Molecular Analysis of Antibiotic Resistance Determinants and Plasmids in Malaysian Isolates of Multidrug Resistant Klebsiella pneumoniae

Infections caused by multidrug resistant Klebsiella pneumoniae have been increasingly reported in many parts of the world. A total of 93 Malaysian multidrug resistant K. pneumoniae isolated from patients attending to University of Malaya Medical Center, Kuala Lumpur, Malaysia from 2010-2012 were inv...

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Bibliographic Details
Published in:PloS one 2015-07, Vol.10 (7), p.e0133654-e0133654
Main Authors: Al-Marzooq, Farah, Mohd Yusof, Mohd Yasim, Tay, Sun Tee
Format: Article
Language:English
Subjects:
Aminoglycoside antibiotics
Aminoglycosides
Analysis
Anti-Bacterial Agents - pharmacology
Antibiotic resistance
Antibiotics
Antimicrobial agents
Bacteria
Bacterial Proteins - genetics
beta-Lactamases - genetics
Chemotherapy
Ciprofloxacin
Conjugation, Genetic
Cotrimoxazole
Cross Infection - epidemiology
Cross Infection - microbiology
Deoxyribonucleic acid
Determinants
DNA
Drug resistance
Drug Resistance, Multiple, Bacterial - genetics
Drug therapy
E coli
Enterobacteriaceae
Escherichia coli
Genes
Genes, Bacterial
Gentamicin
Health aspects
Health care
Health care facilities
Humans
Infections
Klebsiella
Klebsiella Infections - epidemiology
Klebsiella Infections - microbiology
Klebsiella pneumoniae
Klebsiella pneumoniae - drug effects
Klebsiella pneumoniae - enzymology
Klebsiella pneumoniae - genetics
Malaysia - epidemiology
Microbial drug resistance
Microbial Sensitivity Tests
Multidrug resistance
Multidrug resistant organisms
Plasmids
Plasmids - genetics
Pneumonia
R Factors - genetics
Replicon - genetics
Studies
Sulfamethoxazole
Trimethoprim
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Summary:Infections caused by multidrug resistant Klebsiella pneumoniae have been increasingly reported in many parts of the world. A total of 93 Malaysian multidrug resistant K. pneumoniae isolated from patients attending to University of Malaya Medical Center, Kuala Lumpur, Malaysia from 2010-2012 were investigated for antibiotic resistance determinants including extended-spectrum beta-lactamases (ESBLs), aminoglycoside and trimethoprim/sulfamethoxazole resistance genes and plasmid replicons. CTX-M-15 (91.3%) was the predominant ESBL gene detected in this study. aacC2 gene (67.7%) was the most common gene detected in aminoglycoside-resistant isolates. Trimethoprim/sulfamethoxazole resistance (90.3%) was attributed to the presence of sul1 (53.8%) and dfrA (59.1%) genes in the isolates. Multiple plasmid replicons (1-4) were detected in 95.7% of the isolates. FIIK was the dominant replicon detected together with 13 other types of plasmid replicons. Conjugative plasmids (1-3 plasmids of ~3-100 kb) were obtained from 27 of 43 K. pneumoniae isolates. An ESBL gene (either CTX-M-15, CTX-M-3 or SHV-12) was detected from each transconjugant. Co-detection with at least one of other antibiotic resistance determinants [sul1, dfrA, aacC2, aac(6')-Ib, aac(6')-Ib-cr and qnrB] was noted in most conjugative plasmids. The transconjugants were resistant to multiple antibiotics including β-lactams, gentamicin and cotrimoxazole, but not ciprofloxacin. This is the first study describing the characterization of plasmids circulating in Malaysian multidrug resistant K. pneumoniae isolates. The results of this study suggest the diffusion of highly diverse plasmids with multiple antibiotic resistance determinants among the Malaysian isolates. Effective infection control measures and antibiotic stewardship programs should be adopted to limit the spread of the multidrug resistant bacteria in healthcare settings.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0133654