Emergence of Carbapenem-Resistant Enterobacteriaceae in a Tertiary Care Hospital in Southern Thailand†

Prerit Upadhyaya  ARYAL; Benjamas  THAMJARUNGWONG; Kamonnut  SINGKHAMANAN; Paramee  THONGSUKSAI; Natnicha  INGVIYA; Varaporn  LAOHAPRERTTHISAN; Rungtip  DARAYON; Mingkwan  YINGKAJORN

doi:10.48048/wjst.2020.10729

Authors

Prerit Upadhyaya ARYAL Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
Benjamas THAMJARUNGWONG Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
Kamonnut SINGKHAMANAN Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
Paramee THONGSUKSAI Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
Natnicha INGVIYA Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
Varaporn LAOHAPRERTTHISAN Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
Rungtip DARAYON Infection Control Unit, Songklanagarind Hospital, Songkhla 90110, Thailand
Mingkwan YINGKAJORN Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand

DOI:

https://doi.org/10.48048/wjst.2020.10729

Keywords:

Carbapenem resistance, Enterobacteriaceae, Carbapenemases, K. pneumoniae, NDM-1

Abstract

Carbapenem-resistant Enterobacteriaceae (CRE) is emerging as a major problem in healthcare settings globally, including Thailand, due to limited therapeutic options. We reported the detection, antimicrobial susceptibility profiles, and the presence of carbapenemase genes of CRE isolates obtained from Songklanagarind Hospital between July 2012 and June 2015. A total of 273 non-duplicated CRE isolates was recovered from 248 patients. The predominant organism was Klebsiella pneumoniae (183 [67.0 %]), followed by Escherichia coli (38 [13.9 %]). The susceptibility to 13 antibiotics was performed by disk diffusion assay. Most of the CRE isolates remained susceptible to amikacin. Minimum inhibitory concentrations (MIC) of carbapenems were determined by E-test. The MIC₅₀ and MIC₉₀ were varied among genera and species. Multiplex PCRs for the carbapenemase genes bla_IMP, bla_VIM, bla_OXA-48, bla_NDM-1, bla_KPC, and bla_GES were performed. One hundred and seventy-eight out of these 273 CRE isolates (65.2 %) harbored either single or multiple carbapenemase genes. One hundred and fifty nine isolates harbored the bla_NDM-1 gene (113 K. pneumoniae, 25 E. coli, 17 E. cloacae, 2 Citrobacter freundii, 1 Enterobacter aerogenes, and 1 Pantoea agglomerans), 7 isolates carried bla_IMP (4 K. pneumoniae, 2 C. freundii, and 1 E. cloacae), 7 isolates possessed bla_OXA-48 (1 K. pneumoniae, 5 E. coli, and 1 E. aerogenes), whereas 3 and 2 isolates harbored bla_NDM-1 and bla_IMP(2 K. pneumoniae and 1 E. cloacae) and bla_NDM-1 and bla_OXA-48 (1 E. coli and 1 E. cloacae), respectively. In conclusion, this study revealed the detection of CRE, with the majority of K. pneumoniae harboring bla_NDM-1 in this setting.

Downloads

Download data is not yet available.

References

KM Papp-Wallace, A Endimiani, MA Taracila and RA Bonomo. Carbapenems: Past, present, and future. Antimicrob. Agents Chemother. 2011; 55, 4943-60.

DL Paterson and RA Bonomo. Extended-spectrum beta-lactamases: A clinical update. Clin. Microbiol. Rev. 2005; 18, 657-86.

KZ Vardakas, GS Tansarli, PI Rafailidis and ME Falagas. Carbapenems versus alternative antibiotics for the treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum beta-lactamases: A systematic review and meta-analysis. J. Antimicrob. Chemother. 2012; 67, 2793-803.

P Nordmann, L Dortet and L Poirel. Carbapenem resistance in Enterobacteriaceae: Here is the storm! Trends Mol. Med. 2012; 18, 263-72.

D van Duin and Y Doi. The global epidemiology of carbapenemase-producing Enterobacteriaceae. Virulence 2017; 8, 460-9.

K Lunha, A Chanawong, A Lulitanond, C Wilailuckana, N Charoensri, L Wonglakorn, P Saenjamla, P Chaimanee, S Angkititrakul and P Chetchotisakd. High-level carbapenem-resistant OXA-48-producing Klebsiella pneumoniae with a novel OmpK36 variant and low-level, carbapenem-resistant, non-porin-deficient, OXA-181-producing Escherichia coli from Thailand. Diagn. Microbiol. Infect. Dis. 2016; 85, 221-6.

