BibTex RIS Cite

Epidemiology of carbapenemase producing Enterobacteriaceae in a general hospital

Year 2015, Volume: 5 Issue: 2, 57 - 62, 16.07.2015
https://doi.org/10.5799/ahinjs.02.2015.02.0177

Abstract

Objective: Detect the presence of carbapenemases producing Enterobacteriaceae (CPE) and associated epidemiologi­cal, microbiological, and clinical characteristics of patients in our hospital

Methods: During 15 months period, all non duplicate Enterobacteriaceae isolates with reduced susceptibility to car­bapenem detected by MicroScan WalkAway system and confirmed by E test were collected. These suspected isolates were further screened by modified Hodge test and carbapenemase inhibition discs to identify CPE.

Results: Out of 54 suspected Enterobacteriaceae isolates, 44 (88.5%) isolates were either extended spectrum beta-lac­tamases (ESBLs) or AmpC producers with porin loss whereas 10 isolates (18.5%) were confirmed to produce carbapen­emase representing (0.74%) of the total Enterobacteriaceae. Among these 10 isolates, 6 were OXA 48 producers and 2 isolates were class B and class A each. Six out of the 10 CPE were detected in ICU and specimen source was tracheal aspirate in 5 CPE isolates. All CPE isolates were sensitive to colistin and all but one to tigecycline. All patients had history of previous antibiotic exposure and hospital stays for more than 5 days.

Conclusion: Although CPE is not the main cause of carbapenem resistance in Enterobacteriaceae in our setting, its emergence there represents a serious infection control and therapeutic challenge. This mandates its early detection using MHT and carbapenemase inhibition tests together with strict infection control measures to limit its spread. J Mi­crobiol Infect Dis 2015;5(2): 57-62

Amina Kandeel,Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Egyp, Epidemiology of carbapenemase producing Enterobacteriaceae in a general hospital, Amina Kandeel, Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Egyp, J Microbiol Infect Dis 2015; 5(2): 57-62 doi: 10.5799/ahinjs.02.2015.02.0177

Key words: Enterobacteriaceae, carbapenemases, resistant organisms, carbapenems, epidemiology

