Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of <i>Klebsiella pneumoniae</i> in the University of Port-Harcourt Teaching Hospital

Igunma Agbons Jeremiah; Akujobi Comfort Nne; Oboro Ibinabo Laura

doi:doi:10.11648/j.ajlm.20200503.12

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Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital

Igunma Agbons Jeremiah, Akujobi Comfort Nne, Oboro Ibinabo Laura

Published in American Journal of Laboratory Medicine (Volume 5, Issue 3)

Received: 27 June 2020 Accepted: 13 July 2020 Published: 30 July 2020

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Abstract

Carbapenem resistance among Enterobacteriaceae, especially Klebsiella pneumoniae and Escherichia coli, has remained a challenge in infectious disease management. Although several resistance mechanisms have been documented that neutralize the efficacy of carbapenems, the expression of carbapenemases is the most prominent. Carbapenemase producing Klebsiella pneumoniae has been identified as a major public health threat because of the potential for rapid plasmid mediated spread of the resistance genes among bacterial species and resulting limited therapeutic options available. These pathogens could express resistance to almost all available antibiotics and are associated with high morbidity and mortality. This cross-sectional study was carried out in the University of Port Harcourt Teaching Hospital, Nigeria. A total of 225 clinical isolates of Klebsiella pneumoniae from wounds, urine, blood, sputum and cerebrospinal fluid were recruited. All isolates were screened for Carbapenem resistance using Ertapenem (10µg; Oxoid, England) according to CLSI guidelines. All non-susceptible isolates were then tested for phenotypic carbapenemase production using the Modified Hodge test (MHT). The MHT positive isolates were thereafter, subjected to Polymerase Chain Reaction to detect the presence of blaKPC resistance gene. The study showed that 8.4% (19/225) of Klebsiella pneumoniae isolates were not susceptible to Ertapenem. Out of these, 6.2% (14/225) expressed carbapenemase production by the modified Hodge test. However, on molecular analysis, only six (6) of these isolates possessed the blaKPC gene giving a 2.7% genotypic prevalence of Klebsiella pneumoniae carbapenemase among the isolates. Critically ill patients are more likely to develop infections by blaKPC-producing Klebsiella pneumoniae. It is therefore pertinent that the approach to prevention and control of infections by multi-drug resistant Klebsiella pneumoniae isolates must be multi-pronged to effectively counteract the various mechanisms that may be responsible. From control of prescribing and dispensing patterns, rational use of antimicrobials, institution of antimicrobial stewardship programs, optimization of infection prevention and control measures to effective surveillance; a well-coordinated approach is necessary to reduce the prevalence and spread of this pathogens since the blaKPC resistance gene is plasmid mediated and associated with high rates of both inter and intra-species transfer among bacteria.

Published in	American Journal of Laboratory Medicine (Volume 5, Issue 3)
DOI	10.11648/j.ajlm.20200503.12
Page(s)	70-75
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

KPC, Klebsiella pneumoniae, Multidrug Resistance, Carbapenemase

References

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Igunma Agbons Jeremiah, Akujobi Comfort Nne, Oboro Ibinabo Laura. (2020). Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital. American Journal of Laboratory Medicine, 5(3), 70-75. https://doi.org/10.11648/j.ajlm.20200503.12

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ACS Style

Igunma Agbons Jeremiah; Akujobi Comfort Nne; Oboro Ibinabo Laura. Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital. Am. J. Lab. Med. 2020, 5(3), 70-75. doi: 10.11648/j.ajlm.20200503.12

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AMA Style

Igunma Agbons Jeremiah, Akujobi Comfort Nne, Oboro Ibinabo Laura. Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital. Am J Lab Med. 2020;5(3):70-75. doi: 10.11648/j.ajlm.20200503.12

