scholarly journals Metallo - β - Lactamase Producers among Carbapenem Resistant Gram-Negative Isolates from Clinical Samples in a Tertiary Care Hospital

2021 ◽  
Vol 10 (9) ◽  
pp. 105-113
Author(s):  
M. Shabnum P. Sreenivasulu Reddy
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Control Measures ◽  
Clinical Samples ◽  
Care Hospital ◽  
Klebsiella Species ◽  
Strict Adherence ◽  
Gram Negative ◽  
Carbapenem Resistant

Gram – Negative Bacilli (GNB) are important cause of UTI, Blood stream infections, hospital acquired pneumonias. With the Carbapenems becoming the drug of choice in treating Multidrug resistant Organisms (MDRO) due to their safety and efficacy, there is rise in Carbapenem Resistant organisms which is becoming a threat to health care setup. Early diagnosis of Metallo – β – lactamase (MBL) producers by routine laboratory methods makes it the need of the hour to prevent spread of resistant strains. To detect MBL producers among Carbapenem resistant GNB. GNB were isolated from 2576 various clinical samples received by Department of Microbiology between December 2020 to March 2021. MBL production among Carbapenem resistant GNB was tested by Combined Disc Diffusion Assay using Imipenem disc and Imipenem + EDTA disc. Results: 899 GNB were isolated among 2576 samples with E. coli (35.05%) followed by Klebsiella species (28.58%) and Pseudomonas aeruginosa (14.90%). 180 isolates (20.02%) were Carbapenem Resistant GNB of which 55 isolates (30.55%) were MBL producers with Klebsiella species (29.01%) being highest MBL producer followed by Pseudomonas aeruginosa (27.27%). Rapid dissemination of MBL producers is worrisome making routine detection of MBL strains important. Regular surveillance, strict adherence to infection control measures and implementation of proper antibiotic policy is crucial to minimize the increasing Carbapenem resistance.

scholarly journals Emerging resistance to carbapenem among Gram-negative bacteria in a tertiary care hospital

2020 ◽  
Vol 11 (SPL2) ◽  
pp. 153-156
Author(s):  
Pooja Nair ◽  
Renu Mathews ◽  
Kalyani M
Keyword(s):  
Minimum Inhibitory Concentration ◽  
Inhibitory Concentration ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Clinical Samples ◽  
Care Hospital ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Diffusion Technique

The emergence of bacterial antibiotic resistance is a cardinal concern in the health care system. The spread of resistance in Enterobacteriaceae and non-fermenters to the currently available drugs make the treatment of serious nosocomial infections troublesome.  The purpose of the study is to find out the carbapenem resistance among Gram-negative bacilli in a tertiary care hospital. Antibiotic susceptibility pattern of 1913 aerobic Gram-negative bacilli isolated from clinical samples was made for a period of 6 months. All the isolates were tested for susceptibility to antibiotics by the Kirby-Bauer disc diffusion technique according to CLSI guidelines. Carbapenemase production was confirmed by the Modified Hodge Test (MHT). Minimum Inhibitory Concentration (MIC) by Epsilometer (E) test was performed (for Imipenem and Meropenem) for carbapenem-resistant strains. A total of 1731 clinical samples, 1913 Gram-negative bacilli were isolated. 1476 (77.1%) were Enterobacteriaceae and 433 (22.6%) were non-fermenters. 54 were carbapenemase-producing Gram-negative bacilli. Meropenem E test was done for carbapenemase-producing Gram-negative bacilli. The minimum inhibitory concentration for Meropenem ranged from 0.002μg/ml to 32μg/ml. To overcome the problem of emerging resistance, combined interaction and cooperation of microbiologists, clinicians and the infection control team is needed.

scholarly journals Phenotypic detection of carbapenem resistance and metallo-beta-lactamase among Enterobacteriaceae from clinical samples in tertiary care hospital

