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Infections caused by carbapenem-resistant Enterobacterales (CRE) present an important therapeutic problem, as there are limited number of effective therapeutic alternatives available. In this study, phenotypic and genotypic methods were used to characterize carbapenemase-production and other resistance-determinants (AmpC and ESBL-production, efflux pump-overexpression) in 50 isolates ( Klebsiella  spp.  n  = 35,  Escherichia coli n  = 12 and  Enterobacter cloacae  complex  n  = 3) collected at the Albert Szent-Györgyi Clinical Center (University of Szeged) between 2014 and 2017. Minimum inhibitory concentrations of meropenem, sulfamethoxazole/trimethoprim, tigecycline, amikacin, moxifloxacin, colistin and fosfomycin were also determined. 24% of isolates were AmpC-producers, while 30% carried  bla  CTX-M  ESBL-genes. Carbapenemase-genes were detected in 18 (36%) of the tested isolates: in 2 isolates  bla   NDM  , in 6 isolates  bla   OXA-48-like   and in 12 isolates,  bla   VIM   was detected by PCR. The species-distribution for isolates positive for carbapenemase-genes was the following:  Klebsiella pneumoniae n  = 11,  Klebsiella oxytoca n  = 1,  E. coli n  = 5,  E. cloacae  complex  n  = 1. Efflux pump-overexpression based on the PAβN-screening agar was shown in  n  = 3 of the tested strains. In nine isolates (18%), carbapenemase and ESBL-genes were detected simultaneously. Highest levels of resistance were noted for fosfomycin (74%) and moxifloxacin (70%), while all isolates were susceptible to colistin. Among applied phenotypic tests in this study the modified carbapenem inactivation method (mCIM) proved to be the most accurate one compared to that of PCR results.

Detection of VIM, NDM and OXA-48 producing carbapenem resistant Enterobacterales among clinical isolates in Southern Hungary