1887

Abstract

Multidrug-resistant is a common nosocomial pathogen that plays an important role in ventilator-associated pneumonia (VAP). This study aimed to define the clonal relatedness of strains isolated from paediatric VAP in addition to those isolated from environmental samples.

This study included 19 clinical and 4 environmental isolates recovered from the paediatric intensive care unit (PICU) in Assiut University Children's Hospital. The isolates were confirmed by biotyping using API strips and subjected to antimicrobial susceptibility testing. The genes coding K1 and K2 capsular types were detected by PCR. The clonal relationships between the isolates were determined by pulsed-field gel electrophoresis (PFGE).

Ten resistotypes were detected among all the isolates, while PFGE identified seventeen pulsotypes. Similar PFGE patterns were found between environmental and clinical isolates and between isolates recovered from different patients, suggesting the circulation of pathogens in the PICU and the role of the environment in the spread of infection. No correlation was found between the resistotypes and pulsotypes of the isolates. PFGE showed higher discriminatory power for the typing of nosocomial [Simpson’s diversity index (DI)=0.96] than resistotyping (DI=0.72).

As far as we know, this is the first report of the isolation of the same multidrug-resistant (MDR) pulsotype from patients and environmental samples in the same hospital ward in Egypt. This study provides a step on the way to understanding the genotyping and epidemiology of MDR for enhanced prevention of bacterial transmission.

Keyword(s): clonal relatedness , PFGE and VAP
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2017-05-01
2019-12-13
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References