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@article{10.11648/j.ajlm.20200503.12,
  author = {Igunma Agbons Jeremiah and Akujobi Comfort Nne and Oboro Ibinabo Laura},
  title = {Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital},
  journal = {American Journal of Laboratory Medicine},
  volume = {5},
  number = {3},
  pages = {70-75},
  doi = {10.11648/j.ajlm.20200503.12},
  url = {https://doi.org/10.11648/j.ajlm.20200503.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajlm.20200503.12},
  abstract = {Carbapenem resistance among Enterobacteriaceae, especially Klebsiella pneumoniae and Escherichia coli, has remained a challenge in infectious disease management. Although several resistance mechanisms have been documented that neutralize the efficacy of carbapenems, the expression of carbapenemases is the most prominent. Carbapenemase producing Klebsiella pneumoniae has been identified as a major public health threat because of the potential for rapid plasmid mediated spread of the resistance genes among bacterial species and resulting limited therapeutic options available. These pathogens could express resistance to almost all available antibiotics and are associated with high morbidity and mortality. This cross-sectional study was carried out in the University of Port Harcourt Teaching Hospital, Nigeria. A total of 225 clinical isolates of Klebsiella pneumoniae from wounds, urine, blood, sputum and cerebrospinal fluid were recruited. All isolates were screened for Carbapenem resistance using Ertapenem (10µg; Oxoid, England) according to CLSI guidelines. All non-susceptible isolates were then tested for phenotypic carbapenemase production using the Modified Hodge test (MHT). The MHT positive isolates were thereafter, subjected to Polymerase Chain Reaction to detect the presence of blaKPC resistance gene. The study showed that 8.4% (19/225) of Klebsiella pneumoniae isolates were not susceptible to Ertapenem. Out of these, 6.2% (14/225) expressed carbapenemase production by the modified Hodge test. However, on molecular analysis, only six (6) of these isolates possessed the blaKPC gene giving a 2.7% genotypic prevalence of Klebsiella pneumoniae carbapenemase among the isolates. Critically ill patients are more likely to develop infections by blaKPC-producing Klebsiella pneumoniae. It is therefore pertinent that the approach to prevention and control of infections by multi-drug resistant Klebsiella pneumoniae isolates must be multi-pronged to effectively counteract the various mechanisms that may be responsible. From control of prescribing and dispensing patterns, rational use of antimicrobials, institution of antimicrobial stewardship programs, optimization of infection prevention and control measures to effective surveillance; a well-coordinated approach is necessary to reduce the prevalence and spread of this pathogens since the blaKPC resistance gene is plasmid mediated and associated with high rates of both inter and intra-species transfer among bacteria.},
 year = {2020}
}

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TY  - JOUR
T1  - Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital
AU  - Igunma Agbons Jeremiah
AU  - Akujobi Comfort Nne
AU  - Oboro Ibinabo Laura
Y1  - 2020/07/30
PY  - 2020
N1  - https://doi.org/10.11648/j.ajlm.20200503.12
DO  - 10.11648/j.ajlm.20200503.12
T2  - American Journal of Laboratory Medicine
JF  - American Journal of Laboratory Medicine
JO  - American Journal of Laboratory Medicine
SP  - 70
EP  - 75
PB  - Science Publishing Group
SN  - 2575-386X
UR  - https://doi.org/10.11648/j.ajlm.20200503.12
AB  - Carbapenem resistance among Enterobacteriaceae, especially Klebsiella pneumoniae and Escherichia coli, has remained a challenge in infectious disease management. Although several resistance mechanisms have been documented that neutralize the efficacy of carbapenems, the expression of carbapenemases is the most prominent. Carbapenemase producing Klebsiella pneumoniae has been identified as a major public health threat because of the potential for rapid plasmid mediated spread of the resistance genes among bacterial species and resulting limited therapeutic options available. These pathogens could express resistance to almost all available antibiotics and are associated with high morbidity and mortality. This cross-sectional study was carried out in the University of Port Harcourt Teaching Hospital, Nigeria. A total of 225 clinical isolates of Klebsiella pneumoniae from wounds, urine, blood, sputum and cerebrospinal fluid were recruited. All isolates were screened for Carbapenem resistance using Ertapenem (10µg; Oxoid, England) according to CLSI guidelines. All non-susceptible isolates were then tested for phenotypic carbapenemase production using the Modified Hodge test (MHT). The MHT positive isolates were thereafter, subjected to Polymerase Chain Reaction to detect the presence of blaKPC resistance gene. The study showed that 8.4% (19/225) of Klebsiella pneumoniae isolates were not susceptible to Ertapenem. Out of these, 6.2% (14/225) expressed carbapenemase production by the modified Hodge test. However, on molecular analysis, only six (6) of these isolates possessed the blaKPC gene giving a 2.7% genotypic prevalence of Klebsiella pneumoniae carbapenemase among the isolates. Critically ill patients are more likely to develop infections by blaKPC-producing Klebsiella pneumoniae. It is therefore pertinent that the approach to prevention and control of infections by multi-drug resistant Klebsiella pneumoniae isolates must be multi-pronged to effectively counteract the various mechanisms that may be responsible. From control of prescribing and dispensing patterns, rational use of antimicrobials, institution of antimicrobial stewardship programs, optimization of infection prevention and control measures to effective surveillance; a well-coordinated approach is necessary to reduce the prevalence and spread of this pathogens since the blaKPC resistance gene is plasmid mediated and associated with high rates of both inter and intra-species transfer among bacteria.
VL  - 5
IS  - 3
ER  -

