Detection and distribution of carbapenemase-encoding genes in clinical Klebsiella pneumoniae isolates from Kayseri, Türkiye
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Abstract
Background and Objectives: Carbapenem Resistance Klebsiella pneumonia (CRKP ), mostly caused by carbapenemase enzymes, poses a serious public health threat due to limited treatment options. This study aimed to genotypically identify carbapenemase-encoding genes in CRKP isolates recovered from fecal swabs and to correlate these genotypes with phenotypic antibiotic resistance profiles.
Materials and Methods: In this study, fecal samples from 150 hospitalized patients were screened for K. pneumoniae. Phenotypic testing included the Phoenix automated system, CHROMagar KPC, biochemical tests, and disk diffusion assays. Genotypic analysis was performed using the BD MAX Checkpoint CPO PCR test, marking its first use in Kayseri, Türkiye, to detect carbapenemase genes in this pathogen.
Results: Out of 150 fecal samples, 47 tested positive for K. pneumoniae, with 28 (59.6%) identified as carbapenem-resistant (CRKP). Molecular analysis identified five distinct carbapenemase gene patterns among these resistant isolates. The most prevalent gene, blaOXA-48, was found alone in 60.7% of CRKP isolates, followed by blaNDM in 3.6%; blaKPC was not detected. Co-occurrence of genes was observed as follows: blaOXA-48/blaNDM (14.3%), blaOXA-48 with blaVIM/blaIMP (10.7%), and blaOXA-48 with blaNDM and blaVIM/blaIMP (10.7%) in CRKP clinical isolates.
Conclusion: The study found that blaKPC was consistently absent, while blaOXA-48 was highly prevalent and exhibited co-occurrences of carbapenemase genes. It underscored the need for strict hospital surveillance and effective infection control to prevent the spread of CRKP strains. Rapid molecular methods, such as the BD MAX multiplex PCR, have shown promise in accurately and efficiently identifying carbapenemase genes.
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27. Kalayci-Yuksek F, Gumus D, Uyanik-Ocal A, Gun G, Bayirli-Turan D, Macunluoglu AC, et al. Carbapenem and colistin resistance, integrons and plasmid replicon types in multi-drug resistant Klebsiella strains isolated in Turkey. Clin Lab 2023; 69: 10.7754/Clin.Lab.2022.220503.
28. Ciftci E, Sesli Cetin E, Us E, Haydar Kutlu H, Cicioglu Arıdogan B. Investigation of carbapenem resistance mechanisms in Klebsiella pneumoniae by using phenotypic tests and a molecular assay. J Infect Dev Ctries 2019; 13:992-1000.
29. Chen S, Feng W, Chen J, Liao W, He N, Wang Q, et al. Spread of carbapenemase-producing enterobacteria in a southwest hospital in China. Ann Clin Microbiol Antimicrob 2014; 13:42.
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31. Chung HS, Lee M. Verification of the performance of the BD MAX Check-Points CPO assay on clinical isolates. J Lab Med 2020; 44:165-168.
32. Su HR, Turhan Ö, Erman Daloğlu CA, Öğünç MD, Özhak B, Öngüt G, et al. Molecular epidemiology of carbapenem-resistant Enterobacterales strains isolated from Blood Cultures in Antalya, Turkey. Lab Med 2020; 51:601-605.
33. Demirci-Duarte S, Unalan-Altintop T, Gulay Z, Sari Kaygisiz AN, Cakar A, Gur D. In vitro susceptibility of OXA-48, NDM, VIM and IMP enzyme- producing Klebsiella spp. and Escherichia coli to fosfomycin. J Infect Dev Ctries 2020; 14:394-397.
