Abstract
K. pneumoniae ssp pneumoniae is notorious for causing nosocomial as well as community-acquired infections. Over the decades, K. pneumoniae strains have increasingly acquired resistance to a wide range of antibiotics, one of the major mechanisms of resistance being expression of β-lactamases. Carbapenems have been the drug of choice for ESBL and Amp-C β-lactamase producing strains. The presence of carbapenemases like Metallo-β-lactamase renders the bacteria recalcitrant to treatment due to its broad-spectrum resistance profile. The MBL-positive strains are usually resistant to β-lactams, aminoglycosides and fluoroquinolones, leaving the treatment option with potentially toxic drugs like colistin. In the present study, 291 K. pneumoniae ssp pneumoniae clinical isolates were tested by Combined Disc Test for phenotypic detection of MBL production. A ≥ 7 mm increase in the inhibition zone diameter around imipenem+EDTA disk in comparison to imipenem-only disk was interpreted as a positive result for MBL production. Out of 191 MBL screen-positive isolates, 68 were confirmed to be MBL producers by CDT (23.37% prevalence of MBL producing isolates). MBL producing isolates were 98.5% resistant to amoxicillin-clavulanate combination,100% resistant to third-generation and fourth-generation cephalosporins, 100% resistant to carbapenems, 100% resistant to fluoroquinolone, 98.5% resistant to monobactams, 83-88% resistant to aminoglycosides and 75% resistant to cotrimoxazole. Maximum sensitivity was towards tigecycline (47.06%). This situation warrants a consistent surveillance of antimicrobial resistance of Klebsiella pneumoniae ssp pneumoniae and requires implementation of an efficient infection control programme.
Keywords: Klebsiella pneumoniae, Metallo-β-lactamase, antimicrobial susceptibility testing, Combined disc test, multi-drug resistant.
References
- Bagley ST.1985.Habitat association of Klebsiella species. InfectControl 6:52–58
- Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, Scheld M, Spellberg B, Bartlett J.2009.Badbugs, nodrugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 48:1–12.
- Kanj SS, Kanafani ZA. Current concepts in antimicrobial therapy against resistant gram-negative organisms: extended-spectrum beta-lactamase producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa. Mayo Clin Proc. 2011;86(3):250–9
- Bora A, Sanjana R, Jha BK, Mahaseth SN, Pokharel K. Incidence of metallo-beta-lactamase producing clinical isolates of Escherichia coli and Klebsiella pneumoniae in central Nepal. BMC Res Notes. 2014;7:557
- Walsh TR, Toleman MA, Poirel L, Nordmann P. Metallo-β-lactamases: the quiet before the storm? Clin Microbiol Rev2005;18:306-25.
- Wadekar MD, Anuradha K, Venkatesha D. Phenotypic detection of ESBL and MBL in clinical isolates of Enterobacteriaceae. Int J Curr Res Acad Rev 2013;1:89‑5
- Dahiya S, Singla P, Chaudhary U, Singh B. Carbapenemases: A Review International Journal of Advanced Health Sciences, 2015;Vol 2 ( 4 ): 11-17.
- Chaudhary U, Agarwal S, Raghuraman K. Identification of extended spectrum beta lactamases, AmpC and carbapenemase production among isolates of Escherichia coli in North Indian tertiary care centre. Avicenna J Med 2018;8:46-50.
- Yong D, Lee K, Yum JH et al. Imipenem–EDTA disc method for differentiation of metallo-β-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol 2002; 40: 3798–801.
- Hudzicki J. 2009. Kirby-bauer disk diffusion susceptibility test protocol.
- The performance standards for the antimicrobial disc susceptibility testing. 29th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2019.
- Galani I, Rekatsina PD, Hatzaki D, Plachouras D, Souli M, Giamarellou H, Evaluation of different laboratory tests for the detection of metallo-β-lactamase production in Enterobacteriaceae, Journal of Antimicrobial Chemotherapy, Volume 61, Issue 3, March 2008, Pages 548–553
- Oberoi L, Singh N, Sharma P, Agarwal A. ESBL, MBL and Ampc β Lactamases Producing Superbugs – Havoc in the Intensive Care Units of Punjab India. Journal of Clinical and Diagnostic Research. 2013 Jan; 7(1): 70-73.
- Shahandeh Z, Sadighian F, Rekabpou KB. Phenotypic study of Extended-spectrum beta-lactamase, AmpC and Carbapenemase among E.coli clinical isolates in affiliated hospitals of Babol University of Medical Sciences. Int J Health Syst Disaster Manage 2015;3:74-8.
- Nagdeo NV, Kaore NM, Thombare VR. Phenotypic methods for detection of various β-lactamases in Gram-negative clinical isolates: Need of the hour. Chron Young Sci 2012;3:292-8.
- Kamble D. Phenotypic detection of ESBL and MBL in Gram Negative bacilli isolated from clinical specimens. Int J Med Res Rev 2015;3(8):866-870.
- Singh M, Kakati B, Agarwal RK, Kotwal A. Detection of Klebsiella pneumoniae carbapenemases (KPCs) among ESBL / MBL producing clinical isolates of Klebsiella pneumoniae. International Journal of current Microbiology and Applied Sciences. ISSN: 2319-7706 Volume 4 Number 4 (2015) pp. 726-731
- Deshmukh DG, Damle AS, Bajaj JK, Bhakre JB, Patwardhan NS. Metallo-β-lactamase-producing clinical isolates from patients of a tertiary care hospital. J Lab Physicians 2011;3(2):93–7
- Franco MRG, Caiaffa-Filho HH, Burattini MN, Rossi F. Metallo-beta-lactamases among imipenem-resistant Pseudomonas aeruginosa in a Brazilian university hospital. Clinics (Sao Paulo). 2010;65(9):825-9
- Souli M, Galani I, Antoniadou A, Papadomichelakis E, Poulakou G, Panagea T, et al. An Outbreak of Infection due to β-Lactamase Klebsiella pneumoniae Carbapenemase 2–Producing pneumoniaein a Greek University Hospital: Molecular Characterization, Epidemiology, and Outcomes, Clinical Infectious Diseases, Volume 50, Issue 3, 1 February 2010, Pages 364–373.
- Toleman MA, Simm AM, Murphy TA, Gales AC, Biedenbach DJ, Jones RN, et al. Molecular characterization of SPM-1, a novel metallo-blactamase isolated in Latin America: report from the SENTRY antimicrobial surveillance programme. J Antimicrob Chemother. 2002;50: 673-9.
Corresponding Author
Ved Prakash Mamoria
Professor and Head, Department of Microbiology, Mahatma Gandhi Medical College& Hospital, Jaipur (Raj.)
DOI: https://dx.doi.org/10.18535/jmscr/v8i3.120
