American Journal of Internal Medicine
Volume 5, Issue 1, January 2017, Pages: 1-6
Received: Nov. 15, 2016;
Accepted: Nov. 30, 2016;
Published: Jan. 3, 2017
Views 3460 Downloads 139
Maha Assem, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Mohamed-Naguib Abdalla Wifi, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Rasha Elsherif, Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Ahmed Saad, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Dalia Kadry Ismail, Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Ahmed Hasanin, Anesthesiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Rasha Bassyouni, Medical Microbiology and Immunology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
Mohamed Saeed Hussein Gomaa, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Multidrug-resistant Gram-negative organisms have emerged as a major threat to hospitalized patients, and are associated with serious morbidity and mortality. This study aimed to characterize carbapenem resistance genes among Gram-negative bacilli isolated from clinical samples from patients in the intensive care unit of Cairo University Hospital. A total of 211 samples were collected from patients showing clinical evidence of infection. Bacteria were isolated and identified by conventional microbiological methods. Acinetobacter baumannii isolates were furtherly characterized by polymerase chain reaction (PCR), using primers specific for blaOXA-51-like genes. The Kirby Bauer disc diffusion method was used to determine susceptibility patterns of isolates, and carbapenem resistance was further examined by a modified Hodge test. Positive isolates were tested for the presence of blaKPC, blaOXA-48, and blaNDM-like genes by PCR. NDM gene types were determined by direct sequencing. From the 211 samples, 229 Gram-negative bacilli were isolated. Fifty isolates (21.2%) were resistant to carbapenem. PCR analysis showed that none of the 50 isolates carried blaKPC-like genes, while 24 (48%) isolates carried blaOXA-48-like genes, 8 (16%) carried blaNDM-1, and five isolates (10%) carried both blaNDM-1 and blaOXA-48-like genes. These results indicate that continuous surveillance of these multidrug-resistant pathogens is urgently required. And that is very important is to activate the antimicrobial stewardship programs of which the most important is restriction of the big gun antibiotics like carbapenems, colistin, tigecyclin and vancomycin and restricting their prescription to privileged specialties.
Mohamed-Naguib Abdalla Wifi,
Dalia Kadry Ismail,
Mohamed Saeed Hussein Gomaa,
Emergence of Gram-Negative Bacilli with Concomitant blaNDM-1- and blaOXA-48-Like Genes in Egypt, American Journal of Internal Medicine.
Vol. 5, No. 1,
2017, pp. 1-6.
Peleg AY, and Hooper DC. Hospital-Acquired Infections Due to Gram-Negative Bacteria. N Engl J 2010; 362 (19): 1804–1813.
Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18: 268–281.
Tamma PD, Cosgrove SE, Maragakis LL. Combination Therapy for Treatment of Infections with Gram-Negative Bacteria. Clin Microbiol Rev 2012; 25 (3): 450-470.
Shibl A, Al-Agamy A, Memish, Z, Senok A, Abdul Khader S, Assiri A. The emergence of OXA-48- and NDM-1-positive Klebsiella pneumoniae in Riyadh, Saudi Arabia. International Journal of Infectious Diseases 2013; 17 (12): 1130–1133.
Gupta N, Brandi M, Limbago BM, Jean B, Patel JB, Kallen, AJ. Carbapenem-Resistant Enterobacteriaceae: Epidemiology and Prevention. Clin Infect Dis 2011; 53 (1): 60-67.
Rahal JJ. Antimicrobial Resistance among and Therapeutic Options against Gram-Negative Pathogens. Clin Infect Dis., Aug 15; 49 Suppl 1: S4-S10. doi: 10.1086/599810.
Mushi MF, Mshana SE, Imirzalioglu C, Bwanga F. Carbapenemase Genes among Multidrug Resistant Gram Negative Clinical Isolates from a Tertiary Hospital in Mwanza, Tanzania. BioMed Research International. vol. 2014, Article ID 303104, 6 pages, 2014. doi: 10.1155/2014/303104.
Qureshi ZA, Hittle LE, O'Hara JA, Rivera JI, Syed A, Shields RK. Colistin-Resistant Acinetobacter baumannii: Beyond Carbapenem Resistance. Clin Infect Dis. (2015) 1; 60 (9): 1295-303.
Ribeiro VB, Linhares AR, Zavascki AP, Barth AL. Performance of Quantification of Modified Hodge Test: An Evaluation with Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Isolates,. BioMed Research International vol. 2014; Article ID 139305, 6 pages, 2014. doi: 10.1155/2014/139305.
Cohen MJ, Block C, Levin PD, et al. Institutional Control Measures to Curtail the Epidemic Spread of Carbapenem-Resistant Klebsiella pneumoniae: A 4-Year Perspective. Infect Control Hosp Epidemiol 2011; 32: 673-678.
Schreckenberger PC, Janda JM, Wong JD. Algorism for identification of aerobic Gram negative bacilli. In: Murray, P. R., Baron, E. J., Jorgensen, J. H. et al. Manual of clinical microbiology 9th ed., Washington 2009; 26: 438-441.
