Login Register Cart 0
Generic placeholder image

Infectious Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Prevalence of OXA-type Class D β-lactamases Among Clinical Isolates of Klebsiella Pneumoniae in Multiple Centers of Tehran, Iran

Author(s): Pariya Mehrbakhsh, Yalda Basharkhah, Ashraf Bahkshi, Lida Tahmasebi Nezhad Kamarposhti and Shahin Bolori*

Volume 21, Issue 4, 2021

Published on: 17 September, 2020

Page: [558 - 563] Pages: 6

DOI: 10.2174/1871526520999200917152502

Price: $65

Abstract

Background: Drug- and multidrug-resistant Klebsiella pneumoniae isolates have been found worldwide. Treatment failures against carbapenems and extended-spectrum cephalosporins, the currently recommended drugs, contribute to consider K. pneumoniae infections as untreatable infections. The emergence and spread of oxacillinases (OXAs) with carbapenem-hydrolyzing properties are a major concern and seriously become a public health problem worldwide. The present study was aimed to explore the blaOXA genes among clinical isolates of K. pneumoniae in some clinical settings in Tehran, Iran.

Methods: A total of 90 K. pneumoniae isolates were collected from different clinical samples at hospitals in Tehran during the year 2016 and 2018. Antimicrobial susceptibility testing was performed on bacterial isolates using the Kirby-Bauer disc diffusion method on Mueller Hinton agar plates. PCR experiments were carried out to detect the presence of the blaOXA genes, including blaOXA- 1, blaOXA-2, blaOXA-4, blaOXA10, and blaOXA-48-like, using specific primers.

Results: The antibiotics susceptibility results showed that 41% of the K. pneumoniae isolates were resistant to imipenem and meropenem. Resistance rates for cephalosporin agents, including cefpodoxime, ceftazidime, cefuroxime, cefotaxime, and cefepime, were measured as 72.3%, 67.8%, 67.7%, 65.5%, and 60%, respectively. In the present study, 51.1% of isolates were classified as multidrug-resistant K. pneumoniae strains. The molecular assays showed that 56.6% of isolates harbored blaOXA-2. In addition, blaOXA-4, blaOXA-1, blaOXA-10, and blaOXA-48-like genes were also found in 16.7%, 5.6%, 1.1%, and 1.1% of isolates, respectively.

Conclusion: The spread of blaOXAs, especially blaOXA-48-like, among K. pneumoniae isolates indicated the inadequate dissemination control of multidrug-resistant bacteria in the Iranian hospital environment. There is a reason to assume that OXA producing K. pneumoniae will limit clinical therapeutic options in the future and pose threats to national public health among the Iranian population.

Keywords: blaOXA gene, extended-spectrum beta-lactamases, Klebsiella pneumoniae, multidrug resistance, oxacillinase, imipenem, meropenem.

