Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital
American Journal of Laboratory Medicine
Volume 5, Issue 3, May 2020, Pages: 70-75
Received: Jun. 27, 2020; Accepted: Jul. 13, 2020; Published: Jul. 30, 2020
Views 83      Downloads 61
Authors
Igunma Agbons Jeremiah, Department of Medical Microbiology and Parasitology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Akujobi Comfort Nne, Department of Medical Microbiology and Parasitology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
Oboro Ibinabo Laura, Department of Medical Microbiology and Parasitology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Article Tools
Follow on us
Abstract
Carbapenem resistance among Enterobacteriaceae, especially Klebsiella pneumoniae and Escherichia coli, has remained a challenge in infectious disease management. Although several resistance mechanisms have been documented that neutralize the efficacy of carbapenems, the expression of carbapenemases is the most prominent. Carbapenemase producing Klebsiella pneumoniae has been identified as a major public health threat because of the potential for rapid plasmid mediated spread of the resistance genes among bacterial species and resulting limited therapeutic options available. These pathogens could express resistance to almost all available antibiotics and are associated with high morbidity and mortality. This cross-sectional study was carried out in the University of Port Harcourt Teaching Hospital, Nigeria. A total of 225 clinical isolates of Klebsiella pneumoniae from wounds, urine, blood, sputum and cerebrospinal fluid were recruited. All isolates were screened for Carbapenem resistance using Ertapenem (10µg; Oxoid, England) according to CLSI guidelines. All non-susceptible isolates were then tested for phenotypic carbapenemase production using the Modified Hodge test (MHT). The MHT positive isolates were thereafter, subjected to Polymerase Chain Reaction to detect the presence of blaKPC resistance gene. The study showed that 8.4% (19/225) of Klebsiella pneumoniae isolates were not susceptible to Ertapenem. Out of these, 6.2% (14/225) expressed carbapenemase production by the modified Hodge test. However, on molecular analysis, only six (6) of these isolates possessed the blaKPC gene giving a 2.7% genotypic prevalence of Klebsiella pneumoniae carbapenemase among the isolates. Critically ill patients are more likely to develop infections by blaKPC-producing Klebsiella pneumoniae. It is therefore pertinent that the approach to prevention and control of infections by multi-drug resistant Klebsiella pneumoniae isolates must be multi-pronged to effectively counteract the various mechanisms that may be responsible. From control of prescribing and dispensing patterns, rational use of antimicrobials, institution of antimicrobial stewardship programs, optimization of infection prevention and control measures to effective surveillance; a well-coordinated approach is necessary to reduce the prevalence and spread of this pathogens since the blaKPC resistance gene is plasmid mediated and associated with high rates of both inter and intra-species transfer among bacteria.
Keywords
KPC, Klebsiella pneumoniae, Multidrug Resistance, Carbapenemase
To cite this article
Igunma Agbons Jeremiah, Akujobi Comfort Nne, Oboro Ibinabo Laura, Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital, American Journal of Laboratory Medicine. Vol. 5, No. 3, 2020, pp. 70-75. doi: 10.11648/j.ajlm.20200503.12
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Xu Z-Q. Flavin MT, Flavin J. Combating multidrug-resistant Gram negative bacterial infections. Expert Opin Investig Drugs. 2014; 23: 163–82.
[2]
Nordmann P, Naas T, Poirel L. Global spread of Carbapenemase producing Enterobacteriaceae. Emerg Infect Dis. 2011; 17: 1791–1798.
[3]
Poulou A, Voulgari E, Vrioni G, Koumaki V, Xidopoulos G, Chatzipantazi V, Markou F, et al. Outbreak Caused by an Ertapenem-Resistant, CTX-M-15-Producing Klebsiella pneumoniae ST101 Clone Carrying an OmpK36 Porin Variant. J. Clin. Microbiol. 2013; 51 (10): 3176-3182.
