Carbapenem Resistance Pattern of Multiple Drug-Resistantand Extended-Spectrum Beta-Lactamase-Positive Klebsiella pneumonia in Isfahan

Klebsiella pneumoniais producer of carbapenemase (KPC) an emerging pathogen with propensity to malady in weak patients, increasing their morality rates.Carbapenemaseis an enzyme that destroys all beta-lactam antibiotics and is the therapeutic choice for infections with extended-spectrum beta-lactamase (ESBL)-producing organisms.ESBLESBLs are penicillin, narrow spectrum also third-generation cephalosporin, and monobactams hydrolyser and checkrein by clavulanic acid. The present study was performed to separate and identify the carbapenemase resistance pattern of multidrug-resistant (MDR) and ESBL-positive K.pneumoniaas well as its prevalence among different wards and various clinical specimens in Isfahan. Over 500 different clinical samples were collected from different sections of great teaching hospitals in Isfahan, in which K. pneumonia isolates were identified by IMVIC and urease standard biochemical tests and also were confirmed by determination of the ureD Gene. Antimicrobial susceptibility tests were performed as standard disk-diffusion on Mueller-Hinton agar (Merck, Germany) based on the instructions of Clinical Laboratory Standards Institute (CLSI, 2013). Sieving and phenotype conformation of ESBL isolates were performed by double disc synergy test (DDST), and then, the strains identified as ESBL were test by carbapenem, ertapenem, imipenem andmeropenem. Finally, the statistical analyses were performed using the WHONET software version 5.6. Of clinical isolates of K.pneumonia, 142 were confirmed using biochemical methods and then the molecular confirmation was performed by PCR of the ureD gene. Of the total isolates, 57% were from males and 43% from females; 120(84%) of isolates were recognized as MDR. The highest rates of resistance were related to piperacillin (80%), ceftazidime (76%), and cefotaxime (73%). Among these MDR isolates, 101 (71%) were detected as ESBL, using DDST. The ward and the clinical specimen with the most prevalence were ICU with 55 (38.7%) and urine with 61(42.9%) samples, respectively. The lowest prevalence was related to the neurosurgery ward with 8 (5.6%) samples and the clinical specimen with the lowest prevalence was cerebrospinal fluid (CSF) with 2 (1.4%) samples. The susceptibility patterns to carbapenem agents were as follows: ertapenem50.7%, meropenem 44.8% and imipenem35.8%. In this study, the prevalence of carbapenem-resistant K.pneumoniae was high in positive ESBL isolates, which can create significant therapeutic problems. According to the resistance pattern of ESBL-positive isolates for carbapenems in this research, ertapenem can probably serve as a suitable therapeutic option for uncomplicated infections by ESBL-producing K.pneumoniae instead of imipenem and meropenem.

Klebsiella pneumoniais producer of carbapenemase (KPC) an emerging pathogen with propensity to malady in weak patients, increasing their morality rates.Carbapenemaseis an enzyme that destroys all beta-lactam antibiotics and is the therapeutic choice for infections with extended-spectrum beta-lactamase (ESBL)-producing organisms.ESBLESBLs are penicillin, narrow spectrum also third-generation cephalosporin, and monobactams hydrolyser and checkrein by clavulanic acid. The present study was performed to separate and identify the carbapenemase resistance pattern of multidrug-resistant (MDR) and ESBL-positive K.pneumoniaas well as its prevalence among different wards and various clinical specimens in Isfahan. Over 500 different clinical samples were collected from different sections of great teaching hospitals in Isfahan, in which K. pneumonia isolates were identified by IMVIC and urease standard biochemical tests and also were confirmed by determination of the ureD Gene. Antimicrobial susceptibility tests were performed as standard disk-diffusion on Mueller-Hinton agar (Merck, Germany) based on the instructions of Clinical Laboratory Standards Institute (CLSI, 2013). Sieving and phenotype conformation of ESBL isolates were performed by double disc synergy test (DDST), and then, the strains identified as ESBL were test by carbapenem, ertapenem, imipenem andmeropenem. Finally, the statistical analyses were performed using the WHONET software version 5.6. Of clinical isolates of K.pneumonia, 142 were confirmed using biochemical methods and then the molecular confirmation was performed by PCR of the ureD gene. Of the total isolates, 57% were from males and 43% from females; 120(84%) of isolates were recognized as MDR. The highest rates of resistance were related to piperacillin (80%), ceftazidime (76%), and cefotaxime (73%). Among these MDR isolates, 101 (71%) were detected as ESBL, using DDST. The ward and the clinical specimen with the most prevalence were ICU with 55 (38.7%) and urine with 61(42.9%) samples, respectively. The lowest prevalence was related to the neurosurgery ward with 8 (5.6%) samples and the clinical specimen with the lowest prevalence was cerebrospinal fluid (CSF) with 2 (1.4%) samples. The susceptibility patterns to carbapenem agents were as follows: ertapenem50.7%, meropenem 44.8% and imipenem35.8%. In this study, the prevalence of carbapenem-resistant K.pneumoniae was high in positive ESBL isolates, which can create significant therapeutic problems. According to the resistance pattern of ESBL-positive isolates for carbapenems in this research, ertapenem can probably serve as a suitable therapeutic option for uncomplicated infections by ESBL-producing K.pneumoniae instead of imipenem and meropenem.