Evaluation of the Antimicrobial Resistance of Klebsiella pneumoniae by E-Test Method in Khatam_ol_Anbia Hospital, Tehran, Iran, during 2015

Authors
D. Yadegarynia
J. Karimi
S. Rahmati Roodsari
Z. Arab-Mazar
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
Abstract
Background: Gram-negative organisms producing Extended-spectrum beta-lactamases (ESBLs) are presented as a global problem. Klebsiella pneumoniae is considered as one of the most important microorganism of this group. The prevalence rate of K. pneumoniae species is increasing, and this increase is higher in the ESBL group, indicating the increase in antibiotic resistance. We must have sufficient knowledge about regional antibiotics resistance in order to monitor the prevalence rate and antimicrobial resistance among the isolates by appropriate treatment. In this regard, the objective of our study was to evaluate antimicrobial susceptibility among K. pneumoniae isolates by E-test method in Khatam ol Anbia hospital during 2015.
Materials and methods: This descriptive cross-sectional study was carried out during 2015. All clinical samples were collected from intensive care unit (ICU) and general wards of Khatam ol Anbia hospital. All of the K. pneumoniae strains were detected by biochemical and microscopic tests. Antimicrobial susceptibility and minimum inhibitory concentration (MIC) were determined by disk diffusion and E-test methods. Descriptive statistics was used to analyze data.
Results: About 62 K. pneumoniae strains were isolated from clinical samples of ICU and general wards during one year. Of these, 38 (61.3%) isolates were isolated from intensive care unit, and 24 (38.7%) isolates were isolated from the general wards. In this review, the least resistance was related to colistin (4.8%) and Amikacin (14.5%), respectively, and the most resistance was observed to the antibiotics of ciprofloxacin (66.1%), ceftriaxone (62.9%) and gentamicin (59.7%), respectively. Resistance to imipenem was observed in 38.7% of the isolates.
Conclusion: The current study demonstrates that antibiotic resistance pattern is changing, and resistance to imipenem and colistin is rising, so this should be considered as a serious risk for admitted patients in hospital.

Keywords

1.   Holt KE, Wertheim H, Zadoks RN, Baker S, Whitehouse CA, Dance D, et al. Genomic analysis of diversity, population structure, virulence, and antimicrobial resistance in Klebsiella pneumoniae, an urgent threat to public health. Proc Natl Acad Sci USA. 2015;112(27):E3574-E81.
2.   Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev. 1998;11(4):589-603.
3.   Feizabadi MM, Etemadi G, Yadegarinia D, Rahmati M, Shabanpoor S, Bokaei S. Antibiotic-resistance patterns and frequency of extended-spectrum b-lactamase-producing isolates of Klebsiella pneumoniae in Tehran. Med Sci Monit. 2006;12(11):BR362-BR5.
4.   Yigit H, Queenan AM, Anderson GJ, Domenech-Sanchez A, Biddle JW, Steward CD, et al. Novel carbapenem-hydrolyzing β-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother. 2001;45(4):1151-61.
5.   Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis. 2009;9(4):228-36.
6.   Ben‐David D, Kordevani R, Keller N, Tal I, Marzel A, Gal‐Mor O, et al. Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections. Clin Microbiol Infect. 2012;18(1):54-60.
7.   Lin W, Kao C, Yang D, Tseng C, Wu A, Teng C, et al. Clinical and microbiological characteristics of Klebsiella pneumoniae from community-acquired recurrent urinary tract infections. Eur J Clin Microbiol Infect Dis. 2014;33(9):1533-9.
8.   Tu YC, Lu MC, Chiang MK, Lai YC. Genetic requirements for Klebsiella pneumoniae-induced liver abscess in an oral infection model. Infect Immun. 2009;77(7):2657-71.
9.   Kim JK, Chung DR, Wie SH, Yoo JH, Park SW. Risk factor analysis of invasive liver abscess caused by the K1 serotype Klebsiella pneumoniae. Eur J Clin Microbiol Infect Dis. 2009;28(1):109-11.
10. Oelschlaeger TA, Tall BD. Invasion of cultured human epithelial cells by Klebsiella pneumoniae isolated from the urinary tract. Infect Immun. 1997;65(7):2950-8.
11. Forbes BA, Sahm DF, Weissfeld AS. Study guide for Bailey & Scott's Diagnostic Microbiology. 12th edition. Mosby; 2007.
12. Hsueh PR, Ko WC, Wu JJ, Lu JJ, Wang FD, Wu HY, et al. Consensus statement on the adherence to Clinical and Laboratory Standards Institute (CLSI) Antimicrobial Susceptibility Testing Guidelines (CLSI-2010 and CLSI-2010-update) for Enterobacteriaceae in clinical microbiology laboratories in Taiwan. J Microbiol Immunol Infect. 2010;43(5):452-5.
13. Olaitan AO, Diene SM, Kempf M, Berrazeg M, Bakour S, Gupta SK, et al. Worldwide emergence of colistin resistance in Klebsiella pneumoniae from healthy humans and patients in Lao PDR, Thailand, Israel, Nigeria and France owing to inactivation of the PhoP/PhoQ regulator mgrB: an epidemiological and molecular study. Int J Antimicrob Agents. 2014;44(6):500-7.
14. Ah YM, Kim AJ, Lee JY. Colistin resistance in Klebsiella pneumoniae. Int J Antimicrob Agents. 2014;44(1):8-15.
15. Nasehi L, Shahcheraghi F, Nikbin VS, Nematzadeh S. PER, CTX-M, TEM and SHV Beta-lactamases in clinical isolates of Klebsiella pneumoniae isolated from Tehran, Iran. Iran J Basic Med Sci. 2010;13(3):111-8.
16. Won SY, Munoz-Price LS, Lolans K, Hota B, Weinstein RA, Hayden MK. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase–producing Enterobacteriaceae. Clin Infect Dis. 2011;53(6):532-40.
17. Gales AC, Jones RN, Sader HS. Contemporary activity of colistin and polymyxin B against a worldwide collection of Gram-negative pathogens: results from the SENTRY Antimicrobial Surveillance Program (2006–09). J Antimicrob Chemother. 2011;66(9):2070-4.
18. Neonakis I, Samonis G, Messaritakis H, Baritaki S, Georgiladakis A, Maraki S, et al. Resistance status and evolution trends of Klebsiella pneumoniae isolates in a university hospital in Greece: ineffectiveness of carbapenems and increasing resistance to colistin. Chemother. 2010;56(6):448-52.
19. Poudyal A, Howden BP, Bell JM, Gao W, Owen RJ, Turnidge JD, et al. In vitro pharmacodynamics of colistin against multidrug-resistant Klebsiella pneumoniae. J Antimicrob Chemother. 2008;62(6):1311-8.
20. Maalej SM, Meziou MR, Mahjoubi F, Hammami A. Epidemiological study of Enterobacteriaceae resistance to colistin in Sfax (Tunisia). Med Mal infect. 2012;42(6):256-63.
21. Orsi G, Scorzolini L, Franchi C, Mondillo V, Rosa G, Venditti M. Hospital-acquired infection surveillance in a neurosurgical intensive care unit. J Hosp Infect. 2006;64(1):23-9.
22. Azzopardi EA, Azzopardi E, Camilleri L, Villapalos J, Boyce DE, Dziewulski P, et al. Gram negative wound infection in hospitalised adult burn patients-systematic review and metanalysis. PloS One. 2014;9(4):e95042.