Abstract
Dissemination of carbapenem resistant Enterobacteriaceae (CRE) poses a considerable threat to public health. The aim of the present work was to estimate the prevalence of metallo beta lactamases (MBL) among CRE isolated from Alexandria Main University Hospital, Egypt, to evaluate the performance of different phenotypic methods for the detection of MBL, and to investigate the local antimicrobial sensitivity profile of these isolates. Eighty CRE were tested for MBL production by Etest® MBL MP/MPI, EDTA double disc synergy test, and EDTA combined disc test. All isolates were confirmed as MBL producers by polymerase chain reaction (PCR). Antibiotic sensitivity testing was performed using disc diffusion method. Among the 80 CRE, 56 isolates (70%) were MBL by PCR. Fifty-four isolates were positive for NDM (96.4%). Meropenem EDTA CDT was the most sensitive test (94.6%). Blood was the most frequent sample from which MBL were isolated (51.7%). Majority of the isolates were isolated from intensive care units (82.1%). All MBL were multidrug resistant; Colistin and polymyxin B showed the lowest resistance rate (26.8 and 19.6%, respectively). The EDTA-CDT will provide a reliable, convenient, and cost-effective approach for detection of MBL in laboratories, which cannot afford to perform molecular tests. Key words: Metallo beta lactamases, carbapenem resistant Enterobacteriaceae, New Delhi lactamase.
Highlights
Multidrug resistance is emerging worldwide at an alarming rate among a variety of bacterial species, including the family Enterobacteriaceae (EB) (IDSA et al, 2011)
The aim of the present work was to estimate the prevalence of metallo beta lactamases (MBL) among carbapenem resistant Enterobacteriaceae (CRE) isolated from Alexandria Main University Hospital, Egypt, to evaluate the performance of different phenotypic methods for the detection of MBL, and to investigate the local antimicrobial sensitivity profile of these isolates
Eighty CRE were tested for MBL production by Etest® MBL MP/MPI, ethylenediaminetetraacetic acid (EDTA) double disc synergy test, and EDTA combined disc test
Summary
Multidrug resistance is emerging worldwide at an alarming rate among a variety of bacterial species, including the family Enterobacteriaceae (EB) (IDSA et al, 2011). The rapid dissemination of extended spectrum beta lactamases (ESBL) in EB has led to the increased utilization of carbapenems in clinical practice. This is largely because ESBL-producers are capable of hydrolyzing all beta lactams except carbapenems, making carbapenems the last option for the treatment of serious infections associated with these organisms. As a consequence of increased use of carbapenems has been the emergence of isolates coding for carbapenemases (Nordmann et al, 2011a). Carbapenem-hydrolysing β-lactamases belong mainly to three clinically significant Amber classes, namely Ambler class A (Klebsiella pneumoniae carbapenemases; KPCs), class B (metallo-beta-lactamases; MBLs) and class D (oxacillinases) (Queenan and Bush, 2007)
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