References

  • Gupta N, Limbago BM, Patel JB, Kallen AJ. Carbapenem-resistant
  • Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53:60-67.
  • Birgy A, Bidet P, Genel N et al. Phenotypic screening of carbapenemases and associated β-lactamases in carbapenem-resistant
  • Enterobacteriaceae. J Clin Microbiol 2012;50:1295-1302.
  • Nordmann P, Naas T, Poirel L. Global spread of arbapenemaseproducing Enterobacteriaceae. Emerg Infect Dis 2011; 17:1791-1798.
  • Queenan AM, Bush K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev 2007;20:440-458.
  • Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis
  • ;9:228-236.
  • Navon-Venezia S, Leavitt A, Schwaber MJ, et al. First report on a hyperepidemic clone of KPC-3-producing Klebsiella pneumonia in Israel genetically related to a strain causing outbreaks in the United States. Antimicrob Agents Chemother 2009;53:818-820.
  • Walsh TR, Toleman MA, Poirel L, Nordmannn P. Metallo-β-lactamases: the quiet before the storm? Clin Microbiol Rev2005;18:306-325.
  • Poirel L, Héritier C, Tolün V, Nordmann P. Emergence of oxacillinase-mediated resistance to imipenem in Klebsiella pneumoniae.Antimicrob Agents Chemother 2004;48:15-22.
  • Balkhy HH, El-Saed A, Al Johani SM, et al. The epidemiology of
  • the first described carbapenem- resistant Klebsiella pneumonia
  • outbreak in a tertiary care hospital in Saudi Arabia: how far do we go? Eur. J. Clin. Microbiol. Infect. Dis. 2012; 31:1901-1909.
  • Poirel L, Al Maskari Z, Al Rashdi F, et al. NDM-1-producing Klebsiella
  • pneumoniae isolated in the Sultanate of Oman. J Antimicrob Chemother 2011;66:304-306.
  • Dortet L, Poirel L, Al Yaqoubi F, Nordmann P. NDM-1, OXA-48 and OXA-181 carbapenemase-producing Enterobacteriaceae in Sultanate of Oman. Clin Microbiol Infect 2012;18:E144-E148.
  • Maragakis LL. Recognition and prevention of multidrug-resistant
  • Gram-negative bacteria in the intensive care unit. Crit Care Med. 2010;38(Suppl 8):S345-351.
  • Patel G, Huprikar S, Factor SH, et al. Outcomes of carbapenemresistant Klebsiella pneumonia infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol.
  • ;29:1099-106.
  • Hong T, Moland E, Abdalhamid B, et al. Escherichia coli: development
  • of carbapenem resistance during therapy. Clin Infect Dis 2005;40:e84-e86.
  • Clinical and Laboratory Standards Institute 2012. Performance
  • standards for antimicrobial susceptibility testing: 22nd informational
  • supplement. . CLSI document M100-S22. Clinical and Laboratory Standards Institute, Wayne, PA
  • Clinical and Laboratory Standards Institute. 2009. Performance
  • standards for antimicrobial susceptibility testing: 20th informational
  • supplement. CLSI document M100-S20. Clinical and Laboratory
  • Standards Institute, Wayne, PA.
  • Carvalhaes CG, Picao RC, Nicoletti AG, et al. Cloverleaf test (modified Hodge test) for detecting carbapenemase production in Klebsiella pneumoniae: be aware of false positive results. J Antimicrob Chemother 2010;65:249-251.
  • Van Dijk K, Voets GM, Scharringa J, et al. Disc diffusion assay for detection of class A, B and OXA-48 carbapenemases in Enterobacteriaceae using phenyl boronic acid, dipicolinic acid and
  • temocillin. Clin Microbiol Infect 2014;20:345-349.
  • European Committee on Antimicrobial Susceptibility Testing (EUCAST).Breakpoint tables for interpretation of MICs and zone diameters, version 1.3, January 5, 2011. EUCAST, Växjö, Sweden.
  • Kronvall G, Karlsson I, Walder M, et al. Epidemiological MIC cutoff
  • values for tigecycline calculated from E test MIC values using normalized resistance interpretation. J Antimicrob Chemother 2006;57:498-505.
  • Hara G, Gould I, Endimiani A, et al. Detection, treatment, and prevention of carbapenemase-producing Enterobacteriaceae: recommendations from an International working group. J Chemother
  • ;25:129-140.
  • Swaminathan M, Sharma S, Blash SP, et al. Prevalence and Risk
  • Factors for Acquisition of Carbapenem-Resistant Enterobacteriaceae
  • in the Setting of Endemicity. Infect Control Hosp Epidemiol 2013;34:809-817.
  • Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: antimicrobial resistant pathogens associated with healthcareassociated
  • infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29:996-1011.
  • Pasteran F, Mendez T, Rapoport M, et al. Controlling false-positive
  • results obtained with the Hodge and Masuda assays for detection of class A carbapenemase in species of Enterobacteri-aceaeby incorporating boronic acid. J Clin Microbiol 2010;48:1323-1332.
  • Livermore DM, Tulkens PM. Temocillin revived. J Antimicrob Chemother 2009; 63:243-245.
  • Bartolini A, Frasson I, Cavallaro A, et al. Comparison of phenotypic
  • methods for the detection of carbapenem non-susceptible Enterobacteriaceae. Gut Pathog 2014;6:1-7.
  • Kandeel A. Prevalence and risk factors of extended-spectrum β-lactamases producing Enterobacteriaceaein a general hospital in Saudi Arabia. J Microbiol Infect Dis 2014; 4:50-54.
  • Landman D, Urban C, Backer M, et al. Susceptibility profiles,
  • molecular epidemiology, and detection of KPC-producing Escherichia
  • coli isolates from the New York City vicinity. J Clin Microbiol
  • ;48:4604-4607.
  • Endimiani A, Depasquale JM, Forero S, et al. Emergence of blaKPC-containing Klebsiella pneumoniaein a long-term acute care hospital: a new challenge to our healthcare system. J Antimicrob Chemother 2009;64:1102-1110.
  • Poirel L, Potron A, Nordmann P. OXA-48-like carbapenemase:the phantom menace, J. Antimicrob Chemother. 2012;67:1597-1606.
  • Shibl A, Al-Agamy M, Memish Z, et al. The emergence of OXA-48- and NDM-1-positive Klebsiella pneumoniae in Riyadh, Saudi Arabia. Int J Infect Dis 2013; 17: e1130-e1133
  • Zowawi H, Balkhy H, Walsh T, Patersona D. β-Lactamase Production
  • in Key Gram-Negative Pathogen Isolates from the Arabian Peninsula Clin. Microbiol Rev 2013;26:361-380.
  • Chitnis AS, Caruthers PS, Rao AK, et al. Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: Sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol 2012;33:984-992.
  • Teo J, Cai Y, Tang S, et al. Risk Factors, Molecular Epidemiology
  • and Outcomes of Ertapenem-Resistant, Carbapenem-Susceptible Enterobacteriaceae: A Case-Case-Control Study. PLoS One 2012; 7:e34254.

