Acta Microbiologica et Immunologica Hungarica
Volume/Issue:
Volume 70: Issue 4
Investigation of carbapenem-resistant Enterobacterales isolates at a tertiary laboratory in Pretoria, South Africa
Authors:
Mbudzeni Ramashia Department of Microbiological Pathology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa

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Thabiso D. Phofa Department of Microbiological Pathology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa

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Granny M. Nkawane Department of Microbiological Pathology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa

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Noel-David Nogbou Department of Microbiological Pathology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa

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https://orcid.org/0000-0003-0938-0073
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John Y. Bolukaoto Department of Microbiological Pathology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa

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https://orcid.org/0000-0001-9483-7466
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Maphoshane Nchabeleng Department of Microbiological Pathology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
Department of Microbiology, National Health Laboratory Services, Dr George Mukhari Tertiary Laboratory, Pretoria, South Africa

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Andrew M. Musyoki Department of Microbiological Pathology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa

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https://orcid.org/0000-0002-6577-6155
Pages:
295–303
Online Publication Date:
02 Nov 2023
Publication Date:
07 Dec 2023
Article Category:
Research Article
DOI:
https://doi.org/10.1556/030.2023.02157
Keywords:
carbapenem; carbapenem resistant Enterobacterales; antimicrobial resistance; Klebsiella pneumoniae; ICU
Restricted access

Abstract

This study aimed to investigate phenotypic and genotypic characteristics of carbapenem-resistant Enterobacterales isolates (CRE) at a tertiary laboratory in South Africa. A total of 99 CRE isolates were collected between 2019 and 2021. Carbapenemase production was tested using modified carbapenem inhibitory method. Colistin susceptibility testing was performed using the ComASP™ Colistin broth microdilution method. Conventional PCR assays were conducted for detection of mcr-1 gene and common carbapenemase genes (blaVIM, blaNDM, blaIMP, blaKPC, blaOXA-23, blaOXA-51 and blaOXA-48). Rep-PCR assay was conducted to determine the genetic relatedness of the study isolates. Majority of the isolates were Klebsiella pneumoniae (83%). Carbapenem resistant K. pneumoniae cluster was observed from ICU and surgical ward samples. Colistin resistance was observed in 13% (12/93) of the isolates namely, in 11 K. pneumoniae and one Enterobacter cloacae. The blaOXA-48 (65%) was the most prevalent gene detected followed by blaNDM (25%) and blaVIM (22%). Several K. pneumoniae isolates concomitantly carried multiple carbapenemase genes with one isolate carry up to 5 five genes blaVIM, blaNDM, blaOXA-48, blaOXA-23 and blaOXA-51. The mcr-1 gene was not detected in the isolates. Rep-PCR assay showed that most isolates matched cluster A (50%). The high prevalence of blaOXA-48, blaNDM and emerging colistin resistant isolates is of concern for patient management at this institution and needs close monitoring. Rep-PCR is a valuable tool in establishing infection clusters in resource-limited settings.

  • 1.

    Samreen AI, Malak HA, Abulreesh HH. Environmental antimicrobial resistance and its drivers: a potential threat to public health. J Glob Antimicrob Resist 2021 Dec 1; 27: 101–11.

    • Search Google Scholar
    • Export Citation
  • 2.

    Shibabaw A, Sahle Z, Metaferia Y, Atlaw A, Adenew B, Gedefie A, et al. Epidemiology and prevention of hospital-acquired carbapenem-resistant Enterobacterales infection in hospitalized patients, Northeast Ethiopia. IJID Reg 2023 Jun 1; 7: 77–83.

    • Search Google Scholar
    • Export Citation
  • 3.

    Li C, Zhou P, Liu Y, Zhang L. Treatment of ventriculitis and meningitis after neurosurgery caused by carbapenem-resistant enterobacteriaceae (CRE): a challenging topic. Infect Drug Resist 2023 Dec 31; 16: 3807–18.

    • Search Google Scholar
    • Export Citation
  • 4.

    Yao X, Doi Y, Zeng L, Lv L, Liu JH. Carbapenem-resistant and colistin-resistant Escherichia coli co-producing NDM-9 and MCR-1. Lancet Infect Dis 2016 Mar 1; 16(3): 288–9.

    • Search Google Scholar
    • Export Citation
  • 5.

