Healthcare associated infections caused by plasmid-encoded blaKPC and blaNDM strains of Klebsiella pneumoniae in Ibadan, Nigeria

Introduction: Carbapenemase producing Klebsiella pneumoniae (CPKP) has recently emerged as major cause of healthcare associated infections (HAIs). These strains are now classified by the US Center for Disease Control as superbugs of urgent concern. This study investigated the occurrence of CPKP in HAIs among hospitalized patients in University College Hospital (UCH), Ibadan. Methods: Non-duplicate specimens obtained from 250 patients with clinical HAIs were cultured by standard microbiological methods over a period of 6 months. K. pneumoniae was identified using GNB 24E Microbact kit and invitro susceptibility to selected antibiotics was performed by the disk diffusion test. Carbapenemase production was tested by Modified Hodge technique. K pneumoniae carbapenemase (blaKPC) and New Delhi Metallo-β-lactamase (blaNDM) genes were detected by conventional PCR assay. Data were analyzed for the 50 (20%) patients who were culture positive for K pneumoniae infections. Results: Isolates were resistant to ampicillin (100%), cefuroxime (96%), amoxicillin (92%), gentamicin (86%), nitrofurantoin (80%), ciprofloxacin (80%), ceftazidime (78%) and ofloxacin (72%) but 76% were sensitive to meropenem. No carbapenemase enzyme was detected but 8 of 12 iso-lates resistant to meropenem carried blaKPC while 2 carried both blaKPC and blaNDM genes. The study shows that blaKPC and blaNDM K pneumoniae are involved in clinical infections in Ibadan. Conclusion: This study reports the second case of K pneumoniae NDM clinical infection in Nigeria. There is need to strengthen the infection control programme of Nigerian hospitals to prevent nationwide spread of these organisms.