A Pseudo-Outbreak due toAcinetobacterSpecies (GIM-1) Contamination of the Pneumatic Transport System of a Large University Hospital

2014 ◽  
Vol 35 (11) ◽  
pp. 1364-1372 ◽  
Author(s):  
Mathias Herrmann ◽  
Sven Jungmann ◽  
Alexander Halfmann ◽  
Alik Dawson ◽  
Martin Kaase ◽  
...  
Keyword(s):  
Transport System ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Pneumatic Transport ◽  
Positive Patient ◽  
University Hospital ◽  
Potential Hazard ◽  
Outbreak Management ◽  
Carbapenem Resistant ◽  
Management Procedures

Objective.To establish the source and contamination routes resulting in positive clinical and surveillance microbiological cultures with carbapenem-resistant, GIM-1 metallo-β-lactamase–positiveAcinetobacter pitiiandAcinetobacter radioresistensfrom 21 patients in 8 departmentsDesign.Retrospective, descriptive study.Setting.A 1,300-bed tertiary care academic medical facility consisting of 90 buildings linked by a pneumatic transport system (PTS).Methods.Microbiological workup of the cluster strains included matrix-assisted laser desorption/ionization time-of-flight species identification, phenotypic carbapenemase tests, polymerase chain reaction–based genotyping of carbapenemase, and pulsed-field gel electrophoresis. Outbreak management procedures were employed according to institutional regulations.Results.The rarity of GIM-1Acinetobacterspecies in the hospital and region, the lack of epidemiological links between patients, and the fact that in some patients the apparent colonization was clearly nonnosocomial prompted the suspicion of a pseudo-outbreak. Numerous environmental cultures were positive for GIM-1-positiveAcinetobacter(including archived sample requisition forms, PTS capsules, cultures from line-diverter and dispenser stations, and sterilized transport capsules following PTS delivery). Moreover, it was observed that condensation fluid from subterranean PTS tubing resulted in water entry in PTS capsules, possibly conferring specimen contamination. After extensive system disinfection, environmental surveys of the PTS were negative, and no further positive patient specimens were encountered.Conclusions.This is the first report of a PTS-associated pseudo-outbreak. The large number of falsely positive patient-related specimens in conjunction with the potential hazard of airborne and contact spread of multidrug-resistant microorganisms (in this case, GIM-1 carbapenem-resistantAcinetobacterspecies) underscores the need for implementation of infection control–based monitoring and operating procedures in a hospital PTS.

scholarly journals Implementation of an automated cluster alert system into the routine work of infection control and hospital epidemiology: experiences from a tertiary care university hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Seven Johannes Sam Aghdassi ◽  
Britta Kohlmorgen ◽  
Christin Schröder ◽  
Luis Alberto Peña Diaz ◽  
Norbert Thoma ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Median Number ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Infection Prevention And Control ◽  
Alert System ◽  
Related Data ◽  
Healthcare Settings ◽  
Care Systems ◽  
One Year

Abstract Background Early detection of clusters of pathogens is crucial for infection prevention and control (IPC) in hospitals. Conventional manual cluster detection is usually restricted to certain areas of the hospital and multidrug resistant organisms. Automation can increase the comprehensiveness of cluster surveillance without depleting human resources. We aimed to describe the application of an automated cluster alert system (CLAR) in the routine IPC work in a hospital. Additionally, we aimed to provide information on the clusters detected and their properties. Methods CLAR was continuously utilized during the year 2019 at Charité university hospital. CLAR analyzed microbiological and patient-related data to calculate a pathogen-baseline for every ward. Daily, this baseline was compared to data of the previous 14 days. If the baseline was exceeded, a cluster alert was generated and sent to the IPC team. From July 2019 onwards, alerts were systematically categorized as relevant or non-relevant at the discretion of the IPC physician in charge. Results In one year, CLAR detected 1,714 clusters. The median number of isolates per cluster was two. The most common cluster pathogens were Enterococcus faecium (n = 326, 19 %), Escherichia coli (n = 274, 16 %) and Enterococcus faecalis (n = 250, 15 %). The majority of clusters (n = 1,360, 79 %) comprised of susceptible organisms. For 906 alerts relevance assessment was performed, with 317 (35 %) alerts being classified as relevant. Conclusions CLAR demonstrated the capability of detecting small clusters and clusters of susceptible organisms. Future improvements must aim to reduce the number of non-relevant alerts without impeding detection of relevant clusters. Digital solutions to IPC represent a considerable potential for improved patient care. Systems such as CLAR could be adapted to other hospitals and healthcare settings, and thereby serve as a means to fulfill these potentials.