-

Year 2015, Volume: 5 Issue: 2, 57 - 62, 16.07.2015
https://doi.org/10.5799/ahinjs.02.2015.02.0177

Abstract

Amaç: Genel hastanede Karbapenemaz üreten Entereobakterlerin (KÜE) tespiti, epidemiyolojisi, mikrobiyolojisi ve hastaların klinik karakteristik özelliklerinin belirlenmesi.Yöntemler: On beş aylık dönem içinde, dublike olmayan MikroScan WalkAway sistemi ile karbapenem duyarlılığı azalmış ve E test ile doğrulanan Enterobakterler tespit edildi. Daha sonra modifiye Hodge testi ve disk inhibisyon yöntemi ile karbapenemaz üreten enterobakterler belirlendi.Bulgular: Tespit edilen 54 enterobakter izolatı içinde 44 (%88.5)’i genişletilmiş spektrumlu beta-laktamaz (GSBL) veya porin kayıplı AmpC üretiyordu. Bunun yanında 10 izolat (%18.5) karbapenemaz üretiyordu. Karbapenemaz üreten izolatlatlar tüm enterobakterler içinde %0.74 oranında idi. Bu 10 izolatın 6’sı OXA-48 üretirken 2’si grup B ve grup A idi. Bu 10 izolatın 6’sı yoğun bakım ünitesinde yatan hastalarda tespit edildi. Bu 6 izolatın 5’i trakeal aspiratta üredi. Tüm KÜE kolistine duyarlı idi, sadece 1 izolat tigesikline dirençli idi. Tüm hastalar öncesinde antibiyotik tedavisi almıştı ve 5 günden uzun süredir hastanede yatmakta idi.Sonuç: Bizim ünitemizde karbapenem direnci başlıca KÜE bağlı olmasa bile KÜE tespit edilmiş olması enfeksiyon kontrol önlemleri ve tedavi yaklaşımlarının tekrar gözden geçirilmesini gerekli kılmaktadır. Bu da erken dönemde modifiye hodge testi ve karbapenemaz inhibisyon testlerinin beraber kullanılması ile KÜE erken tesbiti ve sıkı enfeksiyon kontrol önlemlerinin uygulanması ile yayılımının önlenmesi sağlanabilir

