Cefoxitin Resistance In Hypermucoviscous Klebsiella Species Isolated from Patients With Hospital-Acquired Infections In Mansoura University Hospitals

Document Type : New and original researches in the field of Microbiology.

Authors

1 Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

2 Department of Anesthesiology, Intensive Care and Pain Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Abstract

Background: AmpC beta-lactamases have a major role in mediating cefoxitin resistance which is escalating worldwide in pathogenic Klebsiella species. Two main pathogenic models of Klebsiella species are classical Klebsiella species and hypervirulent Klebsiella species. Hypermucoviscous Klebsiella species (hmK) retain the unique characteristic of inflicting intense patterns of infection in both young and immunocompetent individuals. Objectives: The current study aimed to ascertain the risk factors for hmK species acquisition in patients with healthcare-associated infections (HAIs), ascertain the prevalence of cefoxitin-resistant hmK species in patients with HAIs, and compare various phenotypic approaches to PCR for precise cefoxitin resistance detection. Methodology: 67 Klebsiella isolates were identified and classified as non-hmK and hmK phenotypes by string test. The boronic acid assay, Modified three-dimensional test, and AmpC cefoxitin-EDTA test were performed for phenotypic evaluation. Two multiplex PCR assays were performed to evaluate the presence of AmpC genes in hypermucoviscous strains with cefoxitin resistance. Results: In relation to other Klebsiella infections, the prevalence of hmK species was 77.6%. The prevalence of hmK species among HAIs was 46.4%. The prevalence of cefoxitin-resistant hmK species among HAIs was 38.4%. Boronic acid-based assay revealed that 79.1% of the 43 cefoxitin-resistant hmK isolates were positive and 20.9% were negative. Using the MTDT 88.4% were positive and 11.6% were negative. By AmpC cefoxitin-EDTA test 81.4% were positive and 18.6% were negative. Using multiplex PCR, among 43 cefoxitin-resistant hmK isolates, 69.8% carried AmpC genes while 30.2% carried no genes. Conclusions: There is an alarming increase in HAIs caused by hmK species.

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