Emergence of Klebsiella pneumoniae clinical isolates harboring Klebsiella pneumoniae carbapenemase and metallo-β-lactamase in two hospitals in Egypt

Abstract

Klebsiella pneumoniae carbapenemases (KPCs) as well as metallo- β-lactamases (MBL) producing Enterobacteriaceae are associated with severe and often fatal infections in severely ill patients. This study was carried out to investigate and confirm the emergence of carbapenemase producing Enterobacteriaceae in Egyptian Hospitals. Particularly the molecular class A KPC and the molecular class B MBL namely the imipenem resistant phenotype carbapenemase (IMP) and verona integron-encoded metallo-beta-lactamase (VIM) producers. To pursue this aim, 134 non-duplicate clinical isolates belonging to Enterobacteriaceae were collected from three Hospitals in Cairo Egypt. The antimicrobial resistance patterns of all isolates included in the study were following the screening criteria of carbapenemase producing bacteria. Detection of carbapenemase producing isolates was carried out by the modified Hodge test (MHT). Phenotypic detection of KPCs and MBLs was by inhibitors combined disc tests, in MHT positive isolates, and was confirmed by detection of bla _KPC, bla _IMP and bla _VIM. Concomitant existence of: KPCs and IMP was confirmed in clinical isolates of K. pneumoniae from inpatients hospitalized in the National Cancer Institute (NCI) Hospital and Al-Demerdash University Hospital (DUH). bla _KPC and bla _VIM genes were detected together in two isolates from inpatients in the NCI. bla _KPC gene was detected alone in three isolates from inpatients in the NCI and two isolates from inpatients in the DUH. bla _IMP gene was detected alone in two isolates from inpatients in the DUH and one from NCI Hospital. To our knowledge this was the first report on emergence of KPC-VIM and IMP–KPC producing K. pneumoniae isolates in Egyptian hospitals. We concluded that, emergence of KPC and MBL-producing Enterobacteriaceae should be investigated in other hospitals located in other geographic locations in Egypt to assess the magnitude of the problem. Also, infection control practices and antibiotic policies should be strengthened to avoid the blowout of these microbial bums in our hospitals.