Evaluation of Phenotypic and Genotypic Characteristics of Carbapnemases-producing Enterobacteriaceae and Its Prevalence in a Referral Hospital in Tehran City.

Kosar Jalalvand,Elahe Amini,Masha Mohammadpour,Pegah Babaheidarian,Freshteh Shahcheraghi,Nasrin Shayanfar

doi:10.30699/ijp.2020.111181.2188

Abstract

Background & Objective:Carbapenem-resistant Enterobacteriaceae is a growing concern worldwide including Iran. The emergence of this pathogen is worrying as carbapenem is one of the 'last-line' antibiotics for treatment of infections caused by multi drug resistant gram- negative bacteria. The main objective of this study was to determine the prevalence of carbapenem-resistant Enterobacteriaceae in a referral hospital in Tehran, Iran.Methods:In this study, all positive isolates of Enterobacteriaceae recorded in blood, urine, and other body fluids were studied during April 2017 to April 2018 in a referral hospital in Tehran. All cases of resistance to carbapenems were first tested by modified Hodge test. All cases with positive or negative test, after gene extraction, were examined genotypically based on the primers designed for the three Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), and OXA-48 genes by conventional PCR method.Results:108 isolates (13.6%) were resistant to all cephalosporins as well as to imipenem and meropenem. In a genotypic study, including 45 isolates, 13 isolates were positive for OXA-48 gene, 11 isolates for OXA-48 and NDM genes, 11 isolates for OXA-48, NDM and KPC genes, 4 isolates for OXA-48 genes and KPC, 3 isolates for NDM, one isolate for KPC. On the other hand, two isolates were negative for all three genes examined.Conclusion: OXA-48 gene was one of the most common genes resistant to carbapenems in Iran. According to studies, the prevalence of antibiotic resistance in Iran is rising dramatically, which reduces the choice of antibiotics to treat severe infections in the future.

Highlights

Emergence of carbapenem-resistant Enterobacteriaceae is being reported increasingly worldwide and is becoming an important issue in health care systems [1].Nosocomial infections, a major public healthcare problem, are more prevalent in developed countries because of the related mortality and socioeconomic costs [2]
In a genotypic study, including 45 isolates, 13 isolates were positive for OXA-48 gene, 11 isolates for OXA-48 and New Delhi metallo-β-lactamase (NDM) genes, 11 isolates for OXA48, NDM and Klebsiella pneumoniae carbapenemase (KPC) genes, 4 isolates for OXA-48 genes and KPC, 3 isolates for NDM, one isolate for KPC
The prevalence of antibiotic resistance in Iran is rising dramatically, which reduces the choice of antibiotics to treat severe infections in the future

Summary

Introduction

Emergence of carbapenem-resistant Enterobacteriaceae is being reported increasingly worldwide and is becoming an important issue in health care systems [1].Nosocomial infections, a major public healthcare problem, are more prevalent in developed countries because of the related mortality and socioeconomic costs [2]. The carbapenem group (e.g., imipenem, meropenem) is a safe and generally effective therapeutic choice for the treatment of severe gram-negative bacterial infections when resistance to other classes of antimicrobials is present [6]. Due to their broadspectrum activity, these antibiotics are commonly used in the treatment of life-threatening infections. Excessive and inappropriate use of these drugs, has led to an increased resistance to carbapenems. This issue is one of the main causes of the expression of carbapenemase

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