Karmostaji A, Peerayeh SN, Salmanian AH. Distribution of OXA-Type Class D β-Lactamase Genes among Nosocomial Multi Drug Resistant Acinetobacter baumannii Isolated in Tehran Hospitals. Jundishapur Journal of Microbiology 2013; 6 (5): e8219
Clinical and Laboratory Standards Institute. 2012. Performance standards for antimicrobial susceptibility testing. 22nd informational supplement. Clinical and Laboratory Standards Institute document M100–S20. Wayne PA. www.clsi.org
Bratu S, Tolaney P, Karumudi U, et al. Carbapenemase-producing Klebsiella pneumonia in Brooklyn, N. Y.: molecular epidemiology and in vitro activity of polymyxin B and other agents. J. Antimicrob. Chemother 2005; 56: 128-132.
Aktaş Z, Kayacan CB, Schneider I, Can B, Midilli K, Bauernfeind A. Carbapenem hydrolyzing oxacillinase, OXA-48, persists in Klebsiella pneumonia in Istanbul, Turkey. Chemotheraphy 2008; 54: 101-106.
Nordmann P, Naas T, Poirel L. Global spread of carbapenamase-producing Enterobacteriaceae. Emerg Infect Dis 2011; 17 (10): 1791-1798.
Fouad M, Attia AS, Tawakkol WM, Hashem AM. Emergence of carbapenem-resistant Acinetobacter baumannii harboring the OXA-23 carbapenemase in intensive care units of Egyptian hospitals. Int J Infect Dis 2013; 17 (12): e1252-1254.
Maltezou HC, Kontopidou F, Katerelos P, Daikos G, Roilides E, Theodoridou M. Infections caused by carbapenem-resistant Gram-negative pathogens in hospitalized children. Pediatr Infect Dis J 2013; 32 (4): e151-154.
Arnold R, Thom KA, Sharma S, Phillips M, Johnson JK, Morgan DJ. Emergence of Klebsiella pneumoniae carbapenemase-producing bacteria. Southern Med J 2011; 104, (1): 40-45.
Chen Y, Zhou Z, Jiang Y, Yu Y. Emergence of NDM-1-producing Acinetobacter baumannii in China. J. Antimicrob. Chemother 2011; 66: 1255–1259.
Nordmann P, Poirel L, Carrër A, Toleman MA, Walsh TR. How To Detect NDM-1 Producers. J Clin Microbiol 2011a; 49 (2): 718–721.
Levast M, Poirel L, Carrër A, et al. Transfer of OXA-48-positive carbapenem-resistant Klebsiella pneumoniae from Turkey to France. J Antimicrob Chemother 2011; 66: 944–945.
Voulgari E, Zarkotou O, Ranellou K, Karageorgopoulos DE, Vrioni, G, Mamali V. Outbreak of OXA-48 carbapenemase- producing Klebsiella pneumoniae in Greece involving an ST11 clone. J Antimicrob Chemotherapy 2013; 68: 84–88.
Espedido BA, Jason A, Ziochos H, et al. Whole Genome Sequence Analysis of the First Australian OXA-48-Producing Outbreak-Associated Klebsiella pneumonia Isolates: The Resistome and In Vivo Evolution. PLoS ONE 2013; 8 (3): e59920.
Mataseje LF, Boyd DA, Hoang L, et al. Carbapenem-hydrolyzing oxacillinase-48 and oxacillinase-181 in Canada, 2011. Emerg Infect Dis 2013;. 19 (1): 157- 160.
Poirel L, Abdelaziz MO, Bernabeu S, Nordmann P. Occurrence of OX A-48 and VIM-1 carbapenemase-producing Enterobacteriaceae in Egypt. International Journal of Antimicrobial Agents 2013; 41: 90–95.
Goncalves D, Cecilio P, Ferreira H 2013. First detection of OXA-48-like-producing Acinetobacter baumannii in the faecal flora of nursing home residents in northern Portugal. abstr eP748 Abstr. 23rd Eur. Congr. Clin. Microbiol. Infect. Dis., Berlin, Germany https://molecularhub.org/resources/270
Djahmi N, Dunyach-Remy C, Pantel A, Dekhil M, Sotto A, Lavigne JP. Epidemiology of Carbapenemase-Producing Enterobacteriaceae and Acinetobacter baumannii in Mediterranean Countries. BioMed Research International 2014. Hindawi Publishing Corporation BioMed Research International Volume 2014, Article ID 305784, 11 pages http://dx.doi.org/10.1155/2014/305784
Espinal P, Fugazza G, López Y, et al. Dissemination of an NDM-2-Producing Acinetobacter baumannii Clone in an Israeli Rehabilitation Center. Antimicrob Agents Chemother 2011; 55 (11): 5396-5398.
Kaase M, Nordmann P, Wichelhaus TA, Gatermann SG, Bonnin, RA, Poirel L. NDM-2 carbapenemase in Acinetobacter baumannii from Egypt. J. Antimicrob. Chemother 2011; 66: 1260–1262.
Ghazawi A, Sonnevend A, Bonnin RA, Poirel A, Nordmann L, Hashmey P. NDM-2 carbapenemase-producing Acinetobacter baumannii in the United Arab Emirates. Clin Microbiol Infect 2012; 18: E34–E36.
Hrabák J, Stolbová M, Studentová V, Fridrichová M, Chudáčková E, Zemlickova H. NDM-1 producing Acinetobacter baumannii isolated from a patient repatriated to the Czech Republic from Egypt, 2012 Feb 16. Euro Surveill; 17 (17), pii: 20085. www.eurosurveillance.org