scholarly journals 1764. The Gut: A Veiled Reservoir for Multidrug-resistant Organisms (MDROs) Below the Tip of the Iceberg

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S63-S63
Author(s):  
Teppei Shimasaki ◽  
Yoona Rhee ◽  
Rachel D Yelin ◽  
Michelle Ariston ◽  
Stefanie Ollison ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Targeted Prevention ◽  
Prevention Measures ◽  
Carbapenem Resistant ◽  
Multidrug Resistant Organisms ◽  
Clinical Culture

Abstract Background Clinical culture results are sometimes used to estimate the burden of multidrug-resistant organisms (MDROs) in hospitals. The association between positive clinical culture results and prevalence of MDROs in the gut is incompletely understood. Methods Rectal swab or stool samples were collected daily from adult medical intensive care unit (MICU) patients and cultured for target MDROs using selective media between January 2017 and January 2018 at Rush University Medical Center, a 676-bed tertiary-care center in Chicago. Resistance mechanisms were confirmed by phenotypic methods and/or polymerase chain reaction. Clinical culture results during MICU stay were extracted from the hospital information system. Target MDROs included vancomycin-resistant Enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB). Patients with either a study or clinical culture positive for a target MDRO were analyzed. Results We collected 5,086 study samples from 1,661 unique admissions (1,419 patients) and included here data from 413 unique admissions (397 patients) with completed microbiologic analysis. Median (IQR) patient age was 65 (51–75) years and length of MICU stay was 3 (3–4) days. A total of 156 (37.8%) patients had a target MDRO detected from a study sample at any point; 57 (36.5%) patients had >1 MDRO detected. Overall prevalence of these MDROs was found to be 22.5% VRE, 6.5% CRE, 19.8% ESBL, 4.4% CRPA, and 0.7% CRAB. New MDRO acquisition was observed in 58 (14.6%) patients (figure). Once a target MDRO was detected in a study sample, 82.2% of subsequent study samples were positive for that MDRO. Only 13 (5.8%) patients had a positive clinical culture for any target MDRO during their MICU stay (table). Conclusion Clinical cultures capture only the tip of the resistance iceberg and alone are insufficient to guide MDRO-targeted prevention strategies. Universal infection prevention measures are an alternative that may be preferred in settings where overall prevalence of MDROs is moderate or high and patients may be colonized with >1 MDRO. Disclosures All authors: No reported disclosures.

scholarly journals Phenotypic and genotypic characterization of multidrug-resistant isolates from patients with catheter-associated urinary tract infection in a tertiary care hospital

2019 ◽  
Vol 11 (03) ◽  
pp. 206-211
Author(s):  
Jaison Jayakaran ◽  
Nirupa Soundararajan ◽  
Priyadarshini Shanmugam
Keyword(s):  
Urinary Tract ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Care Hospital ◽  
Disk Diffusion Method ◽  
Carbapenem Resistant ◽  
Tract Infections

