scholarly journals Genome-Wide Identification of Carbapenem-Resistant Gram- Negative Bacterial (CR-GNB) Isolates Retrieved From Hospitalized Patients in Bihar, India

2021 ◽  
Author(s):  
Namrata Kumari ◽  
Mukesh Kumar ◽  
Amit Katiyar ◽  
Abhay Kumar ◽  
Pallavi Priya ◽  
...  
Keyword(s):  
Resistance Genes ◽  
Carbapenem Resistance ◽  
Cross Sectional Study ◽  
Clinical Isolates ◽  
Cross Sectional ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Genome Wide ◽  
Synergy Test ◽  
Global Threat

Abstract Carbapenemase-producing clinical isolates are becoming more common over the world, posing a severe public health danger, particularly in developing nations like India. Carbapenem-resistant Gram-negative bacterial (CR-GNB) infection has become a fast-expending global threat with limited antibiotic choice and significant mortality. The aim of this study was to highlight the carbapenem-resistance among clinical isolates of hospital admitted patients in Bihar, India. A cross-sectional study was conducted with 101 clinical isolates of E. coli, K. pneumoniae, A. baumannii, and P. aeruginosa. All GNB isolates were tested for their antimicrobial susceptibility using double disc synergy test / modified hodge test (DDST/MHT) and subsequently confirmed carbapenemase-producing isolates were evaluated for carbapenem-resistance genes using whole-genome sequencing (genotypically) method. The overall percentage of carbapenem-resistance among GNB was (17/101) 16.83%. The AMR analysis demonstrates a significantly high prevalence of blaCTX−M followed by blaSHV, blaTEM, blaOXA and blaNDM β-lactams carbapenem-resistance genes among clinical isolates of GNB. Co-occurrence of carbapenemase-encoding genes with blaNDM was found in 70.6% of carbapenemase-producing isolates. Our study highlights the mechanism of carbapenem-resistance to curb the overwhelming threat posed by emergence of drug-resistance in India.

scholarly journals Detection and Characterization of Carbapenem resistant Gram-negative bacilli isolates recovered from hospitalized patients at Soba University Hospital, Sudan

2020 ◽  
Author(s):  
Hana S. Elbadawi ◽  
Kamal M. Elhag ◽  
Elsheikh Mahgoub ◽  
Hisham N Altayb ◽  
Francine Ntoumi ◽  
...  
Keyword(s):  
Resistance Genes ◽  
Nosocomial Infections ◽  
Carbapenem Resistance ◽  
Clinical Isolates ◽  
University Hospital ◽  
P Value ◽  
Relative Distribution ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene

Abstract Background:Antimicrobial resistance (AMR) poses a threat to global health security. Whilst over the past decade, there has been an increase in reports of nosocomial infections globally caused by carbapenem resistant Gram-negative bacilli (GNB), data from Africa have been scanty. We performed a study of carbapenem resistance genes among GNB isolated from patients treated in hospitals in Khartoum state, Sudan.Methods:A cross-sectional study was conducted at Soba University Hospital (SUH) and Institute of Endemic Diseases, University of Khartoum for the period October 2016 to February 2017. A total of 206 GNB isolates from different clinical specimens were analyzed for carbapenem resistance genes using phenotypic tests and affirmed by genes detection. Multiplex PCR was performed for each strain to detect the carbapenemase genes, including the blaNDM, blaVIM, blaIMP, blaKPC, and blaOXA-48. In addition to blaCTXM, blaTEM and blaSHV. DNA sequencing and bioinformatics analysis were used to detect genes subtypes.Findings:Of 206 isolates, 171 (83%) were confirmed resistant phenotypically and 121 (58.7%) isolates were positive for the presence of one or more carbapenemase gene. New Delhi metallo-β-lactamase (NDM) types were the most predominant genes, blaNDM 107(88.4%). Others included blaIMP 7 (5.7%), blaOXA-48 5(4.1%), blaVIM 2 (1.6%) and blaKPC 0 (0%). Co- resistance genes with NDM producing GNB were detected in 87 (81.3%) of all blaNDM positive isolates. A significant association between phenotypic and genotypic resistance was observed (P- value < 0.001). NDM-1 was the most sub type was observed in 75 isolates (70 %), other subtypes were NDM- 5 and NDM-6. Infections due to Carbapenem resistant GNB are increasing at SUH, with the blaNDM being the prevalent genes among clinical isolates and belong to the Indian lineage.Conclusions:The frequency of carbapenemase producing bacilli was found to be improperly high in Khartoum hospitals. NDM was found to be the most prevalent carbapenemase gene among clinical isolates. Close surveillance across all hospitals in Sudan is required. The relative distribution of Carbapenemase genes among GNB in nosocomial infections in Africa needs to be defined.

