RESUMO
Purpose: The objectives of this study were to determine the magnitude of antibiotic resistance problem among Klebsiella pneumoniae isolates from patients with ventilator associated pneumonia and to investigate the association between multidrug resistance [MDR] strains and DNA, elements called "integrons, ". Also study aimed to test the effect of combined drugs therapy as alternative strategy for these MDR strains
Materials and methods: A total of 32 Klebsiella pneumoniae isolates were isolated from 130 endotracheal samples, randomly collected from suspected cases of ventilator associated pneumonia admitted to the ICU ofzagazig University hospitals and their resistance to different groups of antibiotics were analyzed. All MDR K. pneumoniae strains were tested against Combined antibiotics including Polymyxin B in combination with gentamicin, and rifampin. Also combined ciprofloxacin plus amikacin were tested to identify new treatment strategy. These isolates were further characterized by molecular studies to identify the Class I integr on-encoded intll integrase conferring the antibiotic resistance
Results: Although 22 of the 32 K. pneumoniae strains were MDR [i.e. resistant to three or more classes of antibiotics], all the strains were sensitive to imipenem. PCR detection using resistance gene-specific primers showed that 86.3% of MDR K. pneumoniae strains harboured Class I integr on-encoded intll integrase . Synergy was observed with the combination ofpolymyxin B and rifampin as well as with ciprofloxacin and amikacin
Conclusion: There was an increase in the spread of the MDR clinical isolates of Klebsiella pneumoniae among ventilator associated pneumonic patients. The results suggest that rifampin, may be useful additions to polymyxin B and ciprofloxacin plus amikacin in the treatment of infections caused by MDR K. pneumoniae. The study concluded high prevalence of Class 1 integr on-encoded intll integrase in MDR Klebsiella pneumoniae isolates?