Abstract INTRODUCTION: Urinary tract infections (UTIs) remain as the most common infection. Catheter-associated (CA) UTI can lead to bacteremia and thereby is the leading cause of morbidity and mortality in hospitalized patients in our country. AIMS AND OBJECTIVES: This study aims to check the prevalence of CAUTI and study the phenotypic and genotypic characters of the multidrug-resistant organisms in a tertiary care hospital, with special reference to NDM-1 and OXA-23. MATERIALS AND METHODS: A total of 231 urine samples from patients with CA-UTI in different wards in a tertiary care hospital over a period of 3 months between June and August 2018 were collected and processed following the standard protocol. Antibiotic susceptibility tests were performed by disk-diffusion method. Modified Hodge test (MHT) was done to isolate carbapenem-resistant isolates, and polymerase chain reaction was done to detect NDM-1 and OXA-23. RESULTS: Out of 231 samples, 101 samples yielded significant growth. These 38 samples were Gram-negative bacilli which were resistant to carbapenems. Out of the 38 which showed carbapenem resistance, 23 were MHT positive. Out of the 23 MHT-positive isolates, 8 (21.05%) were positive for NDM-1 gene and only 1 (2.6%) was positive for the OXA-23 gene. CONCLUSION: This study has shown that carbapenem-resistant isolates from all the CA urinary tract-infected patients were 52.77% and most of them were Klebsiella. About 21% of them harbored the NDM-1 gene whereas only 2% had the OXA-23 gene. There has been an alarming increase in the spread of carbapenem resistance.

scholarly journals Increasing frequency of Pseudomonas aeruginosa infections during tigecycline use

2015 ◽  
Vol 9 (03) ◽  
pp. 309-312 ◽  
Author(s):  
Aysegul Ulu-Kilic ◽  
Emine Alp ◽  
Dilek Altun ◽  
Fatma Cevahir ◽  
Gamze Kalın ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Care Facility ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Control Group ◽  
Case Group ◽  
Icu Patients ◽  
Thoracic Drainage ◽  
Tertiary Care Facility

Introduction: The widespread use of tigecycline raises the question of increasing infection rates of Pseudomonas aeruginosa (PA) in ICUs which are not affected by this antibiotic. Objective:  The aim of this study was to determine if treatment with tigecycline is a risk factor for PA infection in ICU patients. Methodology: A retrospective and observational study was conducted at Erciyes University Hospital, Turkey, between 2008 and 2010. The Erciyes University Hospital is a 1300-bed tertiary care facility. The patients included in this study were hospitalized in four adult ICUs. Patients with PA infections (case group) were compared with patients with nosocomial infection other than PA (control group). Results: A total of 1,167 patients with any nosocomial infections were included in the study. Two hundred and seventy eight (23.8%) of the patients had PA infection during their ICU stay. Fifty nine patients (21.2%) in the case group received tigecycline before developing PA infections, which were found to be significantly more frequent than in the controls (p < 0.01). Multivariate analysis showed that risk factors for PA infection were previous tigecycline use (4 times), external ventricular shunt (4.2 times), thoracic drainage catheter (2.5 times) and tracheostomy (1.6 times). Conclusion: Our results contribute to the need for new studies to determine the safety of tigecycline use, especially for the treatment of critically ill patients. Since tigecycline seems to be an alternative for the treatment of multidrug resistant (MDR) microorganisms, rational use of this antibiotic in ICU patients is essential.

scholarly journals Screening for Multidrug-Resistant Organisms in a Tertiary-Care University Hospital in the North West Bank: A Descriptive Study

2020 ◽  
Vol 41 (S1) ◽  
pp. s382-s383
Author(s):  
Souad Belkebir ◽  
Alaa Kanaan ◽  
Rawan Jeetawi
Keyword(s):  
Bacterial Colonization ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Diffusion Method ◽  
Infection Prevention And Control ◽  
Isolation And Identification ◽  
Active Screening ◽  
Multidrug Resistant Organisms ◽  
Positive Results

