Carbapenem-resistant Gram-negative bacteria associated with catheter-related bloodstream infections in three intensive care units in Egypt
Abdulall A.K.; Tawfick M.M.; El Manakhly A.R.; El Kholy A.
Date issued:
2018
Publisher:
IEEE Computer Society
,
Springer Verlag
Series Info:
European Journal of Clinical Microbiology and Infectious Diseases
37
Type:
Article
Keywords:
October University for Modern Sciences and Arts
,
جامعة أكتوبر للعلوم الحديثة والآداب
,
University of Modern Sciences and Arts
,
MSA University
,
Carbapenem resistance
,
Catheter-related bloodstream infections
,
ERIC-PCR
,
Gram-negative bacteria
,
beta lactamase
,
beta lactamase kpc
,
beta lactamase ndm
,
beta lactamase oxa 48
,
carbapenem derivative
,
carbapenemase
,
cefotaxime
,
cephalosporin derivative
,
ciprofloxacin
,
colistin
,
gentamicin
,
meropenem
,
piperacillin plus tazobactam
,
polymyxin
,
polymyxin B
,
unclassified drug
,
antiinfective agent
,
bacterial protein
,
beta lactamase
,
carbapenem derivative
,
carbapenemase
,
antibiotic resistance
,
antibiotic sensitivity
,
antimicrobial stewardship
,
Article
,
bacterium identification
,
bacterium isolation
,
bloodstream infection
,
carbapenem-resistant Enterobacteriaceae
,
catheter infection
,
clinical assessment
,
disk diffusion
,
Egypt
,
enzyme activity
,
genetic screening
,
genetic trait
,
Gram negative bacterium
,
human
,
infection control
,
intensive care unit
,
Klebsiella pneumoniae
,
major clinical study
,
matrix assisted laser desorption ionization time of flight mass spectrometry
,
molecular typing
,
multiplex polymerase chain reaction
,
phenotypic variation
,
polymerase chain reaction
,
practice guideline
,
priority journal
,
tertiary care center
,
bacteremia
,
catheter infection
,
clinical trial
,
cluster analysis
,
genetics
,
Gram negative bacterium
,
microbial sensitivity test
,
microbiology
,
multicenter study
,
physiology
,
statistics and numerical data
,
Anti-Bacterial Agents
,
Bacteremia
,
Bacterial Proteins
,
beta-Lactamases
,
Carbapenems
,
Catheter-Related Infections
,
Cluster Analysis
,
Drug Resistance, Bacterial
,
Egypt
,
Gram-Negative Bacteria
,
Humans
,
Intensive Care Units
,
Microbial Sensitivity Tests
,
Molecular Typing
Abstract:
We aimed to identify the carbapenem-resistant Gram-negative bacteria (GNB) causing catheter-related bloodstream infections (CRBSI) in intensive care units (ICU) in a tertiary care Egyptian hospital, to study their resistance mechanisms by phenotypic and genetic tests, and to use ERIC-PCR for assessing their relatedness. The study was conducted over 2�years in three ICUs in a tertiary care hospital in Egypt during 2015�2016. We identified 194 bloodstream infections (BSIs); 130 (67.01%) were caused by GNB, of which 57 were isolated from CRBSI patients (73.84%). Identification of isolates was performed using conventional methods and MALDI-TOF MS. Antimicrobial susceptibility testing (AST) was done by disc diffusion following CLSI guidelines. Phenotypic detection of carbapenemases enzymes activity was by modified Hodge test and the Carba-NP method. Isolates were investigated for the most common carbapenemases encoding genes bla KPC , bla NDM , and bla OXA-48 using multiplex PCR. Molecular typing of carbapenem-resistant isolates was done by ERIC-PCR followed by sequencing of common resistance genes. The overall rate of CRBSI in our study was 3.6 per 1000 central venous catheter (CVC) days. Among 57 Gram-negative CRBSI isolates, Klebsiella pneumoniae (K. pneumoniae) was the most frequently isolated (27/57; 47.4%), of which more than 70% were resistant to Meropenem. Phenotypic tests for carbapenemases showed that 37.9% of isolates were positive by modified Hodge test and 63.8% by Carba-NP detection. Multiplex PCR assay detected the bla NDM in 28.6% of the isolates and bla KPC in 26.8%, bla NDM and bla KPC were detected together in the same isolate in 5.6%, while bla OXA-48 -like were not detected. ERIC-PCR detected limited genetic relatedness between K. pneumoniae isolates. Elevated resistance rates were observed to all antibiotics including carbapenems among K. pneumoniae isolates causing CRBSI. ERIC-PCR showed that the resistant isolates were mainly polyclonal. Our results call for reinforcement of antimicrobial stewardship and measures to prevent CRBSI. � 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
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