Prevalence Study of Extended Spectrum Beta-Lactamase in Klebsiella Pneumonia Isolated from Patients with Ventilator-Associated Pneumonia in Kermanshah City, Iran

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Infectious Disease, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 Associate Professor, Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

3 Assistant Professor, Department of Pediatrics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

4 Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

5 Department of Biostatistics and Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Background: One of the most common infections in patients with high mortality rate is ventilator-dependent pneumonia. This study aimed to determine the frequency of extended spectrum beta-lactamase (ESBL) in Klebsiella pneumonia isolated from patients with ventilator-associated pneumonia in Kermanshah City, Iran.Methods: This study performed on tracheal tube samples of patients admitted to the intensive care units. After collecting specimens, 57 Klebsiella pneumonia isolates were confirmed via standard bacteriological and biochemical tests. After antibiotic susceptibility testing by using disk diffusion method, the presence of ESBL phenotype was determined via combined disk test. The frequency of ESBL genes was determined by using their specific primers and polymerase chain reaction (PCR) method.Findings: From 57 isolates of Klebsiella pneumonia, 22 (38.6%) were positive for ESBL, phenotypically. The highest genotype frequency was shv gene (31.6%) determined via PCR test. The highest resistance was to ceftriaxone and co-trimoxazole (78.9%), and the lowest resistance was to colistin (3.5%).Conclusion: Considering the high resistance of Klebsiella isolated from samples of patients with ventilator- associated pneumonia against third-generation cephalosporin and the prevalence of ESBL-producing strains among these patients, identification of isolates with ESBL and suitable antibiotic selection for the treatment of this patients seem to be necessary.