Background: The prevalence of multidrug-resistant organisms (MDROs) in acute healthcare settings is increasing worldwide. Active screening for MDROs carriers on admission permits the prompt implementation of the appropriate precautions to decrease the probability of cross transmission to other inpatients. Objective: To report the spectrum of bacterial nasal, axilla, and perianal colonization among in patients at Najah National University Hospital (NNUH) during 2018. Methods: A retrospective observational study was performed at NNUH, a tertiary-care referral university hospital in Nablus, north of Palestine, that includes medical and surgical ICUs for both adults and children from January to August 2018. Nasal, axilla, and perianal swabs were collected within the first 24 hours of admission according to hospital policy. Patients who were referred from another hospital, who were admitted to a hospital for at least 2 nights during the previous 8 months, and who are known to have an MDROs in the past were included. Swab samples were processed for isolation and identification of these multidrug-resistant strains. Transmission-based precautions were implemented if positive results were reported (ie, contact isolation) and decolonization regimens were applied according to the CDC recommendations (muporocin ointment for nasal MRSA, daily bathing with chlorhexidine 2% soap for the rest). A daily isolation list was circulated among bed managers and senior nurses and head of departments for appropriate management of beds and reallocation of patients. The antibiotic susceptibility pattern was assessed using the disc-diffusion method on Mueller–Hinton agar and a Vitek-2 system. Results: During the period of the study, 1,425 nasal swabs, 1,245 axilla swabs, and 300 perianal swabs were collected according to the inclusion criteria. Positive results were reportedin 7%, 4%, and 44% for nasal, axilla, and perianal specimens, respectively. Regarding the distribution of bacterial colonization in the nasal swab, 73% were MRSA; for the axial, 29% were Pseudomonas; and from the perianal swab, the most prevalent pathogen was ESBL (56%) (Figs. 1–3). A discrepancy between the number of nasal or axilla and perianal swabs was observed, which was mainly due to the refusal of many patients to have the sample collected by the nurse. Conclusions: Colonization of the skin and mucous membranes of inpatients with MDROs is considered a risk factor for developing future infections. Therefore, active screening for those pathogens is critical for infection prevention and control programs and patient safety in acute-care settings.Funding: NoneDisclosures: None

Colistin Resistance in KPC-2- and SHV-5-Producing Klebsiella pneumoniae Clinical Isolates in Bulgaria

Chemotherapy ◽  
2017 ◽  
Vol 62 (6) ◽  
pp. 339-342 ◽  
Author(s):  
Encho Savov ◽  
Iva Todorova ◽  
Lida Politi ◽  
Angelina Trifonova ◽  
Maja Borisova ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Colistin Resistance ◽  
Klebsiella Species ◽  
Microbial Identification ◽  
Clonal Type ◽  
Intrinsic Mechanism ◽  
Vitek 2

Background/Aims: Colistin resistance is increasingly recognized among carbapenemase-producing Klebsiella pneumoniae isolates in several European regions. The current study documents the appearance of colistin resistance among KPC-2 and SHV-5-produning K. pneumoniae strains in Bulgaria. Methods: Four colistin-resistant K. pneumoniae isolates were recovered from 2 patients hospitalized in the anesthesiology and resuscitation clinic of a tertiary care university hospital in Sofia, Bulgaria. Microbial identification and antimicrobial susceptibility testing was performed by Vitek 2 (Biomerieux, France). β-Lactamase genes were amplified using a panel of primers for detection of all MBL-types, KPCs, plasmid-mediated AmpCs in single PCR reactions, OXA-type carbapenemases, extended-spectrum β-lactamases (ESBLs) and TEM enzymes. The colistin-resistant mcr-1 gene was also investigated using previously described primers and conditions. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used to investigate clonality. Results: The 4 K. pneumoniae isolates exhibited colistin MICs >16 mg/L and showed multidrug-resistant phenotypes, remaining intermediately susceptible only to gentamicin. They were clustered into a single PFGE clonal type and MLST assigned them to sequence type 258. All isolates possessed KPC-2 carbapenemase and SHV-5 ESBL. They were negative for the plasmid-mediated colistin-resistant mcr-1 gene, possibly implying an intrinsic mechanism of resistance. Conclusions: Although colistin use in Bulgaria only started moderately during 2014, the findings of the current study notify the appearance of colistin resistance among carbapenemase-producing Klebsiella species in another European region.

