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Tartor YH, Ammar AM, Abdelkhalek A, Hassan KA, Shaker A, Elnahriry SS, Nekouei O, Elsohaby I. Emergence of pandrug-resistant carbapenemase-producing Enterobacterales in dogs and cats: a cross-sectional study in Egypt. Front Cell Infect Microbiol 2024; 14:1318585. [PMID: 38562962 PMCID: PMC10982511 DOI: 10.3389/fcimb.2024.1318585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
One of the most important emerging health problems is the increasing role of animals in the rapid global rise in resistance to last-resort antibiotics, such as carbapenems. However, there is limited information on the role of pet animals in harboring and spreading pandrug-resistant (PDR) carbapenemase-producing Enterobacterales (CPE), especially in Egypt. This cross-sectional study was conducted to screen for CPE in healthy and diseased pets using phenotypic and molecular methods and the NG-Test CARBA 5 immunochromatographic assay. Rectal swabs were collected from 62 dogs and 48 cats, incubated overnight in tryptic soy broth containing 10 μg of meropenem disc and subsequently cultured on MacConkey agar supplemented with meropenem (1 mg/L). Sixty-six isolates (60.6%), including 56 Klebsiella pneumoniae, seven Escherichia coli, and three K. oxytoca isolates, were confirmed to be carbapenem-resistant Enterobacterales (CRE) by the disc diffusion method, broth microdilution test, CNPt-direct, and PCR assay targeting carbapenemase genes. Forty-three (65.2%) dogs and 23 (34.8%) cats carried CPE. Of these, 35 (70.0%) were healthy (including 27 dogs and 8 cats) and 31 (52.5%) were diseased (including 16 dogs and 15 cats). bla OXA-181 was the most common gene detected (42/66, 63.6%), followed by bla IMP (40/66, 60.6%), bla OXA-48-like (29/66, 43.9%), bla KPC and bla VIM (20/66, 30.3% each), and bla NDM (17/66, 25.8%). The identified genotypes were bla KPC-2, bla IMP-1, bla VIM-1, bla NDM-1, and bla NDM-5. The CARBA 5 assay showed higher sensitivity and specificity for the detection of NDM, OXA and KPC than that for VIM and IMP genes. Antimicrobial resistance profiles of CRE isolates revealed 20 PDR, 30 extensively drug-resistant (XDR), and 16 multidrug-resistant (MDR) phenotypes. This study provides evidence of colonization with PDR CPE in dogs and cats. To manage the infection or colonization of pets in veterinary clinical settings, extended surveillance systems should be considered, and the use of critical antibiotics should be strictly controlled.
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Affiliation(s)
- Yasmine H. Tartor
- Department of Microbiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed M. Ammar
- Department of Microbiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | | | - Khlood A. Hassan
- Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Asmaa Shaker
- Department of Microbiology, Veterinary Hospital, Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
| | - Shimaa S. Elnahriry
- Department of Bacteriology, Mycology and Immunology, Faculty of Veterinary Medicine, University of Sadat City, Menofia, Egypt
| | - Omid Nekouei
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ibrahim Elsohaby
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Centre for Applied One Health Research and Policy Advice (OHRP), City University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
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Ng XY, Fong KW, Kiew LV, Chung PY, Liew YK, Delsuc N, Zulkefeli M, Low ML. Ruthenium(II) polypyridyl complexes as emerging photosensitisers for antibacterial photodynamic therapy. J Inorg Biochem 2024; 250:112425. [PMID: 37977020 DOI: 10.1016/j.jinorgbio.2023.112425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
Photodynamic therapy (PDT) has recently emerged as a potential valuable alternative to treat microbial infections. In PDT, singlet oxygen is generated in the presence of photosensitisers and oxygen under light irradiation of a specific wavelength, causing cytotoxic damage to bacteria. This review highlights different generations of photosensitisers and the common characteristics of ideal photosensitisers. It also focuses on the emergence of ruthenium and more specifically on Ru(II) polypyridyl complexes as metal-based photosensitisers used in antimicrobial photodynamic therapy (aPDT). Their photochemical and photophysical properties as well as structures are discussed while relating them to their phototoxicity. The use of Ru(II) complexes with recent advancements such as nanoformulations, combinatory therapy and photothermal therapy to improve on previous shortcomings of the complexes are outlined. Future perspectives of these complexes used in two-photon PDT, photoacoustic imaging and sonotherapy are also discussed. This review covers the literature published from 2017 to 2023.
