Dissemination of bla OXA-48 like, bla NDM, bla KPC , bla IMP-1, bla VIM genes among carbapenem-resistant Escherichia coli and Klebsiella pneumoniae strains in Southeastern Turkey: first report of Klebsiella pneumoniae co-producing bla OXA-48-like, bla VIM

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; bla NDM , bla KPC , bla IMP-1, bla VIM , bla OXA-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 bla NDM , bla KPC , bla IMP-1, bla VIM and bla OXA-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 bla OXA-48-like gene was detected in 65 (73%); bla NDM gene in 4 (4.5%); co-production of bla OXA-48-like and bla NDM in 6 (6.7%); co-production of bla OXA-48-like, bla VIM and bla IMP-1 genes in 1(1.2%) isolate. None of the bla OXA-48-like, bla NDM , bla VIM , bla IMP-1, bla KPC 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 bla OXA-48-like gene most frequently in our region. To our knowledge, this is the first report of K. pneumoniae-co-producing bla OXA-48-like, bla VIM and bla IMP-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.