial outbreak of <em>Serratia marcescens</em> harboring <em>bla</em><sub>IMP-4</sub> and <em>bla</em><sub>VIM-2</sub> in a neonatal intensive care unit in Cairo, Egypt

Phenotypic screening and molecular characterization of carbapenemase-producing Gram-negative bacilli recovered from febrile neutropenic pediatric cancer patients in Egypt

Prevalence of Pathogenic Klebsiella Pneumoniae based on PCR Capsular Typing Harbouring Carbapenemases Encoding Genes in Ugandan Tertiary Hospitals

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Spread of carbapenem resistant Enterobacteriaceae at tertiary care cancer hospital in Egypt

Cited by 27 publications

References 9 publications

First reported nosocomial outbreak of <em>Serratia marcescens</em> harboring <em>bla</em><sub>IMP-4</sub> and <em>bla</em><sub>VIM-2</sub> in a neonatal intensive care unit in Cairo, Egypt

First reported nosocomial outbreak of <em>Serratia marcescens</em> harboring <em>bla</em><sub>IMP-4</sub> and <em>bla</em><sub>VIM-2</sub> in a neonatal intensive care unit in Cairo, Egypt

Phenotypic screening and molecular characterization of carbapenemase-producing Gram-negative bacilli recovered from febrile neutropenic pediatric cancer patients in Egypt

Prevalence of Pathogenic Klebsiella Pneumoniae based on PCR Capsular Typing Harbouring&nbsp;Carbapenemases Encoding Genes in Ugandan Tertiary Hospitals

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Prevalence of Pathogenic Klebsiella Pneumoniae based on PCR Capsular Typing Harbouring Carbapenemases Encoding Genes in Ugandan Tertiary Hospitals