[1]
Durdu, B.; Hakyemez, I.N.; Bolukcu, S.; Okay, G.; Gultepe, B.; Aslan, T. Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection. Springerplus, 2016, 5(1), 1892.
[http://dx.doi.org/10.1186/s40064-016-3580-8] [PMID: 27843749]
[2]
Broberg, C.A.; Palacios, M.; Miller, V.L. Klebsiella: a long way to go towards understanding this enigmatic jet-setter. F1000Prime Rep., 2014, 6, 64.
[http://dx.doi.org/10.12703/P6-64] [PMID: 25165563]
[3]
Tumbarello, M.; Sanguinetti, M.; Montuori, E.; Trecarichi, E.M.; Posteraro, B.; Fiori, B.; Citton, R.; D’Inzeo, T.; Fadda, G.; Cauda, R.; Spanu, T. Predictors of mortality in patients with bloodstream infections caused by extended-spectrum-beta-lactamase-producing Enterobacteriaceae: importance of inadequate initial antimicrobial treatment. Antimicrob. Agents Chemother., 2007, 51(6), 1987-1994.
[http://dx.doi.org/10.1128/AAC.01509-06] [PMID: 17387156]
[4]
Lautenbach, E.; Patel, J.B.; Bilker, W.B.; Edelstein, P.H.; Fishman, N.O. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin. Infect. Dis., 2001, 32(8), 1162-1171.
[http://dx.doi.org/10.1086/319757] [PMID: 11283805]
[5]
Girometti, N.; Lewis, R.E.; Giannella, M.; Ambretti, S.; Bartoletti, M.; Tedeschi, S.; Tumietto, F.; Cristini, F.; Trapani, F.; Gaibani, P.; Viale, P. Klebsiella pneumoniae bloodstream infection: epidemiology and impact of inappropriate empirical therapy. Medicine (Baltimore), 2014, 93(17), 298-309.
[http://dx.doi.org/10.1097/MD.0000000000000111] [PMID: 25398065]
[6]
Rawat, D.; Nair, D. Extended-spectrum β-lactamases in Gram Negative Bacteria. J. Glob. Infect. Dis., 2010, 2(3), 263-274.
[http://dx.doi.org/10.4103/0974-777X.68531] [PMID: 20927289]
[7]
Bush, K.; Jacoby, G.A. Updated functional classification of β-lactamases. Antimicrob. Agents Chemother., 2010, 54(3), 969-976.
[http://dx.doi.org/10.1128/AAC.01009-09] [PMID: 19995920]
[8]
Poirel, L.; Naas, T.; Nordmann, P. Diversity, epidemiology, and genetics of class D beta-lactamases. Antimicrob. Agents Chemother., 2010, 54(1), 24-38.
[http://dx.doi.org/10.1128/AAC.01512-08] [PMID: 19721065]
[9]
Poirel, L.; Héritier, C.; Tolün, V.; Nordmann, P. Emergence of oxacillinase-mediated resistance to imipenem in Klebsiella pneumoniae. Antimicrob. Agents Chemother., 2004, 48(1), 15-22.
[http://dx.doi.org/10.1128/AAC.48.1.15-22.2004] [PMID: 14693513]
[10]
Walther-Rasmussen, J.; Høiby, N. OXA-type carbapenemases. J. Antimicrob. Chemother., 2006, 57(3), 373-383.
[http://dx.doi.org/10.1093/jac/dki482] [PMID: 16446375]
[11]
Castanheira, M.; Deshpande, L.M.; Mathai, D.; Bell, J.M.; Jones, R.N.; Mendes, R.E. Early dissemination of NDM-1- and OXA-181-producing Enterobacteriaceae in Indian hospitals: report from the SENTRY Antimicrobial Surveillance Program, 2006-2007. Antimicrob. Agents Chemother., 2011, 55(3), 1274-1278.
[http://dx.doi.org/10.1128/AAC.01497-10] [PMID: 21189345]
[12]
Magiorakos, A.P.; Srinivasan, A.; Carey, R.B.; Carmeli, Y.; Falagas, M.E.; Giske, C.G.; Harbarth, S.; Hindler, J.F.; Kahlmeter, G.; Olsson-Liljequist, B.; Paterson, D.L.; Rice, L.B.; Stelling, J.; Struelens, M.J.; Vatopoulos, A.; Weber, J.T.; Monnet, D.L. 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(3), 268-281.
[http://dx.doi.org/10.1111/j.1469-0691.2011.03570.x] [PMID: 21793988]
[13]
Moradigaravand, D.; Martin, V.; Peacock, S.J.; Parkhill, J. Evolution and Epidemiology of Multidrug-Resistant Klebsiella pneumoniae in the United Kingdom and Ireland. MBio, 2017, 8(1), e01976-16.
[http://dx.doi.org/10.1128/mBio.01976-16] [PMID: 28223459]
[14]
Bathoorn, E.; Tsioutis, C.; da Silva Voorham, J.M.; Scoulica, E.V.; Ioannidou, E.; Zhou, K.; Rossen, J.W.; Gikas, A.; Friedrich, A.W.; Grundmann, H. Emergence of pan-resistance in KPC-2 carbapenemase-producing Klebsiella pneumoniae in Crete, Greece: a close call. J. Antimicrob. Chemother., 2016, 71(5), 1207-1212.
