Phenotypic and molecular detection of extended-spectrum-beta-lactamase and carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in Hospital Tengku Ampuan Afzan, Kuantan /
Background: The worldwide burden of antimicrobial resistance and in particular, extended spectrum β-lactamase (ESBL)-,and carbapenemases-producing Klebsiella pneumoniae and Escherichia coli are dramatically increasing and frequently reported worldwide causing a real health concern. To my best knowle...
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| Main Author: | |
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| Format: | Thesis |
| Language: | English |
| Published: |
Kuala Lumpur :
Kulliyyah of Medicine, International Islamic University Malaysia,
2015
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| Subjects: | |
| Online Access: | Click here to view 1st 24 pages of the thesis. Members can view fulltext at the specified PCs in the library. |
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| Summary: | Background: The worldwide burden of antimicrobial resistance and in particular, extended spectrum β-lactamase (ESBL)-,and carbapenemases-producing Klebsiella pneumoniae and Escherichia coli are dramatically increasing and frequently reported worldwide causing a real health concern. To my best knowledge, no study has specifically been done in Pahang state, Malaysia to detect production of carbapenemases by clinical bacterial isolates. Therefore, the aim of this study was to investigate the presence of carbapenem resistant strains and to assess the prevalence rate of ESBL-producing strains among Klebsiella pneumoniae and E.coli isolates in Hospital Tengku Ampuan Afzan (HTAA), Kuantan as well as to identify the genes responsible for such resistance. Materials and Methods: over a period of five months, from May to September 2014, 259 non-duplicate Klebsiella pneumoniae and Escherichia coli isolates were recovered from clinical samples of hospitalized patients in HTAA. Isolates were screened for antimicrobial resistance using eighteen different antibiotics by standard Kirby-Bauer disc diffusion method. Isolates that showed resistance to oxyimino-cephalosporins were then subjected to phenotypic confirmatory test to detect ESBL production according to CLSI criteria. Moreover, isolates that showed carbapenem resistance were subjected to Modified Hodge Test (MHT) to detect carbapenemase production. Molecular identification of resistance genes were performed using primers specific for the most common ESBL genes (TEM, SHV and CTX-M), and carbapenemases genes (bla NDM-1 and bla KPC genes). Results: ESBL was detected among 35.5% (39/110) and 18.8% (28/149) of K. pneumoniae and E.coli isolates respectively. CTX-M was the most dominant ESBL gene of which 90% (45/50) of the total ESBL-positive strains were CTX-M-positive. Bla SHV and bla TEM genes were found among 56.0% (28 /50) and 52.0% (26 /50) of ESBL positive strains respectively. 28.0% (14/50) of the total ESBL-positive isolates were found carrying the three ESBLs genes (bla CTX-M+ bla SHV+ bla TEM) in the same strains. On other hand 50% of ESBL strains carried two of the ESBL genes either Bla CTX-M + bla SHV or bla CTX-M + bla TEM combination. NDM-1 carbapenemase along with genes of other β-lactamases were detected among three Klebsiella pneumoniae isolates. No KPC gene was detected in any of the bacterial isolates. The three NDM-1-producing isolates were resistant to all β-lactam and the majority of tested non-β-lactam antibiotics. The antibiogram of the total isolates showed high resistance rates against ampicillin, piperacillin and trimethoprim-sulfamethoxazole (SXT), and low resistance rates against amikacin, polymyxin B, piperacillin/tazobactam (TZP) and carbapenems. Conclusion: the presence of NDM-1 producing K. Pneumoniae in HTAA, Kuantan is alarming and constitutes a serious concern because of the high level resistance of these isolates and possibility of transfer and spread of these resistance genes. Genetic characterization of carbapenemases and ESBL-encoding genes is very important in controlling resistance transmission in hospitals. Further studies to detect the genetic relatedness and clonality of these resistant organisms are highly recommended. |
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| Item Description: | Abstracts in English and Arabic. "A dissertation submitted in fulfilment of the requirement for the degree of Master of Medical Sciences." --On t. p. |
| Physical Description: | xiv, 88 leaves : ill. ; 30cm. |
| Bibliography: | Includes bibliographical references (leaves 78-88). |