Prevalence of carbapenemase-producing <i>Klebsiella pneumonia</i> in Gomel Region of Belarus and their sensitivity to antibiotics, antibiotic combinations, and decontaminants

Abstract

Here, we characterized in public health organizations prevalence of carbapenemase-producing Klebsiella pneumoniae, sensitivity to antimicrobial agents (AMAs), combined antimicrobial agents, and decontaminants. For this, there were selected 58 clinical isolates of K. pneumoniae resistant to carbapenems and/or polymyxins and examined within the microbiological monitoring program. Genes encoding KPC, OXA-48, VIM, IMP, NDM carbapenemases were detected by real-time multiplex PCR. Sensitivity to antimicrobial agents was determined by an automated method on a microbiological VITEK-2 Compact analyzer (bioMérieux, France) and by serial broth microdilution method. Sensitivity to 11 dual antimicrobial agent combinations was determined by a modified method of multiple combination bactericidal antibiotic testing. As a part of combinations, AMAs at pharmacokinetic/pharmacodynamics (PK/PD) threshold concentrations (meropenem — 8 μg/ml, amikacin — 16 μg/ml, levofloxacin — 1 μg/ml, tigecycline — 0.5 μg/ml, phosphomycin — 32 μg/ml, colistin — 2 μg/ml) were tested. Susceptibility to 7 combined decontaminants of different composition was determined by the suspension method. Carbapenemase genes were detected in 22 K. pneumoniae clinical isolates, of which 19 isolates contained a blaOXA-48 gene and 3 isolates — gene blaNDM. Carbapenemase producing K. pneumoniae were identified in 10 Gomel public health organizations and five regional centers of the Gomel region. The majority of such strains were isolated from patients in ICU (63.6%) and surgical departments (27.3%). Tigecycline (100% of the sensitive isolates, МIC50 — 1 μg/ml, MIC90 — 1 μg/ml) and colistin (86.4% of the sensitive isolates, МIC50 — 0.5 μg/ml, MIC90 — 4 μg/ml) exhibited the highest activity against carbapenemase-producing K. pneumoniae, whereas aminopenicillins, cephalosporins, aztreonam, aminoglycosides, fluoroquinolones, chloramphenicol (no sensitive isolates) had exhibited the lowest efficacy. Bactericidal activity of all antibiotic combinations containing colistin was shown against 86.4–95.5% of K. pneumoniae isolates. At least 3 distinct combinations of antimicrobial agents with bactericidal activity were efficient against 21 K. pneumoniae isolates (95.5%). Only 1 bactericidal combination (meropenem–amikacin) was unveiled for one isolate (producer of NDM MBL with MIC of colistin 32 μg/ml). Geksadekon, duacid, oksidez, hlorocid and diajsid exerted a bactericidal effect at 1/4 work dose against all isolates. Duacid, oksidez, hlorocid and diajsid showed bactericidal effect at 1/16 work dose against 95.5–100% isolates. Thus, several decontaminant groups (oxidizing agents, chlorine-containing preparations) were characterized by bactericidal activity against multidrug-resistant and extremely drug-resistant of K. pneumoniae even at 4–16 times lower than recommended concentration.

Keywords

• klebsiella pneumoniae
• antimicrobial resistance
• carbapenemase
• polymyxins
• combinations of antibiotics
• disinfectants