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Epidemiology of multidrug-resistant Enterobacteriaceae in Sri Lanka: First evidence of blaKPC harboring Klebsiella pneumoniae.

Authors
  • Kumudunie, Wirittamulla Gamage Maheshika...1
  • Wijesooriya, Lakmini Inoka2
  • Namalie, Kalubowilage Dhananja3
  • Sunil-Chandra, Narapity Pathirannehalage...2
  • Wijayasinghe, Yasanandana Supunsiri4
  • 1 Department of Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. , (Sri Lanka)
  • 2 Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. , (Sri Lanka)
  • 3 Microbiology Laboratory, Colombo North Teaching Hospital, Ragama, Sri Lanka. , (Sri Lanka)
  • 4 Department of Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. Electronic address: [email protected] , (Sri Lanka)
Type
Published Article
Journal
Journal of infection and public health
Publication Date
Sep 01, 2020
Volume
13
Issue
9
Pages
1330–1335
Identifiers
DOI: 10.1016/j.jiph.2020.04.010
PMID: 32439355
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE) and carbapenem-resistant Enterobacteriaceae (CRE) are disseminated worldwide posing a serious public health concern. Although, the presence of ESBL-PE and CRE in Sri Lanka has been reported, the prevalence is unknown. This study aimed to provide up-to-date epidemiological data on multidrug-resistant Enterobacteriaceae and to characterize the molecular determinants of carbapenemase-producing Enterobacteriaceae (CPE) in Sri Lanka. A prospective cross-sectional study was conducted at a tertiary care hospital in Sri Lanka between December 2017 and February 2018. ESBL-PE and CRE were identified by disc diffusion method. Carbapenemase production was determined by carbapenem inactivation method and the presence of selected carbapenemase genes were detected by PCR. Five hundred and ninety three Enterobacteriaceae were isolated from variety of clinical samples. Overall prevalence of ESBL-PE and CRE were 26.0% (n = 154) and 9.6% (n = 57), respectively. The highest rate of ESBL-PE (30.8%) was found in urine samples, while the highest occurrence of CRE (20.8%) was seen in respiratory specimens. The most common CRE species identified was K. pneumoniae (n = 46, 80.7%), followed by C. freundii (n = 4, 7.0%), E. coli (n = 3, 5.3%), P. rettgeri (n = 2, 3.5%), E. cloacae (n = 1, 1.7%), and K. aerogenes (n = 1, 1.7%). Carbapenemase production was observed in 54 (94.7%) of CRE isolates. Fifty eight carbapenemase encoding genes were identified in 54 CPE. The most prevalent carbapenemase gene was blaOXA-48-like (n = 48, 88.9%), followed by blaNDM (n = 8, 14.8%), and blaKPC (n = 2, 3.7%). This study reports an alarming rate of CRE and the emergence of blaKPC harboring K. pneumoniae in Sri Lanka. The need for preventive measures is highlighted to limit the spread of these difficult-to-treat bacteria in the country. Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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