Ethics code: IAU.CHALUS.REC.1401.018
1- Associate Professor, Department of Microbiology, Go.C., Islamic Azad University, Gorgan, Iran , Leila.Fozouni@iau.ac.ir
2- Master of Science in Microbiology, Go.C., Islamic Azad University, Gorgan, Iran
2- Master of Science in Microbiology, Go.C., Islamic Azad University, Gorgan, Iran
Abstract: (17 Views)
Background and Aim: Klebsiella pneumoniae is among the most important pathogens responsible for nosocomial infections worldwide. In recent years, multidrug-resistant (MDR) and extensively drug-resistant (XDR) K.pneumoniae, the causative agent of urinary tract infections (UTI), have emerged as a major global health problem. This study aimed to investigate the prevalence of MDR and XDR K.pneumoniae originating from urinary infections and to compare their antimicrobial susceptibility to fosfomycin and cefiderocol.
Materials and Methods: This descriptive cross-sectional study was conducted using 208 urine samples from hospitalized individuals during 2023-24. After identifying carbapenemase-producing K.pneumoniae strains by phenotypic and genotypic (PCR) tests, MDR and XDR isolates were identified using the Kirby-Bauer method and broth microdilution test according to the CLSI-2021 guideline. The minimum inhibitory concentrations of cefiderocol and fosfomycin were determined using broth microdilution and agar dilution, respectively.
Results: Of the 57 carbapenemase-producing K.pneumoniae isolates, about 84% were collected from urine samples of patients hospitalized for more than 1 week and hospitalized in the intensive care unit (P<0.05), of which the highest level of resistance was observed to aztreonam (84.21%), followed by tetracycline (57.90%). Among the carbapenemase-positive K.pneumoniae isolates, 87.72% exhibited multidrug resistance, and 57.90% demonstrated extensive drug resistance. No significant differences were observed between age groups and gender in antimicrobial resistance (P=0.06). The effects of different fosfomycin concentrations showed that the highest growth changes were observed at concentrations of 16 μg/mL and 32 μg/mL, and 90% of the MDR and XDR strains were inhibited at concentrations of 64 and 512 μg/mL, respectively, with susceptibility rates equal to or greater than 92%. In determining the minimum inhibitory concentration of cefiderocol, the susceptibility rates of K.pneumoniae isolates that were multi- and extensively resistant to it were confirmed to be 88% and 79%, respectively.
Conclusion: Considering the antibacterial effect and potential of fosfomycin in laboratory conditions, which is estimated to be 1.3 times that of cefiderocol, the results of this study suggest that fosfomycin may be effective in treating urinary tract infections with high drug resistance.
Materials and Methods: This descriptive cross-sectional study was conducted using 208 urine samples from hospitalized individuals during 2023-24. After identifying carbapenemase-producing K.pneumoniae strains by phenotypic and genotypic (PCR) tests, MDR and XDR isolates were identified using the Kirby-Bauer method and broth microdilution test according to the CLSI-2021 guideline. The minimum inhibitory concentrations of cefiderocol and fosfomycin were determined using broth microdilution and agar dilution, respectively.
Results: Of the 57 carbapenemase-producing K.pneumoniae isolates, about 84% were collected from urine samples of patients hospitalized for more than 1 week and hospitalized in the intensive care unit (P<0.05), of which the highest level of resistance was observed to aztreonam (84.21%), followed by tetracycline (57.90%). Among the carbapenemase-positive K.pneumoniae isolates, 87.72% exhibited multidrug resistance, and 57.90% demonstrated extensive drug resistance. No significant differences were observed between age groups and gender in antimicrobial resistance (P=0.06). The effects of different fosfomycin concentrations showed that the highest growth changes were observed at concentrations of 16 μg/mL and 32 μg/mL, and 90% of the MDR and XDR strains were inhibited at concentrations of 64 and 512 μg/mL, respectively, with susceptibility rates equal to or greater than 92%. In determining the minimum inhibitory concentration of cefiderocol, the susceptibility rates of K.pneumoniae isolates that were multi- and extensively resistant to it were confirmed to be 88% and 79%, respectively.
Conclusion: Considering the antibacterial effect and potential of fosfomycin in laboratory conditions, which is estimated to be 1.3 times that of cefiderocol, the results of this study suggest that fosfomycin may be effective in treating urinary tract infections with high drug resistance.
Type of Study: Original Research |
Subject:
Laboratory Sciences
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