View More View Less
  • 1 Department of Biology, Branch of Biotechnology, College of Science, Al-Mustansiriyah University, Iraq
Restricted access

Purchase article

USD  $25.00

1 year subscription (Individual Only)

USD  $784.00

Carbapenems are the last drugs of choice apart from colistin against serious infections caused by Gram-negative bacteria. However, there are increasing number of reports indicating prevailing emergence of metallo-β-lactamase (MBL)-producing clinical isolates worldwide and among them New Delhi MBL (NDM) is the most prevalent one. This study reports NDM-1 for the first time among Klebsiella pneumoniae from hospitalized patients in Baghdad, Iraq. Fifty-five clinical isolates of K. pneumoniae resistant to carbapenem were investigated from burned wounds, sputum, and blood samples. The susceptibility to different antibiotics was tested by VITEK-2 system. All strains were multidrug-resistant and they showed nine different antimicrobial-resistant patterns (A-I) and the most effective antibiotic on these strains was levofloxacin (85.45%). The phenotypic detection of carbapenemases by MASTDISCS D70C revealed 29 (52.73%) strains were MBL-producing, out of 55 were carbapenem-resistant K. pneumoniae strains. The blaNDM-1 and other MBL genes were detected by conventional PCR and the result showed 37 (67.27%) strains positive for blaNDM-1 gene and only 5 (9.1%) strains harbored blaIMP gene, while all strains were negative for blaVIM, blaSIM, blaGIM, and blaSPM genes. Our results showed the coexistence of both blaNDM-1 and blaIMP genes in three strains of K. pneumoniae, while indicated widespread NDM-1 in Baghdad, Iraq. Hence, it is necessary to follow proper infection control practices and physicians should be aware of the patients with such risk factors.

  • 1.

    Zaman, T., Aldrees, M., Al Johani, S. M., Alrodayyan, M., Aldughashem, F. A., Balkhy, H. H.: Multi-drug carbapenem-resistant Klebsiella pneumoniae infection carrying the OXA-48 gene and showing variations in outer membrane protein 36 causing an outbreak in a tertiary care hospital in Riyadh, Saudi Arabia. Int J Infect Dis 28, 186192 (2014).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Pitout, J. D., Nordmann, P., Poirel, L.: Carbapenemase-producing Klebsiella pneumoniae, a key pathogen set for global nosocomial dominance. Antimicrob Agents Chemother 59, 58735884 (2015).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Fazeli, H., Norouzi-Barough, M., Ahadi, A. M., Shokri, D., Solgi, H.: Detection of New Delhi metallo-β-lactamase-1 (NDM-1) in carbapenem resistant Klebsiella pneumoniae isolated from a university hospital in Iran. Hippokratia 19, 205209 (2015).

    • Search Google Scholar
    • Export Citation
  • 4.

    Paterson, D. L.: Resistance in gram-negative bacteria: Enterobacteriaceae. Am J Infect Control 34, 2028 (2006).

  • 5.

    Nordmann, P., Poirel, L.: Strategies for identification of carbapenemase-producing Enterobacteriaceae. J Antimicrob Chemother 68, 487489 (2013).

  • 6.

    Nordmann, P., Poirel, L., Dortet, L.: Rapid detection of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 18, 15031507 (2012).

  • 7.

    Oteo, J., Hernandez, J. M., Espasa, M., Fleites, A., Saez, D., Bautista, V., Pérez-Vazquez, M., Fernández-García, M. D., Delgado-Iribarren, A., Sánchez-Romero, I., García-Picazo, L., Miguel, M. D., Solís, S., Aznar, E., Trujillo, G., Mediavilla, C., Fontanals, D., Rojo, S., Vindel, A., Campos, J.: Emergence of OXA-48-producing Klebsiella pneumoniae and the novel carbapenemases OXA-244 and OXA-245 in Spain. J Antimicrob Chemother 68, 317321 (2012).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Singh, M., Kakati, B., Agarwal, R. K., Kotwal, A.: Detection of Klebsiella pneumoniae carbapenemases (KPCs) among ESBL/MBL producing clinical isolates of Klebsiella pneumoniae. Int J Curr Microbiol App Sci 4, 726731 (2015).

