Carbapenemase Producers Among Extensive Drug-Resistant Gram-Negative Pathogens Recovered from Febrile Neutrophilic Patients in Egypt

Abstract

Purpose

This study aimed to detect the prevalence of carbapenemase producers (CPs) among extensive drug-resistant (XDR)-carbapenemase producing Gram-negative bacteria (GNB) recovered from various clinical specimens of hospitalized neutrophilic febrile patients in two major tertiary care hospitals in Egypt.

Methods

Standard methods were used to evaluate the antimicrobial susceptibility of clinical isolates according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Phenotypic and genotypic analysis of CPs were carried out and statistically analyzed using standard methods.

Results

Three hundred and forty-two GNB were obtained from 342 clinical specimens during the period of the study, where 162 (47%) were enterobacterial isolates, including, 63 (18.4%) Escherichia coli, 87 (25.4%) Klebsiella spp., 5 (1.46%) Enterobacter cloacae, 5 (1.46%) Salmonella spp. and 2 (0.6%) Proteus and 180 (53%) were non-fermentative bacilli including, 129 (37.7%), Acinetobacter baumannii, and 51 (14.9%), Pseudomonas spp. Out of the 342 GNB, 188 (54.9%) isolates were multi-drug resistant (MDR). Of these, 52 (27.6%) were XDR as well as CPs as confirmed phenotypically. The MIC of imipenem against the XDR GNB against showed either low (11 isolates; 21.1%; MIC range =4–32 µg/mL) or high levels of resistance (41 isolates; 78.8%; MIC range = 64-≥1024). The most prevalent carbapenem resistance (CR) genes were blaKPC (63.5%) followed by blaOXA-48 (55.7%) and blaVIM (28.8%). No significant association could be observed between the MIC level and the presence of CR genes (P value >0.05).

Conclusion

High prevalence of MDR (54.9%) and XDR (27.6%) GNB pathogens associated with high levels of resistance to carbapenems were observed. All XDR GNB were CPs and tested positive for at least one of the CR genes. However, most of them (78.8%) showed a high level of CR (MIC range = 64-≥1024) with no significant association with the CR genes.

Keywords:

• carbapenem resistance
• carbapenemases
• MDR
• XDR
• Gram-negative pathogens

Acknowledgments

We would like to acknowledge the microbiology laboratories of New Kasr El Aini and El Demerdash Hospitals, Cairo, Egypt for providing us with the clinical isolates. We would like to acknowledge the Department of Microbiology and immunology, of both Faculty of pharmacy, Ain Shams University (ASU) and Ahram Candian University (ACU), Cairo, Egypt for providing support and facilities whenever needed. Also, I would like to acknowledge Miss Ann Elshamy, the assistant lecturer at the Microbiology and Immunology Department, Faculty of Pharmacy, Ain Shams University for providing help and support in performing PCR and agarose gel electrophoresis.

Data Sharing Statement

All the data supporting the findings are included in the manuscript.

Ethical Clearance

The study was approved by the Faculty of Pharmacy Cairo University Ethical Committee Nr. MI (2418) in April, 2019. A written informed consent was obtained from wither the patients or parents of the patients after clarifying them with the purpose of the study which was carried out in accordance with the guidelines outlined in the Declaration of Helsinki.

Disclosure

The authors declare that they have no competing interests for this work.