The Emergence of Carbapenem Resistant Enterobacteriaceae Producing GIM-1 and SIM-1 Clinical Isolates in Khartoum-Sudan

Abstract

Purpose

The aim of this study was to detect multidrug resistant GIM-1 and SIM-1 producing Enterobacteriaceae clinical isolates from hospitalized patients across three Khartoum State Teaching Hospitals, Sudan.

Patients and Methods

From May 2018 to October 2019, Enterobacteriaceae clinical isolates from inpatients admitted to different Khartoum state hospitals. Genes for carbapenemase (GIM-1 and SIM-1) were amplified by polymerase chain reaction (PCR). Agar dilution method was used to determine MICs for imipenem and meropenem after antimicrobial susceptibility testing.

Results

Five (1.29%) isolates of Enterobacteriaceae [2 (0.51%) Escherichia coli isolates produce GIM-1, 2 (0.51%) Klebsiella pneumoniae isolates (one [0.25%] of each produce of GIM-1 and of SIM-1), and 1 (0.25%) Enterobacter cloacae isolate produce GIM-1]. Susceptibility profiling of the isolates showed a low-level resistance to imipenem and meropenem MICs (8, 16 and 32 μg/mL). It also had resistance to ampicillin, extended-spectrum cephalosporin’s, aztreonam, and amoxicillin-clavulanate and with the two K. pneumoniae strains showing resistance to colistin.

Conclusion

We report the emergence of four GIM-1 producing Enterobacteriaceae strains and one strain of SIM-1 producing K. pneumoniae genes, isolated from hospitalized patients, with a high resistance pattern to antimicrobial agents. Whole-genome sequencing (WGS) is necessary for precise identification of clonal diversity backgrounds of acquired carbapenemase genes in diagnostic laboratories as the number of cases of carbapenem resistant Enterobacteriaceae infection increases annually.

Keywords:

• Enterobacteriaceae
• metallo-β-lactamase (MBL)
• GIM-1 and SIM-1 genes

Data Sharing Statement

All data used and/or evaluated during this study are included in this published article (are available from the corresponding author on reasonable request).

Ethics Approval

We would like to confirm that our study complies with the declaration of Helsinki. Besides ethical approval for this study was obtained from the Ethical Committee of the Sudan Federal Ministry of Health (FMOH-Human) (reference number: 29.478/2017), and from Graduate College – University of Medical Sciences and Technology UMST, Khartoum, Sudan, 2017. The purpose of the study was explained in detail to all participants or their relatives before a written and verbal consent form was signed on a voluntary basis.

Acknowledgments

The authors warmly acknowledge the National University Biomedical Research Institute (NUBRI Khartoum-Sudan), for molecular techniques workflow. And Mr. Omer. M.O for contribution in specimen’s collection during the data collection period.

Disclosure

The authors declare that they have no conflicts of interest in this work.

Additional information

Funding

Not funded.