الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: One of the main pathogenic bacteria that infect neonates and are responsible for such infection is Klebsiella spp., which is characterized by high resistance profiles against different antimicrobial agents. Klebsiella pneumoniae causes challenging nosocomial fatal infections including neonatal sepsis. On the other hand, there is an increase in the inactivity of disinfectants against Klebsiella spp. which lead to expanded nosocomial infections by Klebsiella spp. Method: Eighty-six Klebsiella pneumoniae clinical isolates were identified in the present study. The isolates were recovered from blood samples of 276 clinical specimens from Mansoura University Children Hospital. The clinical specimens were collected from neonates clinically diagnosed with septicemia. The specimens were processed and identified as K. pneumoniae based on their growth on MacConkey agar, besides other biochemical tests which include TSI (Triple Sugar Iron Agar), indole, methyl Red (MR), Voges–Proskauer (VP) and citrate (C). Isolates were subjected to antibiotic and biocide susceptibility using disk diffusion and the agar dilution method, respectively. The distribution of different classes of integrons was screened in the isolates by PCR. Detected integron I was sequenced in some selected isolates.Result: Fifty-seven isolates (66.27%) were found to be MDR. In the MDR isolates, class I integron was detected in 23 isolates (40.3%), integron III was detected in 20 isolates (35%), whereas integron II could not be detected. The isolates exhibited high cephalosporin resistance, where rates of resistance for cefepime, cefoperazone/sulbactam, ceftriaxone, and ceftazidime were 56.9%, 66.3%, 69.8%, and 88.4%, respectively. sulbactam was shown to have the highest level of resistance (98.8%). Thankfully, our clinical isolates showed high sensitivity rates up to 98% and 96.5% for colistin and imipenem., respectively. Regarding biocides, Betadine suppressed all K. pneumoniae isolates at 4mg/ml, whereas the MIC50 was 1.4mg/ml. Dettol inhibited K. pneumoniae isolates development at 1.6ml/ml, while the MIC50% was 1.3mg/ml. The MIC50% for K. pneumoniae isolates was 0.55mg/ml for glutaraldehyde, while 0.8mg/ml inhibited all clinical isolates. Sequencing results of integron I from some clinical K. pneumoniae isolates revealed that only aminoglycoside and folate synthesis inhibitors gene cassettes were detected, while the rest of the resistance genes were not associated with integron I Conclusion: The presence of integron I in MDR K. pneumoniae isolates from neonatal sepsis may contribute only to limited antibacterial and biocide resistance, however, it does not seem to be the major contributor. Thankfully, imipenem, colistin, and ofloxacin are still valid options for treatment, however, to preserve their activity implementation of antimicrobial stewardship and antibiotic policies becomes a must.