T Netikul, H Sidjabat, D Paterson and P Kiratisin. Emergence of novel bla(KPC-13) among carbapenem-resistant Enterobacteriaceae in Thailand. Int. J. Antimicrob. Agents 2014; 44, 568-9.

N Suwantarat and KC Carroll. Epidemiology and molecular characterization of multidrug-resistant Gram-negative bacteria in Southeast Asia. Antimicrob. Resist. Infect. Control. 2016; 5, 15.

ME Falagas, GS Tansarli, DE Karageorgopoulos and KZ Vardakas. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerg. Infect. Dis. 2014; 20, 1170-5.

AM Queenan and K Bush. Carbapenemases: The versatile beta-lactamases. Clin. Microbiol. Rev. 2007; 20, 440-58.

H Yigit, AM Queenan, GJ Anderson, A Domenech-Sanchez, JW Biddle, CD Steward, S Alberti, K Bush and FC Tenover. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob. Agents Chemother. 2001; 45, 1151-61.

E Temkin, A Adler, A Lerner and Y Carmeli. Carbapenem-resistant Enterobacteriaceae: Biology, epidemiology, and management. Ann. N. Y. Acad. Sci. 2014; 1323, 22-42.

B Rimrang, A Chanawong, A Lulitanond, C Wilailuckana, N Charoensri, P Sribenjalux, W Phumsrikaew, L Wonglakorn, A Kerdsin and P Chetchotisakd. Emergence of NDM-1- and IMP-14a-producing Enterobacteriaceae in Thailand. J. Antimicrob. Chemother. 2012; 67, 2626-30.

T Netikul and P Kiratisin. Genetic Characterization of Carbapenem-Resistant Enterobacteriaceae and the Spread of Carbapenem-Resistant Klebsiella pneumonia ST340 at a University Hospital in Thailand. PLoS One 2015; 10, e0139116.

CLSI. Performance Standards for Antimicrobial Susceptibility Testing; 29th Informational Supplement. CLSI document M100. Clinical and Laboratory Standards Institute, Wayne, PA, 2019.

L Poirel, TR Walsh, V Cuvillier and P Nordmann. Multiplex PCR for detection of acquired carbapenemase genes. Diagn. Microbiol. Infect. Dis. 2011; 70, 119-23.

C Dallenne, AD Costa, D Decre, C Favier and G Arlet. Development of a set of multiplex PCR assays for the detection of genes encoding important beta-lactamases in Enterobacteriaceae. J. Antimicrob. Chemother. 2010; 65, 490-5.

ML Ling, YM Tee, SG Tan, IM Amin, KB How, KY Tan and LC Lee. Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore. Antimicrob. Resist. Infect. Control. 2015; 4, 26.

AR Zaidah, NI Mohammad, S Suraiya and A Harun. High burden of Carbapenem-resistant Enterobacteriaceae (CRE) fecal carriage at a teaching hospital: Cost-effectiveness of screening in low-resource setting. Antimicrob. Resist. Infect. Control. 2017; 6, 42.

CDC. Available at: https://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf, accessed April 2019.

A Bhargava, K Hayakawa and E Silverman. Risk factors for colonization due to carbapenem-resistant Enterobacteriaceae among patients exposed to long-term acute care and acute care facilities. Infect. Control Hosp. Epidemiol. 2014; 35, 398-405.

TH McConville, SB Sullivan, A Gomez-Simmonds, S Whittier and AC Uhlemann. Carbapenem-resistant Enterobacteriaceae colonization (CRE) and subsequent risk of infection and 90-day mortality in critically ill patients, an observational study. PloS One 2017; 12, e0186195.

KK Kumarasamy, MA Toleman, TR Walsh, J Bagaria, F Butt, R Balakrishnan, U Chaudhary, M Doumith, CG Giske, S Irfan and P Krishnan. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: A molecular, biological, and epidemiological study. Lancet Infect Dis. 2010; 10, 597-602.

TR Walsh. Combinatorial genetic evolution of multiresistance. Curr. Opin. Microbiol. 2006; 9, 476-82.

D Yong, MA Toleman, CG Giske, HS Cho, K Sundman, K Lee and TR Walsh. Characterization of a new metallo-beta-lactamase gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob. Agents Chemother. 2009; 53, 5046-54.

HH Tran, S Ehsani, K Shibayama, M Matsui, S Suzuki, MB Nguyen, DN Tran, VP Tran, DL Tran, HT Nguyen and DA Dang. Common isolation of New Delhi metallo-beta-lactamase 1-producing Enterobacteriaceae in a large surgical hospital in Vietnam. Eur. J. Clin. Microbiol. Infect. Dis. 2015; 34, 1247-54.

N Gupta, BM Limbago, JB Patel and AJ Kallen. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin. Infect. Dis. 2011; 53, 60-7.