Journal of Isfahan Medical School

Journal of Isfahan Medical School

Prevalence of Plasmid-Mediated AmpC ß-Lactamase Genes in Clinical Isolates of Klebsiella Pneumoniae in Arak City, Iran

Document Type : Original Article (s)

Authors
Alireza Japoni-Nejad 1
Nasim Fardmusavi 2
Mojdeh Safari 3
Hamid Kazemian 1
Mahsa Tabibnejad 2
Alireza Amuzandeh Nobaveh 4
Hamid Abtahie 5
Ehsanollah Ghaznavi-Rad 6
1 Student Research Committee, Arak University of Medical Sciences, Arak, Iran
2 MSc Student, Department of Medical Microbiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
3 Food Microbiology Laboratory, Food and Drug Deputy, Arak University of Medical Sciences, Arak, Iran
4 Assistant Professor, Department of Medical Microbiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
5 Associate Professor, Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, Iran
6 Assistant Professor, Department of Medical Microbiology, School of Medicine AND Molecular And Medicine Research Center, Arak University of Medical Sciences, Arak, Iran
Abstract
Background: ß-lactamase enzymes are the most important factor for antimicrobial resistance in Gram-negative rods. This study aimed to determine the antimicrobial susceptibility pattern and the occurrence of AmpC ß-lactamase genes in clinical isolates of Klebsiella pneumoniae (K. pneumonia).Methods: A total of 100 K. pneumonia isolates was collected from clinical specimens obtained in the Vali-Asr hospital, Arak, Iran. The isolates were identified on the basis of standard biochemical tests. Antimicrobial susceptibility pattern was defined by the standard disk diffusion method according to CLSI (Clinical and Laboratory Standards Institute) guidelines. Plasmid-mediated AmpC β-lactamases genes were detected by using polymerase chain reaction (PCR) method.Findings: Of the 100 isolates tested, 19 (19%) were demonstrated to harbor AmpC β-lactamases by multiplex PCR; eight isolates carried β-lactamases genes of the CIT group, seven isolates carried genes belonging to the MOX group, three and one isolates carried genes belonging to the EBC and DHA groups, respectively. ACC and FOX groups were not found in our isolates.Conclusion: This study is the first report of MOX group of AmpC β-lactamases in K. pneumoniae in Iran. High prevalence of plasmid-mediated AmpC in the central hospital of Arak, indicating the antibiotic resistant, is a major concern; hence, antibiotic prescription policy should be revised and infection control measure is necessary to be improved.
Keywords
Klebsiella pneumoniae
AmpC ß-lactamase genes
Antibiotic Resistance
  1. Struve C, Krogfelt KA. Pathogenic potential of environmental Klebsiella pneumoniae isolates. Environ Microbiol 2004; 6(6): 584-90.
  2. Pfeifer Y, Cullik A, Witte W. Resistance to cephalosporins and carbapenems in Gram-negative bacterial pathogens. Int J Med Microbiol 2010; 300(6): 371-9.
  3. Tenover FC, Emery SL, Spiegel CA, Bradford PA, Eells S, Endimiani A, et al. Identification of plasmid-mediated AmpC beta-lactamases in Escherichia coli, Klebsiella spp., and proteus species can potentially improve reporting of cephalosporin susceptibility testing results. J Clin Microbiol 2009; 47(2): 294-9.
  4. Kong KF, Schneper L, Mathee K. Beta-lactam antibiotics: from antibiosis to resistance and bacteriology. APMIS 2010; 118(1): 1-36.
  5. Jacoby GA. AmpC beta-lactamases. Clin Microbiol Rev 2009; 22(1): 161-82, Table.
  6. Bush K, Jacoby GA, Medeiros AA. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother 1995; 39(6): 1211-33.
  7. Nasim K, Elsayed S, Pitout JD, Conly J, Church DL, Gregson DB. New method for laboratory detection of AmpC beta-lactamases in Escherichia coli and Klebsiella pneumoniae. J Clin Microbiol 2004; 42(10): 4799-802.