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Affiliation(s)
- Xiao Ying Ng
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Kar Wai Fong
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Lik Voon Kiew
- Department of Pharmacology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 30068, Taiwan, Republic of China
| | - Pooi Yin Chung
- Department of Microbiology, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Yun Khoon Liew
- Department of Life Sciences, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Nicolas Delsuc
- Laboratoire des Biomolécules, LBM, Département de Chimie, École Normale Supérieur, PSL University, Sorbonne Université, CNRS, 75005 Paris, France
| | - Mohd Zulkefeli
- Department of Pharmaceutical Chemistry, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia.
| | - May Lee Low
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia.
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Mardourian M, Lyons H, Rhodes Brunner J, K. Edwards M, Lennox A, Mahadevaiah S, Chandrashekhar S, Prudhvi Raj S, Pradhan A, Kalyatanda G. Prevalence of antimicrobial resistance in urine, blood, and wound pathogens among rural patients in Karnataka, India. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e91. [PMID: 37228505 PMCID: PMC10204140 DOI: 10.1017/ash.2023.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/27/2023]
Abstract
Background and objective Antimicrobial resistance (AMR) is increasing in tertiary-care hospitals across India, which consumes more antibiotics than any other country. Microorganisms with novel resistance mechanisms, initially isolated in India, are now recognized worldwide. Until now, most efforts to stem AMR in India have focused on the inpatient setting. Ministry of Health data now suggest that rural areas are playing a more significant role in the pathogenesis of AMR than was previously appreciated. Thus, we conducted this pilot study to ascertain whether AMR is common in pathogens causing infections acquired in the wider rural community. Methods We performed a retrospective prevalence survey of 100 urine, 102 wound, and 102 blood cultures obtained from patients who were admitted to a tertiary-care facility in Karnataka, India, with infections acquired in the community. The study population included patients >18 years of age who (1) were referred to the hospital by primary care doctors, (2) had a positive blood, urine, or wound culture, and (3) were not previously hospitalized. Bacterial identification and antimicrobial susceptibility testing (AST) were carried out on all isolates. Results Enterobacteriaceae were the most common pathogens isolated from urine and blood cultures. Significant resistance to quinolones, aminoglycosides, carbapenems, and cephalosporins was noted among pathogens isolated from all cultures. Specifically, high resistance rates (>45%) to quinolones, penicillin, and cephalosporins were evident among all 3 types of culture. Among blood and urinary pathogens, there were high resistance rates (>25%) to both aminoglycosides and carbapenems. Conclusion Efforts to stem AMR rates in India need to focus on rural populations. Such efforts will need to characterize antimicrobial overprescribing practices, healthcare-seeking behaviors, and antimicrobial use in agriculture in rural settings.
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Affiliation(s)
- Markos Mardourian
- University of Florida College of Medicine, Gainesville, Florida, United States
| | - Hannah Lyons
- University of Florida College of Medicine, Gainesville, Florida, United States
| | | | - Matthew K. Edwards
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Archibald Lennox
- Malcolm Randall Department of Veterans’ Affairs Medical Center, Gainesville, Florida, United States
| | - Sumana Mahadevaiah
- Department of Microbiology, JSS Medical College, Mysore, Karnataka, India
| | | | - Suvvada Prudhvi Raj
- JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Anjali Pradhan
- JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Gautam Kalyatanda
- Division of Infectious Disease and Global Medicine, University of Florida, Gainesville, Florida, United States
