Background: Carbapenem-resistant klebsiella pneumoniae is an emerging threat worldwide
causing high rates of morbidity and mortality
Aim: To evaluate the prevalence of carbapenem-resistant K. pneumonia (CRKP), associated risk
factors, type of infections caused by CRKP and their antimicrobial susceptibility. To evaluate
Carbapenemase Detection Set (D70C) as screening test for CRKP
Place and Duration of the Study: A cross sectional study and prospective cohort study was
performed from June 2019 to February 2020 in intensive care unit and medical units of Al
Quwayiyah General hospital.
Methodology: 541 samples were collected from different patient sources. Klebsiella pneumoniae
strain was only selected identified to the species level and AST was done using the Vitek-2.
Original Research Article
Khater et al.; JAMB, 20(11): 76-85, 2020; Article no.JAMB.64191
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Minimum inhibitory concentration (MIC) of meropenem and imipenem was carried out. A
Carbapenemase Detection Set (D70C) was used as screening test for CRKP while Modified Hodge
test and multiplex PCR as confirmatory tests.
Results: A total of 132 isolates were diagnosed as Enterobacteriaceae out of 541 patient
samples.78 clinical isolates were klebsiella pneumoniae which were collected. Out of the 78 clinical
isolates CRKP were 36 (46.2%) and CSKP were 42 (53.8%).) CRKP cases aged from (18-84 years)
with the median patient age 59 year. Seventeen of 36 patients (47.2%) were males. the majority of
the nosocomial CRKP infections were pneumonia 12 (33.3%) followed by urinary tract infection 9
(25%). The most common associated disease was diabetes (30%) followed by renal disease
(27.8%). For invasive procedures, Urinary catheter was 27(75%) and 29(69%) followed by
Mechanical ventilation 25(69.4%) and 22(52.4%) in CRKP and CSKP patients respectively. Reports
of PCR for the 41 isolates which sent to regional laboratory for confirmation revealed that 36 isolates
had carbapenemase genes; twenty eight (77.8%) K. pneumonia isolates positive for bla OXA-48
and 5 (13.9%) isolates were positive for blaNDM. in 2 (5.6%) bla KPC were detected, one isolate
contained blaIMP. 5 isolates contain both blaOXA-48 and blaNDM. The sensitivity of MHT was
analysed to be 91.7%. (95%Cl ratio 77.53% - 98.25%) and the specificity was 100% (95%Cl ratio
54.07% to 100%). The positive predictive value was 100% and the Negative predictive value was
66.7% ( 95%Cl ratio 40.36% to 85.53%). The sensitivity of Carbapenemase Detection Set (D70C)
was 94.4% (81.34% to 99.32%) and the specificity was 80% (95%Cl ratio 28.36% to 99.49%). The
positive predictive value was 97.1% (95%Cl ratio 85.46% to 99.49%).and the Negative predictive
value was 66.7% (95%Cl ratio 32.67% to 89.18%).
Conclusion: CRKP prevalence was 46.2% among K. pneumoniae isolates in Al Quwayiya General
Hospital. Using invasive procedures such as urinary catheters or mechanical ventilator and misuse
of antibiotics were risk factors associated with CRKP indicating that infection control guidelines and
effective preventive measures should be strictly applied. It is very important to monitor and report
changes in antimicrobial-resistant isolates but Carbapenemase Detection Set (D70C) has low
specificity makes it less reliable and need PCR confirmation. |
