الفهرس 
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Abstract
The emergence and rapid dissemination of Carbapenem Resistant Enterobacteriaceae (CRE) worldwide is a cause for concern.
Resistance to carbapenems has increased dramatically among Enterobacteriaceae. Outbreaks of CRE, primarily Klebsiella pneumoniae, have been reported recently in several regions worldwide. The aim of our work is to study rapid method for detection of Klebsiella pneumoniae carbapenemase genes in Enterobacteriaceae isolates in clinical samples
Our study started with 150 Enterobacteriaceae isolates that were collected from different specimens from different hospital departments. For all these samples direct smear and culture on ordinary media then microscopic examination by Gram stain and biochemical identifications were done to all samples. Antibiogram was done then screening test by using Standard disc diffusion method (Imipenem, Meropenem, Ertapenem) after which E- test was done then molecular detection of KPC gene by Real time pcr .
In Our study the isolates included a statistically significant male gender distribution (64.7% male versus 35.3% female; P ≤ 0.05).
The most frequent isolates were from blood culture 38.7%, followed by sputum samples 32.0%, while the least frequent isolates were from stool samples .
among the isolated organisms, Klebsiella pneumoniae was the most predominant 46.6% , followed by Enterobacter 30.7%, E-coli 20.7% and proteus 2.0%. and they were mainly from ICU then urology departments.
Summary
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In our study, 83 (55.3%) had reduced susceptibility to one or more carbapenem disks , we found that out of the 83 carbapenem-resistant isolates, 86.7% were from hospital acquired cases and this was statistically highly significant (p=<0.001) . In our study that showed that the resistant isolates to imipenem by E-test were 88 out of 150 (58.7%).
from all 150 studied patients (75.3%) had history of recent treatment with antimicrobials. Also in our study we found that the high percentage of KPC-producing Enterobacteriaceae spp by PCR were found in patients with history of antibiotic administration (70.3%) .
Ninty six (64%) of our patients were subjected to invasive procedures such as mechanical ventilation, urinary catheterization, CVL and cannula insertion. Interestingly about (97.8%) KPC positive cases had been exposed to invasive procedures.
Our study demonstrated that, 91 (60.6%) isolates were positive for KPC gene among Enterobacteriaceae .
As regard to the isolated blakpc Positive organisms K. pneumoniae was the most predominant 46.1% , followed by Enterobacter 34.1%, E-coli 17.6% and proteus 2.2%.
KPC positive cases were mainly from urology department (74.1%) followed by ICU (57.6%) .
Rapid detection of blaKPC genes is of great importance, since these resistant organisms have the potential to spread rapidly in hospital environments and cause nosocomial infections with high mortality rates.
Summary
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Among KPC PCR positive isolates 95.6% were from hospital acquired cases and this was statistically highly significant (P=< 0.001).
Our study showed that 82 (98.8%) of carbapenem resistant isolates were blaKPC PCR positive cases , We found that DDT was in agreement with PCR for detection of KPC positive cases so the sensitivity of the PCR was 99 %, specificity was 87%,PPV of 90%, NPP of 98% and diagnostic accuracy was 93%, all in relation to DDT as gold standard test , also our study showed that 82 (93.2%) of E -test resistant isolates were blaKPC PCR positive cases , we found that E-test was in agreement with PCR for detection of KPC positive cases so the sensitivity of the PCR was 93.2 %, specificity was 85.5%%, PPV of 90%, NPP of 90% and diagnostic accuracy was 90%, all in relation to E- test as gold standard test.