Abdulall A.K.Tawfick M.M.El Manakhly A.R.El Kholy A.Microbiology and Immunology DepartmentFaculty of Pharmacy (Girls)Al-Azhar UniversityCairoEgypt; Microbiology and Immunology DepartmentFaculty of Pharmacy (Boys)Al-Azhar UniversityCairoEgypt; Microbiology and Immunology DepartmentFaculty of PharmacyOctober University for Modern Sciences and Arts (MSA)6th October CityGizaEgypt; Infection Control DepartmentDar Al Fouad Hospital6th October CityGizaEgypt; Clinical Pathology DepartmentFaculty of MedicineCairo UniversityCairoEgypt2020-01-092020-01-0920189349723https://doi.org/10.1007/s10096-018-3294-7PubMed ID 29936619https://t.ly/eppMEScopusWe 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.EnglishOctober University for Modern Sciences and Artsجامعة أكتوبر للعلوم الحديثة والآدابUniversity of Modern Sciences and ArtsMSA UniversityCarbapenem resistanceCatheter-related bloodstream infectionsERIC-PCRGram-negative bacteriabeta lactamasebeta lactamase kpcbeta lactamase ndmbeta lactamase oxa 48carbapenem derivativecarbapenemasecefotaximecephalosporin derivativeciprofloxacincolistingentamicinmeropenempiperacillin plus tazobactampolymyxinpolymyxin Bunclassified drugantiinfective agentbacterial proteinbeta lactamasecarbapenem derivativecarbapenemaseantibiotic resistanceantibiotic sensitivityantimicrobial stewardshipArticlebacterium identificationbacterium isolationbloodstream infectioncarbapenem-resistant Enterobacteriaceaecatheter infectionclinical assessmentdisk diffusionEgyptenzyme activitygenetic screeninggenetic traitGram negative bacteriumhumaninfection controlintensive care unitKlebsiella pneumoniaemajor clinical studymatrix assisted laser desorption ionization time of flight mass spectrometrymolecular typingmultiplex polymerase chain reactionphenotypic variationpolymerase chain reactionpractice guidelinepriority journaltertiary care centerbacteremiacatheter infectionclinical trialcluster analysisgeneticsGram negative bacteriummicrobial sensitivity testmicrobiologymulticenter studyphysiologystatistics and numerical dataAnti-Bacterial AgentsBacteremiaBacterial Proteinsbeta-LactamasesCarbapenemsCatheter-Related InfectionsCluster AnalysisDrug Resistance, BacterialEgyptGram-Negative BacteriaHumansIntensive Care UnitsMicrobial Sensitivity TestsMolecular TypingArticlehttps://doi.org/10.1007/s10096-018-3294-7PubMed ID 29936619