[http://dx.doi.org/10.1093/jac/dkv467] [PMID: 26817488]
[15]
Zhou, K.; Lokate, M.; Deurenberg, R.H.; Tepper, M.; Arends, J.P.; Raangs, E.G.; Lo-Ten-Foe, J.; Grundmann, H.; Rossen, J.W.; Friedrich, A.W. Use of whole-genome sequencing to trace, control and characterize the regional expansion of extended-spectrum β-lactamase producing ST15 Klebsiella pneumoniae. Sci. Rep., 2016, 6, 20840.
[http://dx.doi.org/10.1038/srep20840] [PMID: 26864946]
[16]
Gheitani, L; Fazeli, H; Moghim, S; Nasr Isfahani, B. Frequency Determination of Carbapenem-Resistant Klebsiella Pneumoniae (CRKP) Isolated from hospitals in Isfahan of Iran and Evaluation of Synergistic Effect of Colistin and Meropenem on them. Cellular and molecular biology (Noisy-le-Grand, France), 2018, 64(1), 70-4.
[17]
Solgi, H; Badmasti, F; Aminzadeh, Z; Giske, CG; Pourahmad, M; Vaziri, F Molecular characterization of intestinal carriage of carbapenem-resistant Enterobacteriaceae among inpatients at two Iranian university hospitals: first report of co-production of bla NDM-7 and bla OXA-48. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology., 2017, 36(11), 2127-35.
[18]
Shoja, S.; Ansari, M.; Faridi, F.; Azad, M.; Davoodian, P.; Javadpour, S.; Farahani, A.; Mobarrez, B.D.; Karmostaji, A. Identification of Carbapenem-Resistant Klebsiella pneumoniae with Emphasis on New Delhi Metallo-Beta-Lactamase-1 (blaNDM-1) in Bandar Abbas, South of Iran. Microb. Drug Resist., 2018, 24(4), 447-454.
[http://dx.doi.org/10.1089/mdr.2017.0058] [PMID: 28972857]
[19]
Hosseinzadeh, Z.; Sedigh Ebrahim-Saraie, H.; Sarvari, J.; Mardaneh, J.; Dehghani, B.; Rokni-Hosseini, S.M.H.; Motamedifar, M. Emerge of blaNDM-1 and blaOXA-48-like harboring carbapenem-resistant Klebsiella pneumoniae isolates from hospitalized patients in southwestern Iran. J. Chin. Med. Assoc., 2018, 81(6), 536-540.
[http://dx.doi.org/10.1016/j.jcma.2017.08.015] [PMID: 29030025]
[20]
Moini, A.S.; Soltani, B.; Taghavi Ardakani, A.; Moravveji, A.; Erami, M.; Haji Rezaei, M.; Namazi, M. Multidrug-Resistant Escherichia coli and Klebsiella pneumoniae Isolated From Patients in Kashan, Iran. Jundishapur J. Microbiol., 2015, 8(10), e27517.
[http://dx.doi.org/10.5812/jjm.27517] [PMID: 26587220]
[21]
Iovleva, A; Mettus, R; McElheny, C; Pasculle, A; Doi, Y. Reduced Ertapenem Susceptibility Due to OXA-2 Production in Klebsiella pneumoniae ST258. Open Forum Infectious Diseases., 2017, 4(suppl_1), S128-S.
[22]
Antunes, N.T.; Fisher, J.F. Acquired Class D β-Lactamases. Antibiotics (Basel), 2014, 3(3), 398-434.
[http://dx.doi.org/10.3390/antibiotics3030398] [PMID: 27025753]
[23]
Machado, E.; Coque, T.M.; Cantón, R.; Baquero, F.; Sousa, J.C.; Peixe, L. Portuguese Resistance Study Group. Dissemination in Portugal of CTX-M-15-, OXA-1-, and TEM-1-producing Enterobacteriaceae strains containing the aac(6′)-Ib-cr gene, which encodes an aminoglycoside- and fluoroquinolone-modifying enzyme. Antimicrob. Agents Chemother., 2006, 50(9), 3220-3221.
[http://dx.doi.org/10.1128/AAC.00473-06] [PMID: 16940136]
[24]
Sugumar, M.; Kumar, K.M.; Manoharan, A.; Anbarasu, A.; Ramaiah, S. Detection of OXA-1 β-lactamase gene of Klebsiella pneumoniae from blood stream infections (BSI) by conventional PCR and in-silico analysis to understand the mechanism of OXA mediated resistance. PLoS One, 2014, 9(3), e91800.
[http://dx.doi.org/10.1371/journal.pone.0091800] [PMID: 24647004]
[25]
Cuzon, G.; Ouanich, J.; Gondret, R.; Naas, T.; Nordmann, P. Outbreak of OXA-48-positive carbapenem-resistant Klebsiella pneumoniae isolates in France. Antimicrob. Agents Chemother., 2011, 55(5), 2420-2423.
[http://dx.doi.org/10.1128/AAC.01452-10] [PMID: 21343451]
[26]
Aubert, D.; Naas, T.; Héritier, C.; Poirel, L.; Nordmann, P. Functional characterization of IS1999, an IS4 family element involved in mobilization and expression of beta-lactam resistance genes. J. Bacteriol., 2006, 188(18), 6506-6514.
