Antibiotic Resistant Strain Clinical Trial
Official title:
Genetic Characterization of Plasmids Carrying Carbapenemases and Quinolone Resistance Determinants in Klebsiella Pneumoniae Isolates in Assiut University Hospitals
Klebsiella pneumoniae is an important pathogen that frequently causes nosocomial
community-acquired and infections, including pneumonia, urinary tract infections, bloodstream
infections, pyogenic liver abscesses, and septic shock.
An emerging co-existence of carbapenems and fluoroquinolone resistance in Klebsiella
pneumoniae is causing major difficulty in treating infections caused by such pathogen
Plasmid mediated carbapenem resistance is mainly due to production of carbapenemase which
belong to three classes of β-lactamases, the Ambler class A, B and D β -lactamases, among
which the New Delhi metallo-β -lactamase has attracted significant attention in the last five
years. New Delhi metallo-β -lactamase-1 is a class B metallo-β-lactamase and was first
identified from a Klebsiella pneumoniae strain in 2008.
New Delhi metallo-β -lactamase-1 is frequently associated with other resistance genes, such
as extended spectrum β- lactamase genes and plasmid-mediated quinolone resistance genes,
which allows bacteria to gain resistance to different classes of antimicrobial agents
simultaneously.
Plasmids and Integrons are mobile genetic elements that carry antimicrobial resistance genes.
Horizontal transfer of those mobile genetic elements has been considered as one of the most
important mechanisms for the dissemination of multi-drug resistance among bacteria.
Classification of plasmids on the basis of molecular typing and phylogenetic relatedness may
help understand the distribution of plasmid types, the relationships involving plasmids
carrying antimicrobial resistance genes. Plasmids can be classified into incompatibility
groups by replicon typing or into types (clusters) by restriction fragment length
polymorphism analysis.
Integrons act as genetic platform, which allow capture and expression of antibiotic
resistance genes. There are 3 classes of integrons that are responsible for multi-drug
resistance, which are classified based on the sequence of the integrase gene. Class 1
integrons are the most widespread class in Gram-negative bacteria.
One approach to preventing multi drug resistant infections is combination of two or more
antimicrobial drugs during a treatment regimen . The combination of imipenem plus
ciprofloxacin had shown Synergistic effect .
Loading of antibacterial agents into nanoparticles is one of the most promising approaches to
reduce anti-microbial resistance. Nano formulations could enhance the intracellular
bioavailability of the antimicrobial drugs, and, thus, decreasing the development of
resistance. Moreover, the potential antibacterial activity of some nanoparticle-forming
polymers might further increase the potency of the antibacterial drugs .
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