  1. Geffers C, Baerwolff S, Schwab F, Gastmeier P. Incidence of healthcare-associated infections in high-risk neonates: results from the German surveillance system for very-low-birthweight infants. J Hosp Infect 2008;68:214–221 [CrossRef][PubMed]
    [Google Scholar]
  2. Deng C, Li X, Zou Y, Wang J, Wang J et al. Risk factors and pathogen profile of ventilator-associated pneumonia in a neonatal intensive care unit in China. Pediat Intl 2011;53:332–337 [CrossRef]
    [Google Scholar]
  3. Fathy A, Abdelhafeez R, El-Gilany AH, Elhafez SA. Analysis of ventilator associated pneumonia (VAP) studies in Egyptian university hospitals. Egyptian Egypt J Chest Dis Tuberculosis 2013;62:17–25 [CrossRef]
    [Google Scholar]
  4. Berezin EN, Solórzano F. Gram-negative infections in pediatric and neonatal intensive care units of Latin America. J Infec Dev Count 2014;8:942–953 [CrossRef][PubMed]
    [Google Scholar]
  5. Mohamed E, Nasser M, El-Maraghy N, Azab K. Pattern of hospital-acquired pneumonia in intensive care unit of Suez Canal University hospital. Egypt J Chest Dis Tuberculosis 2015;64:625–631[CrossRef]
    [Google Scholar]
  6. Khattab AA, El-Lahony DM, Soliman WF. Ventilator-associated pneumonia in the neonatal intensive care unit. Men Med J 2014;27:73–78[CrossRef]
    [Google Scholar]
  7. Azab SFA, Sherbiny HS, Saleh SH, Elsaeed WF, Elshafiey MM et al. Reducing ventilator-associated pneumonia in neonatal intensive care unit using ‘VAP prevention Bundle’: a cohort study. BMC Infect Dis 2015;15:314–320 [CrossRef]
    [Google Scholar]
  8. Marra AR, Wey SB, Castelo A, Gales AC, Cal RGR et al. Nosocomial bloodstream infections caused by Klebsiella pneumoniae: impact of extended-spectrum β-lactamase (ESBL) production on clinical outcome in a hospital with high ESBL prevalence. BMC Infect Dis 2006;6:24–31 [CrossRef]
    [Google Scholar]
  9. Kang JH, Bae IK, Kwon SB, Jeong SH, Lee J et al. Prevalence of Ambler class A extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates in Korea. Kor J Clin Microbiol 2005;8:17–25
    [Google Scholar]
  10. Lin J, Chang F, Fung C, Xu J, Cheng H et al. High prevalence of phagocytic-resistant capsular serotypes of Klebsiella pneumoniae in liver abscess. Microbes Infect 2004;6:1191–1198 [CrossRef]
    [Google Scholar]
  11. Turton JF, Baklan H, Siu LK, Kaufmann ME, Pitt TL. Evaluation of a multiplex PCR for detection of serotypes K1, K2 and K5 in Klebsiella sp. and comparison of isolates within these serotypes. FEMS Microbiol Lett 2008;284:247–252 [CrossRef]
    [Google Scholar]
  12. Shon AS, Russo TA. Hypervirulent Klebsiella pneumoniae: the next superbug?. Future Microbiol 2012;7:669–671 [CrossRef]
    [Google Scholar]
  13. Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. J Clin Microbiol Rev 1998;11:589–603
    [Google Scholar]
  14. Graffunder EM, Preston KE, Evans AM, Venezia RA. Risk factors associated with extended-spectrum beta-lactamase-producing organisms at a tertiary care hospital. J Antimicrob Chemoth 2005;56:139–145 [CrossRef]
    [Google Scholar]
  15. Christian NA, Roye-Green K, Smikle M. Molecular epidemiology of multidrug resistant extended spectrum beta-lactamase producing Klebsiella pneumoniae at a Jamaican hospital, 2000–2004. BMC Microbiol 2010;10:27–34 [CrossRef]
    [Google Scholar]
  16. Sękowska A, Eugenia G, Dorota K. Antimicrobial susceptibility and genetic similarity of ESBL-positive Klebsiella pneumoniae strains. Arch Med Sci 2012;8:993–997[CrossRef]
    [Google Scholar]
  17. Berrazeg M, Diene SM, Drissi M, Kempf M, Richet H et al. Biotyping of multidrug-resistant Klebsiella pneumoniae clinical isolates from France and Algeria using MALDI-TOF MS. PLoS One 2013;8:e61428 [CrossRef]
    [Google Scholar]
  18. Sechter I, Mestre F, Hansen DS. Twenty-three years of Klebsiella phage typing: a review of phage typing of 12 clusters of nosocomial infections, and a comparison of phage typing with K serotyping. Clin Microbiol Infect 2000;6:233–238 [CrossRef]
    [Google Scholar]
  19. Chuang YP, Fang CT, Lai SY, Chang SC, Wang JT. Genetic determinants of capsular serotype K1 of Klebsiella pneumoniae causing primary pyogenic liver abscess. J Infect Dis 2006;193:645–654 [CrossRef][PubMed]
    [Google Scholar]
  20. Bagattini M, Crivaro V, Di Popolo A, Gentile F, Scarcella A et al. Molecular epidemiology of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit. J Antimicrob Chemoth 2006;57:979–982 [CrossRef]
    [Google Scholar]
  21. Ben-Hamouda T, Foulon T, Ben-Cheikh-Masmoudi A, Fendri C, Belhadj O et al. Molecular epidemiology of an outbreak of multiresistant Klebsiella pneumoniae in a Tunisian neonatal ward. J Med Microbiol 2003;52:427–433 [CrossRef][PubMed]
    [Google Scholar]
