Carbapenem-resistant Gram-negative bacteria associated with catheter-related bloodstream infections in three intensive care units in Egypt

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Date

2018

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Volume Title

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Article

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IEEE Computer Society
Springer Verlag

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European Journal of Clinical Microbiology and Infectious Diseases
37

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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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

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