Coexistence of Metallo Beta Lactamase Resistant Gene Variants Among Clinical Isolates in Tertiary Care Hospital

2021 ◽  
Vol 18 (4) ◽  
pp. 429-436
Author(s):  
Santhiya K. ◽  
Jayanthi S. ◽  
Ananthasubramanian M. ◽  
Appalaraju B.
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Medical Science ◽  
Geographical Location ◽  
Carbapenem Resistance ◽  
Clinical Isolates ◽  
Care Hospital ◽  
Detection Rates ◽  
Carbapenem Resistant ◽  
Global Threat

Background: Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a global threat with mortality risk ranging from 48%-71% worldwide. The emergence of MBL resistance is threatening as carbapenem is one of the last line antibiotics. A total 24 variants of NDM resistance raises a concern to the clinicians and epidemiologists worldwide. Objective: The study aims at identifying MBL resistance (NDM, IMP, VIM, GIM, SPM, and SIM) and its coexistence in clinical isolates in a single tertiary care center. Methodology: Forty five clinical isolates characterized phenotypically for Carbapenem resistance obtained from PSG Institute of Medical Science and Research (PSG IMSR), Coimbatore, between February to March 2018 were taken for analysis. Result: Out of the 45 Clinical isolates, 38 isolates (84%) were detected as MBL carriers. VIM, NDM, GIM, and SPM were the predominant resistance genes, with detection rates of 48.8%, 28.8%, 24.4%, and 22.2% respectively. Fifteen isolates were observed to harbor more than one MBL gene in coexistence. Two isolates - U42 and R714 (K. pneumoniae) were found to harbor all 5 MBL variants in combination. Conclusion: 33% of clinical isolates harboring multiple MBL variants is a concern in clinical settings. The presence of SPM and GIM gene amongst isolates in this geographical location within India is an indicator demanding continuous monitoring of these resistance determinants.

scholarly journals Molecular Characterization of Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates from Egyptian Patients

2020 ◽  
Author(s):  
Reem M Hassan ◽  
Sherifa T Salem ◽  
Saly Ismail Mostafa Hassan ◽  
Asmaa Sayed Hegab ◽  
Yasmine S Elkholy
Keyword(s):  
Acinetobacter Baumannii ◽  
Molecular Characterization ◽  
Antimicrobial Agents ◽  
Treatment Options ◽  
Carbapenem Resistance ◽  
Clinical Isolates ◽  
Common Mechanism ◽  
Carbapenem Resistant ◽  
Egyptian Patients ◽  
Global Threat

AbstractAcinetobacter baumannii (A. baumannii) represents a global threat owing to its ability to resist most of the currently available antimicrobial agents. Moreover, emergence of carbapenem resistant A. baumannii (CR-AB) isolates limits the available treatment options. Enzymatic degradation by variety of ß-lactamases, have been identified as the most common mechanism of carbapenem resistance in A. baumannii. The alarming increase in the prevalence of CR-AB necessitates continuous screening and molecular characterization to appreciate the problem. The present study was performed to assess the prevalence and characterize carbapenemases among 206 CR-AB isolated from various clinical specimens collected from different intensive care units at Kasr Al-Aini Hospital.All isolates were confirmed to be A. baumannii by detection of the blaOXA-51-like gene. Molecular screening of 13 common Ambler class bla carbapenemases genes in addition to insertion sequence (IS-1) upstream OXA-23 was performed by using four sets of multiplex PCR, followed by identification using gene sequencing technology. Among the investigated genes, the prevalence of blaOXA-23, and blaOXA-58 were 77.7%, and 1.9%, respectively. The ISAba1 was detected in 10% of the blaOXA-23 positive isolates. The prevalence of metallo-β-lactamases (MBLs) studied; blaNDM-1, blaSPM, blaVIM, blaSIM-1 were 11.7%, 6.3%, 0.5%, and 0.5% respectively. One of class A; bla KPC was detected in 10.7% of the investigated isolates. blaOXA-24/40, blaIMP, blaGES, blaVEB and blaGIM were not detected in any of the studied isolates. Moreover, 18.4% of the isolates have shown to harbor two or more of the screened bla genes. We concluded that the most prevalent type of ß-lactamases genes among CR-AB isolates collected from Egyptian patients were blaOXA-23 followed by blaNDM-1 and blaKPC.Author summaryCarbapenem-resistant A. baumannii has become a real global health threat. The aim of the present study was to characterize and to assess the prevalence of carbapenemases among 206 CR-AB clinical isolates from Egyptian patients. We concluded that the most prevalent type of ß-lactamases genes among CR-AB isolates collected from Egyptian patients were blaOXA-23 followed by blaNDM-1 and blaKPC. In this study, ISAba1 was detected upstream 10% of blaOXA-23 positive isolates only which indicates that the spread of resistance among Acinetobacter isolates could be either chromosomal or plamid-mediated.

