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Molecular Characterization of Carbapenemase-Producing Klebsiella pneumoniae Isolated from Egyptian Pediatric Cancer Patients Including a Strain with a Rare Gene-Combination of β-Lactamases

Authors Osama D, El-Mahallawy H, Mansour MT, Hashem A, Attia AS

Received 1 October 2020

Accepted for publication 5 January 2021

Published 29 January 2021 Volume 2021:14 Pages 335—348

DOI https://doi.org/10.2147/IDR.S284455

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Prof. Dr. Héctor Mora-Montes


Dina Osama,1 Hadir El-Mahallawy,2 Mohamed Tarek Mansour,3 Abdelgawad Hashem,4,5 Ahmed S Attia4

1Department of Microbiology and Immunology, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), Cairo, Egypt; 2Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt; 3Department of Virology and Immunology, National Cancer Institute, Cairo University, Cairo, Egypt; 4Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt; 5Department of Microbiology and Immunology, Faculty of Pharmacy, The British University in Egypt, Shorouk City, Egypt

Correspondence: Ahmed S Attia
Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Room #D404, Kasr El-Ainy Street, Cairo 11562, Egypt
Tel +20-10-65344060
Fax +20-2-23628246
Email ahmed.attia@pharma.cu.edu.eg

Purpose: Healthcare-associated infections caused by multi-drug-resistant (MDR) pathogens are a global threat. We aim to assess the clonal relatedness among carbapenemase-producing Klebsiella pneumoniae (CPKP) strains infecting Egyptian pediatric cancer patients.
Materials and Methods: Identification and antimicrobial susceptibility testing of 149 Gram-negative isolates obtained from pediatric cancer patients were performed by VITEK 2. Genes encoding carbapenemases and extended-spectrum β-lactamases were detected by PCR and verified by DNA sequencing of representative samples. The transferability of the plasmids harboring blaOXA-48, from representative clinical samples, was evaluated by performing a conjugation experiment followed by PCR and MIC shift determination. Clonal relationships among the blaOXA-48-harboring K. pneumoniae isolates were determined by enterobacterial repetitive intergenic consensus (ERIC)-PCR and pulsed-field gel electrophoresis (PFGE).
Results: Carbapenem resistance was observed in 59% of the isolates. The most prevalent species was K. pneumoniae (45.6%) and 57% of them were isolated from ICU. Fifty-nine % of the K. pneumoniae isolates were carbapenemase-producers and blaOXA-48 was detected in (58%) of them. One isolate co-harbored blaOXA-48, blaNDM-1, and blaIMP-1 genes for the first time in Egypt. PCR and meropenem MIC shift confirmed the success of the transferability of representative plasmids to E. coli K12. ERIC and PFGE identified 93% and 100% of the K. pneumoniae with a similarity coefficient ≥ 85%, respectively, including strains with indistinguishable patterns, suggesting possible clonal dissemination.
Conclusion: Our findings underline the dissemination of diverse clones of MDR CPKP among Egyptian pediatric cancer patients. Hence, routine molecular characterizations followed by strict implementation of infection control measures are crucial to tackling this threat.

Keywords: ERIC-PCR, PFGE, blaOXA-48, clonal dissemination, Egypt, carbapenem-resistant

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