[http://dx.doi.org/10.1128/JB.00375-06] [PMID: 16952941]
[27]
Crémet, L.; Bourigault, C.; Lepelletier, D.; Guillouzouic, A.; Juvin, M.E.; Reynaud, A.; Corvec, S.; Caroff, N. Nosocomial outbreak of carbapenem-resistant Enterobacter cloacae highlighting the interspecies transferability of the blaOXA-48 gene in the gut flora. J. Antimicrob. Chemother., 2012, 67(4), 1041-1043.
[http://dx.doi.org/10.1093/jac/dkr547] [PMID: 22223227]
[28]
Cuzon, G.; Naas, T.; Bogaerts, P.; Glupczynski, Y.; Huang, T.D.; Nordmann, P. Plasmid-encoded carbapenem-hydrolyzing beta-lactamase OXA-48 in an imipenem-susceptible Klebsiella pneumoniae strain from Belgium. Antimicrob. Agents Chemother., 2008, 52(9), 3463-3464.
[http://dx.doi.org/10.1128/AAC.00543-08] [PMID: 18644970]
[29]
Castanheira, M.; Watters, A.; Smayevsky, J.; Casellas, J.; Gur, D.; Jones, J. Emergence of blaOXA-48 among Enterobacter cloacae (ECL) in Argentina and its prevalence among carbapenem (CARB) non-susceptible (NS) Enterobacteriaceae, abstr.C2-647. Abstr. 50th Intersci. Conf Antimicrob Agents Chemother American Society for Microbiology; Washington, DC, 2010.
[30]
Livermore, D.M. Has the era of untreatable infections arrived? J. Antimicrob. Chemother., 2009, 64(Suppl. 1), i29-i36.
[http://dx.doi.org/10.1093/jac/dkp255] [PMID: 19675016]
[31]
Cuzon, G.; Naas, T.; Lesenne, A.; Benhamou, M.; Nordmann, P. Plasmid-mediated carbapenem-hydrolysing OXA-48 beta-lactamase in Klebsiella pneumoniae from Tunisia. Int. J. Antimicrob. Agents, 2010, 36(1), 91-93.
[http://dx.doi.org/10.1016/j.ijantimicag.2010.02.014] [PMID: 20356714]
[32]
Lee, C-R.; Lee, J.H.; Park, K.S.; Kim, Y.B.; Jeong, B.C.; Lee, S.H. Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods. Front. Microbiol., 2016, 7, 895.
[http://dx.doi.org/10.3389/fmicb.2016.00895] [PMID: 27379038]
[33]
Bell, J.; Mathai, D.; Jones, R.; Turnidge, J. Emergence of OXA-48 carbapenemases among Klebsiella spp. from India, abstr. C2-650. Abstr.50th Intersci. Conf Antimicrob Agents Chemother American Society for Microbiology; Washington, DC, 2010.
[34]
Azimi, L.; Nordmann, P.; Lari, A.R.; Bonnin, R.A. First report of OXA-48-producing Klebsiella pneumoniae strains in Iran. GMS Hyg. Infect. Control, 2014, 9(1), Doc07.
[PMID: 24653971]
[35]
Solgi, H.; Badmasti, F.; Giske, C.G.; Aghamohammad, S.; Shahcheraghi, F. Molecular epidemiology of NDM-1- and OXA-48-producing Klebsiella pneumoniae in an Iranian hospital: clonal dissemination of ST11 and ST893. J. Antimicrob. Chemother., 2018, 73(6), 1517-1524.
[http://dx.doi.org/10.1093/jac/dky081] [PMID: 29518198]
[36]
Bhattacharjee, A.; Sen, M.R.; Anupurba, S.; Prakash, P.; Nath, G. Detection of OXA-2 group extended-spectrum-β-lactamase-producing clinical isolates of Escherichia coli from India. J. Antimicrob. Chemother., 2007, 60(3), 703-704.
[http://dx.doi.org/10.1093/jac/dkm267] [PMID: 17623688]
[37]
Hujer, K.M.; Hujer, A.M.; Hulten, E.A.; Bajaksouzian, S.; Adams, J.M.; Donskey, C.J.; Ecker, D.J.; Massire, C.; Eshoo, M.W.; Sampath, R.; Thomson, J.M.; Rather, P.N.; Craft, D.W.; Fishbain, J.T.; Ewell, A.J.; Jacobs, M.R.; Paterson, D.L.; Bonomo, R.A. Analysis of antibiotic resistance genes in multidrug-resistant Acinetobacter sp. isolates from military and civilian patients treated at the Walter Reed Army Medical Center. Antimicrob. Agents Chemother., 2006, 50(12), 4114-4123.
[http://dx.doi.org/10.1128/AAC.00778-06] [PMID: 17000742]
[38]
Mlynarcik, P.; Roderova, M.; Kolar, M. Primer Evaluation for PCR and its Application for Detection of Carbapenemases in Enterobacteriaceae. Jundishapur J. Microbiol., 2016, 9(1), e29314.
[http://dx.doi.org/10.5812/jjm.29314] [PMID: 27099689]

Rights & Permissions Print Cite
Article Metrics
9
1
© 2024 Bentham Science Publishers | Privacy Policy