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The First Egyptian Report Showing the Co-Existence of blaNDM-25, blaOXA-23, blaOXA-181, and blaGES-1 Among Carbapenem-Resistant K. pneumoniae Clinical Isolates Genotyped by BOX-PCR

Authors El-Badawy MF, El-Far SW, Althobaiti SS, Abou- Elazm FI, Shohayeb MM

Received 29 December 2019

Accepted for publication 4 April 2020

Published 29 April 2020 Volume 2020:13 Pages 1237—1250

DOI https://doi.org/10.2147/IDR.S244064

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Sahil Khanna


Mohamed F El-Badawy,1,2 Shaymaa W El-Far,1 Shaker S Althobaiti,3 Fatma I Abou- Elazm,2 Mohamed M Shohayeb4

1Division of Pharmaceutical Microbiology, Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Taif, Kingdom of Saudi Arabia; 2Department of Microbiology and Immunology, Faculty of Pharmacy, Misr University for Science and Technology, 6th of October City, Egypt; 3King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia; 4Department of Microbiology and Biotechnology, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa, Egypt

Correspondence: Mohamed F El-Badawy
Division of Pharmaceutical Microbiology, Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Kingdom of Saudi Arabia
Tel +20-103-205-9964
Email m.elbadawy@tu.edu.sa

Background and Objective: The emergence of carbapenem-resistant K. pneumoniae (CRKP) continues to escalate and is alarming because of the emergence of pan drug-resistant strains. The objective of this study was to investigate the existence of 12 carbapenemase genes among CRKP clinical isolates.
Methods: Ninety-six Klebsiella spp. clinical isolates were collected. The isolates were identified phenotypically and genotypically. These isolates were screened for susceptibility to 24 different antibiotics. The modified Hodge test (MHT) and the Carba Nordmann/Poirel (NP) test were used to phenotypically screen carbapenem-resistant strains for carbapenemase production. Phenotypic characterization of carbapenemases was performed using the combined disk synergy test (CDST). Additionally, the presence of 12 carbapenemase genes in CRKP isolates was investigated. The DNA sequence of blaNDM and blaGES genes was determined. The BOX-PCR technique was used to determine the clonal relationship between CRKP isolates.
Results: All carbapenem-resistant isolates were related to K. pneumoniae. Susceptibility testing showed that 19.79% (19/96) of the collected isolates were carbapenem-resistant. Of the CRKP isolates, 68.42% (13/19) tested positive for the MHT and Carba NP test. CDST showed that 42.11% (8/19), 63.16% (12/19), 47.37% (9/19), and 73.68% (14/19) of the CRKP isolates tested positive for the inhibitory effect of clavulanic acid, sulbactam, phenylboronic acid, and tazobactam, respectively, while 84.21% (16/19) and 68.42% (13/16) tested positive for the inhibitory effect of EDTA and mercaptopropionic acid, respectively. It was found that 10.53% (2/19) of the isolates tested positive for the inhibitory effect of sodium chloride. Molecular investigation of carbapenemases showed that 26.32% (5/19), 73.68% (14/19), 21.05% (4/19), 10.53% (2/19), and 5.26% (1/19) of the isolates tested positive for blaNDM, blaOXA-48, blaOXA-181, blaOXA-51, and blaOXA-23, respectively. None of the isolates tested positive for blaOXA-40 and blaOXA-58. Two allelic variants of blaNDM (blaNDM-1 and blaNDM-25) were detected. BOX-PCR revealed high clonal relatedness between CRKP isolates.
Conclusion: MHT was more sensitive than Carba NP test for evaluating carbapenemase production and class D carbapenemase genes were the most prevalent of the 12 carbapenemase genes that were evaluated.

Keywords: carbapenemases, CRKP, BOX-PCR, blaNDM-25, MHT, CDST

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