2019 ◽  
Vol 7 (6) ◽  
pp. 2373
Author(s):  
Nidhi Agarwal ◽  
Sapna Chauhan ◽  
Paramjit Singh ◽  
V. K. Sharma
Keyword(s):  
Infection Control ◽  
Control Strategies ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Clinical Isolates ◽  
Clinical Samples ◽  
Care Hospital ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Lactam Antibiotic

Background: Carbapenems have the broadest activity spectra of any β-lactam antibiotic and are often the most appropriate agents for use in the treatment of infections caused by multi resistant gram negative bacteria. The recent worldwide emergence and dissemination of carbapenemase-producing Gram negative rods that are resistant to carbapenems is a significant concern with respect to patient care and infection control strategies. Hence this study was undertaken to study the magnitude of carbapenem resistance among routine clinical isolates of family Enterobacteriaceae so as to guide the clinicians in selection of appropriate antimicrobial chemotherapies and infection control measures.Methods: The present study was conducted in the Department of Microbiology over a period 18 months from January 2017 to July 2018. All the clinical isolates of Enterobacteriaceae were screened for carbapenem resistance as per CLSI guidelines. Such strains were then subjected to phenotypic confirmation of carbapenemase production by the Modified Hodge test. All isolates that gave a positive screening test were further evaluated for metallo-β-lactamase production. The technique used was the Combined Disk Test using a combination of Imipenem and Imipenem-EDTA.Results: Out of the 400 total clinical isolates of Enterobacteriaceae isolated in the laboratory,57 were found to be Meropenem resistant (14.25%) and were labelled 'Carbapenem resistant Enterobacteriaceae" or CRE. Modified Hodge test (MHT) performed on the 57 carbapenem resistant isolates showed 41 (71.93%) isolates to be carbapenemase enzyme producers. Combined disc test (CDT) conducted on the 57 isolates of CRE detected Metallo-β-lactamase (MBL) enzyme production in 39 isolates (68.42%).Conclusions: Since there is a high prevalence of carbapenemase resistance in our setting hence we need to be cautious with the indiscriminate use of broad spectrum antimicrobials, more so, the carbapenems.

scholarly journals Epidemiology of carbapenem-resistant Enterobacteriaceae in a Tertiary Care Center in the Kingdom of Bahrain

2019 ◽  
Vol 11 (02) ◽  
pp. 111-117 ◽  
Author(s):  
Nermin Kamal Saeed ◽  
Safaa Alkhawaja ◽  
Nashawa Fawzy Abd El Moez Azam ◽  
Khalil Alaradi ◽  
Mohammed Al-Biltagi
Keyword(s):  
Control Measure ◽  
Care Center ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Control Measures ◽  
Clinical Samples ◽  
Common Source ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract PURPOSE: The purpose of the study is to estimate the rate of infection with carbapenem-resistant Enterobacteriaceae (CRE) in the main governmental tertiary care hospital in Bahrain. MATERIALS AND METHODS: All clinical samples with positive growth of CRE over 6-year period (January 2012–December 2017) were collected from the microbiology laboratory data. RESULTS: The CRE incidence was high in the first half of study period (2012–2014) and then decreased between 2015 and 2017, after implementation of intensified CRE control measure bundle. About 49.4% of CRE-positive samples were isolated from the elderly age group (above 65 years old), most of them were admitted in the intensive care unit (ICU). The most common isolated organisms were Klebsiella pneumoniae (87.0%), followed by Escherichia coli (7.9%). Isolates from deep tracheal aspirate and midstream urine specimens were the most common source of CRE isolates (27.3%) and (26.3%), respectively. Bacteremia was documented in 21.2% of cases. CRE isolates in the study showed high rates of resistance to aminoglycosides (72.2% resistant to amikacin and 67.3% to gentamicin). Alternatively, most isolates retained their susceptibility to colistin and tigecycline with sensitivity of 83.9% and 85.7%, respectively. Combined resistance to both colistin and tigecycline was observed in 0.06% of total isolates. CONCLUSION: Elderly population and ICU admission were important risk factors for CRE acquisition. Most of CRE isolates were sensitive to both colistin and tigecycline, which make them the best combination for empiric frontline therapy for suspected serious CRE infection in our facility. Implementing CRE-bundled infection control measures significantly reduced the incidence of CRE infection in our hospital.

