Therapeutic challenges of ESBLS and AmpC beta-lactamase producers in a tertiary care center

Grover, Naveen; Sahni, A.K.; Bhattacharya, S.

doi:10.1016/j.mjafi.2012.02.001

Cited by 49 publications

(38 citation statements)

References 18 publications

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“…Our data showed the sharp rise of AmpC beta-lactamase incidence over the past 3 years. Some studies have showed that AmpC beta-lactamases are produced in upward of 50% of clinical isolates [18][19][20]. A limited number of antibiotic treatment options are available in infections caused by AmpC-producing K. pneumoniae.…”

Section: Discussionmentioning

confidence: 99%

First report of coexistence of AmpC beta-lactamase genes in Klebsiella pneumoniae strains isolated from burn patients

Ghanavati

Darban-Sarokhalil

Navab-Moghadam

et al. 2017

AMicr

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Klebsiella spp. are among the most frequently isolated bacteria from burn wounds. These organisms are among the most important opportunistic pathogens, causing hospital-acquired and healthcare-associated infections worldwide. Limited information is available about prevalence of AmpC-producing Klebsiella pneumoniae from burn patients. Therefore, the aim of this study was to determine the characterization of AmpC beta-lactamase among K. pneumoniae isolated from burn patients. Samples were collected from wound specimens of patients with burn injury from a burn hospital in Tehran during 18 months (March 2015 to August 2016). For phenotypic detection of AmpC beta-lactamase, disk diffusion method with cefoxitin was used for screening, AmpC disk test and boronic acid inhibitor-based method were used as confirmatory tests. Polymerase chain reaction (PCR) was performed to screen all isolates with AmpC genes including ACCM, DHAM, EBCM, FOXM, MOXM, and CITM. Finally, PCR products were validated using sequencing. During this study, 102 isolates of K. pneumoniae were collected. Among these isolates, 52.9% suspected as AmpC producer by disk agar diffusion cefoxitin screening method. By confirmatory phenotypic methods, 19.6% of isolates considered as AmpC producer. Molecular analysis revealed 43.1% of cefoxitin-resistant isolates harbored at least one of the AmpC genes including CITM (22.5%), EBCM (21.5%), DHAM (7.8%), and FOXM (0.98%). In addition, 5.8% of isolates harbored two AmpC genes and 2.9% harbored three AmpC genes. In conclusion, K. pneumoniae is becoming a serious problem in burn patients. Accurate and precise methods and guidelines should be designed for detection of antibiotic-resistant mechanisms. Our data showed the high rate of AmpC beta-lactamase among K. pneumoniae isolated from burn patients, which limit the treatment options. Therefore, the results of this study can provide evidence to help for appropriate treatment of burn patients.

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Section: Discussionmentioning

confidence: 99%

First report of coexistence of AmpC beta-lactamase genes in Klebsiella pneumoniae strains isolated from burn patients

Ghanavati

Darban-Sarokhalil

Navab-Moghadam

et al. 2017

AMicr

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“…Resistance to broad-spectrum β-lactams mediated by extended spectrum broad-spectrum β-lactamases (ESBLs) and AmpC β-lactamase enzymes is an increasing problem worldwide (9). In Portugal, 104/124 (83.9%) of Enterobacteriaceae isolates that were resistant to third generation cephalosporins were also resistant to fourth generation cephalosporins (10).…”

Section: Introductionmentioning

confidence: 99%

Detection and genotype analysis of AmpC β-lactamase in Klebsiella pneumoniae from tertiary hospitals