  8. Hanson ND. AmpC beta-lactamases: what do we need to know for the future? J Antimicrob Chemother 2003; 52(1): 2-4.
  9. Polsfuss S, Bloemberg GV, Giger J, Meyer V, Bottger EC, Hombach M. Practical approach for reliable detection of AmpC beta-lactamase-producing Enterobacteriaceae. J Clin Microbiol 2011; 49(8): 2798-803.
  10. Manchanda V, Singh NP. Occurrence and detection of AmpC beta-lactamases among Gram-negative clinical isolates using a modified three-dimensional test at Guru Tegh Bahadur Hospital, Delhi, India. J Antimicrob Chemother 2003; 51(2): 415-8.
  11. Mahon CR, Manuselis G. Textbook of Diagnostic Microbiology. 2nd ed. Philadelphia, PA: WB Saunders; 2000.
  12. Cockerill FR. Performance Standards for Antimicrobial Susceptibility Testing: Twentieth Informational Supplement. Philadelphia, PA: Clinical and Laboratory Standards Institute; 2010.
  13. Perez-Perez FJ, Hanson ND. Detection of plasmid-mediated AmpC beta-lactamase genes in clinical isolates by using multiplex PCR. J Clin Microbiol 2002; 40(6): 2153-62.
  14. Mansouri S, Chitsaz M, Hajihosseini R, Mirzaee M, Gheini MH. Determination of Resistance Pattern of Plasmid-Mediated AmpC?-Lactamases Producing Isolate of Escherichia coli. Daneshvar 2009; 16(80): 61-70. [In Persian].
  15. Kashif MT, Yassin AS, Hosny A. Detection of AmpC beta-lactamases using sodium salicylate. J Microbiol Methods 2012; 91(3): 354-7.
  16. Barnaud G, Benzerara Y, Gravisse J, Raskine L, Sanson-Le Pors MJ, Labia R, et al. Selection during cefepime treatment of a new cephalosporinase variant with extended-spectrum resistance to cefepime in an Enterobacter aerogenes clinical isolate. Antimicrob Agents Chemother 2004; 48(3): 1040-2.
  17. Niakan M, Chitsaz M, Metwaei AR. Prevalence of AmpC type extended spectrum beta lactamases genes in clinical isolates of Klebsiella pneumoniae. Iran J Med Microbiol 2008; 2(2): 1-8.
  18. Tan TY, Ng LS, He J, Koh TH, Hsu LY. Evaluation of screening methods to detect plasmid-mediated AmpC in Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. Antimicrob Agents Chemother 2009; 53(1): 146-9.
  19. Yamasaki K, Komatsu M, Abe N, Fukuda S, Miyamoto Y, Higuchi T, et al. Laboratory surveillance for prospective plasmid-mediated AmpC beta-lactamases in the Kinki region of Japan. J Clin Microbiol 2010; 48(9): 3267-73.
  20. Moland ES, Black JA, Ourada J, Reisbig MD, Hanson ND, Thomson KS. Occurrence of newer beta-lactamases in Klebsiella pneumoniae isolates from 24 U.S. hospitals. Antimicrob Agents Chemother 2002; 46(12): 3837-42.
  21. Coudron PE, Hanson ND, Climo MW. Occurrence of extended-spectrum and AmpC beta-lactamases in bloodstream isolates of Klebsiella pneumoniae: isolates harbor plasmid-mediated FOX-5 and ACT-1 AmpC beta-lactamases. J Clin Microbiol 2003; 41(2): 772-7.
  22. Pai H, Kang CI, Byeon JH, Lee KD, Park WB, Kim HB, et al. Epidemiology and clinical features of bloodstream infections caused by AmpC-type-beta-lactamase-producing Klebsiella pneumoniae. Antimicrob Agents Chemother 2004; 48(10): 3720-8.
  23. Li Y, Li Q, Du Y, Jiang X, Tang J, Wang J, et al. Prevalence of plasmid-mediated AmpC beta-lactamases in a Chinese university hospital from 2003 to 2005: first report of CMY-2-Type AmpC beta-lactamase resistance in China. J Clin Microbiol 2008; 46(4): 1317-21.
  24. Woodford N, Reddy S, Fagan EJ, Hill RL, Hopkins KL, Kaufmann ME, et al. Wide geographic spread of diverse acquired AmpC beta-lactamases among Escherichia coli and Klebsiella spp. in the UK and Ireland. J Antimicrob Chemother 2007; 59(1): 102-5.
Journal of Isfahan Medical School
Volume 31, Issue 249 - Serial Number 249
July and August 2013
Pages 1285-1295

  • Receive Date 16 May 2013
  • Accept Date 06 April 2022