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Introduction <p>Extended Spectrum β-lactamase (ESBLs) and/or carbapenemases producing <i>Enterobacterales</i> present a significant challenge in treating urinary tract infections (UTIs). Carbapenems, once considered last-resort antibiotics, are now threatened by the emergence of carbapenem-resistant strains.</p> Methods <p>A total of 181 <i>Enterobacterales</i> were collected from (231) urine positive samples of community-acquired (CA) and hospital-acquired (HA) UTI patients from the Urology Department of Jinnah Postgraduate Medical Center (JPMC) Karachi, Pakistan, between January and June 2022. Antimicrobial susceptibility testing (AST) was performed, and carbapenemases production was screened using the Modified Hodge Test (MHT) and Modified Carbapenem Inactivation Method (mCIM). EDTA-Combined Disc Test (CDT) was performed for the phenotypic detection of metallo-β-lactamases. The genes encoding carbapenemases were amplified by PCR, sequenced and submitted to the gene bank.</p> Results <p>Among 181 isolates 107, (59.1%) were from CA and 74 (40.9%) from HA-UTI cases. <i>E. coli</i> (128/181; 70.7%) was the most common uropathogen, followed by <i>K. pneumoniae</i> (24; 13.2%). From CA-UTI cases, 68 (63.5%) isolates were found resistant to ampicillin, cefazolin, and cefuroxime. Whereas resistance to cefoxitin (33/107; 30.8%), cefepime (56/107; 52.3%), ceftazidime (58/107; 54.2%), and ceftriaxone (66/107; 61.6%) was lower in CA-UTI. However, in the isolates from HA-UTI the resistance pattern to these antibiotics was significantly higher. Similarly, resistance to fosfomycin was higher (21.6%) in HA than in the isolates from CA-UTI (5.6%). Carbapenem-resistance was more prevalent in HA-UTI isolates (45/74; 60.8%) than CA-UTI isolates (7/107; 6.5%). Chi-square analysis revealed significantly higher antimicrobial resistance rates in HA-UTI isolates compared to CA-UTI cases. The mCIM detected carbapenemases production in 92.3% (48/52) of CRE isolates, while MHT detected only 23.1% (12/52). PCR confirmed carbapenemases genes in 98.1% (51/52) of the isolates. The <i>bla</i><sub>NDM</sub> gene was found in 86.5% (45/52) of CRE isolates, while <i>bla</i><sub>OXA−48</sub> was detected in 11.5% (6/52).</p> Conclusion <p>CRE prevalence was higher in HA-UTI isolates with <i>bla</i><sub>NDM</sub> was the predominant carbapenemase gene detected.</p>

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Molecular characterization of blaNDM and other carbapenemases genes among carbapenem-resistant Enterobacterales from community-and hospital- acquired urinary tract infections

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  • 发表日期：

    2025年10月9日

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  • Lubna Razaq,
  • Fakhur Uddin,
  • Wissal Audah Alhilfi,
  • Mohammed Alorabi,
  • Muhammad Sohail

摘要

Introduction

Extended Spectrum β-lactamase (ESBLs) and/or carbapenemases producing Enterobacterales present a significant challenge in treating urinary tract infections (UTIs). Carbapenems, once considered last-resort antibiotics, are now threatened by the emergence of carbapenem-resistant strains.

Methods

A total of 181 Enterobacterales were collected from (231) urine positive samples of community-acquired (CA) and hospital-acquired (HA) UTI patients from the Urology Department of Jinnah Postgraduate Medical Center (JPMC) Karachi, Pakistan, between January and June 2022. Antimicrobial susceptibility testing (AST) was performed, and carbapenemases production was screened using the Modified Hodge Test (MHT) and Modified Carbapenem Inactivation Method (mCIM). EDTA-Combined Disc Test (CDT) was performed for the phenotypic detection of metallo-β-lactamases. The genes encoding carbapenemases were amplified by PCR, sequenced and submitted to the gene bank.

Results

Among 181 isolates 107, (59.1%) were from CA and 74 (40.9%) from HA-UTI cases. E. coli (128/181; 70.7%) was the most common uropathogen, followed by K. pneumoniae (24; 13.2%). From CA-UTI cases, 68 (63.5%) isolates were found resistant to ampicillin, cefazolin, and cefuroxime. Whereas resistance to cefoxitin (33/107; 30.8%), cefepime (56/107; 52.3%), ceftazidime (58/107; 54.2%), and ceftriaxone (66/107; 61.6%) was lower in CA-UTI. However, in the isolates from HA-UTI the resistance pattern to these antibiotics was significantly higher. Similarly, resistance to fosfomycin was higher (21.6%) in HA than in the isolates from CA-UTI (5.6%). Carbapenem-resistance was more prevalent in HA-UTI isolates (45/74; 60.8%) than CA-UTI isolates (7/107; 6.5%). Chi-square analysis revealed significantly higher antimicrobial resistance rates in HA-UTI isolates compared to CA-UTI cases. The mCIM detected carbapenemases production in 92.3% (48/52) of CRE isolates, while MHT detected only 23.1% (12/52). PCR confirmed carbapenemases genes in 98.1% (51/52) of the isolates. The blaNDM gene was found in 86.5% (45/52) of CRE isolates, while blaOXA−48 was detected in 11.5% (6/52).

Conclusion

CRE prevalence was higher in HA-UTI isolates with blaNDM was the predominant carbapenemase gene detected.