References

  • Gupta N, Limbago BM, Patel JB, Kallen AJ. Carbapenem-resistant
  • Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53:60-67.
  • Birgy A, Bidet P, Genel N et al. Phenotypic screening of carbapenemases and associated β-lactamases in carbapenem-resistant
  • Enterobacteriaceae. J Clin Microbiol 2012;50:1295-1302.
  • Nordmann P, Naas T, Poirel L. Global spread of arbapenemaseproducing Enterobacteriaceae. Emerg Infect Dis 2011; 17:1791-1798.
  • Queenan AM, Bush K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev 2007;20:440-458.
  • Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis
  • ;9:228-236.
  • Navon-Venezia S, Leavitt A, Schwaber MJ, et al. First report on a hyperepidemic clone of KPC-3-producing Klebsiella pneumonia in Israel genetically related to a strain causing outbreaks in the United States. Antimicrob Agents Chemother 2009;53:818-820.
  • Walsh TR, Toleman MA, Poirel L, Nordmannn P. Metallo-β-lactamases: the quiet before the storm? Clin Microbiol Rev2005;18:306-325.
  • Poirel L, Héritier C, Tolün V, Nordmann P. Emergence of oxacillinase-mediated resistance to imipenem in Klebsiella pneumoniae.Antimicrob Agents Chemother 2004;48:15-22.
  • Balkhy HH, El-Saed A, Al Johani SM, et al. The epidemiology of
  • the first described carbapenem- resistant Klebsiella pneumonia
  • outbreak in a tertiary care hospital in Saudi Arabia: how far do we go? Eur. J. Clin. Microbiol. Infect. Dis. 2012; 31:1901-1909.
  • Poirel L, Al Maskari Z, Al Rashdi F, et al. NDM-1-producing Klebsiella
  • pneumoniae isolated in the Sultanate of Oman. J Antimicrob Chemother 2011;66:304-306.
  • Dortet L, Poirel L, Al Yaqoubi F, Nordmann P. NDM-1, OXA-48 and OXA-181 carbapenemase-producing Enterobacteriaceae in Sultanate of Oman. Clin Microbiol Infect 2012;18:E144-E148.
  • Maragakis LL. Recognition and prevention of multidrug-resistant
  • Gram-negative bacteria in the intensive care unit. Crit Care Med. 2010;38(Suppl 8):S345-351.
  • Patel G, Huprikar S, Factor SH, et al. Outcomes of carbapenemresistant Klebsiella pneumonia infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol.
  • ;29:1099-106.
  • Hong T, Moland E, Abdalhamid B, et al. Escherichia coli: development
  • of carbapenem resistance during therapy. Clin Infect Dis 2005;40:e84-e86.
  • Clinical and Laboratory Standards Institute 2012. Performance
  • standards for antimicrobial susceptibility testing: 22nd informational
  • supplement. . CLSI document M100-S22. Clinical and Laboratory Standards Institute, Wayne, PA
  • Clinical and Laboratory Standards Institute. 2009. Performance
  • standards for antimicrobial susceptibility testing: 20th informational
  • supplement. CLSI document M100-S20. Clinical and Laboratory
  • Standards Institute, Wayne, PA.
  • Carvalhaes CG, Picao RC, Nicoletti AG, et al. Cloverleaf test (modified Hodge test) for detecting carbapenemase production in Klebsiella pneumoniae: be aware of false positive results. J Antimicrob Chemother 2010;65:249-251.
  • Van Dijk K, Voets GM, Scharringa J, et al. Disc diffusion assay for detection of class A, B and OXA-48 carbapenemases in Enterobacteriaceae using phenyl boronic acid, dipicolinic acid and
  • temocillin. Clin Microbiol Infect 2014;20:345-349.
  • European Committee on Antimicrobial Susceptibility Testing (EUCAST).Breakpoint tables for interpretation of MICs and zone diameters, version 1.3, January 5, 2011. EUCAST, Växjö, Sweden.
  • Kronvall G, Karlsson I, Walder M, et al. Epidemiological MIC cutoff
  • values for tigecycline calculated from E test MIC values using normalized resistance interpretation. J Antimicrob Chemother 2006;57:498-505.
  • Hara G, Gould I, Endimiani A, et al. Detection, treatment, and prevention of carbapenemase-producing Enterobacteriaceae: recommendations from an International working group. J Chemother
  • ;25:129-140.
  • Swaminathan M, Sharma S, Blash SP, et al. Prevalence and Risk
  • Factors for Acquisition of Carbapenem-Resistant Enterobacteriaceae
  • in the Setting of Endemicity. Infect Control Hosp Epidemiol 2013;34:809-817.
  • Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: antimicrobial resistant pathogens associated with healthcareassociated
  • infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29:996-1011.
  • Pasteran F, Mendez T, Rapoport M, et al. Controlling false-positive
  • results obtained with the Hodge and Masuda assays for detection of class A carbapenemase in species of Enterobacteri-aceaeby incorporating boronic acid. J Clin Microbiol 2010;48:1323-1332.
  • Livermore DM, Tulkens PM. Temocillin revived. J Antimicrob Chemother 2009; 63:243-245.
  • Bartolini A, Frasson I, Cavallaro A, et al. Comparison of phenotypic
  • methods for the detection of carbapenem non-susceptible Enterobacteriaceae. Gut Pathog 2014;6:1-7.
  • Kandeel A. Prevalence and risk factors of extended-spectrum β-lactamases producing Enterobacteriaceaein a general hospital in Saudi Arabia. J Microbiol Infect Dis 2014; 4:50-54.
  • Landman D, Urban C, Backer M, et al. Susceptibility profiles,
  • molecular epidemiology, and detection of KPC-producing Escherichia
  • coli isolates from the New York City vicinity. J Clin Microbiol
  • ;48:4604-4607.
  • Endimiani A, Depasquale JM, Forero S, et al. Emergence of blaKPC-containing Klebsiella pneumoniaein a long-term acute care hospital: a new challenge to our healthcare system. J Antimicrob Chemother 2009;64:1102-1110.
  • Poirel L, Potron A, Nordmann P. OXA-48-like carbapenemase:the phantom menace, J. Antimicrob Chemother. 2012;67:1597-1606.
  • Shibl A, Al-Agamy M, Memish Z, et al. The emergence of OXA-48- and NDM-1-positive Klebsiella pneumoniae in Riyadh, Saudi Arabia. Int J Infect Dis 2013; 17: e1130-e1133
  • Zowawi H, Balkhy H, Walsh T, Patersona D. β-Lactamase Production
  • in Key Gram-Negative Pathogen Isolates from the Arabian Peninsula Clin. Microbiol Rev 2013;26:361-380.
  • Chitnis AS, Caruthers PS, Rao AK, et al. Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: Sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol 2012;33:984-992.
  • Teo J, Cai Y, Tang S, et al. Risk Factors, Molecular Epidemiology
  • and Outcomes of Ertapenem-Resistant, Carbapenem-Susceptible Enterobacteriaceae: A Case-Case-Control Study. PLoS One 2012; 7:e34254.
There are 61 citations in total.

