Investigation of blaKPC Gene by PCR in Carbapenem-Resistant Escherichia coli and Klebsiella pneumoniae Clinical Isolates in a Tertiary Care Hospital in Turkey

Abstract

Introduction: One of the most common mechanisms in the development of carbapenem resistance is acquiring carbapenemases. A new and different carbapenemase, Klebsiella pneumoniae carbapenemase (KPC), has recently emerged in Turkey. Klebsiella pneumoniae carbapenemases are encoded by the blaKPC gene and can be transferred between different species. Reports showing the presence of blaKPC gene in isolates from Turkey are limited. The current study aimed to investigate the presence of blaKPC gene in carbapenem resistant K. pneumoniae and Escherichia coli isolates in a tertiary care hospital in Turkey. Materials and Methods: Patient samples from various clinical units in Adana Numune Training and Research Hospital between November 2013 and October 2014 were sent to our laboratory at the same hospital. K. pneumoniae and E. coli strains isolated from different clinical samples were identified using both conventional methods and the VITEK® 2.0 automated identification system (bioMérieux, France). Imipenem-cilastatin, meropenem, and ertapenem susceptibility was analyzed using a VITEK® 2.0 antibiotic susceptibility testing system (bioMérieux, France). The presence of blaKPC gene was investigated by polymerase chain reaction. Results: A total of 49 resistant K. pneumoniae and 33 E. coli isolates were included in the study. Most were isolated from urine specimens. Among the carbapenems we tested, highest resistance rates were to ertapenem (98.0% in K. pneumoniae and 84.8% in E. coli isolates). One K. pneumoniae isolate was found positive for the blaKPC gene. Conclusion: According to our literature survey, this study is among the first reports from Turkey presenting the isolation of KPC-producing K. pneumoniae. This finding indicates the need to monitor carbapenem resistance arising from blaKPC, which may spread horizontally. Moreover, surveillance of antibiotic sensitivity rates and observation of regional differences will be useful guidelines in determining infection control and antimicrobial use management policies.

Keywords

• carbapenemase
• blakpc gene
• molecular epidemiology
• urinary tract infection
• modified hodge test