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Carvalho TN, Kobs VC, Hille D, Deglmann RC, Melo LH, de França PHC. Evaluation of in-vitro susceptibility of ß-lactam-resistant Gram-negative bacilli to ceftazidime-avibactam and ceftolozane-tazobactam from clinical samples of a general hospital in southern Brazil. Rev Soc Bras Med Trop 2023; 56:S0037-86822023000100303. [PMID: 36700602 PMCID: PMC9870284 DOI: 10.1590/0037-8682-0277-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The spread of carbapenemase- and extended-spectrum β-lactamase (ESBL)-producing gram-negative bacilli (GNB) represent a global public health threat that limits therapeutic options for hospitalized patients. This study aimed to evaluate the in-vitro susceptibility of β-lactam-resistant GNB to ceftazidime-avibactam (C/A) and ceftolozane-tazobactam (C/T), and investigate the molecular determinants of resistance. METHODS Overall, 101 clinical isolates of Enterobacterales and Pseudomonas aeruginosa collected from a general hospital in Brazil were analyzed. Susceptibility to the antimicrobial agents was evaluated using an automated method, and the minimum inhibitory concentrations (MIC50/90) of C/A and C/T were determined using Etest®. The β-lactamase-encoding genes were investigated using polymerase chain reaction. RESULTS High susceptibility to C/A and C/T was observed among ESBL-producing Enterobacterales (100% and 97.3% for CLSI and 83.8% for BRCAST, respectively) and carbapenem-resistant P. aeruginosa (92.3% and 87.2%, respectively). Carbapenemase-producing Klebsiella pneumoniae exhibited high resistance to C/T (80%- CLSI or 100%- BRCAST) but high susceptibility to C/A (93.4%). All carbapenem-resistant K. pneumoniae isolates were susceptible to C/A, whereas only one isolate was susceptible to C/T. Both antimicrobials were inactive against metallo-β-lactamase-producing K. pneumoniae isolates. Resistance genes were concomitantly identified in 44 (44.9%) isolates, with bla CTX-M and bla SHV being the most common. CONCLUSIONS C/A and C/T were active against microorganisms with β-lactam-resistant phenotypes, except when resistance was mediated by metallo-β-lactamases. Most C/A- and C/T-resistant isolates concomitantly carried two or more β-lactamase-encoding genes (62.5% and 77.4%, respectively).
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Affiliation(s)
- Thaisa Noceti Carvalho
- Universidade da Região de Joinville, Joinville, SC, Brasil., Dona Helena Hospital, Joinville, SC, Brasil
| | | | - Daniela Hille
- Universidade da Região de Joinville, Joinville, SC, Brasil
| | | | - Luiz Henrique Melo
- Universidade da Região de Joinville, Joinville, SC, Brasil., Dona Helena Hospital, Joinville, SC, Brasil
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Ghotaslou R, Salahi B, Naderi G, Alizadeh N. High Frequency of blaOXA-48like
Producing Klebsiella pneumoniae Isolated from Nosocomial Infection in Azerbaijan, Iran. Infect Chemother 2023; 55:90-98. [PMID: 37021426 PMCID: PMC10079451 DOI: 10.3947/ic.2022.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/17/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Klebsiella pneumoniae is one of the significant agents of hospital-acquired infections. In recent years, carbapenem-resistant K. pneumoniae (CRKP) isolates have been found in numerous epidemics of nosocomial infections. This study aimed to determine carbapenem resistance mechanisms and molecular epidemiological of CRKP infections in Azerbaijan, Iran. MATERIALS AND METHODS A total of 50 non-duplicated CRKP from January 2020 to December 2020 were isolated form Sina and Imam Reza Hospitals in Tabriz, Iran. Antimicrobial susceptibility testing was performed by the disk-diffusion method. The carbapenem resistance mechanisms were determined by the phenotypic and PCR procedures. CRKP isolates were typed by the Random Amplified Polymorphic DNA PCR (RAPD-PCR) technique. RESULTS Amikacin was the most effective antibiotics against CRKP isolates. AmpC overproduction was observed in five CRKP isolates. Efflux pump activity was found in one isolate by the phenotypic method. Carba NP test could find carbapenemases genes in 96% of isolates. The most common carbapenemases gene in CRKP isolates were blaOXA-48-like (76%) followed by blaNDM (50%), blaIMP (22%), blaVIM (10%), and blaKPC (10%). The outer membrane protein genes (OmpK36 and OmpK35) were identified in 76% and 82% of CRKP isolates, respectively. RAPD-PCR analysis yielded 37 distinct RAPD-types. Most blaOXA-48-like positive CRKP isolates were obtained from patients hospitalized in intensive care unit (ICU) wards with urinary tract infections. CONCLUSION The blaOXA-48-like is the main carbapenemase among CRKP isolates in this area. Most blaOXA-48-like producer CRKP strains were collected from the ICU ward and urine samples. To control infections due to CRKP, a strict control program in hospital settings is required.
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Affiliation(s)
- Reza Ghotaslou
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Central Laboratory of the Province, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behnaz Salahi
- Razi Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ghazal Naderi
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Alizadeh
- Zanjan Applied Pharmacology Research Center, Zanjan University of Medical Sciences, Zanjan, Iran .