[4]
Athanassios T, Ioulia K, Aggeliki P, Themeli-Digalaki K, Ikonomidis A, Petropoulou D et. Al. Evaluation of Boronic Acid Disk Tests for Differentiating KPC-Possessing Klebsiella pneumoniae isolates in the Clinical Laboratory. JCM. 2009; 362–367.
[5]
Ramirez MS, Xie G, Marshall SH, Hujer KM, Chain PS, Bonomo RA et al. Multidrug-resistant (MDR) Klebsiella pneumoniae clinical isolates: a zone of high heterogeneity (HHZ) as a tool for epidemiological studies. Clin. Microbiol. Infect. 2012; 18: 254–258.
[6]
Freire MP, Pierrotti LC, Filho HHC, Ibrahim KY, Magri AS, Bonazzi PR et al. infections with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients. Eur J Clin Microbiol infect Dis. 2015; 34: 277-86.
[7]
Munoz-Price LS, Poirel L, Bonomo RA, Schwaber MJ, Daikos GL, Cormican M, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis. 2013; 13: 785-796.
[8]
Paterson DL, Siu KL, Chang FY. Klebsiella species (K. pneumoniae, K. oxytoca, K. ozaenae and K. rhinoscleromatis); Antimcrobe. Available at http://www.antimicrobe.org/b107.asp. Accessed 5th September, 2019.
[9]
Paczosa MK, Mecsas J. Klebsiella pneumoniae: going on the offense with a strong defense. Microbiol Mol Biol Rev 2016, 80 (3): 629–661.
[10]
Manenzhe RI, Zar HJ, Nicol MP, Kaba M. The spread of carbapenemase-producing bacteria in Africa: a systematic review. J Antimicrob Chemother. 2015; 70 (1): 23-40.
[11]
Onyedibe KI, Bode-Thomas F, Nwadike V, Afolaranmi T, Okolo MO, Uket O et al. High Rates of Bacteria Isolates of Neonatal sepsis with Multidrug Resistance patterns in Jos Nigeria. Ann pediatr Child Health. 2015; 3 (2): 1052.
[12]
Hussaini IM, Olonitola OS, Suleiman AB. Occurrence of Carbapenem Resistant Klebsiella pneumoniae in Clinical Samples from Some Selected Hospitals in Zaria, Kaduna State, JAMPS. 2017; 13 (3): 1-11.
[13]
Borer A, Saidel-Odes L, Riesenberg K, Eskira S, Peled N, Nativ R et al. Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia. Infect Control Hosp Epidemiol. 2009; 30: 972–6.
[14]
Araoye MO. Sample size determination. Research methodology with statistics for health and social science. Ilorin, Nathadex publishers. 2004; 2: 115-121.
[15]
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 27th ed. CLSI supplement M100-S28. Clinical and Laboratory Standards Institute, Wayne, PA. 2018.
[16]
Performance standards for antimicrobial susceptibility Testing 26th ed; informational supplement. M100S26 Clinical and Laboratory Standards Institute, Wayne, PA 2016.
[17]
Cury AP, Andreazzi D, Maffucci M, Caiaffa-Junior HH, Rossi F. The modified Hodge test is a useful tool for ruling out Klebsiella pneumoniae carbapenemase. Clinics (Sao Paulo). 2012; 67 (12): 1427-1431. doi: 10.6061/clinics/2012(12)13.
[18]
Nagaraj S, Chandran SP, Shamanna P, Macaden R. Carbapenem resistance among Escherichia coli and Klebsiella pneumoniae in a tertiary care hospital in south India. Indian J. Med. Microbiol. 2012; 30 (1): 93-95.
[19]
Schwaber MJ, Klarfeld-Lidji S, Navon-Venezia S, Schwartz D, Leavitt A, Carmeli Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother. 2008; 52: 1028–1033.
[20]
Da Silva KE, Maciel WG, Correia Sacchi FP, Carvalhaes CG, Rodrigues Costa F, da Silva ACR, Risk factors for KPC-producing Klebsiella pneumoniae: watch out for surgery. J Med Microbiol. 2016; 65: 547–553.