2. World Health Organization. Carpeta de recursos de salud pública para los países que presentan brotes de gripe en animales [Internet]. World Health Organization; 2024. Available from: https://www.who.int/europe/publications/i/item/9789289056687
3. World Health Organization. WHO publishes list of bacteria for which new antibiotics are urgently needed [Internet]. World Health Organization; 2017. Available from: https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed
4. Martin RM, Bachman MA. Colonization, infection, and the accessory genome of Klebsiella pneumoniae. Front Cell Infect Microbiol 2018; 8:4.
5. Aurilio C, Sansone P, Barbarisi M, Pota V, Giaccari LG, Coppolino F,et al. Mechanisms of action of carbapenem resistance. Antibiotics (Basel) 2022; 11:421.
6. Liu X, Sai F, Li L, Zhu C, Huang H. Clinical characteristics and risk factors of catheter-associated urinary tract infections caused by Klebsiella Pneumoniae. Ann Palliat Med 2020; 9:2668-2677.
7. Assoni L, Couto AJM, Vieira B, Milani B, Lima AS, Converso TR, et al. Animal models of Klebsiella pneumoniae mucosal infections. Front Microbiol 2024; 15:1367422.
8. Majumder MAA, Rahman S, Cohall D, Bharatha A, Singh K, Haque M, et al. Antimicrobial stewardship: fighting antimicrobial resistance and protecting global public health. Infect Drug Resist 2020; 13:4713-4738.
9. Russo A, Fusco P, Morrone HL, Trecarichi EM, Torti C. New advances in management and treatment of multidrug-resistant Klebsiella pneumoniae. Expert Rev Anti Infect Ther 2023; 21:41-55.
10. Lee CR, Lee JH, Park KS, Kim YB, Jeong BC, Lee SH. Global dissemination of carbapenemase-producing Klebsiella pneumoniae: epidemiology, genetic context, treatment options, and detection methods. Front Microbiol 2016; 7:895.
11. Nordmann P, Poirel L, Walsh TR, Livermore DM. The emerging NDM carbapenemases. Trends Microbiol 2011; 19:588-595.
12. Poirel L, Héritier C, Tolün V, Nordmann P. Emergence of oxacillinase-mediated resistance to imipenem in Klebsiella pneumoniae. Antimicrob Agents Chemother 2004; 48:15-22.
13. Abdallah SA, Zaki SS, Hafez SS, Moustafa EE. Prevalence rate of Klebsiella pneumoniae in the intensive care unit: epidemiology and molecular characteristics. J Biol Res 2018; 91:47-52.
14. Li Y, Shen H, Zhu C, Yu Y. Carbapenem-resistant Klebsiella pneumoniae infections among ICU admission patients in central China: prevalence and prediction model. Biomed Res Int 2019; 2019:9767313.
15. Tamma PD, Simner PJ. Phenotypic detection of carbapenemase-producing organisms from clinical isolates. J Clin Microbiol 2018; 56(11):e01140-18.
16. Banerjee R, Humphries R. Clinical and laboratory considerations for the rapid detection of carbapenem-resistant Enterobacteriaceae. Virulence 2017; 8:427-439.
17. Huy TX. Overcoming Klebsiella pneumoniae antibiotic resistance: new insights into mechanisms and drug discovery. Beni-Suef Univ J Basic Appl Sci 2024; 13:13.
18. Karampatakis T, Tsergouli K, Behzadi P. Carbapenem-resistant Klebsiella pneumoniae: virulence factors, molecular epidemiology and latest updates in treatment options. Antibiotics (Basel) 2023; 12:234.
19. Ripabelli G, Tamburro M, Guerrizio G, Fanelli I, Flocco R, Scutellà M, et al. Tracking multidrug-resistant Klebsiella pneumoniae from an Italian Hospital: molecular epidemiology and surveillance by PFGE, RAPD and PCR-based resistance genes prevalence. Curr Microbiol 2018; 75:977-987.
20. Sękowska A, Gospodarek E, Kusza K. The prevalence of infections and colonisation with Klebsiella pneumoniae strains isolated in ICU patients. Anaesthesiol Intensive Ther 2014; 46:280-283.
