*[1],3Subulade, A. A., 1,[2]Makanjuola, O. B., 2Oduola, A. B., 1,2Adebiyi, I., [3]Azuh, V. O., and 1,2Kehinde, A. O.
1Department of Medical Microbiology and Parasitology, University of Ibadan, Oyo State, Nigeria
2University College Hospital, Ibadan, Oyo State, Nigeria 3Biorepository and Clinical Virology Laboratory, College of Medicine, University of Ibadan, Nigeria
*Correspondence to: adeolaasubulade@gmail.com
Abstract:
Background: Klebsiella species are significant pathogens responsible for various healthcare-associated infections. Despite the existence of several mechanisms of resistance against high priority antibiotics such as carbapenems, the production of carbapenemases remains the most important mechanism of resistance among Klebsiella spp. The aim of this study was to determine the prevalence of carbapenemase-production among Klebsiella spp isolated from clinical specimens at the University College Hospital (UCH) Ibadan, Nigeria.
Methodology: A total of 120 clinical bacterial isolates were collected from the routine laboratories in the Department of Medical Microbiology and Parasitology, UCH, Ibadan between January and August 2023. These isolates were re-identified using conventional microbiological methods, including Gram staining, and biochemical identification tests. Eighty viable isolates were screened for carbapenem resistance using imipenem, following CLSI guidelines. Carbapenemase production was confirmed by the modified carbapenem inactivation (mCIM) and EDTA carbapenem inactivation (eCIM) methods. Conventional multiplex polymerase chain reaction (PCR) was used to amplify and detect carbapenemase resistance genes (blaNDM-1, blaVIM, blaKPC, blaOXA-48, and blaIMP) in the isolates, with the amplified products resolved by agarose gel electrophoresis. Data were entered and analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0.
Results: Ninety-five of the 120 isolates were biochemically identified as Klebsiella spp while only 80 remained viable. Twenty-three (28.8%) biochemically confirmed isolates were resistant to imipenem (carbapenem resistant Klebsiella), and 20 (25.0%) were confirmed as Klebsiella spp by PCR, of which 11 (55.0%) were resistant to all tested antibiotics. Carbapenemase production was detected in 5 (6.3%) isolates using mCIM and eCIM. PCR identified blaNDM-1 gene in 3 (3.8%) of the isolates, while blaVIM, blaKPC, blaOXA-48, and blaIMP genes were not detected in any isolate.
Conclusion: The detection of blaNDM-1 and high resistance levels among isolates is of great concern. The emergence of carbapenem-resistant Klebsiella, especially with blaNDM-1 gene, threatens the effectiveness of ‘lastresort’ antibiotics. There is a need for antimicrobial resistance surveillance and antimicrobial stewardship to stem the tide of antimicrobial resistance in healthcare settings.
Keywords: Klebsiella, carbapenemase, antimicrobial resistance, Ibadan, Nigeria.
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