Abstract
For addressing the issue of antimicrobial drug resistance in developing countries, it is important to investigate the characteristics of carbapenemase-producing organisms. We aimed to genetically characterize a carbapenemase-producing Klebsiella pneumoniae (CPKP) isolated in the intensive care unit of a tertiary hospital in Bangladesh. The number of CPKP isolates were 43/145 (30%), of which pandrug-resistant (PDR) strains were 14%. These carbapenemases were New Delhi metallo-beta-lactamase (NDM)-1 (53%), NDM-5 (14%), oxacillinase (OXA)-181 (12%), OXA-232 (10%), NDM-5 + OXA-181 (5%), and NDM-5 + OXA-232 (2%). Many CPKP isolates harbored a variety of resistance genes, and the prevalence of 16S rRNA methyltransferase was particularly high (91%). The 43 CPKP isolates were classified into 14 different sequence types (STs), and the common STs were ST34 (26%), ST147 (16%), ST11 (9%), ST14 (9%), ST25 (7%), and ST231 (7%). In this study, PDR strains were of three types, ST147, ST231, and ST14, and their PDR rates were 57, 33, and 25%, respectively. The spread of the antimicrobial drug resistance of CPKP in Bangladesh was identified. In particular, the emergence of PDR is problem, and there may be its spread as a superbug of antimicrobial treatment.
Highlights
The worldwide spread of carbapenemase-producing organisms (CPOs) is increasing (Bonomo et al, 2009)
By phenotypic testing and sequencing, carbapenemaseproducing genes were detected from 43 of the 145 isolates (30%). These 43 carbapenemase-producing genes were identified as blaNDM−1 (23, 53%), blaNDM−5 (6, 14%), blaOXA−181 (5, 12%), blaOXA−232 (4, 10%), 2 blaNDM−5 + blaOXA−181 (2, 5%), blaNDM−5 + blaOXA−232 (1, 2%), blaNDM−7 (1, 2%), and blaOXA−48 (1, 2%) by sequence
The mcr gene reported to date was not detected from colistin-resistant isolates
Summary
The worldwide spread of carbapenemase-producing organisms (CPOs) is increasing (Bonomo et al, 2009). In North America, South America, and Europe, the main carbapenemaseproducing genes are the Klebsiella pneumoniae carbapenemase (KPC) types; in the Middle East and Africa, they are the oxacillinase-48-like (OXA-48-like) types; and in the Indian subcontinent, they are of the New Delhi metallo-beta-lactamase (NDM) and OXA-48-like types Many of these multidrug-resistant (MDR) strains are sequence type (ST) 11, ST14, ST37, ST147, and ST258 and are spreading worldwide as international MDR high-risk clones (Mathers et al, 2015). XDR strains have evolved to become PDR by acquiring resistance to tigecycline and polymyxin antibiotics (Papadimitriou-Olivgeris et al, 2018) The spread of such strains is associated with high mortality rates, limited treatment options, and rapid dissemination of successful bacterial clones in the hospital setting (Guo et al, 2016; Protonotariou et al, 2018)
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