Phenotypic and genotypic characteristics of communityacquired and hospital-acquired carbapenem-resistant Enterobacteriaceae in patients with liver cirrhosis at the National Liver Institute of Egypt

Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) is considered one of the most urgent public health problems worldwide with associated high morbidity and mortality rates. CRE has both community-acquired (CA) and hospital-acquired (HA) danger because of the transmissible nature of plasmids. Objectives: We aimed to compare the phenotypic and genotypic characteristics of carbapenemase genes in CRE isolates causing CA and HA infections in cirrhotic patients and the distribution of carbapenemase genes in both settings. Method: CRE isolates were taken from 38 recruited cirrhotic patients at the National Liver Institute at Menoufia University in Egypt between January 2017 and January 2018 with Enterobacteriaceae isolates resistant to at least one carbapenem. Isolates were identified and described by conventional techniques and confirmed by the VITEK 2 system, which was also used for antimicrobial susceptibility and the detection of extended-spectrum β-lactamase production. We then phenotypically and genotypically characterized all isolates for the presence of the most prevalent carbapenemase enzymes (Klebsiella pneumoniae carbapenemase [KPC], Verona integron metallo-betalactamases [VIM], New Delhi metallo-beta lactamase [NDM], and oxacillinase-48 [OXA-48]) and genes using multiplex polymerase chain reaction confirmed results. Results: All CRE isolates included in this study were resistant to all carbapenems tested and susceptible to colistin, while 20 of the 38 isolates were sensitive to tigecycline. Among the 24 HA CRE isolates, nine isolates (37.5%) contained OXA-48, three (12.5%) contained both OXA-48 and NDM-1, two contained KPC (8.3%), one carried NDM-1 (4.2%), and one included VIM (4.2%). The OXA-48 gene was the most frequent gene in both groups, and no statistically significant difference was found between the two groups in regards to prevalence. Conclusion: OXA-48 CRE is the most prevalent carbapenemase gene in Egyptian cirrhotic patients with similar phenotypic and genotypic characteristics to CA cases. This indicates the equal prevalence of CRE in community and hospital settings.