    Cassir N, Rolain JM, Brouqui P. A new strategy to fight antimicrobial resistance: the revival of old antibiotics. Front Microbiol [Internet] 2014 [cited 2023 Jul 13]; 5. Available from: https://www.frontiersin.org/articles/10.3389/fmicb.2014.00551.

    • Search Google Scholar
    • Export Citation
  • 6.

    van Duin D, Doi Y. The global epidemiology of carbapenemase-producing Enterobacteriaceae. Virulence 2017 May 19; 8(4): 460–9.

  • 7.

    Li Y, Sun QL, Shen Y, Zhang Y, Yang JW, Shu LB, et al. Rapid increase in prevalence of carbapenem-resistant enterobacteriaceae (CRE) and emergence of colistin resistance gene mcr-1 in CRE in a hospital in Henan, China. J Clin Microbiol 2018 Mar 26; 56(4). https://doi.org/10.1128/jcm.01932-17.

    • Search Google Scholar
    • Export Citation
  • 8.

    Pa W. Clinical and Laboratory Standards Institute : performance standards for antimicrobial susceptibility testing : 20th informational supplement. CLSI Doc M100-S20 [Internet] 2020 [cited 2023 Jul 13]; Available from: https://cir.nii.ac.jp/crid/1572261550694185984.

    • Search Google Scholar
    • Export Citation
  • 9.

    Kaushik R, Balasubramanian R, de la Cruz AA. Influence of air quality on the composition of microbial pathogens in fresh rainwater. Appl Environ Microbiol 2012 Apr 15; 78(8): 2813–8.

    • Search Google Scholar
    • Export Citation
  • 10.

    Bilal H, Hameed F, Khan MA, Khan S, Yang X, Rehman TU. Detection of mcr-1 gene in extended-spectrum β-lactamase-producing Klebsiella pneumoniae from human urine samples in Pakistan. Jundishapur J Microbiol [Internet] 2020 [cited 2023 Jul 13]; 13(4). Available from: https://brieflands.com/articles/jjm-96646.html#abstract.

    • Search Google Scholar
    • Export Citation
  • 11.

    Warburg G, Hidalgo-Grass C, Partridge SR, Tolmasky ME, Temper V, Moses AE, et al. A carbapenem-resistant Klebsiella pneumoniae epidemic clone in Jerusalem: sequence type 512 carrying a plasmid encoding aac(6′)-Ib. J Antimicrob Chemother 2012 Apr 1; 67(4): 898–901.

    • Search Google Scholar
    • Export Citation
  • 12.

    Dallenne C, Da Costa A, Decré D, Favier C, Arlet G. Development of a set of multiplex PCR assays for the detection of genes encoding important β-lactamases in Enterobacteriaceae. J Antimicrob Chemother 2010 Mar 1; 65(3): 490–5.

    • Search Google Scholar
    • Export Citation
  • 13.

    Voets GM, Fluit AC, Scharringa J, Cohen Stuart J, Leverstein-van Hall MA. A set of multiplex PCRs for genotypic detection of extended-spectrum β-lactamases, carbapenemases, plasmid-mediated AmpC β-lactamases and OXA β-lactamases. Int J Antimicrob Agents 2011 Apr 1; 37(4): 356–9.

    • Search Google Scholar
    • Export Citation
  • 14.

    Woodford N, Ellington MJ, Coelho JM, Turton JF, Ward ME, Brown S, et al. Multiplex PCR for genes encoding prevalent OXA carbapenemases in Acinetobacter spp. Int J Antimicrob Agents 2006 Apr 1; 27(4): 351–3.

    • Search Google Scholar
    • Export Citation
  • 15.

    Santimaleeworagun W, Thathong A, Samret W, Preechachuawong P, Sae-lim W, Jitwasinkul T. Identification and characterization of carbapenemase genes in clinical isolates of carbapenem-resistant Acinetobacter baumannii from general hospital in Thailand. Southeast Asian J Trop Med Public Health 2014 Jul; 45(4): 874–80.

    • Search Google Scholar
    • Export Citation
  • 16.

    Debby BD, Ganor O, Yasmin M, David L, Nathan K, Ilana T, et al. Epidemiology of carbapenem resistant Klebsiella pneumoniae colonization in an intensive care unit. Eur J Clin Microbiol Infect Dis 2012 Aug 1; 31(8): 1811–7.

    • Search Google Scholar
    • Export Citation
  • 17.