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Author Information

Igunma Agbons Jeremiah

Department of Medical Microbiology and Parasitology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Akujobi Comfort Nne

Department of Medical Microbiology and Parasitology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
Oboro Ibinabo Laura

Department of Medical Microbiology and Parasitology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

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Igunma Agbons Jeremiah, Akujobi Comfort Nne, Oboro Ibinabo Laura. (2020). Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital. American Journal of Laboratory Medicine, 5(3), 70-75. https://doi.org/10.11648/j.ajlm.20200503.12

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ACS Style

Igunma Agbons Jeremiah; Akujobi Comfort Nne; Oboro Ibinabo Laura. Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital. Am. J. Lab. Med. 2020, 5(3), 70-75. doi: 10.11648/j.ajlm.20200503.12

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AMA Style

Igunma Agbons Jeremiah, Akujobi Comfort Nne, Oboro Ibinabo Laura. Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital. Am J Lab Med. 2020;5(3):70-75. doi: 10.11648/j.ajlm.20200503.12

Copy | Download

@article{10.11648/j.ajlm.20200503.12,
  author = {Igunma Agbons Jeremiah and Akujobi Comfort Nne and Oboro Ibinabo Laura},
  title = {Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital},
  journal = {American Journal of Laboratory Medicine},
  volume = {5},
  number = {3},
  pages = {70-75},
  doi = {10.11648/j.ajlm.20200503.12},
  url = {https://doi.org/10.11648/j.ajlm.20200503.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajlm.20200503.12},
  abstract = {Carbapenem resistance among Enterobacteriaceae, especially Klebsiella pneumoniae and Escherichia coli, has remained a challenge in infectious disease management. Although several resistance mechanisms have been documented that neutralize the efficacy of carbapenems, the expression of carbapenemases is the most prominent. Carbapenemase producing Klebsiella pneumoniae has been identified as a major public health threat because of the potential for rapid plasmid mediated spread of the resistance genes among bacterial species and resulting limited therapeutic options available. These pathogens could express resistance to almost all available antibiotics and are associated with high morbidity and mortality. This cross-sectional study was carried out in the University of Port Harcourt Teaching Hospital, Nigeria. A total of 225 clinical isolates of Klebsiella pneumoniae from wounds, urine, blood, sputum and cerebrospinal fluid were recruited. All isolates were screened for Carbapenem resistance using Ertapenem (10µg; Oxoid, England) according to CLSI guidelines. All non-susceptible isolates were then tested for phenotypic carbapenemase production using the Modified Hodge test (MHT). The MHT positive isolates were thereafter, subjected to Polymerase Chain Reaction to detect the presence of blaKPC resistance gene. The study showed that 8.4% (19/225) of Klebsiella pneumoniae isolates were not susceptible to Ertapenem. Out of these, 6.2% (14/225) expressed carbapenemase production by the modified Hodge test. However, on molecular analysis, only six (6) of these isolates possessed the blaKPC gene giving a 2.7% genotypic prevalence of Klebsiella pneumoniae carbapenemase among the isolates. Critically ill patients are more likely to develop infections by blaKPC-producing Klebsiella pneumoniae. It is therefore pertinent that the approach to prevention and control of infections by multi-drug resistant Klebsiella pneumoniae isolates must be multi-pronged to effectively counteract the various mechanisms that may be responsible. From control of prescribing and dispensing patterns, rational use of antimicrobials, institution of antimicrobial stewardship programs, optimization of infection prevention and control measures to effective surveillance; a well-coordinated approach is necessary to reduce the prevalence and spread of this pathogens since the blaKPC resistance gene is plasmid mediated and associated with high rates of both inter and intra-species transfer among bacteria.