Phenotypic screening and molecular characterization of carbapenemase-producing Gram-negative bacilli recovered from febrile neutropenic pediatric cancer patients in Egypt

• Published in: PloS one 2018-08, Vol.13 (8), p.e0202119-e0202119
• Main Authors: Kamel, Noha A, El-Tayeb, Wafaa N, El-Ansary, Mona R, Mansour, Mohamed T, Aboshanab, Khaled M
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; Bacilli; Bacterial Proteins - genetics; Bacterial Proteins - metabolism; Bacterial Typing Techniques; Bacteriology; beta-Lactamases - genetics; beta-Lactamases - metabolism; Biology and Life Sciences; Cancer; Cancer patients; Cancer therapies; Carbapenemase; Carbapenems; Carbapenems - pharmacology; Care and treatment; Chemotherapy; Chemotherapy-Induced Febrile Neutropenia - microbiology; Child; Childhood cancer; Complications; Development and progression; Drug Resistance, Bacterial; E coli; Egypt; Enzymes; Escherichia coli; Gram-negative bacilli; Gram-negative bacteria; Gram-Negative Bacteria - classification; Gram-Negative Bacteria - drug effects; Gram-Negative Bacteria - genetics; Gram-Negative Bacteria - pathogenicity; Health aspects; Health risks; Health screening; Hospitals; Humans; Identification methods; Immunology; Infections; Infectious diseases; Klebsiella; Laboratories; Leukemia; Medical screening; Medicine and Health Sciences; Methods; Microbiota; Morbidity; Mortality; Multidrug resistance; Neutropenia; Outbreaks; Patients; Pediatrics; Pharmacy; Phenotype; Plasmids; Primers; Public health; Research and Analysis Methods; Risk factors
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0202119

Infections with carbapenem-resistant Gram-negative bacteria (GNB) are among the most frequent complications in the immunocompromised cancer patients because of their considerable morbidity and mortality. Therefore, the aim of the current study was to characterize the prevalence of carbapenemase-producing GNB recovered from febrile neutropenic pediatric cancer patients in Egypt. Standard methods were used for identification, sensitivity testing (Kirby-Bauer and broth microdilution method according to CLSI guidelines). Standard methods were applied for both phenotypic and genotypic detection of the carbapenemase-producing GNB. A total of 185 GNB were recovered from different clinical specimens, Escherichia (E.) coli (86; 46.48%), followed by Klebsiella spp. (71; 38.37%), Acinetobacter (A.) baumannii (7; 3.78%) and others including Pseudomonas spp., Enterobacter (Ent.) cloacae and Proteus spp. (21; 11.35%). It is a matter of concern that 116 out of 171 enterobacterial isolates (94.15%) showed resistance to three or more antimicrobial classes and were considered multidrug resistant. Additionally, the rate of carbapenem-resistance displayed a worrisome trend as 113 out of 171 enterobacterial isolates (66.08%) and 12 out of 14 non fermenting bacilli (85.71%) showed resistance pattern to at least one of the tested carbapenems. After performing a series of phenotypic tests for initial screening of potential carbapenemase producers, molecular characterization to the 29 extracted plasmids were subjected to PCR (using 5 common carbapenemase primers). The results revealed that blaOXA-48 was the most prevalent 17 (58.62%), followed by blaNDM 8(27.58%), then blaVIM 3 (10.3%) and blaKPC 2 (6.89%). These results are an alarming threat to public health that calls for urgent application of antimicrobial stewardship programs along with routine surveillance for controlling outbreaks.