    Baran I, Aksu N. Phenotypic and genotypic characteristics of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Turkey. Ann Clin Microbiol Antimicrob 2016 Apr 6; 15(1): 20.

    • Search Google Scholar
    • Export Citation
  • 18.

    Gorrie CL, Mirčeta M, Wick RR, Judd LM, Lam MMC, Gomi R, et al. Genomic dissection of Klebsiella pneumoniae infections in hospital patients reveals insights into an opportunistic pathogen. Nat Commun 2022 May 31; 13(1): 3017.

    • Search Google Scholar
    • Export Citation
  • 19.

    Hameed MF, Chen Y, Wang Y, Shafiq M, Bilal H, Liu L, et al. Epidemiological characterization of colistin and carbapenem resistant Enterobacteriaceae in a tertiary: a hospital from Anhui Province. Infect Drug Resist 2021 Mar 30; 14: 1325–33.

    • Search Google Scholar
    • Export Citation
  • 20.

    Dilagui I, Loqman S, Lamrani Hanchi A, Soraa N. Antibiotic resistance patterns of carbapenemase-producing Enterobacterales in Mohammed VI University Hospital of Marrakech, Morocco. Infect Dis Now 2022 Sep 1; 52(6): 334–40.

    • Search Google Scholar
    • Export Citation
  • 21.

    Taha R, Mowallad A, Mufti A, Althaqafi A, Fatani AA, El-Hossary D, et al. Prevalence of Carbapenem-resistant Enterobacteriaceae in Western Saudi Arabia and increasing trends in the antimicrobial resistance of Enterobacteriaceae. Cureus [Internet] 2023 Feb 16 [cited 2023 Jul 14]; Available from: https://www.cureus.com/articles/132621-prevalence-of-carbapenem-resistant-enterobacteriaceae-in-western-saudi-arabia-and-increasing-trends-in-the-antimicrobial-resistance-of-enterobacteriaceae.

    • Search Google Scholar
    • Export Citation
  • 22.

    Taha R, Kader O, Shawky S, Rezk S. Ceftazidime-Avibactam plus aztreonam synergistic combination tested against carbapenem-resistant Enterobacterales characterized phenotypically and genotypically: a glimmer of hope. Ann Clin Microbiol Antimicrob 2023 Mar 21; 22(1): 21.

    • Search Google Scholar
    • Export Citation
  • 23.

    Kar P, Behera B, Mohanty S, Jena J, Mahapatra A. Detection of colistin resistance in carbapenem resistant Enterobacteriaceae by reference broth microdilution and comparative evaluation of three other methods. J Lab Physicians 2021 Sep; 13(3): 263–9.

    • Search Google Scholar
    • Export Citation
  • 24.

    GERMS-Annual-Review-2019_.pdf [Internet]. [Cited 2023 Jul 14]; Available from: https://www.nicd.ac.za/wp-content/uploads/2021/02/GERMS-Annual-Review-2019_.pdf.

  • 25.

    Meng L, Liu Z, Liu C, Li C, Shen H, Cao X. The distribution characteristics of global blaOXA-carrying Klebsiella pneumoniae. BMC Infect Dis 2023 Mar 29; 23(1): 182.

    • Search Google Scholar
    • Export Citation
  • 26.

    Wang Q, Wang X, Wang J, Ouyang P, Jin C, Wang R, et al. Phenotypic and genotypic characterization of carbapenem-resistant Enterobacteriaceae : data from a longitudinal large-scale CRE study in China (2012–2016). Clin Infect Dis 2018 Nov 13; 67(suppl_2): S196–205.

    • Search Google Scholar
    • Export Citation
  • 27.

    Kilic A, Baysallar M. The first Klebsiella pneumoniae isolate Co-producing OXA-48 and NDM-1 in Turkey. Ann Lab Med 2015 May 1; 35(3): 382–3.

    • Search Google Scholar
    • Export Citation
  • 28.

    Wei L, Wu L, Wen H, Feng Y, Zhu S, Liu Y, et al. Spread of Carbapenem-resistant Klebsiella pneumoniae in an intensive care unit: a Whole-genome sequence-based prospective observational study. Microbiol Spectr 2021 Jul 14; 9(1): https://doi.org/10.1128/spectrum.00058-21.

    • Search Google Scholar
    • Export Citation
  • 29.