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Hatrongjit R, Chopjitt P, Boueroy P, Kerdsin A. Multiplex PCR Detection of Common Carbapenemase Genes and Identification of Clinically Relevant Escherichia coli and Klebsiella pneumoniae Complex. Antibiotics (Basel) 2022; 12:antibiotics12010076. [PMID: 36671277 PMCID: PMC9854989 DOI: 10.3390/antibiotics12010076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
Carbapenem-resistant Enterobacterales (CRE) species are top priority pathogens according to the World Health Organization. Rapid detection is necessary and useful for their surveillance and control globally. This study developed a multiplex polymerase chain reaction (mPCR) detection of the common carbapenemase genes NDM, KPC, and OXA-48-like, together with identification of Escherichia coli, and distinguished a Klebsiella pneumoniae complex to be K. pneumoniae, K. quasipneumoniae, and K. variicola. Of 840 target Enterobacterales species, 190 E. coli, 598 K. pneumoniae, 28 K. quasipneumoniae, and 23 K. variicola. with and without NDM, KPC, or OXA-48-like were correctly detected for their species and carbapenemase genes. In contrast, for the Enterobacterales species other than E. coli or K. pneumoniae complex with carbapenemase genes, the mPCR assay could detect only NDM, KPC, or OXA-48-like. This PCR method should be useful in clinical microbiology laboratories requiring rapid detection of CRE for epidemiological investigation and for tracking the trends of carbapenemase gene dynamics.
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Affiliation(s)
- Rujirat Hatrongjit
- Faculty of Science and Engineering, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon 47000, Thailand
- Correspondence:
| | - Peechanika Chopjitt
- Faculty of Public Health, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon 47000, Thailand
| | - Parichart Boueroy
- Faculty of Public Health, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon 47000, Thailand
| | - Anusak Kerdsin
- Faculty of Public Health, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon 47000, Thailand
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Kundu J, Rathore S, Kanaujia R, Kansal S, Gupta A, Kaur R, Angrup A, Biswal M, Ray P. Comparative evaluation of phenotypic and genotypic methods for the rapid and cost-effective detection of carbapenemases in extensively drug resistant Klebsiella pneumoniae. Indian J Med Microbiol 2022; 42:65-70. [PMID: 36229350 DOI: 10.1016/j.ijmmb.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Carbapenemases are the enzymes that can hydrolyze carbapenems and other β-lactam antibiotics. These enzymes confer resistance to multiple antibiotics and act as a stumbling block in the treatment of infections caused by gram-negative bacteria. Therefore, rapid and specific detection of these enzymes is crucial for deciding the course of treatment and better clinical outcomes. MATERIAL AND METHODS This study was conducted to compare various phenotypic and PCR based methods for the detection of carbapenemases in carbapenem- and colistin-resistant Klebsiella pneumoniae. One hundred clinical isolates of extensively resistant Klebsiella pneumoniae were included in the study. Phenotypic detection for carbapenemases was performed by Rapidec® Carba NP (Biomerieux), modified carbapenem inactivation method (mCIM), imipenem-ethylenediaminetetraacetic acid disk synergy (EDS), double disk synergy test using mercaptopropionic acid (DDST-MPA), and combined disk method (CD) and for colistin by microbroth dilution method. Genotypic detection for carbapenemases and colistin resistance was performed by targeted PCR. RESULTS The sensitivity of Carba NP test and mCIM were positive in 95% and 96% respectively and specificity was 100% for both methods. The sensitivity of EDS, DDST-MPA, and CD were 55.6%, 88.9% and 54.5% respectively. Among the carbapenem resistance genes, blaOXA-48 (82%) genes were the most prevalent. Among metallo-beta lactamases, blaVIM (56%) was most common followed by blaNDM (54%) and blaIMP (20%). The mcr-1 gene for colistin resistance was not detected in any isolate. CONCLUSION Among the five phenotypic assays analyzed, the mCIM is the most simple, inexpensive, accurate and reproducible method for carbapenemase detection in Klebsiella pneumoniae. The DDST-MPA test provides the best sensitivity for the detection of carbapenemases, although specificity is low. These tests, when applied in a clinical laboratory and assessed by the microbiologist, can help in guiding the course of treatment.