scholarly journals Using Molecular Diagnostics to Develop Therapeutic Strategies for Carbapenem-Resistant Gram-Negative Infections

2021 ◽  
Vol 11 ◽  
Author(s):  
Fred C. Tenover
Keyword(s):  
Carbapenem Resistance ◽  
Multidrug Resistant ◽  
Therapeutic Strategies ◽  
Beta Lactam ◽  
Gram Negative ◽  
Molecular Tests ◽  
Negative Results ◽  
Carbapenem Resistant ◽  
Class B ◽  
Global Threat

Infections caused by multidrug-resistant Gram-negative organisms have become a global threat. Such infections can be very difficult to treat, especially when they are caused by carbapenemase-producing organisms (CPO). Since infections caused by CPO tend to have worse outcomes than non-CPO infections, it is important to identify the type of carbapenemase present in the isolate or at least the Ambler Class (i.e., A, B, or D), to optimize therapy. Many of the newer beta-lactam/beta-lactamase inhibitor combinations are not active against organisms carrying Class B metallo-enzymes, so differentiating organisms with Class A or D carbapenemases from those with Class B enzymes rapidly is critical. Using molecular tests to detect and differentiate carbapenem-resistance genes (CRG) in bacterial isolates provides fast and actionable results, but utilization of these tests globally appears to be low. Detecting CRG directly in positive blood culture bottles or in syndromic panels coupled with bacterial identification are helpful when results are positive, however, even negative results can provide guidance for anti-infective therapy for key organism-drug combinations when linked to local epidemiology. This perspective will focus on the reluctance of laboratories to use molecular tests as aids to developing therapeutic strategies for infections caused by carbapenem-resistant organisms and how to overcome that reluctance.

Determination of carbapenemase genes in clinical isolates using Cepheid Xpert Carba-R

2021 ◽  
pp. 16-19
Author(s):  
N. I. Gabrielyan ◽  
V. G. Kormilitsyna ◽  
V. K. Zaletaeva ◽  
A. V. Krotevich ◽  
I. A. Miloserdov ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Infection Control ◽  
Resistance Genes ◽  
Carbapenem Resistance ◽  
Critical Issue ◽  
Sensitivity Study ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Carbapenem Resistant

Detection of carbapenem resistance genes is a critical issue for hospitals due to possible recommendations for infection control and targeted therapy. The Cepheid Xpert instrument, a Carba-R test for the detection and differentiation of five common carbapenemase genes, was tested from September 2020 to February 2021. As part of the approbation, 20 tests were provided. This review presents the results of the approbation of a relatively regular sensitivity study on Siemens WalkAway‑96 plus. Cepheid Xpert Carba-R analysis has been shown to be an accurate and fast tool for detecting colonization by carbapenem-resistant gram-negative bacteria, which can help limit the spread of these organisms in hospitals.

scholarly journals Carbapenem-resistant Gram-negative bacteria isolated from poultry samples: a cross-sectional study

The Lancet ◽  
2019 ◽  
Vol 393 ◽  
pp. S21
Author(s):  
Abdelraouf A Elmanama ◽  
Mariam R Al-Reefi ◽  
Madleen A Shamali ◽  
Haya I Hemaid
Keyword(s):  
Cross Sectional Study ◽  
Gram Negative Bacteria ◽  
Sectional Study ◽  
Cross Sectional ◽  
Gram Negative ◽  
Carbapenem Resistant

scholarly journals Bad Bugs and No Drugs: Activity of Colistin as Waging War against Emerging Metallo-β-Lactamases Producing Pathogens