scholarly journals Reduction in Fluoroquinolone Use following Introduction of Ertapenem into a Hospital Formulary Is Associated with Improvement in Susceptibility of Pseudomonas aeruginosa to Group 2 Carbapenems: a 10-Year Study

2011 ◽  
Vol 55 (12) ◽  
pp. 5597-5601 ◽  
Author(s):  
Paul P. Cook ◽  
Michael Gooch ◽  
Shemra Rizzo
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Pearson Correlation ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Hospital Formulary ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Group 2

ABSTRACTWe examined the effect of the addition of ertapenem to our hospital formulary on the resistance of nosocomialPseudomonas aeruginosato group 2 carbapenems (imipenem, meropenem, and doripenem). This was a retrospective, observational study conducted between 1 January 2000 and 31 January 2009 at a large, tertiary-care hospital. Autoregressive integrated moving average (ARIMA) regression models were used to evaluate the effect of ertapenem use on the susceptibility ofPseudomonas aeruginosato group 2 carbapenems as well as on the use of the group 2 carbapenems, ciprofloxacin, and other antipseudomonal drugs (i.e., tobramycin, cefepime, and piperacillin-tazobactam). Resistance was expressed as a percentage of total isolates as well as the number of carbapenem-resistant bacterial isolates per 10,000 patient days. Pearson correlation was used to assess the relationship between antibiotic use and carbapenem resistance. Following the addition of ertapenem to the formulary, there was a statistically significant decrease in the percentage ofPseudomonas aeruginosaisolates resistant to the group 2 carbapenems (P= 0.003). Group 2 carbapenem use and the number of carbapenem-resistantPseudomonas aeruginosaisolates per 10,000 patient days did not change significantly over the time period. There was a large decrease in the use of ciprofloxacin (P= 0.0033), and there was a correlation of ciprofloxacin use with the percentage of isolates resistant to the group 2 carbapenems (ρ = 0.47,P= 0.002). We suspect that the improvement in susceptibility ofPseudomonas aeruginosato group 2 carbapenems was related to a decrease in ciprofloxacin use.

Molecular Typing of Imipenem-ResistantAcinetobacter baumannii-calcoaceticusComplex in a Singapore Hospital Where Carbapenem Resistance Is Endemic

2007 ◽  
Vol 28 (8) ◽  
pp. 941-944 ◽  
Author(s):  
Thean Yen Tan ◽  
Karen Poh ◽  
Siew Yong Ng
Keyword(s):  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Care Hospital ◽  
Typing Method ◽  
Disk Diffusion Method ◽  
Carbapenem Resistant ◽  
High Prevalence ◽  
Resistant Strains

Objective.To investigate the molecular epidemiology of carbapenem-resistantAcinetobacter baumannii-calcoaceticuscomplex isolates in a tertiary care hospital where the prevalence of carbapenem resistance among these organisms is high.Design.The study was a prospective, observational study performed during an 8-month period (May 1 through December 31, 2004).A. baumanniiisolates recovered from all clinical samples during the study period were included in the study. Antibiotic susceptibility testing was performed using the disk diffusion method, and all carbapenem-resistant strains were typed by a polymerase chain reaction-based typing method.Setting.An 800-bed hospital in Singapore.Results.More than half of recovered isolates were clonally unrelated, with the remaining isolates grouped into 4 genotypes.Conclusions.The results of the study suggest that the high prevalence of carbapenem resistance amongAcinetobacterorganisms in this institution is not caused by the spread of a predominant clone and that other factors may need to be investigated.

scholarly journals Frequency and susceptibility pattern of metallo-beta-lactamase producers in a hospital in Pakistan

