Multiple ambler class A ESBL genes among Klebsiella pneumoniae isolates in a Malaysian district hospital

U Mohd Helmi; M N Mohd Desa; N M Taib; T Z M Tengku Jamaluddin; S N Masri

Multiple ambler class A ESBL genes among Klebsiella pneumoniae isolates in a Malaysian district hospital

Trop Biomed. 2016 Mar 1;33(1):109-119.

Authors

U Mohd Helmi¹, M N Mohd Desa^{2

3}, N M Taib¹, T Z M Tengku Jamaluddin¹, S N Masri¹

Affiliations

¹ Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.
² Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.
³ Department of Pathology, Sultanah Fatimah Specialist Hospital, Johor, Malaysia.

PMID: 33579148

Abstract

Detailed reports regarding the distribution and activity of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae isolates are currently not widely available in the Malaysian setting. This study was conducted to determine the ESBL genes distribution rate, phenotypic detection, and antimicrobial susceptibility patterns among betalactam resistant Klebsiella pneumoniae isolated from a Malaysian district hospital. K. pneumoniae isolates were collected from a microbiology laboratory at Hospital Pakar Sultanah Fatimah, Malaysia. Following exclusion and inclusion criteria, 141 isolates were selected for this study. K. pneumoniae was identified by phenotypic method, whilst antibiotics' susceptibility patterns were determined by the Kirby-Bauer method, as described in Clinical Laboratory Standard Institute (CLSI) guidelines (Oxoid, UK; Becton-Dickenson, USA). Detection of Ambler Group A ESBL gene (bla_SHV, bla_TEM, bla_CTX-M-1, bla_CTX-M-2, bla_CTX-M-8, bla_CTX-M-9, and bla_CTX-M-25) was done using polymerase chain reaction (PCR). ESBL genes were found in 85.8% of K. pneumoniae (121 of 141) isolates. Only bla_SHV, bla_TEM, bla_CTX-M-1, and bla_CTX-M-9 were detected among K. pneumoniae isolates with distribution rates of 75.2% (106 of 141), 41.1% (58 of 141), 44% (62 of 141), and 0.7% (1 of 141), respectively. There was no bla_CTX-M-2, bla_CTX-M-8, or bla_CTX-M-25 detected from any isolates in this study. Sequencing of representative amplicons revealed bla_SHV as SHV-12, bla_TEM as TEM-1, bla_CTX-M-1 as CTX-M-15, and bla_CTX-M-9 as CTX-M-18. The phenotypic detection rate of ESBL was 71.6% (101 of 141), whilst 9.2% (13 of 141) were positive for carbapenemase. AmpC betalactamase was detected in 22% (31 of 141) of all isolates. Antibiotic resistance was between 44.6% (netilmicin) and 97.2% (cefotaxime). Based on ESBL genes distribution, blaSHV was a predominant gene found in one of Malaysian district hospitals, notwithstanding having bla_TEM, bla_CTX-M-1, and bla_CTX-M-9. Despite carrying multiple ESBL genes, some strains were positive for carbapenemase or AmpC betalactamase, which resulted in high antimicrobial resistance rates.