The role of new antibiotics in intra-abdominal infections in the era of multi-resistant bacteria

2019 ◽  
Vol 98 (4) ◽  
pp. 145-151
Keyword(s):  
Multidrug Resistant ◽  
University Hospital ◽  
Resistant Bacteria ◽  
Highly Active ◽  
Carbapenem Resistant ◽  
New Antibiotics ◽  
Amoxicillin Clavulanic Acid ◽  
Resistant Strains ◽  
Lactam B ◽  
Abdominal Infections

Complicated intra-abdominal infections (cIAI) are a substantial cause of morbidity at intensive care units. cIAI are frequently caused by multidrug- resistant strains of Enterobacteriaceae and Pseudomonas aeruginosa. In 592 cIAI patients from the First Department of Surgery, General University Hospital in Prague, we found an alarming increase in resistance of Escherichia coli to amoxicillin/clavulanic acid, piperacillin/tazobactam and third-generation cephalosporins in 2014–2017 (from 28.7% in 2014 to 37.5% in 2017, from 25% to 32% and from 2.3% to 5.6%, respectively). Ceftolozane/tazobactam and ceftazidime/avibactam are novel cephalosporins available for the treatment of cIAI. Ceftolozane/tazobactam is highly active against multidrug-resistant strains of P. aeruginosa, including carbapenem-resistant isolates. The new non-b-lactam b-lactamase inhibitor avibactam plus ceftazidime is active against carbapenemases-producing strains of Enterobacteriaceae. Both antibiotics are included in the new WSES guidelines for the management of cIAI.

Risk factors and outcomes of patients colonized with carbapenemase-producing and non–carbapenemase-producing carbapenem-resistant Enterobacteriaceae

2020 ◽  
Vol 41 (10) ◽  
pp. 1154-1161
Author(s):  
Amal Kassem ◽  
Aman Raed ◽  
Tal Michael ◽  
Orli Sagi ◽  
Orly Shimoni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Rectal Swab ◽  
Tertiary Care ◽  
Mortality Prediction ◽  
Charlson Index ◽  
University Hospital ◽  
Historical Study ◽  
Carbapenem Resistant

AbstractObjective:To compare risk factors and outcome of patients colonized with carbapenemase-producing (CP) carbapenem-resistant Enterobactereaceae (CRE) and non–CP-CRE.Design:A comparative historical study.Setting:A 1,000-bed tertiary-care university hospital.Patients:Adults with CP-CRE positive rectal swab cultures, non–CP-CRE positive rectal swab cultures, and negative rectal swab cultures (non-CRE).Methods:CP-CRE and non–CP-CRE colonized adult patients versus patients not colonized with CRE hospitalized during 24 months were included. We identified patients retrospectively through the microbiology laboratory, and we reviewed their files for demographics, underlying diseases, Charlson Index, treatment, and outcome.Results:This study included 447 patients for whom a rectal swab for CRE was obtained: 147 positive for CP-CRE, 147 positive for non–CP-CRE, and 147 negative for both. Patients with CP-CRE and non–CP-CRE versus no CRE more frequently resided in nursing homes (P<0.001), received antibiotics 3 months prior to admission (P < .001), and received glucocorticosteroids 3 months prior to admission (P = .047 and P < .001, respectively). Risk factors unique for non–CP-CRE versus CP-CRE colonization included mechanical ventilation and patient movement between hospital departments. Non–CP-CRE was a predictor for mechanical ventilation 2.5 that of CP-CRE colonization. In-hospital mortality was highest among non–CP-CRE–colonized patients. On COX multivariate regression for mortality prediction age, Charlson index and steroid treatment 3 months before admission influenced mortality (P = .027, P = .023, and P = .013, respectively).Conclusions:Overlapping and unique risk factors are associated with CP-CRE and non–CP-CRE colonization. Non–CP-CRE colonized patients had a higher in-hospital mortality rate.

