Molecular Detection of bla OXA-48 Carbapenemase in Uropathogenic Klebsiella pneumoniae Strains from Suez Canal University Hospital

Abstract

Background: The emergence of multidrug resistant Klebsiella pneumoniae (K. pneumoniae) is a new storm of antibiotic resistant threats. With the rise of resistance to carbapenems, antibiotics of last choice, the problem is reaching life-threatening scopes. Objective: our aim of this study was to make recommendations for the identification and detection of Klebsiella Producing Carbapenemases (KPC) to improve patient management and antimicrobial stewardship. Methodology: this study included 120 consecutive and non-duplicate clinical strains of K. pneumonia isolated from cases of urinary tract infections. Phenotypic detection of ESBL and Carbapenemases production were performed. Identification of class D carbapenemases by 16S rRNA gene sequence was done. Carbapenem resistance bla OXA-48 gene was detected using conventional PCR. Results: Phenotypic tests show 57 strains (47.5%) were carbapenem resistance (p value = 0.002) and 47 strains (39.1%) were ESBL producers (p value = 0.001). By 16S rRNA sequencing analysis, most of class D carbapenemases were K. pneumonia (17 strains out of 20 strains). Two strains were K. oxytoca and the other strain was Bacillus cereus. Among class D carbapenemase resistant K. pneumonia identified by 16S rRNA sequencing, PCR for bla OXA-48 gene produced amplified product of 744 bp and was positive in 10 isolates (58.8%). All these isolates were ESBL producers by phenotypic tests and resistant to ciprofloxacin, levofloxacin, gentamycin and amikacin. Conclusion: There are high frequencies of both carbapenem resistance (47.5%) and ESBL production (39.1%) among K. pneumoniae isolates. Effective infection control and strict antimicrobial stewardship are decisive basics to limit the spread of resentence genes.