2010 ◽  
Vol 4 (12) ◽  
pp. 810-813 ◽  
Author(s):  
Fatima Kaleem ◽  
Javaid Usman ◽  
Afreenish Hassan ◽  
Aslam Khan
Keyword(s):  
Tertiary Care ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Care Hospital ◽  
Gram Negative ◽  
Medical College ◽  
Strip Method ◽  
Carbapenem Resistant ◽  
Microbiological Methods ◽  
National University

Introduction: The rapid spread of acquired metallo-beta-lactamases (MBLs) among major Gram-negative pathogens is an emerging threat and a matter of particular concern worldwide. Methodology: This descriptive study was conducted between January and August 2009 in the department of Microbiology, Army Medical College, National University of Sciences and Technology, Rawalpindi, to determine the frequency and susceptibility patterns of MBL-producers among carbapenem-resistant Gram-negative rods (GNRs) from clinical isolates of a tertiary care hospital. All clinical samples were processed according to standard microbiological methods. Isolated GNRs were subjected to susceptibility testing against various antibiotics by disc diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines.  Carbapenem-resistant isolates were subjected to the detection of MBL production by the E-test MBL strip method. Results: Out of 50 carbapenem resistant isolates, 39 (78%) of were confirmed to be MBL producers by the E-strip method.  Acinetobacter baumannii were the most frequent MBL producers, followed by Pseudomonas aeruginosa. A total of 19 (37%) of the MBL producers were susceptible to cefoperazone-sulbactam. Conclusion: The findings strongly suggest that there is a need to track the detection of MBL producers and that judicious use of carbapenems is necessary to prevent the further spread of these organisms.

scholarly journals PREVALENCE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF PSEUDOMONAS SPECIES ISOLATED FROM CLINICAL SAMPLES IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 50-53
Author(s):  
M. ABDUR RAHMAN ◽  
POOJA NAIR
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antimicrobial Susceptibility ◽  
Tertiary Care ◽  
Control Measures ◽  
Diffusion Method ◽  
Multi Drug Resistance ◽  
Clinical Samples ◽  
Care Hospital ◽  
Susceptibility Pattern ◽  
Pseudomonas Species

Objective: Pseudomonas aeruginosa is the commonest agent causing opportunistic nosocomial infections, contributing to mortality and morbidity worldwide. Along with its intrinsic and acquired resistance mechanisms, infections caused by Pseudomonas species further lead to treatment failure. This study was done to determine the prevalence and antimicrobial susceptibility pattern of different species of Pseudomonas isolated from various clinical samples by phenotypic methods. Methods: This study involved the examination of clinical samples for various species of Pseudomonas by using different standard biochemical tests. Their antimicrobial susceptibility profile was performed by the Kirby Bauer disc diffusion method. Analysis of the antibiogram pattern was done to study the multi-drug resistance among Pseudomonas species. Results: Out of the 1249 bacterial isolates, Pseudomonas species accounted for 12.9%. Pseudomonas species showed maximum resistance to gentamicin (31.4%), followed by ciprofloxacin (30.2%. and showed the least resistance tocolistin and polymyxin B. 46 isolates out of the 162 (28%) were found to be Multi-Drug Resistant (MDR) Pseudomonas aeruginosa. Conclusion: The present study highlights that Pseudomonas species remains a major cause of hospital-acquired infections. Multidrug resistance was observed in most of the strains, which makes the therapeutic options more difficult. Surveillance of antimicrobial resistance and strict infection control measures are essentially to be practiced in managing and control of infections caused by Pseudomonas.

scholarly journals Detection of carbapenemase-producing Pseudomonas aeruginosa by phenotypic and genotypic methods in a tertiary care hospital of East India