21. Lin MY, Lyles-Banks RD, Lolans K, Hines DW, Spear JB, Petrak R, et al. The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2013; 57:1246-1252.
22. Girlich D, Oueslati S, Bernabeu S, Langlois I, Begasse C, Arangia N, et al. Evaluation of the BD MAX check-points CPO assay for the detection of carbapenemase producers directly from rectal Swabs. J Mol Diagn 2020; 22:294-300.
23. Kilic A, Baysallar M. The First Klebsiella pneumoniae isolate Co-Producing OXA-48 and NDM-1 in Turkey. Ann Lab Med 2015; 35:382-383.
24. Demir HK, Nakipoglu Y. Investigation of the prevalence of carbapenem resistance genes in faecal carriage of carbapenem resistant Klebsiella spp. isolates by multiplex real-time PCR method. J Infect Dev Ctries 2023; 17:1606-1612.
25. Durmuş MA, Aydin MD. Detection of carbapenem resistance using the Genotypic and Phenotypic methods in Klebsiella pneumoniae. Duzce Med J 2024; 26:15-20.
26. sler B, Özer B, Çınar G, Aslan AT, Vatansever C, Falconer C, et al. Characteristics and outcomes of carbapenemase harbouring carbapenem-resistant Klebsiella spp. bloodstream infections: a multicentre prospective cohort study in an OXA-48 endemic setting. Eur J Clin Microbiol Infect Dis 2022; 41:841-847.
27. Kalayci-Yuksek F, Gumus D, Uyanik-Ocal A, Gun G, Bayirli-Turan D, Macunluoglu AC, et al. Carbapenem and colistin resistance, integrons and plasmid replicon types in multi-drug resistant Klebsiella strains isolated in Turkey. Clin Lab 2023; 69: 10.7754/Clin.Lab.2022.220503.
28. Ciftci E, Sesli Cetin E, Us E, Haydar Kutlu H, Cicioglu Arıdogan B. Investigation of carbapenem resistance mechanisms in Klebsiella pneumoniae by using phenotypic tests and a molecular assay. J Infect Dev Ctries 2019; 13:992-1000.
29. Chen S, Feng W, Chen J, Liao W, He N, Wang Q, et al. Spread of carbapenemase-producing enterobacteria in a southwest hospital in China. Ann Clin Microbiol Antimicrob 2014; 13:42.
30. Elshamy AA, Aboshanab KM. A review on bacterial resistance to carbapenems: epidemiology, detection and treatment options. Future Sci OA 2020; 6:FSO438.
31. Chung HS, Lee M. Verification of the performance of the BD MAX Check-Points CPO assay on clinical isolates. J Lab Med 2020; 44:165-168.
32. Su HR, Turhan Ö, Erman Daloğlu CA, Öğünç MD, Özhak B, Öngüt G, et al. Molecular epidemiology of carbapenem-resistant Enterobacterales strains isolated from Blood Cultures in Antalya, Turkey. Lab Med 2020; 51:601-605.
33. Demirci-Duarte S, Unalan-Altintop T, Gulay Z, Sari Kaygisiz AN, Cakar A, Gur D. In vitro susceptibility of OXA-48, NDM, VIM and IMP enzyme- producing Klebsiella spp. and Escherichia coli to fosfomycin. J Infect Dev Ctries 2020; 14:394-397.
| Files | ||
| Issue | Vol 18 No 1 (2026) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v18i1.20903 | |
| Keywords | ||
| Carbapenems Carbapenemases Genes Klebsiella pneumoniae | ||
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How to Cite
1.
Jameel T, Ayvaz A, Sağıroğlu P, Atalay M. Detection and distribution of carbapenemase-encoding genes in clinical Klebsiella pneumoniae isolates from Kayseri, Türkiye. Iran J Microbiol. 2026;18(1):23-31.
