The emergence of blaOXA-48 and blaNDM among ESBL-producing Klebsiella pneumoniae in clinical isolates of a tertiary hospital in Iran

Abstract

The aim of this study was to investigate the prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) and the most common types of carbapenemases, metallo-beta-lactamases (MBLs), and extended-spectrum beta-lactamases (ESBLs) among CRKP isolates in a tertiary hospital in Isfahan, Iran. Eighty non-repetitive clinical isolates of K. pneumoniae were obtained from different clinical specimens. Antibiotic resistance pattern of isolates was determined by disk diffusion method and production of carbapenemases and MBLs was confirmed using modified Hodge test and E-test, respectively. Molecular detection of the antibiotic resistance genes was performed using PCR. Fifty-one (63.8%) isolates have decreased susceptibility to carbapenems, of which 46 (90.2%) isolates were as carbapenemase producer and four (7.8%) isolates were positive for MBLs, phenotypically. The results of PCR showed that the prevalence of bla, bla, bla, bla, and bla genes among CRKP isolates were 90.2%, 15.7%, 98%, 96.1%, and 90.2%, respectively. No isolates carrying the bla, bla, bla, bla, and bla genes were detected. This study showed that the production of OXA-48 is one of the main mechanisms of resistance to carbapenems in CRKP isolates in Isfahan. In addition, the dissemination of NDM-producing CRKP isolates is a potential risk for the health care system of this area in the near future.

Antibiotic resistance, virulence and genetic diversity of Klebsiella pneumoniae in community- and hospital-acquired urinary tract infections in Iran

“…The absence of the ESBL genes in two of the phenotypically ESBL-positive isolates suggests that ESBL production in these isolates might be related to other classes of ESBLs, which requires further studies [37]. In accordance with our findings, a high prevalence of CTX-M is reported among the ESBL-positive strains from Asia, America, and Africa [35,38,39]. Furthermore, in agreement with the present study, an increased shift from TEM or SHV to CTX-M genotype was shown in Europe [35,38]; whereas in addition to CTX-M, the high frequency of TEM and SHV genotypes was reported in Isfahan, 362 EGHBALPOOR ET AL.…”

“…Iran [39]. Different concurrent presence of ESBL genes is also reported from Iran and other countries [35].…”

<p>Dissemination Pattern of Multidrug Resistant Carbapenemase Producing <em>Klebsiella pneumoniae</em> Isolates Using Pulsed-Field Gel Electrophoresis in Southwestern Iran</p>

“…29 Different distribution of the bla OXA-48 gene was reported in different parts of Iran, in Tehran in 2014 (96.4%) and Isfahan in 2018 (90.2%). 29,30 Also, the prevalence of OXA-48 genes among K. pneumoniae strains was reported from several countries including China, France, Turkey, and Saudi Arabia, [31][32][33][34] which raises serious concerns when treating patients in different parts of the world. In the current study, the results showed that a combination of phenotypic and molecular tests should be used simultaneously to detect carbapenemase.…”

Understanding the Epidemiology of Multi-Drug Resistant Gram-Negative Bacilli in the Middle East Using a One Health Approach

“…In Iran, K. pneumoniae is the most common carbapenemase producing Enterobacteriaceae clinical isolate. Carbapenem resistance in these is often mediated by NDM-1 and OXA-48 production followed by KPC (KPC-2), VIM (VIM-1 and VIM-4), and IMP (Rastegar Lari et al, 2013; Azimi et al, 2014; Nobari et al, 2014; Fazeli et al, 2015; Rajabnia et al, 2015; Firoozeh et al, 2016, 2017; Sedighi et al, 2017; Shahcheraghi et al, 2017; Armin et al, 2018; Ghotaslou et al, 2018; Hosseinzadeh et al, 2018; Moghadampour et al, 2018a). The majority of the studies reported no clonal relatedness among isolated carbapenem resistant K. pneumoniae in each center (Shahcheraghi et al, 2013; Jafari et al, 2018; Kiaei et al, 2018).…”