High Prevalence of Multiple Drug Resistance among ESBLs-Producing Klebsiella pneumoniae Isolated from Hospitalized Patients in Isfahan, Iran
AbstractBackground: This study was to evaluate the prevalence of CTX-Mand TEM type ESBLs-producing K. pneumoniae and determination of MDR, XDR, and PDR phenotypes of these isolates as well as find out the genetic relationship and molecular typing of these isolates using phenotypic and genotypic methods.Methods: Non-repetitive 96 K. pneumonia isolates were isolated from hospitalized patients in Al-Zahra hospital of Isfahan, Iran. The antibiotic susceptibility test was assessed for 20 antibiotics using Kirby-Bauer disk diffusion method. The frequency of ESBL-producing isolates was determined by phenotypic confirmatory test. All ESBLs-producing isolates were assessed for blaTEM and blaCTX-M genes using PCR method. Molecular typing was performed by enterobacterial repetitive intergenic consensus sequence-based PCR (ERIC-PCR).Results: Among 96 isolates, 58 isolates (60.4%) were ESBL-producers. In this study, 85.7% and 30.3% of ESBL-producing isolates showed MDR and XDR phenotypes, respectively. No PDR isolate was found. PCR amplification on ESBL-producing isolates showed that 47 (81%) isolates were carried blaTEM gene, while blaCTX-M was detected in all isolates (100%). ERIC-PCR typing was characterized the high genetic similarity among ESBL-producing K. pneumonia isolates and revealed 32 band pattern for the isolates. Conclusion: This study showed high prevalence of important ESBL genes (blaCTX-M and blaTEM genes) among the K. pneumoniae isolated from in-patients. Constant following of ESBLs, also identification of their types, in bacteria isolated from hospitalized patients has an important clinical impact. It can provide valuable information for the choice of appropriate antibacterial therapy and decrease of antibiotic resistance.
Farhat Ullah SAM, Jawad Ahmed. Antimicrobial susceptibility pattern and ESBL prevalence in Klebsiella pneumoniae from urinary tract infections in the North-West of Pakistan. Afr J Microbiol Res 2009; 3(11): 676-80.
Fung CP, Hu BS, Chang FY, et al. A 5-year study of the seroepidemiology of Klebsiella pneumoniae: high prevalence of capsular serotype K1 in Taiwan and implication for vaccine efficacy. J Infect Dis 2000; 181(6): 2075-9.
Otman J, Perugini, ME., Tognim, MCB, et al. Atypical phenotypic characteristics of Klebsiella pneumoniae isolates from an outbreak in a neonatal intensive care unit in Brazil. Braz J Microbiol 2007; 38(2): 273-7.
Fresno S, Jimenez N, Izquierdo L, et al. The ionic interaction of Klebsiella pneumoniae K2 capsule and core lipopolysaccharide. Microbiology 2006; 152(6): 1807-18.
Zaniani FR, Meshkat Z, Naderi Nasab M, et al. The Prevalence of TEM and SHV Genes among Extended-Spectrum Beta-Lactamases Producing Escherichia coli and Klebsiella pneumoniae. Iran J Basic Med Sci 2012; 15(1): 654-60.
Shahraki-Zahedani S, Moghadampour M, Bokaeian M, et al. Prevalence of CTX-M-8 and CTX-M-15 type extended-spectrum beta-lactamases between Klebsiella pneumoniae spp. isolated from Zahedan, Southeast Iran. J Chemother 2015; 1973947815Y. 0000000008.
Alekshun MN, Levy SB. Molecular mechanisms of antibacterial multidrug resistance. Cell 2007; 128(6): 1037-50.
Wang G, Huang T, Surendraiah PKM, et al. CTX-M β-Lactamase–producing Klebsiella pneumoniae in Suburban New York, New York, USA. Emerg Infect Dis 2013; 19(11): 1803-10.
Edelstein M, Pimkin M, Palagin I, et al. Prevalence and molecular epidemiology of CTX-M extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Russian hospitals. Antimicrob Agents Chemother 2003; 47(12): 3724-32.
Cantón R, Oliver A, Coque TM, et al. Epidemiology of extended-spectrum β-lactamase-producing Enterobacter isolates in a Spanish hospital during a 12-year period. J Clin Microbiol 2002; 40(4): 1237-43.
Lartigue MF, Zinsius C, Wenger A, et al. Extended-spectrum β-lactamases of the CTX-M type now in Switzerland. Antimicrob Agents Chemother 2007; 51(8): 2855-60.
Quinteros M, Radice M, Gardella N, et al. Extended-spectrum β-lactamases in Enterobacteriaceae in Buenos Aires, Argentina, public hospitals. Antimicrob Agents Chemother 2003; 47(9): 2864-7.