[21]
Girmenia C, Serrao A, Canichella M, Epidemiology of Carbapenem Resistant Klebsiella pneumoniae Infections in Mediterranean Countries. Mediterr J Hematol Infect Di. 2016; 8; e2016032.
[22]
Gotoff SP. Sepsis in the newborn in Krugman, S, Katz SI, Gershon AA and Wilfert CM(ed.), Infectious diseases of children, 9th ed. Mosby—Year Book, St. Louis, Mo. 1 992, 402–418.
[23]
Padilla E, Llobet E, Domenech-Sanchez A, Martinez-Martinez L, Bengoechea JA, Alberti S. Klebsiella pneumoniae AcrAB efflux pump contributes to antimicrobial resistance and virulence. Antimicrob Agents Chemother. 2010; 54 (1): 177–183.
[24]
Potron A, Kalpoe J, Poirel L, Nordmann P. European dissemination of a single OXA-48-producing Klebsiella pneumoniae clone. Clin Microbiol Infect. 2011; 17: 24–6.
[25]
Masoume B, Abazar P, Shiva M, Malihe T, Gholamreza I. Detection of the Klebsiella pneumoniae carbapenemase in K. pneumoniae isolated from the Clinical Samples by the Phenotypic and Genotypic Methods. Iran J Pathol. 2015; 10 (3): 199-205.
[26]
Anderson KF, Lonswy DR, Rasheed JK, Biddle J, Jensen B, McDougal LK, et al.; Evaluation of method to identify the Klebsiella pneumoniae carbapenemase in enterobacteriaceae. J. Chin microbial. 2007; 45: 2723-2725.
[27]
Vasaikar S, Obi L, Morobe I, Bisi-Johnson M. Molecular Characteristics and Antibiotic Resistance Profiles of Klebsiella Isolates in Mthatha, Eastern Cape Province, South Africa. Int J Microbiol. 2017; 8486742.
[28]
Ehrhard L, Karaalp AK, Hackel T, Höll G, Rodewald N, Reif U et al. Prevalence of carbapenemase-producing bacteria in hospitals in Saxony, Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57 (4): 406–413.
[29]
Parisi SG, Bartolini A, Santacatterina E, Castellani E, Ghirardo R, Berto A, et al. Prevalence of Klebsiella pneumoniae strains producing carbapenemases and increase of resistance to colistin in an Italian teaching hospital from January 2012 To December 2014. BMC Infect Dis. 2015; 15: 244; PMID: 26116560.
[30]
Okoche D, Asiimwe BB, Katabazi FA, Kato L, Najjuka CF. Prevalence and Characterization of Carbapenem-Resistant Enterobacteriaceae Isolated from Mulago National Referral Hospital, Uganda. PLoS ONE. 2015; 10 (8): e0135745. doi: 10.1371/journal.pone.0135745
[31]
Metwally L. Gomaa N, Attallah M, Kamel N. High prevalence of Klebsiella pneumoniae carbapenemase-mediated resistance in K. pneumoniae isolates from Egypt. EMHJ. 2013; 19 (11): 947-952.
[32]
Villegas MV, Pallares CJ, Escandon-Vargas K, Hernandez-Gomez C, Correa A, Alvarez C et al. Characterization and clinical impact of bloodstream infection caused by carbapenemase- producing enterobacteriaceae in seven latin American countries. PLoS One. 2016; 11: e0154092; PMID: 27104910.
[33]
Naas T, Cuzon G, Villegas MV, Lartigue MF, Quinn JP, Nordmann P. Genetic structures at the origin of acquisition of the b-lactamase blaKPC gene. Antimicrob Agents Chemother. 2014; 52: 1257-1263.
[34]
Wang P, Hu F, Xiong Z, Ye X, Zhu D, Wang YF, et al, Susceptibility of extended spectrum β-lactamase producing Enterobacteriaceae according to the new CLSI breakpoints. J Clin Microbiol. 2011; 49: 3127–3131.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186