Predominance of OXA-48 carbapenemase-producing Klebsiella pneumoniae strains in tertiary hospital in Sarajevo, Bosnia and Herzegovina

Amela Dedeić Ljubović; Đana Granov; Edina Zahirović; Azra Čamdžić; Adis Muhić; Irma Salimović Bešić

doi:10.17305/bb.2024.10406

Authors

Amela Dedeić Ljubović Unit for Clinical Microbiology, Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina; Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina; Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
Đana Granov Unit for Clinical Microbiology, Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina; Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0001-5267-0426
Edina Zahirović Unit for Clinical Microbiology, Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina; Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Azra Čamdžić Unit for Clinical Microbiology, Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Adis Muhić Department of Clinical Pathology, Cytology and Human Genetics, Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Irma Salimović Bešić Unit for Clinical Microbiology, Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina; Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina https://orcid.org/0000-0003-3793-2154

DOI:

https://doi.org/10.17305/bb.2024.10406

Keywords:

Klebsiella pneumoniae, carbapenemases, oxacillinase-48 (OXA-48)

Abstract

Klebsiella pneumoniae, a member of the Enterobacteriaceae family, demonstrates an increasing trend of resistance to carbapenems and is a common cause of both hospital- and community-acquired infections. The current study provides insights into the genetic characterization of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates circulating during 2022 in a Sarajevo tertiary hospital. Among the 87 CRKP strains analyzed, real-time polymerase chain reaction (rtPCR) results showed that 85 (97.7%) tested positive for the carbapenem resistance gene. The oxacillinase-48 (OXA-48) gene was detected in 83 (95.4%) isolates, while the Klebsiella pneumoniae carbapenemase (KPC) and the New Delhi metallo-beta-lactamase (NDM) genes were detected in one isolate each. No Verona integron-encoded-metallo-beta-lactamase (VIM) or imipenemase-metallo-beta-lactamase 1 (IMP-1) genes were found in any of the tested isolates. The multilocus sequence typing (MLST) analysis of sequence types (STs) revealed that ST101, an emerging high-risk clone exhibiting extensive drug resistance, was the most prevalent, whereas ST307 was detected in only one isolate. Phylogenetic analysis of the ten CRKP isolates indicated the presence of three clusters that could constitute an outbreak. A comparison of the results of the utilized phenotypic test (the combined-disk test [CDT]) and rtPCR showed high concordance, suggesting that the phenotypic assay may be useful for the early detection of resistance mechanisms as part of routine susceptibility testing. With the increased affordability of next-generation sequencing (NGS), its application in hospital settings has proven highly beneficial, aiding in the implementation of infection control and prevention measures. Given the significant resistance demonstrated by the CRKP isolates to most tested antibiotics, it is imperative to establish effective methods to restrict the spread of these isolates, as well as to carefully monitor the use of carbapenems in clinical practice.