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The Internet Journal of Microbiology
Volume 17 Number 1
DOI: 10.5580/IJMB.54794
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Molecular Detection of the Genes bla OXA, bla KPC and bla
NDM Among Carbapenem-Resistant Klebsiella Pneumoniae
Isolated From Different Hospitals in Duhok City, Iraq
H Hassan, N A Yassin, A T Saadi
Citation
H Hassan, N A Yassin, A T Saadi. Molecular Detection of the Genes bla OXA, bla KPC and bla NDM Among Carbapenem-
Resistant Klebsiella Pneumoniae Isolated From Different Hospitals in Duhok City, Iraq. The Internet Journal of
Microbiology. 2020 Volume 17 Number 1.
DOI: 10.5580/IJMB.54794
Abstract
Background: Spreading of Carbapenem-resistant Klebsiella pneumoniae among hospitalized patients are beyond expected with
potential infections and little is known in Iraq. The aims were to find out the prevalence of carbapenem genes among
carbapenem-resistant K. pneumoniae isolates in major hospitals in Duhok city, Iraq.
Methods: For the 281 isolates recovered from different clinical specimens in 2017, species identification was done first by
classical method and confirmed by Vitek 2 and antimicrobial susceptibilities were determined by both Kirby-Bauer method and
Vitek 2. Isolates with reduced susceptibility to ertapenem were tested for production of carbapenemase by using the Modified
Hodge Test and double disk synergy test (DDST). Positive isolates for carbapenemase were further characterized and
subjected to PCR for carbapenemase genes including blaOXA-48, blaNDM-1 and blaKPC.
Results: Out of 281 K. pneumoniae isolates, 123 (43%) were carbapenem-resistant and showed high resistant to ampicillin,
ceftazidime, ceftriaxone and pipracellin 100%, 76.9%, 74.0%, and 71.5 % respectively. High sensitivity was toward colistin and
fosfomycin 35.9% and 19.9%, respectively. Of 50/123 carbapenem-resistant studied isolates, MHT and DDST showed that all
studied isolates were carbapenemase producer. The presence of blaKPC, blaNDM-1 and blaOXA-48 was detected in 14
(10.9%), 13 (0.9%) and 6 (12%) of studied isolates, respectively. two co-producing were occurred between blaKPC with
blaNDM-1 and blaKPC with blaOXA-48
Conclusion: Carbapenem-resistant K pneumoniae isolates harbored carbapenemase genes (blaNDM-1,bla KPC and
blaOXA-48- types) with multiple drug resistance profiles are circulating in our setting, Iraq , namely bla KPC when compared
with neighbored. Surveillance and reemphasis on infection control measures with rational use of antibiotics in Iraqi hospitals will
minimize the spread of carbapenem resistance.
INTRODUCTION
Klebsiella pneumoniae belongs to the Enterobacteriaceae
family and has the ability to cause various infections ranging
from pneumonia to urinary tract infections as well as wound,
surgical site infections, bloodstream infection, and
meningitis (Cristina et al., 2016, Codjoe & Donkor, 2018).
The occurrence of infections caused by K pneumoniae
strains that are resistant to extended-spectrum-lactam
antimicrobial agents make clinicians to select the latest
choices such as carbapenems to treat these resistant
pathogens. However, over- and above misuse of
carbapenems can variably induce different mechanisms of
résistance. Infections in hospitalized patients with
carbapenem-resistant K. pneumoniae isolates have recently
become the most common infection with a pathogen that
spread worldwide and caused an increase in mortality rates.
Carbapenemases enzyme production with extended-
spectrum beta-lactamase and high level AmpC are
considered the major causes of the occurrence of resistance.
There are many recognized carbapenemases types including:
serine carbapenemases, such as K. pneumoniae
carbapenemase (KPC)( class A), MBLs, like Verona
integron-encoded MBL (VIM)) and New Delhi MBL
(NDM), and imipenemase (IMP)(class B) and OXA