Isolation and Identification of Carbapenemase KPC Producing Strains of Enterobacteriaceae and Determination of Their Antibiotic Susceptibility Patterns

Document Type : Original Article (s)

Authors

1 PhD Student, Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 PhD Student, Department of Molecular Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran

3 Technical Manager, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The aim of this study was to isolate and identify KPC (Klebsiella pneumonia carbapenemase) enzyme producing strains of Enterobacteriaceae, and determine their antibiotic susceptibility pattern in three hospitals of Isfahan, Iran. This subject has not previously been investigated comprehensively.Methods: KPC detection was done by Modified Hodge Test (MHT) and their antibiotic susceptibility patterns were determined by disc diffusion method.Findings: The total of 475 strains were isolated and detected as Enterobacteriaceae during the period of 9 months (July 2012-March 2013) in three hospitals in Isfahan province, Iran. These isolates contained Escherichia coli: 285 strains (60%), Klebsiella: 128 strains (27%), Enterobacter aerogenes: 16 strains (3.4%), Enterobacter cloacae: 9 strains (1.9%), Proteus vulgaris: 12 strains (2.5%), Proteus mirabilis: 4 strains (0.84%), Citrobacter freundii: 8 strains (1.7%), Citrobacter diversus: 3 strains (0.6%), Serratia marcescens: 3 strains (0.6%), Shigella sonnei: 4 strains (0.84%), Salmonella paratyphi A: 2 strains (0.42%), and Providencia stuartii: 1 strain (0.2%). Percentage resistant to ceftazidime and cefotaxime and non-susceptibility to imipenem and meropenem for above isolates were, respectively, as follows: for Escherichia coli isolates 60, 63, 6, and 9; for Klebsiella isolates 70, 75, 55, and 58; for Klebsiella pneumoniae 100, 100, 95, and 94; and for other Enterobacteriaceae isolates 20, 17, 5, and 3. Our results showed that KPC test was positive for 2 isolates (0.7%) among Escherichia coli strains, 65 (87%) isolates among Klebsiella pneumoniae, and 1 isolate (6%) among Proteus strains . This was approved by Etest based MIC method.Conclusion: In general, our results showed that among Enterobacteriaceae isolates, Klebsiella pneumoniae isolates had higher KPC enzyme production, and most strains had multidrug resistant. 

Keywords

References

  1. Siegel JD, Rhinehart E, Jackson M, Chiarello L, The Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings. Atlanta, GA: Centers for Disease Control and Prevention; 2006.
  2. Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis 2008; 8(3): 159-66.
  3. Jesudason MV, Kandathil AJ, Balaji V. Comparison of two methods to detect carbapenemase & metallo-beta- lactamase production in clinical isolates. Indian J Med Res 2005; 121(6): 780-3.
  4. Meletis G, Tzampaz E, Protonotariou E, Sofianou D. Emergence of Klebsiella pneumoniae carrying bla(VIM) and bla(KPC) genes. Hippokratia 2010; 14(2): 139-40.
  5. Queenan AM, Bush K. Carbapenemases: the versatile beta-lactamases. Clin Microbiol Rev 2007; 20(3): 440-58, table.
  6. Forbes BA, Saham DF, Wesisfeld AS. Bailley and Scotte's diagnostic microbilogy. Philadelphia, PA: Mosby; 1998.
  7. Performance standards for antimicrobial disk susceptibility tests. Approved standard M2-A9. Wayne PA; Clinical and Laboratory Standards Institute: 2013.
  8. Modified Hodge test for carbapenemase detection in Enterobacteriaceae. Atlanta, GA: Centers for Disease Control and Prevention; 2007.
  9. Harris AD, McGregor JC, Johnson JA, Strauss SM, Moore AC, Standiford HC, et al. Risk factors for colonization with extended-spectrum beta-lactamase-producing bacteria and intensive care unit admission. Emerg Infect Dis 2007; 13(8): 1144-9.
  10. Anderson KF, Lonsway DR, Rasheed JK, Biddle J, Jensen B, McDougal LK, et al. Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae. J Clin Microbiol 2007; 45(8): 2723-5.
  11. Bulik CC, Fauntleroy KA, Jenkins SG, Abuali M, LaBombardi VJ, Nicolau DP, et al. Comparison of meropenem MICs and susceptibilities for carbapenemase-producing Klebsiella pneumoniae isolates by various testing methods. J Clin Microbiol 2010; 48(7): 2402-6.
  12. Bratu S, Tolaney P, Karumudi U, Quale J, Mooty M, Nichani S, et al. Carbapenemase-producing Klebsiella pneumoniae in Brooklyn, NY: molecular epidemiology and in vitro activity of polymyxin B and other agents. J Antimicrob Chemother 2005; 56(1): 128-32.
  13. Carvalhaes CG, Picao RC, Nicoletti AG, Xavier DE, Gales AC. Cloverleaf test (modified Hodge test) for detecting carbapenemase production in Klebsiella pneumoniae: be aware of false positive results. J Antimicrob Chemother 2010; 65(2): 249-51.
  14. Urban C, Bradford PA, Tuckman M, Segal-Maurer S, Wehbeh W, Grenner L, et al. Carbapenem-resistant Escherichia coli harboring Klebsiella pneumoniae carbapenemase beta-lactamases associated with long-term care facilities. Clin Infect Dis 2008; 46(11): e127-e130.
  15. Zhang R, Zhou HW, Cai JC, Chen GX. Plasmid-mediated carbapenem-hydrolysing beta-lactamase KPC-2 in carbapenem-resistant Serratia marcescens isolates from Hangzhou, China. J Antimicrob Chemother 2007; 59(3): 574-6.
  16. Tsakris A, Voulgari E, Poulou A, Kimouli M, Pournaras S, Ranellou K, et al. In vivo acquisition of a plasmid-mediated bla(KPC-2) gene among clonal isolates of Serratia marcescens. J Clin Microbiol 2010; 48(7): 2546-9.
  17. Cai JC, Zhou HW, Zhang R, Chen GX. Emergence of Serratia marcescens, Klebsiella pneumoniae, and Escherichia coli Isolates possessing the plasmid-mediated carbapenem-hydrolyzing beta-lactamase KPC-2 in intensive care units of a Chinese hospital. Antimicrob Agents Chemother 2008; 52(6): 2014-8.
  18. Deshpande LM, Rhomberg PR, Sader HS, Jones RN. Emergence of serine carbapenemases (KPC and SME) among clinical strains of Enterobacteriaceae isolated in the United States Medical Centers: report from the MYSTIC Program (1999-2005). Diagn Microbiol Infect Dis 2006; 56(4): 367-72.
  19. Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009; 9(4): 228-36.
  20. Cuzon G, Naas T, Truong H, Villegas MV, Wisell KT, Carmeli Y, et al. Worldwide diversity of Klebsiella pneumoniae that produce beta-lactamase blaKPC-2 gene. Emerg Infect Dis 2010; 16(9): 1349-56.
  21. Pasteran F, Mendez T, Guerriero L, Rapoport M, Corso A. Sensitive screening tests for suspected class A carbapenemase production in species of Enterobacteriaceae. J Clin Microbiol 2009; 47(6): 1631-9.
Journal of Isfahan Medical School
Volume 31, Issue 248 - Serial Number 248
July and August 2013
Pages 1247-1256

Files

History

  • Receive Date: 29 July 2013
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics