New Delhi metallo-β-lactamase-1–producing Klebsiella pneumoniae isolates in hospitalized patients in Kashan, Iran
AbstractBackground and Objectives: New Delhi metallo-ß-lactamase (NDM) is a newly emerging metallo-ß-lactamases, which can destroy all β-lactams including carbapenems. Therefore, this study aimed at evaluating New Delhi metallo-ß-lactamase-1–production in clinical isolates of Klebsiella pneumoniae in Kashan, Iran.Materials and Methods: In a cross-sectional study, 181 K. pneumoniae isolates were collected from clinical samples of patients, who referred to Shahid Beheshi hospital in Kashan during November 2013 and October 2014. Antimicrobial susceptibility patterns were determined using disk diffusion method, according to CLSI guidelines. Metallo-ß-lactamase (MBL) production was identified among imipenem- resistant K. pneumoniae isolates using imipenem-EDTA double disk synergy test (EDTA-IMP DDST). PCR method and sequencing were used to detect integron Class 1 and blaNDM-1 gene. Statistical analyses were performed using SPSS software Version 16.Results: Of the 181 K. pneumoniae isolates, 36 (19.9 %) were imipenem-resistant strains. A total of 28 out of 36 (77.7%) imipenem- resistant K. pneumoniae isolates were identified as MBL producer strains. Also, 150 (82.9%) K. pneumoniae isolates carried intI1 gene, and 20 (11.1%) K. pneumoniae isolates harbored blaNDM-1 gene.Conclusion: Our study revealed a high frequency of MBL production and the presence of blaNDM-1 among K. pneumoniae strains, especially among hospitalized patients, which is alarming. Moreover, the presence of Class 1 integrons in all multi-drug resistant K. pneumoniae isolates highlights the risk of rapid spread of the resistance genes, especially in clinical settings.
Neamati F, Firoozeh F, Saffari M, Zibaei M. Virulence genes and antimicrobial resistance pattern in uropathogenic Escherichia coli isolated from hospitalized patients in Kashan, Iran. Jundishapur J Microbiol 2015; 8:e17514.
Firoozeh F, Aghaseyed Hosseini M, Zibaei M, Piroozmand A. Detection of blaKPC and blaGES carbapenemase genes in Klebsiella pneumoniae isolated from hospitalized patients in Kashan, Iran. Recent Pat Antiinfect Drug Discov 2016; 11: 183-188.
Nordmann P, Poirel L. Emerging carbapenemases in gram negative aerobes. Clin Microbiol Infect 2002; 8: 321-331.
Palzkill T. Metallo-β-lactamase structure and function. Ann N Y Acad Sci 2013; 1277: 91-104.
Cornaglia G, Giamarellou H, Rossolini GM. Metallo-β-lactamases: a last frontier for β-lactams? Lancet Infect Dis 2011; 11:381-393.
Mahluji Z, Firoozeh F, Khorshidi A, Zibaei M. The frequency of Class 1 integrons in multi-drug resistant Klebsiella pneumoniae isolated from clinical samples using polymerase chain reaction assay. Sci J Kurd Univ Med Sci 2016; 21: 68-78.
Jamal WY, Albert MJ, Rotimi VO. High prevalence of new delhi metallo-β-lactamase-1 (NDM-1) producers among carbapenem-resistant Enterobacteriaceae in Kuwait. PLoS One 2016; 11: e0152638.
Moellering RC Jr. NDM-1- a cause for worldwide concern. N Engl J Med 2010; 363: 2377-2379.
Mahon CR, Lehman DC, Manuselis G (2011). Textbook of diagnostic microbiology.4th ed. Saunders. Washington DC.
Fallah F, Noori M, Hashemi A, Goudarzi H, Karimi A, Erfanimanesh S, et al. Prevalence of blaNDM, blaPER, blaVEB, blaIMP, and blaVIM genes among Acinetobacter baumannii isolated from two hospitals of Tehran, Iran. Scientifica (Cairo) 2014; 2014:245162.
Muir A, Weinbren MJ. New Delhi metallo-b-lactamase: a cautionary tale. J Hosp Infect 2010; 75: 239-240.
Fazeli H, Norouzi-Barough M, Ahadi AM, Shokri D, Solgi H. Detection of new delhi metallo-beta-lactamase-1 (NDM-1) in carbapenem-resistant Klebsiella pneumoniae isolated from a university hospital in Iran. Hippokratia 2015; 19: 205-209.
Lovayová V, Vargová L, Habalová V, Pastvová L, Čurová K, Siegfried L. New Delhi metallo-beta-lactamase Ndm-1 producing Klebsiella pneumoniae in Slovakia. Clin Microbiol 2014; 5: 1-5.
Castanheira M, Deshpande LM, Mathai D, Bell JM, Jones RN, Mendes RE. Early dissemination of NDM-1- and OXA-181-producing Enterobacteriaceae in Indian Hospitals: report from the SENTRY antimicrobial surveillance program, 2006-2007. Antimicrob Agents Chemother 2011; 55: 1274-1278.
Brink AJ, Coetzee J, Clay CG, Sithole S, Richards GA, Poirel L, et al. Emergence of new delhi metallo-beta-lactamase (NDM-1) and Klebsiella pneumoniae carbapenemase (KPC-2) in South Africa. J Clin Microbiol 2012; 50: 525-527.