Phenotypic and genotypic characteristics of communityacquired and hospital-acquired carbapenem-resistant Enterobacteriaceae in patients with liver cirrhosis at the National Liver Institute of Egypt
Bibliographic record
Abstract
Background: Carbapenem-resistant Enterobacteriaceae (CRE) is considered one of the most urgent public health problems worldwide with associated high morbidity and mortality rates. CRE has both community-acquired (CA) and hospital-acquired (HA) danger because of the transmissible nature of plasmids. Objectives: We aimed to compare the phenotypic and genotypic characteristics of carbapenemase genes in CRE isolates causing CA and HA infections in cirrhotic patients and the distribution of carbapenemase genes in both settings. Method: CRE isolates were taken from 38 recruited cirrhotic patients at the National Liver Institute at Menoufia University in Egypt between January 2017 and January 2018 with Enterobacteriaceae isolates resistant to at least one carbapenem. Isolates were identified and described by conventional techniques and confirmed by the VITEK 2 system, which was also used for antimicrobial susceptibility and the detection of extended-spectrum β-lactamase production. We then phenotypically and genotypically characterized all isolates for the presence of the most prevalent carbapenemase enzymes (Klebsiella pneumoniae carbapenemase [KPC], Verona integron metallo-betalactamases [VIM], New Delhi metallo-beta lactamase [NDM], and oxacillinase-48 [OXA-48]) and genes using multiplex polymerase chain reaction confirmed results. Results: All CRE isolates included in this study were resistant to all carbapenems tested and susceptible to colistin, while 20 of the 38 isolates were sensitive to tigecycline. Among the 24 HA CRE isolates, nine isolates (37.5%) contained OXA-48, three (12.5%) contained both OXA-48 and NDM-1, two contained KPC (8.3%), one carried NDM-1 (4.2%), and one included VIM (4.2%). The OXA-48 gene was the most frequent gene in both groups, and no statistically significant difference was found between the two groups in regards to prevalence. Conclusion: OXA-48 CRE is the most prevalent carbapenemase gene in Egyptian cirrhotic patients with similar phenotypic and genotypic characteristics to CA cases. This indicates the equal prevalence of CRE in community and hospital settings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".