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Carbapenem-resistant Gram-negative bacteria associated with catheter-related bloodstream infections in three intensive care units in Egypt

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Abstract

We aimed to identify the carbapenem-resistant Gram-negative bacteria (GNB) causing catheter-related bloodstream infections (CRBSI) in intensive care units (ICU) in a tertiary care Egyptian hospital, to study their resistance mechanisms by phenotypic and genetic tests, and to use ERIC-PCR for assessing their relatedness. The study was conducted over 2 years in three ICUs in a tertiary care hospital in Egypt during 2015–2016. We identified 194 bloodstream infections (BSIs); 130 (67.01%) were caused by GNB, of which 57 were isolated from CRBSI patients (73.84%). Identification of isolates was performed using conventional methods and MALDI-TOF MS. Antimicrobial susceptibility testing (AST) was done by disc diffusion following CLSI guidelines. Phenotypic detection of carbapenemases enzymes activity was by modified Hodge test and the Carba-NP method. Isolates were investigated for the most common carbapenemases encoding genes blaKPC, blaNDM, and blaOXA-48 using multiplex PCR. Molecular typing of carbapenem-resistant isolates was done by ERIC-PCR followed by sequencing of common resistance genes. The overall rate of CRBSI in our study was 3.6 per 1000 central venous catheter (CVC) days. Among 57 Gram-negative CRBSI isolates, Klebsiella pneumoniae (K. pneumoniae) was the most frequently isolated (27/57; 47.4%), of which more than 70% were resistant to Meropenem. Phenotypic tests for carbapenemases showed that 37.9% of isolates were positive by modified Hodge test and 63.8% by Carba-NP detection. Multiplex PCR assay detected the blaNDM in 28.6% of the isolates and blaKPC in 26.8%, blaNDM and blaKPC were detected together in the same isolate in 5.6%, while blaOXA-48-like were not detected. ERIC-PCR detected limited genetic relatedness between K. pneumoniae isolates. Elevated resistance rates were observed to all antibiotics including carbapenems among K. pneumoniae isolates causing CRBSI. ERIC-PCR showed that the resistant isolates were mainly polyclonal. Our results call for reinforcement of antimicrobial stewardship and measures to prevent CRBSI.

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Authors and Affiliations

  1. Microbiology and Immunology Department, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt

    Abeer K. Abdulall

  2. Microbiology and Immunology Department, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, Egypt

    Mahmoud M. Tawfick

  3. Microbiology and Immunology Department, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), 6th October City, Giza, Egypt

    Mahmoud M. Tawfick

  4. Infection Control Department, Dar Al Fouad Hospital, 6th October City, Giza, Egypt

    Arwa R. El Manakhly & Amani El Kholy

  5. Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Amani El Kholy

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  1. Abeer K. Abdulall
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  2. Mahmoud M. Tawfick
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  3. Arwa R. El Manakhly
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  4. Amani El Kholy
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Correspondence to Amani El Kholy.

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Abdulall, A.K., Tawfick, M.M., El Manakhly, A.R. et al. Carbapenem-resistant Gram-negative bacteria associated with catheter-related bloodstream infections in three intensive care units in Egypt. Eur J Clin Microbiol Infect Dis 37, 1647–1652 (2018). https://doi.org/10.1007/s10096-018-3294-7

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  • DOI: https://doi.org/10.1007/s10096-018-3294-7

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