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. 2021 Jan 15:11:612020.
doi: 10.3389/fmicb.2020.612020. eCollection 2020.

Characteristics of Carbapenemase-Producing Klebsiella pneumoniae Isolated in the Intensive Care Unit of the Largest Tertiary Hospital in Bangladesh

Takashi Okanda  1   2   3 , Anwarul Haque  3 , Takuro Koshikawa  2 , Amirul Islam  4 , Qumrul Huda  4 , Hiromu Takemura  2 , Tetsuya Matsumoto  3 , Shigeki Nakamura  1
Affiliations

Characteristics of Carbapenemase-Producing Klebsiella pneumoniae Isolated in the Intensive Care Unit of the Largest Tertiary Hospital in Bangladesh

Takashi Okanda et al. Front Microbiol. .

Abstract

For addressing the issue of antimicrobial drug resistance in developing countries, it is important to investigate the characteristics of carbapenemase-producing organisms. We aimed to genetically characterize a carbapenemase-producing Klebsiella pneumoniae (CPKP) isolated in the intensive care unit of a tertiary hospital in Bangladesh. The number of CPKP isolates were 43/145 (30%), of which pandrug-resistant (PDR) strains were 14%. These carbapenemases were New Delhi metallo-beta-lactamase (NDM)-1 (53%), NDM-5 (14%), oxacillinase (OXA)-181 (12%), OXA-232 (10%), NDM-5 + OXA-181 (5%), and NDM-5 + OXA-232 (2%). Many CPKP isolates harbored a variety of resistance genes, and the prevalence of 16S rRNA methyltransferase was particularly high (91%). The 43 CPKP isolates were classified into 14 different sequence types (STs), and the common STs were ST34 (26%), ST147 (16%), ST11 (9%), ST14 (9%), ST25 (7%), and ST231 (7%). In this study, PDR strains were of three types, ST147, ST231, and ST14, and their PDR rates were 57, 33, and 25%, respectively. The spread of the antimicrobial drug resistance of CPKP in Bangladesh was identified. In particular, the emergence of PDR is problem, and there may be its spread as a superbug of antimicrobial treatment.

Keywords: NDM-1; NDM-5; OXA-181; OXA-232; PDR; ST147.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Genetic and antibiogram profiles of 43 carbapenemase-producing Klebsiella pneumoniae isolates. A similarity coefficient of 80% was selected to define the clusters after reviewing the epidemiological data associated with each of the clusters of isolates. The presence or absence of plasmid-mediated antimicrobial resistance genes is indicated by black filled square or gray filled square, respectively. Antimicrobial susceptibility: susceptible (S) and resistant/intermediate (–). TZP, piperacillin/tazobactam; FEP, cefepime; CMZ, cefmetazole; MOX, moxalactam; FOX, flomoxef; ATM, aztreonam; IPM, imipenem; MEM, meropenem; DOR, doripenem; BPM, biapenem; CST, colistin; GEN, gentamicin; AMK, amikacin; MIN, minocycline; TGC, tigecycline; CIP, ciprofloxacin; LVX, levofloxacin; FOF, fosfomycin; SXT, trimethoprim/sulfamethoxazole.
FIGURE 2
FIGURE 2
Changes in the number of detected resistance genes. (A) Extended-spectrum β-lactamases (ESBLs)-, plasmid-mediated AmpC β-lactamase (PABLs)-, and carbapenemase-producing genes. (B) 16S rRNA methyltransferase- and tetracycline resistance protein-producing genes. (C) Plasmid-mediated quinolone resistance and fosfomycin resistance genes. (D) Sulfonamide resistance genes and dihydrofolate reductase encoding genes.
FIGURE 3
FIGURE 3
Classification of multidrug resistance type of each STs.
See this image and copyright information in PMC

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