2018 ◽  
Vol 24 (1) ◽  
pp. 625-631 ◽  
Author(s):  
Sahar Naz ◽  
Farhan Rasheed ◽  
Muhammad Saeed ◽  
Shagufta Iram ◽  
Ambereen Anwar Imran
Keyword(s):  
Cross Sectional Study ◽  
Resistant Isolate ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Klebsiella Species ◽  
Cross Sectional ◽  
Acinetobacter Species ◽  
Gram Negative ◽  
Negative Results ◽  
Carbapenem Resistant

Inter-hospital and intra-hospital dissemination of metallo-β-lactamase (MβL) producing strains possess significant therapeutic challenges. Objective: This study was carried out to evaluate the efficacy of Colistin against MβL producers. Material and Methods: This cross-sectional study was conducted in Microbiology Laboratory, Allama Iqbal Medical College, Lahore, Pakistan from 1stJuly 2016 to 25th February 2017. A total of 12126 clinical samples were collected from patients presenting to Jinnah Hospital, Lahore. Every sample was processed for bacterial culture. Bacterial identification was performed according to standard guidelines. Every gram-negative isolate was further processed for antimicrobial susceptibility testing by modified Kirby Baur disc diffusion method. Zone sizes were interpreted according to CLSI 2016 guidelines. Next day every carbapenem-resistant isolate were further processed for MβL detection by EDTA method, zone size of Carbapenem disc only and Carbapenem disc impregnated with EDTA was compared ( >7 mm increase MβL positive, 0-5 mm increase MβL-negative). Results: Out of total 12126 samples, 35.9% (n=4361) were culture positive and only 40.5% (n=1770) were Gram negative rods. Of these 9.6% (n=170) were Carbapenem-resistant isolates with 47% (n=80) MβL producers. Briefly 51.7% (n=30) Acinetobacter species were MβL positive, Pseudomonas species 38.5% (n=22), Escherichia coli 69.5% (n=16), Klebsiella species 37.0% (n=10), Proteus 66.6% (n=2) and 0% Citrobacter sppwere MβL positive. 32.5% MβL positive isolates were from ICU, 21.2% were from OPD, 12.5%were from Surgical Units, 12.5% were from Medical Unit, 17.5% were from Orthopedic Unit, and 3.7% were from Pulmonology ward. Almost 100% resistant was observed in MβL positive isolates for Imipenem,Piperacillin+ Tazobactum, Ceftriaxone, Co-amoxyclav, Cefoperazone+Sulbactam, Ciprofloxacin, and Amikacin, Doxycycline, and Gentamicin showed 91.2%, 94.0%, and 97.5% resistant rate respectively. No resistance was observed against Colistin. Conclusion: MβL producing Gram negative rods are rising in clinical setups. They are becoming a nightmare for clinicians to treat such infections. Colistin remains the only choice of drug for MβL positive and Negative isolates with 0% resistant rate except for Proteus species, to which it is intrinsically resistant.

Carbapenem resistance among common Enterobacteriaceae Clinical Isolates in part of North-East India

2021 ◽  
Vol 19 ◽  
Author(s):  
Mohan Sharma ◽  
Pankaj Chetia ◽  
Minakshi Puzari ◽  
Nakul Neog ◽  
Upasana Phukan ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Treatment Options ◽  
Carbapenem Resistance ◽  
Cross Sectional Study ◽  
Clinical Isolates ◽  
Diffusion Method ◽  
Multi Drug Resistance ◽  
Biochemical Tests ◽  
Cross Sectional ◽  
North East

Background: Enterobacteriaceae, the normal dwellers in the human intestine, are commonly associated with a variety of community acquired and nosocomial infections. Emerging trend of antibiotic resistance among these strains is a notable issue globally; more serious threat is the resistance against the available last resort antibiotics- the carbapenems. Objective: The objective of our study was intended to determine the burden of resistance towards common antibiotic classes, so as to address the gap of drug resistance prevalence data, among the Enterobacteriaceae isolates obtained from the health settings in this region. Methodology: A cross-sectional study was done with inclusion of clinical isolates collected from varied sources, from health settings in upper Assam. The isolates were identified based on standard methods of morphology study and biochemical tests. The identified isolates were then subjected to antibiotic susceptibility testing by following Kirby-Bauer disc diffusion method and the result interpreted as per the CLSI guidelines. The resistance of the reported carbapenem resistant isolates was confirmed by minimum inhibitory concentration (MIC) determination using commercial E-strip kit. Results: Among the enterobacterial isolates Klebsiella spp. accounted the majority, followed by Escherichia coli, Citrobacter spp., Shigella spp. and others. Multi-drug resistance (MDR) was noted among 67.6% isolates; however, carbapenem resistance was confirmed in 18.9% of the total Enterobacteriaceae isolates. Conclusion: Higher prevalence of resistance towards carbapenems, among the Enterbacteriaceae isolates of upper Assam seems to be upcoming threat to the region, limiting the treatment options in future.

