The Inc FII Plasmid and its Contribution in the Transmission of blaNDM-1 and blaKPC-2 in Klebsiella pneumoniae in Egypt

Abstract

The emergence of <i>bla</i>_KPC-2 and <i>bla</i>_NDM-1 producing <i>Klebsiella pneumoniae</i> represents a great problem in many Egyptian hospitals. One hundred and twenty-six <i>K</i>. <i>pneumoniae</i> isolates from patients admitted to Assiut University Hospital were identified by an API20E kit. Carbapenemase-producing <i>K</i>. <i>pneumoniae</i> (CPKP) was detected by the modified carbapenem inactivation method (mCIM), the EDTA-modified carbapenem inactivation method (eCIM), and an E-test. Based on the polymerase chain reaction, all isolates were negative for <i>bla-</i>_VIM-1 and <i>bla-</i>_IMP-1<i>,</i> fifteen of these isolates were positive for both <i>bla</i>_KPC-2 and <i>bla</i>_NDM-1, two isolates were positive for <i>bla</i>_KPC-2 only, and twenty-eight isolates were positive for <i>bla-</i>_NDM-1 only. Although one isolate was positive for the string test, all CPKP isolates were negative for capsular genes. Only 71.1% of CPKP transferred their plasmids to their corresponding transconjugants (<i>E. coli</i> J53). The resistance patterns of the clinical isolates and their transconjugates were similar, except for 12 isolates, which showed differences with their transconjugates in the resistance profile of four antibiotics. Molecular typing of the plasmids based on replicon typing showed that Inc FIIK and FII plasmids predominated in isolates and their transconjugants carrying <i>bla</i>_KPC-2 and/or <i>bla</i>_NDM-1<i>.</i> Conjugative Inc FII plasmids play an important role in the spread of CPKP, and their recognition is essential to limit their spread.