    • Search Google Scholar
    • Export Citation
  • 9.

    Nordmann, P., Poirel, L., Carrer, A., Toleman, M. A., Walsh, T. R.: How to detect NDM-1 producers. J Clin Microbiol 49, 718721 (2011).

  • 10.

    Mulvey, M. R., Grant, J. M., Plewes, K., Roscoe, D., Boyd, D. A.: New Delhi metallo-β-lactamase in Klebsiella pneumoniae and Escherichia coli, Canada. Emerg Infect Dis 17, 103106 (2011).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Bonnin, R. A., Naas, T., Poirel, L., Nordmann, P.: Phenotypic, biochemical, and molecular techniques for detection of metallo-β-lactamase NDM in Acinetobacter baumannii. J Clin Microbiol 50, 14191421 (2012).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Ellington, M. J., Kistler, J., Livermore, D. M., Woodford, N.: Multiplex PCR for rapid detection of genes encoding acquired metallo-β-lactamases. J Antimicrob Chemother 59, 321322 (2007).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Sambrook, J., Fritsch, E. F., Maniatis, T.: Molecular Cloning: A Laboratory Manual, 2nd Edition. Cold Spring Harbor Laboratory Press, Cold Spring Harbor, 1989, p. 68.

    • Search Google Scholar
    • Export Citation
  • 14.

    AL-Harmoosh, R. A., Jarallah, E. M.: First detection of the bla NDM-1 and bla NDM-2 genes in a clinical isolates of Acinetobacter baumannii in Hillah hospitals Iraq. Int J Adv Res 3, 14071416 (2015).

    • Search Google Scholar
    • Export Citation
  • 15.

    Nordmann, P., Poirel, L., Walsh, T. R., Livermore, D. M.: The emerging NDM carbapenemases. Trends Microbiol 19, 588595 (2011).

  • 16.

    Bastian, S., Nordmann, P., Creton, E., Malpote, E., Thiery, G., Martino, F., Breurec, S., Dortet, L.: First case of NDM-1 producing Klebsiella pneumoniae in Caribbean islands. Int J Infect Dis 34, 5354 (2015).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Poirel, L., Al Maskari, Z., Al Rashdi, F., Bernabeu, S., Nordmann, P.: NDM-1-producing Klebsiella pneumoniae isolated in the Sultanate of Oman. J Antimicrob Chemother 66, 304306 (2011).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Yong, D., Toleman, M. A., Giske, C. G., Cho, H. S., Sundman, K., Lee, K., Walsh, T. R.:Characterization of a new metallo-β-lactamase-1 gene, bla NDM-1, and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother 53, 50465054 (2009).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Johnson, A. P., Woodford, N.: Global spread of antibiotic resistance: The example of New Delhi metallo-β-lactamase (NDM)-mediated carbapenem resistance. J Med Microbiol 62, 499513 (2013).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Nordmann, P., Poirel, L., Toleman, M. A., Walsh, T. R.: Does broad spectrum beta-lactam resistance due to NDM-1 herald the end of the antibiotic era for treatment of infections caused by Gram-negative bacteria? J Antimicrob Chemother 66, 689692 (2011).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Poirel, L., Hombrouck-Alet, C., Freneaux, C., Bernabeu, S., Nordmann, P.: Global spread of New Delhi metallo-β-lactamase 1. Lancet Infect Dis 10, 832 (2010).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Poirel, L., Ros, A., Carricajo, A., Berthelot, P., Pozzetto, B.: Extremely drug-resistant Citrobacter freundii isolate producing NDM-1 and other carbapenemases identified in a patient returning from India. Antimicrob Agents Chemother 55, 447448 (2011).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Poirel, L., Fortineau, N., Nordmann, P.: International transfer of NDM-1-producing Klebsiella pneumoniae from Iraq to France. Antimicrob Agents Chemother 55, 18211822 (2011).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Pesesky, M. W., Hussain, T., Wallace, M., Wang, B., Andleeb, S., Burnham, C. D., Dantas, G.: KPC and NDM-1 genes in related Enterobacteriaceae strains and plasmids from Pakistan and the United States. Emerg Infect Dis 21, 10341037 (2015).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Centers for Disease Control and Prevention: Detection of Enterobacteriaceae isolates carrying metallo-β-lactamase, United States. MMWR Morb Mortal Wkly Rep 59, 750 (2010).

