GENOMIC DETERMINANTS OF RESISTANCE IN EXTENDED SPECTRUM BETA LACTAMASES (ESBLS) KLEBSIELLA PNEUMONIAE ISOLATES OF A TEACHING HOSPITAL IN KLANG VALLEY

Abstract

Intro: The emergence of resistance in Enterobacteriaceae is considered an alarming health threat. During the last decades, many Klebsiella pneumoniae and Escherecia coli have developed resistance against third-generation cephalosporin due to ESBLs. Infectious diseases caused by ESBL-producing Enterobacteriaceae are an emerging problem worldwide, increasing empirical treatment failure, hospital cost, morbidity, and mortality. This also leads to the hospital infection outbreak hence this study was conducted to determine the genomic resistance of extended spectrum beta-lactamases (ESBLs) of Klebsiella pneumoniae isolates of a Teaching Hospital in Klang Valley. Methods: A total of 64 isolates of Klebsiella pneumoniae were collected from the Microbiology Department of the Hospital, the isolates were reconfirmed through an analytical profile index (API) 20E kit. Antibiotic susceptibility profile was determined by the disc diffusion method followed by phenotypic and genotypic detection of ESBLs. Findings: The study revealed that 22(34%) of the 64 isolates were positive for ESBL production and the presence of ESBL genes was high among the positive isolates (77%). The most frequently detected gene of the ESBL among all tested isolates was blaCTXM-15 (77%), followed by blaTEM (68%) and blaSHV (64%). The study revealed that 13(59%) of the isolates carried all the three ESBL genes, 13(59%) of the isolates carried SHV/TEM, 14(64%) carried SHV/CTXM-15 while 15(68%) carried TEM/CTXM-15 but none of the genes was detected in 5(23%) of the isolates. Conclusion: In conclusion, there is a high prevalence of ESBL K. pneumoniae in the study area and therefore, regular surveillance is required in closely monitoring this endemic situation for an epidemiological outbreak of ESBL carrying K. pneumoniae and more restrictions should be applied on beta-lactam antibiotics usage to decrease the emergence of resistant strains.