    Alizadeh H, Khodavandi A, Alizadeh F, Bahador N. Molecular characteristics of carbapenem-resistant Klebsiella pneumoniae isolates producing blaVIM, blaNDM, and blaIMP in clinical centers in Isfahan, Iran Jundishapur J Microbiol [Internet] 2021 [cited 2023 Jul 14]; 14(2). Available from: https://brieflands.com/articles/jjm-114473.html#abstract.

    • Search Google Scholar
    • Export Citation
  • 30.

    Sabat AJ, Budimir A, Nashev D, Sá-Leão R, Dijl JM van, Laurent F, et al. Overview of molecular typing methods for outbreak detection and epidemiological surveillance. Eurosurveillance 2013 Jan 24; 18(4): 20380.

    • Search Google Scholar
    • Export Citation
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Cover Acta Microbiologica et Immunologica Hungarica
Acta Microbiologica et Immunologica Hungarica A Quarterly of the Hungarian Academy of Sciences
Print ISSN:
1217-8950
Online ISSN:
1588-2640
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Senior editors

Editor-in-Chief: Prof. Dóra Szabó (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)

Managing Editor: Dr. Béla Kocsis (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)

Co-editor: Dr. Andrea Horváth (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)

Editorial Board

  • Prof. Éva ÁDÁM (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)
  • Prof. Sebastian AMYES (Department of Medical Microbiology, University of Edinburgh, Edinburgh, UK.)
  • Dr. Katalin BURIÁN (Institute of Clinical Microbiology University of Szeged, Szeged, Hungary; Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary.)
  • Dr. Orsolya DOBAY (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)
  • Prof. Ildikó Rita DUNAY (Institute of Inflammation and Neurodegeneration, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany)
  • Prof. Levente EMŐDY(Department of Medical Microbiology and Immunology, University of Pécs, Pécs, Hungary.)
  • Prof. Anna ERDEI (Department of Immunology, Eötvös Loránd University, Budapest, Hungary, MTA-ELTE Immunology Research Group, Eötvös Loránd University, Budapest, Hungary.)
  • Prof. Éva Mária FENYŐ (Division of Medical Microbiology, University of Lund, Lund, Sweden)
  • Prof. László FODOR (Department of Microbiology and Infectious Diseases, University of Veterinary Medicine, Budapest, Hungary)
  • Prof. József KÓNYA (Department of Medical Microbiology, University of Debrecen, Debrecen, Hungary)
  • Prof. Yvette MÁNDI (Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary)
  • Prof. Károly MÁRIALIGETI (Department of Microbiology, Eötvös Loránd University, Budapest, Hungary)
  • Prof. János MINÁROVITS (Department of Oral Biology and Experimental Dental Research, University of Szeged, Szeged, Hungary)
  • Prof. Béla NAGY (Centre for Agricultural Research, Institute for Veterinary Medical Research, Budapest, Hungary.)
  • Prof. István NÁSZ (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)
  • Prof. Kristóf NÉKÁM (Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary.)
  • Dr. Eszter OSTORHÁZI (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)
  • Prof. Rozália PUSZTAI (Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary)
  • Prof. Peter L. RÁDY (Department of Dermatology, University of Texas, Houston, Texas, USA)
  • Prof. Éva RAJNAVÖLGYI (Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary)
  • Prof. Ferenc ROZGONYI (Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary)
  • Prof. Joseph G. SINKOVICS (The Cancer Institute, St. Joseph’s Hospital, Tampa, Florida, USA)
  • Prof. Júlia SZEKERES (Department of Medical Biology, University of Pécs, Pécs, Hungary.)
  • Prof. Mária TAKÁCS (National Reference Laboratory for Viral Zoonoses, National Public Health Center, Budapest, Hungary.)
  • Prof. Edit URBÁN (Department of Medical Microbiology and Immunology University of Pécs, Pécs, Hungary; Institute of Translational Medicine, University of Pécs, Pécs, Hungary.)

 

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Acta Microbiologica et Immunologica Hungarica
Language English
Size A4
Year of
Foundation		 1954
Volumes
per Year		 1
Issues
per Year		 4
Founder Magyar Tudományos Akadémia
Founder's
Address		 H-1051 Budapest, Hungary, Széchenyi István tér 9.
Publisher Akadémiai Kiadó
Publisher's
Address		 H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
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Publisher		 Chief Executive Officer, Akadémiai Kiadó
ISSN 1217-8950 (Print)
ISSN 1588-2640 (Online)

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