    • Search Google Scholar
    • Export Citation
  • 26.

    Poirel, L., Lagrutta, E., Taylor, P., Pham, J., Nordmann, P.: Emergence of metallo-β-lactamase NDM-1-producing multidrug-resistant Escherichia coli in Australia. Antimicrob Agents Chemother 54, 49144916 (2010).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Poirel, L., Revathi, G., Bernabeu, S., Nordmann, P.: Detection of NDM-1-producing Klebsiella pneumoniae in Kenya. Antimicrob Agents Chemother 55, 934936 (2011).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Zheng, R., Zhang, Q., Guo, Y., Feng, Y., Liu, L., Zhang, A., Zhao, Y., Yang, X., Xia, X.:Outbreak of plasmid-mediated NDM-1-producing Klebsiella pneumoniae ST105 among neonatal patients in Yunnan, China. Ann Clin Microbiol Antimicrob 15, 18 (2016).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Yıldız, S. S., Kaşkatepe, B., Avcıküçük, H., Öztürk, Ş.: Performance of CarbaNP and CIM tests in OXA-48 carbapenemase-producing Enterobacteriaceae. Acta Microbiol Immunol Hung 64, 916 (2017).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Somily, A. M., Garaween, G. A., Abukhalid, N., Absar, M. M., Senok, A. C.: Comparison of molecular and phenotypic methods for the detection and characterization of carbapenem resistant Enterobacteriaceae. Acta Microbiol Immunol Hung 63, 6981 (2016).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Ikonomidis, A., Labrou, M., Afkou, Z., Maniatis, A. N., Sofianou, D., Tsakris, A., Pournaras, S.: First occurrence of an Escherichia coli clinical isolate producing the VIM-1/VIM-2 hybrid metallo-β-lactamase VIM-12. Antimicrob Agents Chemother 51, 30383039 (2007).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Giakkoupi, P., Pappa, O., Polemis, M., Vatopoulos, A. C., Miriagou, V., Zioga, A., Papagiannitsis, C. C., Tzouvelekis, L. S.: Emerging Klebsiella pneumoniae isolates coproducing KPC-2 and VIM-1 Carbapenemases. Antimicrob Agents Chemother 53, 40484050 (2009).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Pournaras, S., Poulou, A., Voulgari, E., Vrioni, G., Kristo, I., Tsakris, A.: Detection of the new metallo-β-lactamase VIM-19 along with KPC-2, CMY-2 and CTX-M-15 in Klebsiella pneumonia. J Antimicrob Chemother 65, 16041607 (2010).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Leavitt, A., Navon-Venezia, S., Chmelnitsky, I., Schwaber, M. J., Carmeli, Y.: Emergence of KPC-2 and KPC-3 in carbapenem-resistant Klebsiella pneumoniae strains in an Israeli hospital. Antimicrob Agents Chemother 51, 30263029 (2007).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Gacar, G. G., Midilli, K., Kolayli, F., Ergen, K., Gundes, S., Hosoglu, S., Karadenizli, A., Vahaboglu, H.: Genetic and enzymatic properties of metallo-β-lactamase VIM-5 from a clinical isolate of Enterobacter cloacae. Antimicrob Agents Chemother 49, 44004403 (2005).

    • Crossref
    • Search Google Scholar
    • Export Citation