Keywords

References

  1. Alikiaie B, Moradi D, Mosaddegh M, Salimi N, Mosaddegh J. Early- and late-onset ventilator-associated pneumonia in emergency- and non-emergency-admitted patients in the intensive care units of Alzahra Hospital (Isfahan, Iran): Comparison of bacterial subgroups. J Isfahan Med Sch 2015; 33(344): 1220-32. [In Persian].
  2. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002; 165(7): 867-903.
  3. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171(4): 388-416.
  4. Alikiaii B, Aghadavoudi O, Emami N. Evaluating antibiotic resistance pattern of ventilator-associated pneumonia in intensive care units of Alzahra Hospital, Isfahan University of Medical Sciences, Iran. J Isfahan Med Sch 2016; 34(399): 1083-9. [In Persian].
  5. Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002; 122(6): 2115-21.
  6. Kumar MS, Lakshmi V, Rajagopalan R. Occurrence of extended spectrum beta-lactamases among Enterobacteriaceae spp. isolated at a tertiary care institute. Indian J Med Microbiol 2006; 24(3): 208-11.
  7. Kamatchi C, Magesh H, Sekhar U, Vaidyanathan R. Identification of clonal clusters of Klebsiella pneumoniae isolates from chennai by extended spectrum beta lactamase genotyping and antibiotic resistance phenotyping analysis. Am J Infect Dis 2009; 5(2): 74-82.
  8. Livermore DM, Canton R, Gniadkowski M, Nordmann P, Rossolini GM, Arlet G, et al. CTX-M: Changing the face of ESBLs in Europe. J Antimicrob Chemother 2007; 59(2): 165-74.
  9. Yousefi-Fatmesari G, Hemmati M, Mortazavi SH, Mansouri F, Azizi M, Etemadimajd M, et al. Frequency of blaCTX-M, blaTEM, and blaSHV Genes in Escherichia coli isolated from urine samples of children in Kermanshah City, Iran. J Isfahan Med Sch 2017; 35(430): 551-7. [In Persian].
  10. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement. CLSI document M100-S22. Wayne, PA: CLSI; 2012.
  11. Bajpai T, Pandey M, Varma M, Bhatambare GS. Prevalence of TEM, SHV, and CTX-M beta-lactamase genes in the urinary isolates of a tertiary care hospital. Avicenna J Med 2017; 7(1): 12-6.
  12. Behrooozi A, Rahbar M, Vand Yousefi J. Frequency of extended spectrum beta-lactamase (ESBLs) producing Escherichia coli and Klebseilla pneumonia isolated from urine in an Iranian 1000-bed tertiary care hospital. Afr J Microbiol Res 2010; 4(9): 881-4.
  13. Bagheri-Nesami M, Rafiei A, Eslami G, Ahangarkani F, Rezai MS, Nikkhah A, et al. Assessment of extended-spectrum beta-lactamases and integrons among Enterobacteriaceae in device-associated infections: Multicenter study in north of Iran. Antimicrob Resist Infect Control 2016; 5: 52.
  14. Ahanjan M, Naderi F, Solimanii A. Prevalence of beta-lactamases genes and antibiotic resistance pattern of Klebsiella pneumoniae isolated from teaching hospitals, Sari, Iran, 2014. J Mazandaran Univ Med Sci 2017; 27(149): 79-87. [In Persian].
  15. Feizabadi MM, Mahamadi-Yeganeh S, Mirsalehian A, Mirafshar SM, Mahboobi M, Nili F, et al. Genetic characterization of ESBL producing strains of Klebsiella pneumoniae from Tehran hospitals. J Infect Dev Ctries 2010; 4(10): 609-15.
  16. Sarojamma V, Ramakrishna V. Prevalence of ESBL-producing Klebsiella pneumoniae isolates in tertiary care hospital. ISRN Microbiol 2011; 2011: 318348.
  17. Khorshidi A, Moazen Z, Rohani M, Moniri R, Shajari GR, Mousavi GA. Prevalence of TEM1 and SHV1 genes in Kelebsiella pneumoniea with ESBL. J Mil Med 2009; 11(3):149-53. [In Persian].
  18. Schumacher H, Scheibel J, Moller JK. Cross-resistance patterns among clinical isolates of Klebsiella pneumoniae with decreased susceptibility to cefuroxime. J Antimicrob Chemother 2000; 46(2): 215-21.
  19. Krishnamurthy V, Vijaykumar GS, Sudeepa Kumar M, Prashanth HV, Prakash R, Nagaraj ER. Phenotypic and genotypic methods for detection of extended spectrum beta lactamase producing Escherichia coli and Klebsiella pneumoniae isolated from ventilator associated pneumonia. J Clin Diagn Res 2013; 7(9): 1975-8.
  20. Yazdi M, Nazemi A, Mirinargasi M, Jafarpour M, Sharifi SH. Genotypic versus phenotypic methods to detect extended-spectrum beta-lactamases (ESBLs) in Uropathogenic Escherichia coli. Annals of Biological Research 2012, 3(5): 2454-8.
  21. Afkhamzadeh A, Lahoorpour F, Delpisheh A, Janmardi R. Incidence of ventilator- associated pneumonia (VAP) and bacterial resistance pattern in adult patients hospitalised at the intensive care unit of Besat Hospital in Sanandaj. Sci J Kurdistan Univ Med Sci 2011; 16(1): 20-6. [In Persian].
  22. Guo S, Xu J, Wei Y, Xu J, Li Y, Xue R. Clinical and molecular characteristics of Klebsiella pneumoniae ventilator-associated pneumonia in mainland China. BMC Infect Dis 2016; 16(1): 608.
  23. Ranjan N, Ranjan KP, Chaudhary U, Chaudhry D. Antimicrobial resistance in bacteria causing ventilator-associated pneumonia in a tertiary care hospital: one year prospective study. Int J Res Med Sci 2014; 2(1): 228-33. [In Persian].
  24. Pourali Sheshblouki G, Mardaneh J. Characterization of blaCTX gene and Cross-resistance in Klebsiella pneumoniae Isolated from Hospitalized Patients. J Birjand Univ Med Sci 2016; 23(1): 56-66. [In Persian].
  25. Archin T, Afzalian E, Kargar M, Ghasemi Y. Molecular identification of SHV, TEM, CTX-M? lactamases genes and antibiotics resistance pattern of k.pneumoniae isolates collected from ICU patients of Namazi Hospital, Shiraz, Iran. Armaghane-danesh 2014; 18(10): 816-25. [In Persian].
  26. Ahmadi K, Vaziri S, Mortazavi SH, Mansouri F, Afsharian M, Tajehmiri A, et al. Prevalence study of exoenzyme U (exoU) and exoenzyme S (exoS) genes in Pseudomonas aeruginosa isolated from burn patients in Kermanshah City, Iran. J Isfahan Med Sch 2017; 35(428): 496-502. [In Persian].
Journal of Isfahan Medical School
Volume 35, Issue 444 - Serial Number 444
July and August 2017
Pages 1113-1119

Files

History

  • Receive Date: 11 August 2017
  • Revise Date: 02 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics