الفهرس 
Introduction &Aim of the workOnly 14 pages are availabe for public view
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Abstract
Carbapenem resistant K. pneumoniae is an emerging nosocomial pathogen. As carbapenems have long been considered the antibiotic class of last resort in the treatment of infections caused by multidrug-resistant gram-negative organisms, the dissemination of carbapenem resistance among pathogenic bacteria has been declared a threat to public health.
The potential for widespread and rapid transmission of these pathogens and/or the underlying genetic determinants of their resistance is of great concern in order to control their spread.
The aim of this study is to evaluate incidence , risk factors and significance of carbapenem resistant Klebsiella pneumonie among patients in Beni-Suef university hospital and molecular detection of OXA-232 gene(OXA-48 like) variant among the isolates.
Our study was conducted on all phenotypically carbapenem resistant Klebsiella pneumoniae isolates by disk diffusion method which were collected from different specimens from different hospital departments from December 2014 to June 2015.
Among the 120 Klebsiella isolates, 49 Klebsiella pneumonie (40.8 %) were resistant to one or more carbapenems.
All the 49 studied isolates were resistant to imipenem and meropenem but there were 6 (12.2%) of them were sensitive to ertapenem.
Our isolates showed resistance rates of 67.3% , 65.3% to Amikacin and Levofloxacin respectively and Thirty three (67.3%) isolates were MDR.
Our isolates were mostly collected from neonatology ward followed by ICU.
Twenty eight (57.1%) of our patients were males. Neonates were the main age group recorded in our study
Frequency of admission duration more than 7 days was (63.3%)
Our studied isolates were collected mainly from sputum followed by blood and urine.
Our patients were mainly from Neonatology ward followed by ICU whom 100% , 87.5% were Ertapenem resistant respectively
Sixteen (94.1% )of sputum samples, which was the main source of our isolates ,were Ertapenem resistant .
Out of 31 patients with respiratory disease,the main comorbidity in our patients , 28 (90.3%) were Ertapenem resistant
All the 12 died patients and 31(72.1%) of the 37 survived patients were Ertapenem resistant .
OXA‑48 enzyme was prevalent in our hospital as 44 (89.8%) out of the studied isolates were OXA‑48 producers.
After PCR procedures, the amplified OXA48gene was detected on 1.2% gel electrophoresis , then 10 samples of DNA products with OXA48 gene positive are purified to be submitted for sequencing by ABI 3730x1 Sequencer. These samples were :the six Ertapenem sensitive samples and four multi drug resistant ,including Ertapenem ,from ICU.
Results of Sequence blast demonstrated the presence of OXA-48 gene in eight isolates , a Carbapenemase OXA181(OXA-48 like) variant was detected which was published as 100% similar to Carbapenemase OXA232, Klebsiella pneumonie after submitted to GenBank sequence database of NCBI and an OXA505 allel ( OXA-48 Family class D beta- lactamase).
In conclusion :
Our study demonstrated that, age ,gender ,admission ward and duration were risk factors to Ertapenem resistance .Whereas comorbidity ,history of recent treatment with antimicrobials of patients and their outcome were not. Ertapenem resistance in relation to OXA-48 gene was statistically insignificant.
Also,OXA-48 and at least 2 different blaOXA-48 variants existed among K.pneumonie and were circulating in our Beni-Suef university hospital.
Recommendations:
we suggest that there is an urgent need for further studies to clearly map out the epidemiology and to conduct molecular characterization of carbapenemase producing isolates in healthcare facilities in the country to be aware of the emergence of these multidrugresistant isolates, as these are of significant public health concern both in the hospital and community setting. A process of enhanced surveillance for the detection of these multidrug-resistant pathogens is urgently advocated so that patients can be identified quickly and appropriate infection control measures instituted to stem further dissemination.