Liu

2016

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to investigate the phenotype and genotype of plasmid-mediated AmpC (pAmpC) β-lactamase in Klebsiella pneumoniae and its antibiotic resistance. A total of 130 non-repetitive clinical isolates of Klebsiella pneumoniae, obtained from tertiary hospitals, were phenotypically screened for pAmpC β-lactamase production with the cefoxitin disk diffusion test. β-lactamase genes in the screened isolates were detected using multiplex polymerase chain reaction (PCR); carbapenemase genes in pAmpC β-lactamase-producing isolates that were resistant to imipenem were detected using PCR. Out of the 130 isolates of Klebsiella pneumoniae, 62 strains (47.7%) were resistant to cefoxitin, including 14 strains (10.8%) positive for pAmpC β-lactamase (DHA type), among which 12 strains (85.7%) were susceptible to imipenem, and 2 strains, which were carrying Klebsiella pneumoniae carbapenemase (KPC)-2 gene, were resistant to imipenem. The pAmpC β-lactamase-producing Klebsiella pneumoniae isolates from the tertiary hospitals were mainly of DHA-1 genotype, and the majority were susceptible to carbapenems; drug-resistant strains were associated with KPC-2 expression. IntroductionAmpC β-lactamase, which is a type of cephalosporinase (1), is known to be responsible for antimicrobial resistance in gram-negative bacilli (2). The knowledge of potential risk factors for that resistance may help to limit its impact by enabling the implementation of effective control measures and judicious antimicrobial therapy (3). AmpC β-lactamases are either plasmid-or chromosomal-mediated (4). With regard to plasmid-mediated AmpC (pAmpC), no single phenotypic method is satisfactory for its detection; the combined application of phenotypic tests is necessary for the screening and confirmation of the presence of pAmpC-mediated resistance (5). Chromosomal-mediated AmpC hyperproducing Escherichia coli (E. coli) continues to be mostly susceptible to third-generation cephalosporins (6). Polymerase chain reaction (PCR) remains the gold standard for the detection of AmpC β-lactamases (7). As β-lactam antibiotics are widely used, the production of AmpC β-lactamases by bacteria results in considerable antibiotic resistance (8).Resistance to broad-spectrum β-lactams mediated by extended spectrum broad-spectrum β-lactamases (ESBLs) and AmpC β-lactamase enzymes is an increasing problem worldwide (9). In Portugal, 104/124 (83.9%) of Enterobacteriaceae isolates that were resistant to third generation cephalosporins were also resistant to fourth generation cephalosporins (10). In comparison with ESBL-producing gram-negative bacilli, AmpC β-lactamase-producing strains show more extensive antibiotic resistance; 29% of Acinetobacter strains, for example, were found to produce both ESBL and AmpC enzymes (11). To be more specific, the majority of Acinetobacter baumannii isolates were producers of carbapenemase and metallo-β-lactamase (12). In a study of isolates collected between 2002 and 2008, DHA-1 was the most prevalent acquired AmpC (94%)...

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“…Extended spectrum β-lactamase (ESBL) on the other hand confer resistance against fourth generation cephalosporins (cefepime, cefpirome) in addition to oxyimino-cephalosporins and are inhibited by clavulanic acid. Despite this fact, coproduction of AmpC and ESBLs has been documented in many studies (Grover et al, 2013;Doi and Paterson, 2007;Bakthavatchalu et al, 2013;Mohanty et al, 2010). Prevalence of AmpC producers have been reported to be from 8% to as high as 41.3% in various studies from India and from 1.15% to as high as 46.7% in various studies from other countries (Peter-Getzlaff et al, 2011;Grover et al, 2013;Bakthavatchalu et al, 2013;Polsfuss et al, 2011;Li et al, 2003;Singhal et al, 2005;Manoharan et al, 2012;Maraskolhr et al, 2014;Rudresh and Nagarathnamma, 2011;Tan et al, 2009;Helmy and Wasfi, 2014;Ingram et al, 2011;Yilmaz et al, 2013;Coudron, 2005).…”

Section: Resultsmentioning

confidence: 99%

“…Mohanty et al,reported 20.35% and 3.54% pure AmpC and pure ESBL producers respectively with 58.41% isolates to be AmpC ESBL co-producers (Mohanty et al, 2010). Grover et al reported 4.96 and 30.15% isolates to be pure AmpC and pure ESBL producers respectively with 9.92% isolates to be AmpC ESBL co-producers (Grover et al, 2013).…”

Section: Resultsmentioning

confidence: 99%

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AmpC and Extended Spectrum Beta Lactamase Producing Isolates of E. coli, Klebsiella spp. and P. mirabilis in a Tertiary Care Center and their Sensitivity to Other Antibiotics

Chaudhari¹,

Kumar²,

Das³

2017

Int.J.Curr.Microbiol.App.Sci

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Therapeutic challenges of ESBLS and AmpC beta-lactamase producers in a tertiary care center

Cited by 49 publications

References 18 publications

First report of coexistence of AmpC beta-lactamase genes in Klebsiella pneumoniae strains isolated from burn patients

First report of coexistence of AmpC beta-lactamase genes in Klebsiella pneumoniae strains isolated from burn patients

Detection and genotype analysis of AmpC β-lactamase in Klebsiella pneumoniae from tertiary hospitals

AmpC and Extended Spectrum Beta Lactamase Producing Isolates of E. coli, Klebsiella spp. and P. mirabilis in a Tertiary Care Center and their Sensitivity to Other Antibiotics

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