Submitted: 26 Jun 2014
Revised: 18 Aug 2014
Accepted: 23 Aug 2014
First published online: 06 Oct 2016
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Int J Enteric Pathog. 2014;2(4): e21495.
doi: 10.17795/ijep21495
  Abstract View: 1406
  PDF Download: 854

Research Article

Carbapenem Resistance Pattern of Multiple Drug-Resistantand  Extended-Spectrum Beta-Lactamase-Positive Klebsiella pneumonia in Isfahan

Hossein Fazeli 1, Razie Kamali Dolatabadi 1 * , Azade Taraghian 1, Bahram Nasr Nasr 1, Sharareh Moghim 1, Masoumeh Norouzi 2

1 Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran
2 Department of Biochemistry and Genetic, Qazvin University of Medical Sciences, Qazvin, IR Iran
*Corresponding author: Razie Kamali Dolatabadi, Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-9132117037, Fax: +98-3136688597, Email:


Background: Klebsiella pneumoniais producer of carbapenemase (KPC) an emerging pathogen with propensity to malady in weak patients, increasing their morality rates.Carbapenemaseis an enzyme that destroys all beta-lactam antibiotics and is the therapeutic choice for infections with extended-spectrum beta-lactamase (ESBL)-producing organisms.ESBLESBLs are penicillin, narrow spectrum also third-generation cephalosporin, and monobactams hydrolyser and checkrein by clavulanic acid.

Objectives: The present study was performed to separate and identify the carbapenemase resistance pattern of multidrug-resistant (MDR) and ESBL-positive K.pneumoniaas well as its prevalence among different wards and various clinical specimens in Isfahan.

Patients and Methods: Over 500 different clinical samples were collected from different sections of great teaching hospitals in Isfahan, in which K. pneumonia isolates were identified by IMVIC and urease standard biochemical tests and also were confirmed by determination of the ureD Gene. Antimicrobial susceptibility tests were performed as standard disk-diffusion on Mueller-Hinton agar (Merck, Germany) based on the instructions of Clinical Laboratory Standards Institute (CLSI, 2013). Sieving and phenotype conformation of ESBL isolates were performed by double disc synergy test (DDST), and then, the strains identified as ESBL were test by carbapenem, ertapenem, imipenem andmeropenem. Finally, the statistical analyses were performed using the WHONET software version 5.6.

Results: Of clinical isolates of K.pneumonia, 142 were confirmed using biochemical methods and then the molecular confirmation was performed by PCR of the ureD gene. Of the total isolates, 57% were from males and 43% from females; 120(84%) of isolates were recognized as MDR. The highest rates of resistance were related to piperacillin (80%), ceftazidime (76%), and cefotaxime (73%). Among these MDR isolates, 101 (71%) were detected as ESBL, using DDST. The ward and the clinical specimen with the most prevalence were ICU with 55 (38.7%) and urine with 61(42.9%) samples, respectively. The lowest prevalence was related to the neurosurgery ward with 8 (5.6%) samples and the clinical specimen with the lowest prevalence was cerebrospinal fluid (CSF) with 2 (1.4%) samples. The susceptibility patterns to carbapenem agents were as follows: ertapenem50.7%, meropenem 44.8% and imipenem35.8%.


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