Detection of carbapenemase enzymes and genes among carbapenem-resistant Enterobacteriaceae isolates in Suez Canal University Hospitals in Ismailia ,Egypt.

Background: Carbapenem antibiotics are important therapeutic agents in the health care setting, they are frequently used as an empiric therapy for life-threatening infections as well as infections with multi-drug-resistant gram-negative bacilli. Carbapenemase-producing Carbapenem-Resistant Enterobacteriaceae (CRE) are a significant public health challenge worldwide. The detection of carbapenemases productions in CRE strains is performed by phenotypic and genotypic methods. The phenotypic methods target carbapenemases production but provide no guidance regarding the specific carbapenemases types, while the genotypic diagnosis has the benefit of determining the exact mechanism conferring carbapenems resistance. Aim: Improvement of the antibiotic policy and infection control strategies in Suez Canal University Hospitals in Ismailia; through adequate detection of carbapenem resistance in the hospitals. Methods: All the CRE isolates were tested by the phenotypic methods (mCIM & eCIM) test to detect carbapenemases production, and screened by the conventional PCR for the presence of five carbapenemase genes, namely blaKPC, blaIMI, blaVIM, blaNDM, blaOXA-48 Results: The study showed that (53/155) 34.1% of the Enterobacteriaceae isolates were carbapenems resistant. Carbapenemases activity was detected in (36/53) 67.9% of the examined CRE isolates using mCIM test (20/36)37.8 % showed Metallo-carbapenemases and (16/36) 30.2% showed Serine- carbapenemases by eCIM test. 60.4% (32/53) were sensitive to colistin. While by PCR all the isolates (100%) harbor one or more carbapenemases genes. (51/53) 96.2% were proved to harbor blaOXA-48 gene, (47/53) 88.7% were proved to harbor blaNDM gene, (28/53) 52.8%, were proved to harbor blaVIM,gene, the percentage of blaIMI, blaKPC isolation was  (17/53) 32.1%, (4/53)7.5% respectively. Conclusion: High frequencies of carbapenemase genes among CRE isolates.