2019 ◽  
Vol 11 (04) ◽  
pp. 287-291 ◽  
Author(s):  
Nishu Verma ◽  
Ashok Prahraj ◽  
Baijayantimala Mishra ◽  
Bijayini Behera ◽  
Kavita Gupta
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Molecular Mechanisms ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Hospital Infection ◽  
High Rate ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Hospital Infection Control ◽  
Synergy Test

Abstract BACKGROUND: Carbapenemase-producing Pseudomonas aeruginosa is a serious threat in hospital infection due to its multidrug resistance. AIM: The aim of the study was to determine the frequency of carbapenem resistance in clinical isolates of Pseudomonas aeruginosa and detect the presence of carbapenemase enzymes in carbapenem-resistant P. aeruginosa (CRPA) isolates by phenotypic and genotypic methods. MATERIAL AND METHODS: Double-disk synergy test [DDST] and combined disk synergy test [CDST]) was performed in CRPA isolates and the prevalence ofblaKPC,blaNDM-1,blaIMP,blaVIM,blaSIM,blaSPM,blaGIM, andblaOXA-48 was determined. RESULTS: Of 559 isolates included in the study, a total of 102 isolates were resistant to carbapenem that accounted for overall 18.24% (102/559) prevalence. Of these 102 isolates, 89 (87.25%) isolates were positive by DDST and 95 (93.17%) isolates were positive by CDST. Of 102 CRPA isolates,blaVIM was detected in 30 isolates (30/102, 29.1%), followed byblaNDM-1 in 29 (29/102, 28.4%) isolates andblaSIM andblaGIM in 6 isolates each (6/102, 5.8%). A combination of two carbapenemase genes was detected in 12 isolates, with six (6/102, 5.88%) CRPA isolates harboring with bothblaVIM andblaNDM-1 genes. Four isolates were found to harbor a combination of three carbapenem-resistant genes. CONCLUSION: A high rate of carbapenemase production was observed in P. aeruginosa. Coproducers of multiple carbapenemases are also a cause of concern. An in-depth understanding of molecular mechanisms of resistance will be helpful in optimizing patient management and hospital infection control.

scholarly journals Molecular Characterization Identifies Upstream Presence of ISAba1 to OXA Carbapenemase Genes in Carbapenem-Resistant Acinetobacter baumannii Isolated from a Tertiary Care Hospital in Western Maharashtra

2021 ◽  
Author(s):  
Nageswari Gandham ◽  
Neetu Gupta ◽  
Chanda Vyawahare ◽  
Shahzad Beg Mirza ◽  
Rabindra Nath Misra
Keyword(s):  
Acinetobacter Baumannii ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Clinical Samples ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Resistant Strains ◽  
Polymerase Chain ◽  
Antibiotics Sensitivity

Abstract Background Evaluating the expression pattern of oxacillinases (OXA) carbapenemases is essential to understand the prevalence and spread of carbapenem resistance Acinetobacter baumannii. Objectives The aim of the study is to evaluate the presence of OXA carbapenemase genes and ISAba1 upstream to these genes in carbapenem-resistant A. baumannii clinical isolates. Material and Methods A. baumannii isolated from clinical samples were phenotypically identified and antibiotics sensitivity was performed. Multiplex polymerase chain reaction (PCR) was used to detect OXA51-like gene, OXA carbapenemases genes (OXA-23-like, OXA-24-like, and OXA-58-like), and ISAba1 in carbapenem-resistant isolates. Results Out of 55 Acinetobacter isolates, 54 were confirmed as A. baumannii by PCR. Bla OXA-23-like gene was observed in 51 isolates of A. baumannii and none of the isolates showed the presence of bla OXA-24-like and bla OXA-58-like genes. Presence of ISAba1 upstream to OXA-23-like gene, OXA-51-like gene, and both OXA-51-like/OXA-23-like genes was observed in 51, 7, and 4 A. baumannii isolates, respectively. Conclusion The genetic pattern of carbapenem-resistant A. baumannii isolated in this study was unique, which should be factored for clinical protocols to manage infections caused by emerging resistant strains of A. baumannii.

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