The Role of Integron in the Evolution of Antimicrobial Resistance in Uropathogenic Clinical Isolates of Klebsiella pneumoniae

Antibiotic resistance can depend on many factors, such that one of the most important concerns in Klebsiella pneumoniae isolated from nosocomial infections is antibiotic resistance due to transferable resistance genes. This study was investigated the relationship and role of integrons in the transport of OXA-type genes in the production of carbapenem-resistant isolates. In this study, ۲۷۰ isolates of K. pneumoniae were isolated from patients with urinary tract infection symptoms hospitalized at Milad hospital of Tehran during ۲۰۱۷-۲۰۱۸. The biochemical methods confirmed K. pneumoniae isolates. Also, antimicrobial susceptibility testing was performed using an E-test method. Carbapenem-resistant isolates were confirmed using an automated antimicrobial susceptibility testing system (Phenix BD USA). The presence of OXA genes, integron and its class was determined by PCR method. According to our findings, the most effective antibiotics against uropathogen K. pneumoniae isolates were piperacillin-tazobactam and meropenem, respectively. Out of the ۲۷۰ isolates, ۲۷ (۱۰%) were detected as carbapenem-resistant K. pneumoniae isolates. Moreover, ۴۷.۲%, ۴۰.۱%, ۳۹.۲%, and ۳۶.۴% of K. pneumoniae isolates were resistant to ceftriaxone, ceftazidime, trimethoprim-sulfamethoxazole and amoxicillin/clavulanate, respectively. The significant proportion of isolates had class I integron. Meaningful differences in OXA-۵۱, ۵۸ and ۲۴ genes were found in carbapenem-resistant and carbapenem-susceptible K. pneumoniae isolates. No significant relationship was observed between class ۱ and ۲ integrons and other studied gene determinants of antimicrobial resistance. According to the observed results, OXA-۲۳, OXA-۲۴, OXA-۵۸ and OXA-۵۱-like groups were the most prevalent genes in carbapenem-resistant K. pneumoniae isolates, respectively. Also, ۹۷.۹% of carbapenem-susceptible K. pneumoniae isolates had class ۱ integron.

Keywords:

carbapenem-resistant K. pneumoniae , integrin , Klebsiella pneumoniae , urinary tract infection.