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Genotypic Determination of Carbapenamase Gene Production in Clinical Isolates of Klebsiella pneumoniae in the University of Port-Harcourt Teaching Hospital
AU  - Igunma Agbons Jeremiah
AU  - Akujobi Comfort Nne
AU  - Oboro Ibinabo Laura
Y1  - 2020/07/30
PY  - 2020
N1  - https://doi.org/10.11648/j.ajlm.20200503.12
DO  - 10.11648/j.ajlm.20200503.12
T2  - American Journal of Laboratory Medicine
JF  - American Journal of Laboratory Medicine
JO  - American Journal of Laboratory Medicine
SP  - 70
EP  - 75
PB  - Science Publishing Group
SN  - 2575-386X
UR  - https://doi.org/10.11648/j.ajlm.20200503.12
AB  - Carbapenem resistance among Enterobacteriaceae, especially Klebsiella pneumoniae and Escherichia coli, has remained a challenge in infectious disease management. Although several resistance mechanisms have been documented that neutralize the efficacy of carbapenems, the expression of carbapenemases is the most prominent. Carbapenemase producing Klebsiella pneumoniae has been identified as a major public health threat because of the potential for rapid plasmid mediated spread of the resistance genes among bacterial species and resulting limited therapeutic options available. These pathogens could express resistance to almost all available antibiotics and are associated with high morbidity and mortality. This cross-sectional study was carried out in the University of Port Harcourt Teaching Hospital, Nigeria. A total of 225 clinical isolates of Klebsiella pneumoniae from wounds, urine, blood, sputum and cerebrospinal fluid were recruited. All isolates were screened for Carbapenem resistance using Ertapenem (10µg; Oxoid, England) according to CLSI guidelines. All non-susceptible isolates were then tested for phenotypic carbapenemase production using the Modified Hodge test (MHT). The MHT positive isolates were thereafter, subjected to Polymerase Chain Reaction to detect the presence of blaKPC resistance gene. The study showed that 8.4% (19/225) of Klebsiella pneumoniae isolates were not susceptible to Ertapenem. Out of these, 6.2% (14/225) expressed carbapenemase production by the modified Hodge test. However, on molecular analysis, only six (6) of these isolates possessed the blaKPC gene giving a 2.7% genotypic prevalence of Klebsiella pneumoniae carbapenemase among the isolates. Critically ill patients are more likely to develop infections by blaKPC-producing Klebsiella pneumoniae. It is therefore pertinent that the approach to prevention and control of infections by multi-drug resistant Klebsiella pneumoniae isolates must be multi-pronged to effectively counteract the various mechanisms that may be responsible. From control of prescribing and dispensing patterns, rational use of antimicrobials, institution of antimicrobial stewardship programs, optimization of infection prevention and control measures to effective surveillance; a well-coordinated approach is necessary to reduce the prevalence and spread of this pathogens since the blaKPC resistance gene is plasmid mediated and associated with high rates of both inter and intra-species transfer among bacteria.
VL  - 5
IS  - 3
ER  -

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