Feizabadi MM, Delfani S, Raji N, et al. Distribution of bla TEM, bla SHV, bla CTX-M genes among clinical isolates of Klebsiella pneumoniae at Labbafinejad Hospital, Tehran, Iran. Microb Drug Resist 2010; 16(1): 49-53.
Fazeli H, Dolatabadi RK, Taraghian A, et al. Carbapenem resistance pattern of multiple drug-resistantand extended-spectrum beta-lactamase-positive Klebsiella pneumoniae in Isfahan. Int J Enteric Pathog 2014; 2: e21495.
Cheng WL, Hsueh PR, Lee CC, et al. Bacteremic pneumonia caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: Appropriateness of empirical treatment matters. J Microbiol Immunol Infect 2014; 49(2): 208-15.
Souli M, Galani I, Giamarellou H. Emergence of extensively drug-resistant and pandrug-resistant Gram-negative bacilli in Europe. Euro surveill 2008; 13(47): 19045.
Falagas ME, Maraki S, Karageorgopoulos DE, et al. Antimicrobial susceptibility of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Enterobacteriaceae isolates to fosfomycin. Int J Antimicrob Agents 2010; 35(3): 240-3.
Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev 1998; 11(4): 589-603.
Baron JO PR, Finegold M. Diagnostic Microbiology. United States of America: Mosby Press 2010; 362-85.
Harada S, Ishii Y, Yamaguchi K. Extended-spectrum beta-lactamases: implications for the clinical laboratory and therapy. Korean J Lab Med 2008; 28(6): 401-12.
CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement. Clinical and Laboratory Standards Institute (CLSI) document M100-S24 2014; 34: 1-230.
Sedighi M, Vaez H, Moghoofeie M, Hadifar S, Oryan G, Faghri J. Molecular detection of metallo-beta-lactamase gene blaVIM-1 in imipenem-resistant Pseudomonas aeruginosa strains isolated from hospitalized patients in the hospitals of Isfahan. Adv Biomed Res 2015; 4: 57.
Norouzi A, Azizi O, Nave HH, et al. Analysis of amino acid substitution mutations of gyrA and parC genes in clonal lineage of Klebsiella pneumoniae conferring high-level quinolone resistance. J Med Microbiol Infec Dis 2014; 2(3): 109-17.
Moghaddam MN, Beidokhti MH, Jamehdar SA, et al. Genetic properties of blaCTX-M and blaPER β-lactamase genes in clinical isolates of Enterobacteriaceae by polymerase chain reaction. Iran J Basic Med Sci 2014; 17(5): 378.
Nasehi L, Shahcheraghi F, Nikbin VS, et al. PER, CTX-M, TEM and SHV Beta-lactamases in clinical isolates of Klebsiella pneumoniae isolated from Tehran, Iran. Iran J Basic Med Sci 2010; 13(3): 111-8.
Li B, Yi Y, Wang Q, et al. Analysis of drug resistance determinants in Klebsiella pneumoniae isolates from a tertiary-care hospital in Beijing, China. PLoS One 2012; 7: e42280.
Taherpour A and Hashemi A. Detection of OqxAB efflux pumps, OmpK35 and OmpK36 porins in extended-spectrum β-lactamase-producing Klebsiella pneumoniae isolates from Iran. Hippokratia 2013; 17(4): 355-
Farrell DJ, Flamm RK, Sader HS, et al. Antimicrobial activity of ceftolozane/tazobactam tested against Enterobacteriaceae and Pseudomonas aeruginosa with various resistance patterns isolated in US hospitals (2011-2012). Antimicrob. Agents Chemother 2013; 57(12): 6305-10.
Cabral AB, Melo RdCdA, Maciel MAV, Lopes ACS. Multidrug resistance genes, including blaKPC and blaCTX-M-2, among Klebsiella pneumoniae isolated in Recife, Brazil. Rev Soc Bras Med Trop 2012; 45(5): 572-8.
Xia Y, Liang Z, Su X, et al. Characterization of carbapenemase genes in Enterobacteriaceae species exhibiting decreased susceptibility to carbapenems in a university hospital in Chongqing, China. Ann Lab Med 2012; 32(4): 270-5.
Ramazanzadeh R, Zamani S, Zamani S. Genetic diversity in clinical isolates of Escherichia coli by enterobacterial repetitive intergenic consensus (ERIC)-PCR technique in Sanandaj hospitals. IJM 2013; 5(2): 126-31.
Giamarellou H. Multidrug-resistant Gram-negative bacteria: how to treat and for how long. Int J Antimicrob Agents 2010; 36: S50-S4.
Prabhu V, Isloor S, Balu M, Suryanarayana V, Rathnamma D. Genotyping by ERIC-PCR of Escherichia coli isolated from bovine mastitis cases. IJBT 2010; 9(3): 298-301.