Abstract
BackgroundThe spread of carbapenemase-producing Enterobacteriaceae (CPE) is a great problem of healthcare worldwide. Study of the spread for blaOXA-48-like genes coding epidemically significant carbapenemases among hospital pathogens is important for the regional and global epidemiology of antimicrobial resistance.MethodsAntibacterial resistant isolates of Klebsiella pneumoniae (n = 95) from 54 patients, P.mirabilis (n = 32) from 20 patients, Enterobacter aerogenes (n = 6) from four patients, and Enterobacter cloacae (n = 4) from four patients were collected from January, 2013 to October, 2014 in neurosurgical intensive care unit (ICU) of the Burdenko Neurosurgery Institute, Moscow. Characteristics of the isolates were done using susceptibility tests, PCR detection of the resistance genes, genotyping, conjugation, DNA sequencing, and bioinformatic analysis.ResultsMajor strains under study were multi drug resistant (MDR), resistant to three or more functional classes of drugs simultaneously—98.9 % K. pneumoniae, 100 % P.mirabilis, one E.aerogenes isolate, and one E.cloacae isolate. Molecular-genetic mechanism of MDR in K.pneumoniae and P.mirabilis isolates were based on carrying of epidemic extended-spectrum beta-lactamase blaCTX-M-15 gene (87.2 and 90.6 % accordingly), carbapenemase blaOXA-48-like gene (55.3 and 23.3 % accordingly), and class 1 (54.8 and 31.3 % accordingly) and class 2 (90.6 % P. mirabilis) integrons. The blaOXA-48-like-positive K. pneumoniae were collected during whole two-year surveillance period, while P. mirabilis and Enterobacter spp. carrying blaOXA-48-like genes were detected only after four and 18 months after the research start, respectively. The blaOXA-48-like gene acquisition was shown for P. mirabilis isolates collected from five patients and for E. cloacae isolate collected from one patient during their stay in the ICU, presumably from blaOXA-48-like-positive K. pneumoniae. The source of the blaOXA-244 gene acquired by E. aerogenes isolates and the time of this event were not recognized.ConclusionsThe expanding of CPE in the surveyed ICU was associated with the spread of blaOXA-48 and blaOXA-244 carbapenemase genes documented not only among K.pneumoniae, well-known bacterial host for such genes, but among P.mirabilis, E.aerogenes, and E. cloacae.
Highlights
The spread of carbapenemase-producing Enterobacteriaceae (CPE) is a great problem of healthcare worldwide
In this paper we present phenotypic and genotypic characterization of antibacterial resistant K. pneumoniae, Proteus mirabilis, Enterobacter aerogenes, and E. cloacae isolates carrying blaOXA-48 and blaOXA-244 carbapenemase genes, and discuss K. pneumoniae as possibly source for blaOXA-48-like genes spreading in the intensive care unit (ICU)
Isolate sources and resistance phenotypes Antibacterial resistant enterobacterial hospital isolates collected on the period of January, 2013 to October, 2014 from the patients with mechanical ventilation in neurosurgical intensive care unit (ICU) of the Burdenko Neurosurgery Institute, Moscow, belonged to Klebsiella pneumoniae (n = 95), Proteus mirabilis (n = 32), Enterobacter aerogenes (n = 6), Enterobacter cloacae (n = 4), Escherichia coli (n = 4), Serratia marcescens (n = 3), and Morganella morganii (n = 2)
Summary
The spread of carbapenemase-producing Enterobacteriaceae (CPE) is a great problem of healthcare worldwide. One of the main problems of healthcare worldwide is hospital-acquired infections (HAI) caused by multi drug resistant (MDR) pathogens [1, 2] including carbapenemase-producing Enterobacteriaceae (CPE) [3]. Nosocomial outbreaks caused by OXA-48-producers are registered in many European countries including France, Germany, Switzerland, Spain, Holland, and Great Britain Sporadic cases of such infections are observed in North and South America, China, Australia, and in the Middle East countries [10]. Wide spread of blaOXA-48-like genes among enterobacteria is explained by their localization on the 62 kb conjugative plasmid belonged to IncL/M incompatibility group. Such plasmids are characterized by a high rate of transfer and a wide range of hosts. It should be noted that carbapenemase activity of all OXA-48-like enzymes are low, so they cannot provide the high levels of carbapenem resistance without additional contribution of other factors such as porin mutations resulting in decrease of cell wall permeability [14]
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