Dissemination of blaOXA-48 like, blaNDM, blaKPC, blaIMP-1, blaVIM genes among carbapenem-resistant Escherichia coli and Klebsiella pneumoniae strains in Southeastern Turkey: first report of Klebsiella pneumoniae co-producing blaOXA-48-like, blaVIM and blaIMP-1 genes

Introduction: Carbapenem-resistant Enterobacterales (CRE) cause serious and life-threatening infections with limited treatment options. The most common causes of carbapenem resistance are carbapenemases. We aimed to determine the most prevalent carbapenemase genes; blaNDM, blaKPC, blaIMP-1, blaVIM, blaOXA-48 like genes among Klebsiella pneumoniae and Escherichia coli strains in the southeast region of Turkey. Methods: Eighty-nine isolates (74 K. pneumoniae, 15 E. coli) were included in the study. The isolates were found as carbapenem-resistant by BD Phoenix automated system and Kirby Bauer disk diffusion test. Antibiotic susceptibility testing was performed by BD Phoenix automated system. Combination disc method (CDM) was also carried out as phenotypic method of carbapenemase detection. The presence of blaNDM, blaKPC, blaIMP-1, blaVIM and blaOXA-48-like genes were investigated by Xpert CARBA-R (Cepheid, USA) multiplex PCR commercial system. Results: Antibiotic resistance rates by Phoenix were 48.3 97.8, 80.9, 96.6, 93.3, 96.6, 97.8, 69.7 and 97.8% for amikacin, aztreonam, cefepime, ceftazidime, ciprofloxacin, levofloxacin, moxifloxacin, trimethoprim sulfamethoxazole and piperacillin-tazobactam, respectively. The blaOXA-48-like gene was detected in 65 (73%); blaNDM gene in 4 (4.5%); co-production of blaOXA-48-like and blaNDM in 6 (6.7%); co-production of blaOXA-48-like, blaVIM and blaIMP-1 genes in 1(1.2%) isolate. None of the blaOXA-48-like, blaNDM, blaVIM, blaIMP-1, blaKPC genes were detected in 13 (14.6%) of the isolates. The sensitivity and specificity of CDM were calculated as 80 and 85% respectively. Conclusion: We detected blaOXA-48-like gene most frequently in our region. To our knowledge, this is the first report of K. pneumoniae-co-producing blaOXA-48-like, blaVIM and blaIMP-1 genes. The coexistence of these genes is alarming and causes both infection control and treatment problems. Effective infection control measures are essential to prevent the spread of antibiotic resistance.