The management of NDM-β-lactamase-producing carbapenem-resistant Enterobacterales in Tuscany

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Ninci ◽  
M Grazzini ◽  
D Paolini ◽  
F Niccolini ◽  
M T Mechi ◽  
...  
Keyword(s):  
Prevention And Control ◽  
Rectal Swab ◽  
Task Force ◽  
Hospital Setting ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Outbreak Management ◽  
Carbapenem Resistant ◽  
Multidrug Resistant Organisms ◽  
And Control

Abstract Issue An important outbreak of New Delhi metallo-β-beta-lactamase (NDM)-producing carbapenem-resistant Enterobacterales (CRE) has been reported from north-western of Tuscany since November 2018. NDM is a metallo-β-lactamase able to hydrolyze most β-lactames (including carbapenems) with limited treatment options. Description of the Problem From November 2018 to May 2019, 7 Tuscan hospitals notified a total of 350 infected or colonized cases. This outbreak was described in a risk assessment edited by the European Centre for Disease Prevention and Control (ECDC) in June 2019. The Ministry of Health and the Tuscany Region promptly adopted infection prevention control measures. Results Since July 2019, a regional task force, composed by experts in infectivology, microbiology and public health, coordinated the following actions: Publication of Regional Resolutions which have established practical guidelines for the outbreak management. These measures included:(I) the introduction of screening test for CRE by rectal swab for hospitalized patients; (II) the implementation of microbiological rapid molecular tests and genotyping of rectal swab; (III) the enhancement of standard and transmission-based precautions; (iv) the strengthening of handover between hospital setting and primary healthcare; (v) the implementation of a regional data-base for outbreak surveillance.Monthly regional meetings with the infection control teams of each hospital.Site visits (n. 44) performed by a group of experts in all healthcare facilities. After the implementation of these measures, a trend for decrease in positive blood cultures of NDM was registered. Lessons The spread of NDM in Tuscany has been the opportunity to standardize and improve the approach to Multidrug-Resistant Organisms (MDROs) prevention and control. Key messages The spread of NDM in Tuscany has been the opportunity to standardize and improve the approach to Multidrug-Resistant Organisms (MDROs) prevention and control. The cooperation among stakeholders and the standardization of precaution measures and healthcare workers’ behavior allows to effectively face the MDROs diffusion.

scholarly journals Prevalence and Risk Factors of Metallo β-lactamase Producing Pseudomonas aeruginosa and Acinetobacter species in Burns and Surgical Wards in a Tertiary Care Hospital

2012 ◽  
Vol 4 (01) ◽  
pp. 039-042 ◽  
Author(s):  
Simit H Kumar ◽  
Anuradha S De ◽  
Sujata M Baveja ◽  
Madhuri A Gore
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Care Hospital ◽  
Acinetobacter Species ◽  
Carbapenem Resistant

ABSTRACT Introduction: The production of Metallo-β-lactamases (MBLs) is one of the resistance mechanisms of Pseudomonas aeruginosa and Acinetobacter species. There is not much Indian data on the prevalence of MBLs in burns and surgical wards. Materials and Methods: A total of 145 non-duplicate isolates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species, isolated from pus/wound swabs and endotracheal secretions from burns and surgical wards, were tested for MBL production by modified ethylene diamine tetra acetic acid (EDTA) disc synergy and double disc synergy tests. Results: Prevalence of MBLs was 26.9% by both the above tests. All MBL-positive isolates were multidrug resistant. Only 6.06% (2/33) P.aeruginosa and 16.67% (1/06) Acinetobacter species were susceptible to piperacillin-tazobactam and netilmycin, respectively. These patients had multiple risk factors like >8 days hospital stay, catheterization, IV lines, previous antibiotic use, mechanical ventilation, etc. Graft application and surgical intervention were significant risk factors in MBL-positive patients. Overall mortality in MBL-positive patients was 34.21%. Conclusion: Emergence of MBL-producing Pseudomonas aeruginosa and Acinetobacter species in this hospital is alarming, which reflect excessive use of carbapenems and at the same time, pose a therapeutic challenge to clinicians as well as to microbiologists. Therefore, a strict antibiotic policy and implementation of proper infection control practices will go a long way to prevent further spread of MBLs. Detection of MBLs should also become mandatory in all hospitals.

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