scholarly journals Carbapenemase Genes among Multidrug Resistant Gram Negative Clinical Isolates from a Tertiary Hospital in Mwanza, Tanzania

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Martha F. Mushi ◽  
Stephen E. Mshana ◽  
Can Imirzalioglu ◽  
Freddie Bwanga
Keyword(s):  
Resistance Genes ◽  
Carbapenem Resistance ◽  
Tertiary Hospital ◽  
Multidrug Resistant ◽  
Clinical Isolates ◽  
Gram Negative ◽  
Beta Lactamases ◽  
Class D ◽  
Carbapenemase Gene ◽  
Systemic Infections

The burden of antimicrobial resistance (AMR) is rapidly growing across antibiotic classes, with increased detection of isolates resistant to carbapenems. Data on the prevalence of carbapenem resistance in developing countries is limited; therefore, in this study, we determined the prevalence of carbapenemase genes among multidrug resistant gram negative bacteria (MDR-GNB) isolated from clinical specimens in a tertiary hospital in Mwanza, Tanzania. A total of 227 MDR-GNB isolates were analyzed for carbapenem resistance genes. For each isolate, five different PCR assays were performed, allowing for the detection of the major carbapenemase genes, including those encoding the VIM-, IMP-, and NDM-type metallo-beta-lactamases, the class A KPC-type carbapenemases, and the class D OXA-48 enzyme. Of 227 isolates, 80 (35%) were positive for one or more carbapenemase gene. IMP-types were the most predominant gene followed by VIM, in 49 (21.59%) and 28 (12%) isolates, respectively. Carbapenemase genes were most detected inK. pneumoniae24 (11%), followed byP. aeruginosa23 (10%), andE. coliwith 19 isolates (8%). We have demonstrated for the first time a high prevalence of MDR-GNB clinical isolates having carbapenem resistance genes in Tanzania. We recommend routine testing for carbapenem resistance among the MDR-GNB particularly in systemic infections.

scholarly journals Detection Of Kpc And Oxa-48 Gene In Clinical Isolates Of Carbapenem Resistant Klebsiella Pneumoniae

2019 ◽  
Author(s):  
Bhanu Shrestha ◽  
Anil Kumar Sah ◽  
Laxmi Sen Thakuri ◽  
Roshani Nhuchhen Pradhan ◽  
Dharmendra Kumar Nath ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Cross Sectional Study ◽  
Clinical Isolates ◽  
Age Group ◽  
Community Settings ◽  
Cross Sectional ◽  
Pcr Screening ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Culture Positivity

Abstract Objectives: The emergence of carbapenem resistant Klebsiella pneumoniae has been problematic in health sectors. It has been increasing widely in both hospital and community settings. The resistance acquired due to presence of Klebsiella pneumoniae carbapenemase (KPC) and Oxacillinase-48 carbapenemase (OXA-48) is of great concern. This cross-sectional study was designed to detect the carbapenem resistant gene namely blaKPC and blaOXA-48 in K. pneumoniae obtained from different clinical specimens. Results: Among the clinical isolates tested, culture positivity was 51.31% with K. pneumoniae as predominant isolates with 28.20%. AST revealed 38 (69.09%) carbapenemase producing K. pneumoniae while MHT confirmed 31 (56.36%) isolates as carbapenemase producer phenotypically. Similarly, highest percentage of carbapenemase production was seen in sputum (45.16%), in male (67.74%), in age group 51-60 (25.80%) and in OPD (45.16%). PCR screening was done for 31 carbapenemase producing isolates to detect blaKPC and blaOXA-48 genes. Two (6.45%) isolates were positive for blaKPC gene and 9 (29.03%) for blaOXA-48 genes. Significant numbers of blaKPC and blaOXA-48 genes were detected in carbapenem resistant Klebsiella pneumoniae from clinical isolates.Keywords: Klebsiella pneumoniae, blaKPC, blaOXA-48, Carbapenem

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