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Genetic diversity of carbapenem-resistant Klebsiella Pneumoniae causing neonatal sepsis in intensive care unit, Cairo, Egypt

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Abstract

Neonatal sepsis is a great challenge for clinicians and infection control practitioners, especially in facilities with limited resources. Carbapenem-resistant Klebsiella pneumoniae (CRKP) is rapidly increasing and carriages a major threat to neonates. We aimed to examine phenotypes causing neonatal late onset sepsis (NLOS) in comparison with neonatal early onset sepsis (NEOS) with further investigations of genotypes, and genetic relatedness of CRKP in neonatal late-onset sepsis. Our study included 88 neonates diagnosed with sepsis: 58 with (NLOS) and 30 with (NEOS) from November 2015 to April 2016, at neonatal intensive care unit (NICU) of Cairo University Hospital. K. pneumoniae was the most common encountered pathogen in the NLOS group (37.9%) with a mean sepsis score of 6.39 when compared to the NEOS group (p < 0.05). In Klebsiella group, C-reactive protein and interleukin-6 levels were significantly high (p ˂ 0.001) and 56.5% of the isolates were meropenem resistant. The most prevalent carbapenemase gene was OXA-48 which was identified in 14/23 (60.8%) followed by NDM-1 which was identified in 12/23 (52.2%) as detected by multiplex PCR. Coexistence of both carbapenemases was found in 52.2% (12/23). The blaKPC, blaIMP, and blaVIM genes were not harbored in the isolates. By investigating the genetic relatedness of CRKP by pulsed-field gel electrophoresis, 23 isolates of K. pneumoniae revealed various pulsed-field gel electrophoresis (PFGE) patterns, demonstrating that the isolates were non-clonal. Awareness of the existing phenotypes and genotypes is important for proper treatment and infection control practices.

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Acknowledgments

The authors extend their appreciation to the College of Pharmacy Research Center, Deanship of Scientific Research, King Saud University, for funding genotyping of this study.

Funding

Genotyping of the study was funded by College of Pharmacy Research Center, Deanship of Scientific Research, King Saud University.

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Authors and Affiliations

  1. Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, 1st Al-Saray Street, Al-Manial, Cairo, 11559, Egypt

    Doaa M. Ghaith

  2. Department of Microbiology and Immunology, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt

    Mai Mahmoud Zafer

  3. Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt

    Halaa Mufeed Said, Sherif Elanwary & Salwa Elsaban

  4. Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia

    Mohamed Hamed Al-Agamy

  5. Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt

    Mohamed Hamed Al-Agamy

  6. Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Marie Fe F. Bohol, Ahmed Al-Qahtani & Mohammed N Al-Ahdal

  7. Department of Microbiology and Immunology, Faculty of Pharmacy, Port Said University, Port Said Governorate, Egypt

    Mahmoud Mohamed Bendary

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  1. Doaa M. Ghaith
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  2. Mai Mahmoud Zafer
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  9. Ahmed Al-Qahtani
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  10. Mohammed N Al-Ahdal
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Contributions

H.M.S. and D.G. designed the study. D.G. provided the isolates. D.G. performed the phenotypic laboratory experiments. M.H.A., M.F.B., A.A., and M.N.A. carried out the molecular experiments. S.E and M.M.Z. reviewed and analyzed the data. D.G. and M.M.Z. drafted the manuscript. M.H.A. revised and edited the final version of the manuscript. All authors reviewed and approved the manuscript.

Corresponding author

Correspondence to Doaa M. Ghaith.

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The authors declare that they have no conflict of interest.

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The study was ethically approved by Clinical and Chemical Pathology Department ethical committee.

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Ghaith, D.M., Zafer, M.M., Said, H.M. et al. Genetic diversity of carbapenem-resistant Klebsiella Pneumoniae causing neonatal sepsis in intensive care unit, Cairo, Egypt. Eur J Clin Microbiol Infect Dis 39, 583–591 (2020). https://doi.org/10.1007/s10096-019-03761-2

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  • DOI: https://doi.org/10.1007/s10096-019-03761-2

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