Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.4103/JLP.JLP_29_18
Prevalence of blaKPC and its occurrence with other beta-lactamases in Klebsiella pneumoniae
Financial support and sponsorship This study was financially supported by Founder Chancellor Ramasamy Udayar Fellowship provided by Sri Ramachandra Medical College and Research Institute.![](https://www.thieme-connect.de/media/10.1055-s-00044881/201804/lookinside/thumbnails/10-4103-jlp-jlp_29_18_387-1.jpg)
ABSTRACT
BACKGROUND: Klebsiella pneumoniae (K. pneumoniae) is an important nosocomial pathogen, and the emergence of multidrug resistance in these organisms limits the treatment options for serious infections caused by them. K. pneumoniae carbapenemase (KPC) is one of the clinically significant Class A beta-lactamases.
AIM AND OBJECTIVE: This study was aimed to detect the KPC and its coexistence with other beta-lactamases in K. pneumoniae.
MATERIALS AND METHODS: A total of 370 isolates, collected over a period of 1 year, were included in this study. The source of these isolates were urine (n = 170), exudative specimens (n = 132), respiratory secretions such as bronchial wash, endotracheal aspirate, and pleural fluid (n = 38), and blood (n = 30). For all the isolates, antibiotic susceptibility tests by disc diffusion, modified Hodge test, and KPC screening test were done. Polymerase chain reaction (PCR) was performed for the detection of KPC and the copresence of other beta-lactamases genes.
RESULTS: Among the 370 isolates, 41 were resistant to the carbapenem by disc diffusion and minimum inhibitory concentration tests. Screen test using ertapenem and the boronic acid disk was positive in 14 isolates. Only one isolate harbored KPC gene by PCR, and it was co-produced with SHV-12 and CTX-M-15.
CONCLUSION: PCR remains the gold standard for detection of KPC compared with any other phenotypic methods. Early detection of these genes helps in initiating proper antibiotic treatment.
Keywords
Extended-spectrum beta-lactamases - Klebsiella pneumoniae carbapenemase - Klebsiella pneumoniae - molecular methods - phenotypic methodsPublication History
Article published online:
20 February 2020
© 2018.
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
-
REFERENCES
- 1 Zhao F, Bai J, Wu J, Liu J, Zhou M, Xia S, et al. Sequencing and genetic variation of multidrug resistance plasmids in Klebsiella pneumoniae. PLoS One 2010;5:e10141.
- 2 Singh M, Kakati B, Agarwal RK, Kotwal A. Detection of Klebsiella pneumoniae carbapenemases (KPCs) among ESBL/MBL producing clinical isolates of Klebsiella pneumoniae. Int J Curr Microbiol Appl Sci 2015;4:726-31.
- 3 Patel G, Bonomo RA. Status report on carbapenemases: Challenges and prospects. Expert Rev Anti Infect Ther 2011;9:555-70.
- 4 Nordmann P, Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect 2014;20:821-30.
- 5 Queenan AM, Bush K. Carbapenemases: The versatile beta-lactamases. Clin Microbiol Rev 2007;20:440-58.
- 6 Swathi CH, Chikala R, Ratnakar KS, Sritharan V. A structural, epidemiological & genetic overview of Klebsiella pneumoniae carbapenemases (KPCs). Indian J Med Res 2016;144:21-31.
- 7 Lee CR, Lee JH, Park KS, Kim YB, Jeong BC, Lee SH, et al. Global dissemination of carbapenemase-producing Klebsiella pneumoniae: Epidemiology, genetic context, treatment options, and detection methods. Front Microbiol 2016;7:895.
- 8 Kumarasamy K, Kalyanasundaram A. Emergence of Klebsiella pneumoniae isolate co-producing NDM-1 with KPC-2 from India. J Antimicrob Chemother 2012;67:243-4.
- 9 Shanmugam P, Meenakshisundaram J, Jayaraman P. BlaKPC gene detection in clinical isolates of carbapenem resistant Enterobacteriaceae in a tertiary care hospital. J Clin Diagn Res 2013;7:2736-8.
- 10 Solanki R, Vanjari L, Subramanian S, Aparna B, Nagapriyanka E, Lakshmi V, et al. Comparative evaluation of multiplex PCR and routine laboratory phenotypic methods for detection of carbapenemases among gram negative bacilli. J Clin Diagn Res 2014;8:DC23-6.
- 11 Aseem R, Shenoy S, Mala SS, Baliga S, Ashish A. Approach to carbapenemase detection in Klebsiella pneumoniae in routine diagnostic laboratories. J Clin Diagn Res 2016;10:DC24-7.
- 12 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 25th informational supplement document M100-S25. Wayne: Clinical and Laboratory Standards Institute; 2015.
- 13 Tsakris A, Kristo I, Poulou A, Themeli-Digalaki K, Ikonomidis A, Petropoulou D, et al. Evaluation of boronic acid disk tests for differentiating KPC-possessing Klebsiella pneumoniae isolates in the clinical laboratory. J Clin Microbiol 2009;47:362-7.
- 14 Pérez-Pérez FJ, Hanson ND. Detection of plasmid-mediated AmpC beta-lactamase genes in clinical isolates by using multiplex PCR. J Clin Microbiol 2002;40:2153-62.
- 15 Poirel L, Walsh TR, Cuvillier V, Nordmann P. Multiplex PCR for detection of acquired carbapenemase genes. Diagn Microbiol Infect Dis 2011;70:119-23.
- 16 Hassan MI, Alkharsah KR, Alzahrani AJ, Obeid OE, Khamis AH, Diab A, et al. Detection of extended spectrum beta-lactamases-producing isolates and effect of AmpC overlapping. J Infect Dev Ctries 2013;7:618-29.
- 17 Chen L, Mathema B, Chavda KD, DeLeo FR, Bonomo RA, Kreiswirth BN, et al. Carbapenemase-producing Klebsiella pneumoniae: Molecular and genetic decoding. Trends Microbiol 2014;22:686-96.
- 18 Gupta N, Limbago BM, Patel JB, Kallen AJ. Carbapenem-resistant Enterobacteriaceae: Epidemiology and prevention. Clin Infect Dis 2011;53:60-7.
- 19 Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009;9:228-36.
- 20 Tijet N, Sheth PM, Lastovetska O, Chung C, Patel SN, Melano RG, et al. Molecular characterization of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae in Ontario, Canada, 2008-2011. PLoS One 2014;9:e116421.
- 21 Paul D, Dhar Chanda D, Maurya AP, Mishra S, Chakravarty A, Sharma GD, et al. Co-carriage of blaKPC-2 and blaNDM-1 in clinical isolates of Pseudomonas aeruginosa associated with hospital infections from India. PLoS One 2015;10:e0145823.
- 22 Pournaras S, Poulou A, Tsakris A. Inhibitor-based methods for the detection of KPC carbapenemase-producing Enterobacteriaceae in clinical practice by using boronic acid compounds. J Antimicrob Chemother 2010;65:1319-21.
- 23 Nordmann P, Naas T, Poirel L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011;17:1791-8.