Investigation of lsepamicin, Chloramphenicol and Minocycline Sensitivity in Carbapenem-Resistant Enterobacteriaceae

Objective: In this study, we aimed to determine the resistance mechanisms of carbapenem-resistant Enterobacteriaceae (CRE), and evaluate the prospective alternative treatment options. Methods: Between October 2014 and July 2015, rectal swabs routinely obtained from hospitalized patients were included in the study. The isolated Gram-negative enteric bacteria were identified to the species level by using standard conventional microbiological methods. Determined carbapenem resistance in enteric bacteria was confirmed by using meropenem Etest (R) (bioMerieux, Marcy l'Etoile, France), and the resistance mechanisms were investigated with MAST-ID (TM) Discs (Mast Diagnostics Ltd, Bootle, Merseyside, UK). Antibiotic susceptibilities of the CRE were determined by disk diffusion method using isepamicin, chloramphenicol, and minocycline disks (Oxoid, Basingstoke, Hampshire, UK). Results: Of the 3,323 rectal swabs sent to the laboratory during the study period, totally 84 (2.5%) CRE were isolated with one strain from each patient. Of the 84 CRE, 74 (88%) were Klebsiella pneumoniae and 10 (12%) were Escherichia coli. Among the 84 CRE, 66 (78.5%) with OXA-48, 11 (13.1%) with OXA48 + metallo-beta-lactamase (MBL), 1 (1.2%) with only MBL and 1 (1.2%) with AmpC + porin loss were detected, none of the strains were positive for KPC. In 5 (6%) strains, none of the resistance mechanisms were found. Of the 84 CRE, 80 (95.2%), 77 (91.6%) and 14 (16.6%) were found to be susceptible to isepamicin, chloramphenicol and minocycline, respectively. Conclusions: The OXA-48 type, endemic in Turkey, was also the most commonly detected carbapenemase in the study. It has been observed that isepamicin and chloramphenicol can be the potential antibiotics in the treatment of KDE-related infections.