Detection of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli Recovered from Clinical Specimens in Erbil City Kurdistan Region of Iraq

Abstract

Background: Carbapenems are usually the choice of antimicrobial agents in infections produced by Enterobacteriaceae bacteria-producing ESBL (extended spectrum β-lactamases). Carbapenemase production among clinical isolates of Enterobacteriaceae has been widely reported and Resistance to carbapenems group is generally due to production of Carbapenemases. Phenotypic determination and distinction of Carbapenemases in drug-resistant gram-negative is crucial for appropriate infection control. Materials and Methods: Carbapenemase production among Enterobacteriaceae isolates was identified phenotypically using a commercially available EDTA-combined disc diffusion test containing inhibitors to the various carbapenemase classes and Modified Hodge test (MHT). Results: A total of 98 Enterobacteriaceae isolates were included, 42(42.8%) were Multi-drug resistant (MDR), 27(27.5%) were XDR while 8(8.2%) exhibited pan-drug resistance (PDR). Of the 74 isolates of Escherichia coli and 24 Klebsiella pneumoniae that were positive for carbapenemase production, 12 (16.2%) and 9 (37.5%) were Metallo beta-lactamase (MBL) producers respectively, Hence, the overall prevalence of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in this study were 47.3% and 87.5%. Conclusion: Carbapenemase-producing Enterobacteriaceae was indeed recognized in our hospitals. The EDTA-combination disk test was a rapid, cost-effective and suitable method which will be able to identify and distinguish the carbapenem-resistant bacterial isolates within the hospitals especially when molecular detection techniques are not available.

Keywords

• Carbapenemase, Escherichia coli, EDTA-combination disk test, Klebsiella pneumoniae, Modified Hodge test, Multi-drug resistant.