Osong Public Health and Research Perspectives

Original Articles

Characterization of Plasmid-Mediated AmpC and Carbapenemases among Iranain Nosocomial Isolates of Klebsiella pneumoniae Using Phenotyping and Genotyping Methods: Alireza Japoni-Nejad, Ehsanollah Ghaznavi-Rad, Alex van Belkum; Osong Public Health Res Perspect. 2014;5(6):333-338. Published online December 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.09.003

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Objectives
Plasmid-mediated AmpC β-lactamases (PMABLs) and carbapenemases are emerging groups of antimicrobial-resistance determinants. The aims of the study were to evaluate the occurrence of PMABLs and carbapenemases in clinical isolates of Klebsiella pneumoniae and compare the test performance of various phenotypic methods for detection of these enzymes in Iran.
Methods
A total of 100 K. pneumoniae isolates were collected from clinical specimens obtained in Valiasr Hospital. AmpC production in all isolates was determined using the AmpC disk test, the cephamycin Hodge test, the AmpC Etest, and the boronic acid combined-disk test. In addition, carbapenemase production was determined using the modified Hodge test, the EDTA disk synergy test, and the boronic acid combined-disk test. The performances of various phenotypic methods were evaluated by the comparison of their results with polymerase chain reaction (PCR) method as the gold standard.
Results
Of the 100 isolates, 19 (19%) were demonstrated to harbor the PMABL-resistance gene by the multiplex PCR method. The PCR result indicated the presence of carbapenemase genes in 12 isolates. The performance of various phenotypic tests carried out for detection of carbapenemase-producing isolates varied widely, ranging in sensitivity from 30% to 100% and in specificity from 90.8% to 100%.
Conclusion
This is the first report of MOX-type AmpC β-lactamase and bla_GES in K. pneumoniae in Iran. A comparison of the phenotypic methods showed that a combination of cefoxitin plus boronic acid is optimal for detecting plasmid-mediated AmpC enzymes in K. pneumoniae, whereas the implementation of molecular methods is often complex, requires specially trained personnel, and is associated with higher costs.

Citations

Citations to this article as recorded by

The Global and Regional Prevalence of Hospital-Acquired Carbapenem-Resistant Klebsiella pneumoniae Infection: A Systematic Review and Meta-analysis
Xing-chen Lin, Chang-li Li, Shao-yang Zhang, Xiao-feng Yang, Meng Jiang
Open Forum Infectious Diseases.2024;[Epub] CrossRef
High frequency of NDM-1 and OXA-48 carbapenemase genes among Klebsiella pneumoniae isolates in central Iran
Elnaz Abbasi, Ehsanollah Ghaznavi-Rad
BMC Microbiology.2023;[Epub] CrossRef
Detection of ESBL and AmpC producing Klebsiella pneumoniae ST11 and ST147 from urinary tract infections in Iran
Shaghayegh Shahkolahi, Pegah Shakibnia, Shahla Shahbazi, Samira Sabzi, Farzad Badmasti, Mohammad Reza Asadi Karam, Mehri Habibi
Acta Microbiologica et Immunologica Hungarica.2022;[Epub] CrossRef
Plasmid-mediated AmpC β-Lactamase gene analysis in Klebsiella Pneumoniae clinical isolates
Nabi Jomehzadeh, Khadijeh Ahmadi, Hasti Shaabaninejad, Gholamali Eslami
Biomedical and Biotechnology Research Journal (BBR.2022; 6(4): 582. CrossRef
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Roya Ghanavati, Hossein Kazemian, Parisa Asadollahi , Hamid Heidari, Gholamreza Irajian, Fatemeh Navab-Moghadam, Shabnam Razavi
Infectious Disorders - Drug Targets .2021; 21(1): 119. CrossRef
An investigation of extended-spectrum β-lactamases (ESBLs) in Klebsiella isolated from foodborne outbreaks in Iran
Farnaz Hajikarim, Mohammad Mehdi Soltan Dallal, Mohammad Reza Pourmand, Milad Abdi
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Prevalence and Mechanisms of Carbapenem Resistance in Klebsiella pneumoniae and Escherichia coli: A Systematic Review and Meta-Analysis of Cross-Sectional Studies from Iran
Mohammad Javad Nasiri, Mehdi Mirsaeidi, Seyyed Mohammad Javad Mousavi, Mania Arshadi, Fatemeh Fardsanei, Behnaz Deihim, Sara Davoudabadi, Samin Zamani, Bahareh Hajikhani, Hossein Goudarzi, Mehdi Goudarzi, Zahra Sadat Seghatoleslami, Hossein Dabiri, Payam
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Mohammad Reza Sadeghi, Reza Ghotaslou, Mohammad Taghi Akhi, Mohammad Asgharzadeh, Alka Hasani
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High Prevalence of AmpC β-Lactamases in Clinical Isolates of Escherichia coli in Ilam, Iran
Abbas Maleki, Afra Khosravi, Sobhan Ghafourian, Iraj Pakzad, Shiva Hosseini, Rashid Ramazanzadeh, Nourkhoda Sadeghifard
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High Prevalence of Class 1 to 3 Integrons Among Multidrug-Resistant Diarrheagenic Escherichia coli in Southwest of Iran: Mohammad Kargar, Zahra Mohammadalipour, Abbas Doosti, Shahrokh Lorzadeh, Alireza Japoni-Nejad; Osong Public Health Res Perspect. 2014;5(4):193-198. Published online August 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.06.003

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Abstract PDF

Objectives
Horizontal transfer of integrons is one of the important factors that can contribute to the occurrence of multidrug-resistant (MDR) bacteria. This study aimed to determine the prevalence of integrons among MDR Escherichia coli strains isolated from stool specimens and investigate the associations between the existence of integrons and MDR properties in the southwest of Iran.
Methods
There were 164 E. coli strains isolated from January 2012 to June 2012. Fecal specimens identified as E. coli by the conventional methods. Subsequently the antibiotic resistance was assessed using Clinical and Laboratory Standard Institute criteria. The presence of class 1–3 integrons and embedded gene cassettes was verified using specific primers by multiplex polymerase chain reaction assay.
Results
Among a total of 164 studied samples, 69 (42.07%) isolates were multidrug resistant. Class 1 and class 2 integrons were present in 78.26% and 76.81% MDR isolates, respectively. For the first time in Iran, class 3 integron was observed in 26.09% MDR isolates. Significant correlations were identified between: class 1 integron and resistance to amikacin, gentamicin, chloramphenicol, ampicillin, tetracycline, nalidixic acid, and co-trimoxazole; class 2 integron and resistance to aminoglycosides, co-trimoxazole, cefalexin, ampicillin, and chloramphenicol; and class 3 integron and resistance to gentamicin, kanamycin, and streptomycin.
Conclusion
Our results indicate that integrons are common among MDR isolates and they can be used as a marker for the identification of MDR isolates. Therefore, due to the possibility of a widespread outbreak of MDR isolates, molecular surveillance and sequencing of the integrons in other parts of the country is recommended.

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