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Detection of Klebsiella pneumoniae Carbapenemase (KPC) Producing Gram Negative Superbugs: An Emerging Cause of Multidrug-Resistant Infections in General Surgery Department of Sohag University Hospital, Egypt

Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria are emerging highly drug-resistant Gram-negative bacilli causing infections associated with significant morbidity and mortality. This study was undertaken to detect the resistance to carbapenems in clinical isolates of Gram negative pathogens obtained from patients admitted in the Department of General Surgery, Sohag University Hospital and to assess KPC production among these isolates. A total of 215 clinical isolates obtained over a period from September 2013 to March 2015. These isolates were screened for carbapenem resistance by culturing on CHROM agar KPC media. Species identification by using API 20 E test strips as a biochemical identification system and antimicrobial susceptibility testing by the disk diffusion method were carried out. Carbapenem-resistant isolates were screened for carbapenemase production by the modified Hodge test (MHT) and positive isolates were further checked for KPC production by phenylboronic acid (PBA) test. Isolates were also checked for metallo-lacatmase (MBLs) production by the EDTA combined disk test (CDT) and by disk enhancement test with both PBA and EDTA for the detection of co-production of KPC and MBL. Of the total 59 carbapenem resistant isolates, MHT identified 52 (88.14%) isolates as carbapenemase producers, MBLs activity was detected in 20 (33.9%) isolates by CDT, KPC in 14 (23.73%) isolates by PBA test and co-existence of both KPC and MBL in 9 (15.25%) isolates. Multidrug resistance characterized the studied isolates, with colistin being the most active agent. Emergence of KPC producing pathogens in our setting creates an important challenge for clinicians and hospital epidemiologists, because it is added to the already high burden of antimicrobial K e y w o r d s