Molecular epidemiology of carbapenem resistant Enterobacteriaceae in Sri Lanka: First report of KPC-producing Klebsiella pneumoniae [post]

2019 unpublished
Extended spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE) and carbapenamase producing Enterocacteriaceae (CPE) are widely disseminated globally creating a huge public health threat. Even though incidence of multidrug-resistant Enterobacteriaceae is rapidly growing, the epidemiological data regarding the occurrence of CRE in Sri Lanka is scarce. In this study, we determined the prevalence of ESBP-PE and CRE and the genetic determinants of CPE. Methods A total of 593 clinically
more » ... clinically significant Enterobacteriaceae was isolated from different clinical samples (urine, pus/wound, respiratory, blood, and other sterile specimens) at a tertiary care hospital in Sri Lanka from December 2017 -February 2018. Antimicrobial susceptibility and identification of ESBL-PE, CRE were done by disc diffusion method. CRE were identified to species level using a rapid identification kit and carbapenemase production was determined by modified carbapenem inactivation method. The presence of blaKPC, blaNDM, blaOXA-48-like genes were detected by PCR. Results The overall prevalence of ESBL-PE and CRE were found to be 26.0% and 9.6%, respectively. The rate of ESBL-PE in different sample types ranged from 18.2% to 30.8% with the highest prevalence among uropathogenic Enterobacteriaceae. The occurrence of CRE ranged from 6.7% to 20.8% with the highest prevalence among respiratory Enterobacteriaceae. CRE species identified were K. pneumoniae (80.7%), E. coli (5.3%), C. freundii (7.0%), P. rettgeri (3.5%), E. cloacae (1.7%), and E. aerogenes (1.7%). The carbapenemase production was detected in 94.7% of CRE isolates. The carbapenemases found were OXA-48-like (88.9%), NDM (14.8%), and KPC (3.7%). Conclusions The prevalence of CRE in Sri Lanka is alarming. Carbapenamse production was the major mechanism of carbapenem resistance and K. pneumoniae was the predominant CRE. Presence of KPC enzyme was detected in addition to the previously reported NDM and OXA-48-like carbapenamases in Sri Lanka. The rapid spread of CPE, necessitates the prompt implementation of preventive measures in
doi:10.21203/rs.2.9753/v1 fatcat:2dkfavl6lbdcjfmhm5hlp67jvq