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First reported nosocomial outbreak of Serratia marcescens harboring blaIMP-4 and blaVIM-2 in a neonatal intensive care unit in Cairo, Egypt

Authors Ghaith DM, Zafer MM, Ismail DK, Al-Agamy MH, Bohol MFF, Al-Qahtani A, Al-Ahdal MN, Elnagdy SM, Mostafa IY

Received 30 May 2018

Accepted for publication 17 August 2018

Published 8 November 2018 Volume 2018:11 Pages 2211—2217

DOI https://doi.org/10.2147/IDR.S174869

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 2

Editor who approved publication: Dr Joachim Wink


Doaa Mohammad Ghaith,1 Mai Mahmoud Zafer,2 Dalia Kadry Ismail,1 Mohamed Hamed Al-Agamy,3,4 Marie Fe F Bohol,5 Ahmed Al-Qahtani,5 Mohammed N Al-Ahdal,5 Sherif M Elnagdy,6 Islam Yousif Mostafa7

1Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Microbiology and Immunology, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt; 3Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 4Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt; 5Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; 6Department of Botany and Microbiology, Faculty of Science, Cairo University, Cairo, Egypt; 7Department of Microbiology, Faculty of Dentistry and Oral Medicine, Future University, Cairo, Egypt

Introduction: Serratia marcescens is a significant hospital-acquired pathogen, and many outbreaks of S. marcescens infection have been reported in neonates. We report a sudden breakout of S. marcescens harboring the blaIMP-4 and blaVIM-2 metallo-β-lactamase (MBL) genes that occurred from March to August 2015 in the neonatal intensive care unit of Cairo University Hospital, Cairo, Egypt.
Methods: During the study period, 40 nonduplicate clinical isolates of S. marcescens were collected from blood culture samples. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was used to identify each isolate. Then, minimum inhibitory concentrations of different antibiotics were assessed by the Vitek 2 compact system. Screening of the MBL genes blaIMPblaVIMblaSIM-1blaSPM-1, and blaGIM-1 as well as the carbapenemase genes KPC, NDM, OXA-48, SME-1, and SME-2 were evaluated. Pulsed field gel electrophoresis was preformed to detect the genetic relationship of the isolates.
Results: Analysis showed that 37.5% of the S. marcescens clinical isolates were resistant to meropenem (minimum inhibitory concentrations ≥ 2 µg/mL), and blaIMP-4 and blaVIM-2 were the most prevalent MBL genes (42.5% and 37.5%, respectively). None of the other investigated genes were observed. Pulsed field gel electrophoresis typing revealed two discrete clones; 33/40 (82.5%) were pulsotype A and 7/40 (17.5%) were pulsotype B.
Conclusion: Here, we report for the first time the detection of MBL-producing S. marcescens isolates, particularly IMP-4 and VIM-2 recovered from inpatients with bacteremias from the intensive care unit at Cairo University Hospital.

Keywords: PFGE, outbreak, MALDI-TOFF, SME-1, SME-2, carbapenemases, MBL genes

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