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Affiliation(s)
- Jyoti Kundu
- Department of Medical Microbiology PGIMER, Chandigarh, India
| | - Shivali Rathore
- Department of Medical Microbiology PGIMER, Chandigarh, India
| | | | | | - Alka Gupta
- Department of Medical Microbiology PGIMER, Chandigarh, India
| | - Rajdeep Kaur
- Department of Medical Microbiology PGIMER, Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology PGIMER, Chandigarh, India.
| | - Manisha Biswal
- Department of Medical Microbiology PGIMER, Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology PGIMER, Chandigarh, India
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Chiș AA, Rus LL, Morgovan C, Arseniu AM, Frum A, Vonica-Țincu AL, Gligor FG, Mureșan ML, Dobrea CM. Microbial Resistance to Antibiotics and Effective Antibiotherapy. Biomedicines 2022; 10:biomedicines10051121. [PMID: 35625857 PMCID: PMC9138529 DOI: 10.3390/biomedicines10051121] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 12/24/2022] Open
Abstract
Currently, the efficacy of antibiotics is severely affected by the emergence of the antimicrobial resistance phenomenon, leading to increased morbidity and mortality worldwide. Multidrug-resistant pathogens are found not only in hospital settings, but also in the community, and are considered one of the biggest public health concerns. The main mechanisms by which bacteria develop resistance to antibiotics include changes in the drug target, prevention of entering the cell, elimination through efflux pumps or inactivation of drugs. A better understanding and prediction of resistance patterns of a pathogen will lead to a better selection of active antibiotics for the treatment of multidrug-resistant infections.
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Alizadeh N, Ahangarzadeh Rezaee M, Samadi Kafil H, Hasani A, Soroush Barhaghi MH, Milani M, Yeganeh Sefidan F, Memar MY, Lalehzadeh A, Ghotaslou R. Evaluation of Resistance Mechanisms in Carbapenem-Resistant Enterobacteriaceae. Infect Drug Resist 2020; 13:1377-1385. [PMID: 32494169 PMCID: PMC7229782 DOI: 10.2147/idr.s244357] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) is a major concern leading to morbidity and mortality in the world. CRE often is becoming a cause of therapeutic failure in both hospital and community-acquired infections. AIM This study aimed to investigate the resistance mechanisms of CRE by phenotypic and molecular methods. MATERIALS AND METHODS Sixty CRE (50 Klebsiella pneumoniae, 6 Escherichia coli, and 4 Enterobacter spp.) were isolated from October 2018 to June 2019. Antimicrobial susceptibility testing was carried out using phenotypic methods. The carbapenem resistance mechanisms including efflux pump hyperexpression, AmpC overproduction, carbapenemase genes, and deficiency in OmpK35 and OmpK36 were determined by phenotypic and molecular methods, respectively. RESULTS Sixty CRE (50 Klebsiella pneumoniae, 6 Escherichia coli, and 4 Enterobacter spp.) were isolated from October 2018 to June 2019. Amikacin was found to be the most effective drug against CRE isolates. All isolates were resistant to imipenem and meropenem by the micro-broth dilution. AmpC overproduction was observed in all Enterobacter spp. and three K. pneumoniae isolates. No efflux pump activity was found. Carba NP test and Modified Hodge Test could find carbapenemase in 59 (98%) isolates and 57 (95%) isolates, respectively. The most common carbapenemase gene was bla OXA-48-like (72.8%) followed by bla NDM (50.8%), bla IMP (18.6%), bla VIM (11.8%), and bla KPC (6.7%). The ompK35 and ompK36 genes were not detected in 10 and 7 K. pneumoniae isolates, respectively. CONCLUSION The amikacin is considered as a very efficient antibiotic for the treatment of CRE isolates in our region. Carbapenemase production and overproduction of AmpC are the main carbapenem resistance mechanisms in CRE isolates. Finally, Carba NP test is a rapid and reliable test for early detection of carbapenemase-producing isolates.
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Affiliation(s)
- Naser Alizadeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Ahangarzadeh Rezaee
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | - Hossein Samadi Kafil
- Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | - Alka Hasani
- Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | | | - Morteza Milani
- Department of Medical Nanotechnology, Faculty of Advanced Medical Science, Medical, University of Tabriz, Tabriz, Iran
| | - Fatemeh Yeganeh Sefidan
- Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | - Mohammad Yousef Memar
- Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, IR, Iran
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aidin Lalehzadeh
- Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | - Reza Ghotaslou
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, IR, Iran
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