Details

Primary Language English
Journal Section Brief Report
Authors

Amina Kandeel This is me

Publication Date July 16, 2015
Published in Issue Year 2015 Volume: 5 Issue: 2

Cite

APA Kandeel, A. (2015). Epidemiology of carbapenemase producing Enterobacteriaceae in a general hospital. Journal of Microbiology and Infectious Diseases, 5(2), 57-62. https://doi.org/10.5799/ahinjs.02.2015.02.0177
AMA Kandeel A. Epidemiology of carbapenemase producing Enterobacteriaceae in a general hospital. J Microbil Infect Dis. July 2015;5(2):57-62. doi:10.5799/ahinjs.02.2015.02.0177
Chicago Kandeel, Amina. “Epidemiology of Carbapenemase Producing Enterobacteriaceae in a General Hospital”. Journal of Microbiology and Infectious Diseases 5, no. 2 (July 2015): 57-62. https://doi.org/10.5799/ahinjs.02.2015.02.0177.
EndNote Kandeel A (July 1, 2015) Epidemiology of carbapenemase producing Enterobacteriaceae in a general hospital. Journal of Microbiology and Infectious Diseases 5 2 57–62.
IEEE A. Kandeel, “Epidemiology of carbapenemase producing Enterobacteriaceae in a general hospital”, J Microbil Infect Dis, vol. 5, no. 2, pp. 57–62, 2015, doi: 10.5799/ahinjs.02.2015.02.0177.
ISNAD Kandeel, Amina. “Epidemiology of Carbapenemase Producing Enterobacteriaceae in a General Hospital”. Journal of Microbiology and Infectious Diseases 5/2 (July 2015), 57-62. https://doi.org/10.5799/ahinjs.02.2015.02.0177.
JAMA Kandeel A. Epidemiology of carbapenemase producing Enterobacteriaceae in a general hospital. J Microbil Infect Dis. 2015;5:57–62.
MLA Kandeel, Amina. “Epidemiology of Carbapenemase Producing Enterobacteriaceae in a General Hospital”. Journal of Microbiology and Infectious Diseases, vol. 5, no. 2, 2015, pp. 57-62, doi:10.5799/ahinjs.02.2015.02.0177.
Vancouver Kandeel A. Epidemiology of carbapenemase producing Enterobacteriaceae in a general hospital. J Microbil Infect Dis. 2015;5(2):57-62.