  22. Goering RV. Pulsed field gel electrophoresis: a review of application and interpretation in the molecular epidemiology of infectious disease. Infect Genet Evol 2010;10:866–875 [CrossRef]
    [Google Scholar]
  23. Lanini S, D'Arezzo S, Puro V, Martini L, Imperi F et al. Molecular epidemiology of a Pseudomonas aeruginosa hospital outbreak driven by a contaminated disinfectant-soap dispenser. PLoS One 2011;6:e17064 [CrossRef]
    [Google Scholar]
  24. Guo C, Yang X, Wu Y, Yang H, Han Y et al. MLST-based inference of genetic diversity and population structure of clinical Klebsiella pneumoniae, China. Sci Rep 2015;5:1–6
    [Google Scholar]
  25. Centers for Disease Control/National Healthcare Safety Network, 25-/NHSN 2015; Pneumonia (ventilator-associated [VAP] and non-ventilator-associated pneumonia [PNEU]) event. http://www.cdc.gov/ nhsn/PDFs/ pscManual/ 6pscVAPcurrent.pdf
  26. Clinical and Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement M100-S24 Wayne, PA: CLSI; 2015
    [Google Scholar]
  27. Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL et al. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis 2007;45:284–293 [CrossRef]
    [Google Scholar]
  28. Centers for Disease Control and Prevention (CDC) 2013; Standard operating procedure for PulseNet PFGE of Escherichia coli O157 : H7, Escherichia coli non-O157 (STEC), Salmonella serotypes, Shigella sonnei and Shigella flexneri. http://www.cdc.gov/pulsenet/PDF/ecoli-shigella-salmonella-pfge-protocol-508c.pdf
  29. Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2339[PubMed]
    [Google Scholar]
  30. Hunter PR, Gaston MA. Numerical index of the discriminatory ability of typing systems: an application of Simpson’s index of diversity. J Clin Microbiol 1998;26:2465–2466
    [Google Scholar]
  31. Tullu MS, Deshmukh CT, Baveja SM. Bacterial nosocomial pneumonia in paediatric intensive care unit. J Postgrad Med 2000;46:18–22
    [Google Scholar]
  32. Foglia E, Meier MD, Elward A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev 2007;20:409–425 [CrossRef]
    [Google Scholar]
  33. Maltezou HC, Kontopidou F, Katerelos P, Daikos G, Roilides E et al. Infections caused by carbapenem-resistant Gram-negative pathogens in hospitalized children. Pediatr Infect Dis J 2013;32:e151–e154 [CrossRef]
    [Google Scholar]
  34. Badr M, Ali Y, Albanna E, Beshir M, Amr G. Ventilator associated pneumonia in critically-ill neonates admitted to neonatal intensive care unit, Zagazig University hospitals. Iran J Pediat 2011;21:418–424
    [Google Scholar]
  35. Fang CT, Chuang YP, Shun CT, Chang SC, Wang JT. A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exp Med 2004;199:697–705 [CrossRef]
    [Google Scholar]
  36. Lin YT, Wang FD, Chan YJ, Fu YC, Fung CP. Clinical and microbiological characteristics of tigecycline non-susceptible Klebsiella pneumoniaebacteremia in Taiwan. BMC Infect Dis 2014;14:1–8 [CrossRef]
    [Google Scholar]
  37. Aitta AA, El Said M, Gamal D, El-Kholy A, Omer M et al. Biotyping and molecular characterization of Klebsiella pneumoniae producing extended-spectrum beta-lactamase in Cairo, Egypt: a multicenter study. Researcher 2013;5:1–11
    [Google Scholar]
  38. El Kholy AA, Gomma HE, Younan MA, Thabet EH, Haleim MMA et al. Extended spectrum β-lactamase-producing Klebsiella pneumoniae and Escherichia coli strains in a pediatric teaching hospital in Egypt. Med Res J 2011;10:27–31 [CrossRef]
    [Google Scholar]
  39. Yu F, Ying Q, Chen C, Li T, Ding B et al. Outbreak of pulmonary infection caused by Klebsiella pneumoniae isolates harbouring blaIMP-4 and blaDHA-1 in a neonatal intensive care unit in China. J Med Microbiol 2012;61:984–989 [CrossRef]
    [Google Scholar]
  40. Paulin-Curlee GG, Singer RS, Sreevatsan S, Isaacson R, Reneau J et al. Genetic diversity of mastitis-associated Klebsiella pneumoniae in dairy cows. J Dairy Sci 2007;90:3681–3689 [CrossRef]
    [Google Scholar]
  41. Dashti AA, Jadaon MM, Gomaa HH, Noronha B, Udo EE. Transmission of a Klebsiella pneumoniae clone harbouring genes for CTX-M-15-like and SHV-112 enzymes in a neonatal intensive care unit of a Kuwaiti hospital. J Med Microbiol 2010;59:687–692 [CrossRef]
    [Google Scholar]
  42. Coque TM, Oliver A, Perez-Diaz JC, Baquero F, Canton R. Genes encoding TEM-4, SHV-2, and CTX-M-10 extended-spectrum β-lactamases are carried by multiple Klebsiella pneumoniae clones in a single hospital (Madrid, 1989 to 2000). Antimicrob Agents Chemother 2002;46:500–510 [CrossRef]
    [Google Scholar]
  43. Dancer SJ. The role of environmental cleaning in the control of hospital-acquired infection. J Hosp Infect 2009;73:378–385 [CrossRef]
    [Google Scholar]
  44. Otter JA, Yezli S, French GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Cont Hospt Epidemiol 2011;32:687–699 [CrossRef]
    [Google Scholar]
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