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Shanta AS, Islam N, Al Asad M, Akter K, Habib MB, Hossain MJ, Nahar S, Godman B, Islam S. Resistance and Co-Resistance of Metallo-Beta-Lactamase Genes in Diarrheal and Urinary-Tract Pathogens in Bangladesh. Microorganisms 2024; 12:1589. [PMID: 39203431 PMCID: PMC11356267 DOI: 10.3390/microorganisms12081589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/24/2024] [Accepted: 08/03/2024] [Indexed: 09/03/2024] Open
Abstract
Carbapenems are the antibiotics of choice for treating multidrug-resistant bacterial infections. Metallo-β-lactamases (MBLs) are carbapenemases capable of hydrolyzing nearly all therapeutically available beta-lactam antibiotics. Consequently, this research assessed the distribution of two MBL genes and three β-lactamases and their associated phenotypic resistance in diarrheal and urinary-tract infections (UTIs) to guide future policies. Samples were collected through a cross-sectional study, and β-lactamase genes were detected via PCR. A total of 228 diarrheal bacteria were isolated from 240 samples. The most predominant pathogens were Escherichia coli (32%) and Klebsiella spp. (7%). Phenotypic resistance to amoxicillin-clavulanic acid, aztreonam, cefuroxime, cefixime, cefepime, imipenem, meropenem, gentamicin, netilmicin, and amikacin was 50.4%, 65.6%, 66.8%, 80.5%, 54.4%, 41.6%, 25.7%, 41.2%, 37.2%, and 42.9%, respectively. A total of 142 UTI pathogens were identified from 150 urine samples. Klebsiella spp. (39%) and Escherichia coli (24%) were the major pathogens isolated. Phenotypic resistance to amoxicillin-clavulanic acid, aztreonam, cefuroxime, cefixime, cefepime, imipenem, meropenem, gentamicin, netilmicin, and amikacin was 93.7%, 75.0%, 91.5%, 93.7%, 88.0%, 72.5%, 13.6%, 44.4%, 71.1%, and 43%, respectively. Twenty-four diarrheal isolates carried blaNDM-1 or blaVIM genes. The overall MBL gene prevalence was 10.5%. Thirty-six UTI pathogens carried either blaNDM-1 or blaVIM genes (25.4%). Seven isolates carried both blaNDM-1 and blaVIM genes. MBL genes were strongly associated with phenotypic carbapenem and other β-lactam antibiotic resistance. blaOXA imparted significantly higher phenotypic resistance to β-lactam antibiotics. Active surveillance and stewardship programs are urgently needed to reduce carbapenem resistance in Bangladesh.
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Affiliation(s)
- Ayasha Siddique Shanta
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Nahidul Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Mamun Al Asad
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Kakoli Akter
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Marnusa Binte Habib
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Md. Jubayer Hossain
- Center for Health Innovation, Research, Action, and Learning—Bangladesh (CHIRAL Bangladesh), Dhaka 1205, Bangladesh;
| | - Shamsun Nahar
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
- Faculty of Medicine and Health, School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW 2052, Australia
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Prevalence of carbapenemase-producing Klebsiella pneumoniae at a tertiary care hospital in Kathmandu, Nepal. Trop Med Health 2021; 49:78. [PMID: 34565485 PMCID: PMC8474737 DOI: 10.1186/s41182-021-00368-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
Aim Although carbapenem is the last-resort drug for treating drug-resistant Gram-negative bacterial infections, prevalence of carbapenem-resistant bacteria has substantially increased worldwide owing to irrational use of antibiotics particularly in developing countries like Nepal. Therefore, this study was aimed to determine the prevalence of carbapenemase-producing K. pneumoniae and to detect the carbapenemase genes (blaNDM-2 and blaOXA-48) in at a tertiary care hospital in Nepal. Materials and methods A hospital-based cross-sectional study was carried out from June 2018 to January 2019 at the Microbiology Laboratory of Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal. Different clinical samples were collected and cultured in appropriate growth media. Biochemical tests were performed for the identification of K. pneumoniae. Antibiotic susceptibility testing (AST) was performed by the Kirby–Bauer disc diffusion method. The modified Hodge test (MHT) was performed to detect carbapenemase producers. The plasmid was extracted by the modified alkaline hydrolysis method. Carbapenemase-producing K. pneumoniae were further confirmed by detecting blaNDM-2 and blaOXA-48 genes by PCR using specific forward and reverse primers followed by gel electrophoresis. Results Out of the total 720 samples, 38.9% (280/720) were culture positive. K. pneumoniae was the most predominant isolate 31.4% (88/280). Of 88 K. pneumoniae isolates, 56.8% (50/88) were multi-drug resistant (MDR), and 51.1% (45/88) were MHT positive. Colistin showed the highest sensitivity (100%; 88/88), followed by tigecycline (86.4%; 76/88). blaNDM-2 and blaOXA-48 genes were detected in 24.4% (11/45) and 15.5% (7/45) of carbapenemase-producing K. pneumoniae isolates, respectively. Conclusion The rate of MDR and carbapenemase production was high in the K. pneumoniae isolates. Colistin and tigecycline could be the drug of choice for the empirical treatments of MDR and carbapenemase-producing K. pneumoniae. Our study provides a better understanding of antibiotic resistance threat and enables physicians to select the most appropriate antibiotics. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-021-00368-2.
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