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 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.

Molecular detection of blaOXA-23gene and blaOXA-51 gene in carbapenem resistant strains of Acinetobacterbaumannii in patients with ventilator associated pneumonia at tertiary care hospital

2021 ◽  
Vol 71 (11) ◽  
pp. 2576-2581
Author(s):  
Saima Ishtiaq ◽  
Sidrah Saleem ◽  
Abdul Waheed ◽  
Arslan Ahmed Alvi
Keyword(s):  
Acinetobacter Baumannii ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Conventional Polymerase Chain Reaction ◽  
Diffusion Method ◽  
Military Hospital ◽  
Care Hospital ◽  
Acinetobacter Baumanii ◽  
Cross Sectional ◽  
Carbapenem Resistant

Objective: To evaluate carbapenem resistance and to detect blaOXA-23 and blaOXA-51 genes in carbapenem-resistant acinetobacter baumanii isolates recovered from patients having pneumonia secondry to ventilation. Methods: The cross-sectional study was conducted from July 2017 to June 2018 at the Department of Microbiology, University of Health Sciences, Lahore, Pakistan, and comprised endotracheal aspirates / tracheobroncheal lavage samples from patients irrespective of age and gender who developed pneumonia after being on the ventilator for 48 hrs at the Combined Military Hospital, and Jinnah Hospital, Lahore.  The samples were inoculated on MacConkey and blood agar and aerobically incubated at a temperature of 370C for 18-24 hours. The isolated organisms were further assessed by standard morphological, cultural and biochemical profile. Antibiotic susceptibility was done by Kirby-Bauer disc diffusion method. Carbapenem-resistant acinetobacter baumannii were checked for carbapenemase production using Modified Hodge Test. Conventional polymerase chain reaction and agarose gel electrophoreses were performed to detect blaOXA-23 and blaOXA-51 genes. Data was analysed using SPSS 17. Results: Out of 157 samples, 92(58.6%) yielded growth of bacteria, and, among them, 39(42.4%) were identified as acinetobacter baumannii. All (100%) acinetobacter baumannii cases showed resistance to carbapenem, were producing carbapenemase enzyme, and were positive for blaOXA-51 gene. The blaOXA-23 gene was amplified in 38(97.4%) isolates. Conclusion: BlaOXA-23 gene appeared to be the major cause of carbapenem resistance. Continuous...

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 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 Prevalence of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital of Gujarat, India

2021 ◽  
Author(s):  
Chirag Manojkumar Modi ◽  
Suman Praveen Singh ◽  
Yagnesh Gajanand Pandya ◽  
Chirag Premjibhai Patel ◽  
Rupal Minesh Patel
Keyword(s):  
Tertiary Care Hospital ◽  
Demographic Data ◽  
Treatment Options ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Defined Daily Dose ◽  
Sample Type ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Introduction: Carbapenem Resistant Enterobacteriaceae (CRE) are major cause of community as well as healthcare associated infections and have limited treatment options. Measuring the magnitude of the problem of CRE, it is important for making strategies to lower its spread. Aim: To assess the incidence and prevalence rate of CRE in a tertiary care hospital of Gujarat, India. Materials and Methods: Retrospective data was collected for a period from 2014 to 2018 using Laboratory Information System (LIS). Prevalence of CRE was determined as number of CRE isolated per 100 Enterobacteriaceae isolated during the study period whereas incidence rate was determined as number of CRE cases per 1000 patient-days. Consumption of Carbapenems was calculated as Defined Daily Dose (DDD) per 1000 patient-days. Demographic data including age, gender, location in the hospital and sample type from which CRE was isolated was also analysed using Microsoft Excel. Results: The incidence of CRE cases per 1000 patient-days in 2014 to 2018 was 1.66, 2.11, 1.90, 2.26 and 1.91, respectively with an overall incidence of 1.99 per 1000 patient-days. The overall prevalence of CRE over a period of five years was found to be 29.07%. Klebsiellasp. was the most common CRE and had the highest percentage of Carbapenem resistance among all Enterobacteriaceae. Conclusion: The rate of CRE in present study was high and worrisome. Screening of the patient for CRE, source isolation and stringent implementation of infection control practices is required to confine the spread of CRE in this institute.

scholarly journals 1189. A Comprehensive Characterization of the Emerging Carbapenem-Resistant Klebsiella pneumoniae Clinical Isolates From a Public Hospital in Lima, Peru

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S359-S360 ◽  
Author(s):  
Fiorella Krapp ◽  
Catherine Amaro ◽  
Karen Ocampo ◽  
Lizeth Astocondor ◽  
Noemi Hinostroza ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Dna Extraction ◽  
Antibiotic Susceptibility ◽  
Tertiary Care ◽  
Clinical Isolates ◽  
Molecular Characteristics ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene ◽  
String Test

Abstract Background In contrast with other countries in Latin America, Peru had been notoriously spared by the global dissemination of carbapenem-resistant Klebsiella pneumoniae (CR-Kp), until recently. Even though, isolated cases of KPC-producing K. pneumoniae had been reported since 2013, it was not until 2016 that the first outbreak of NDM- producing K. pneumoniae was described in Peru. By 2017, rapid emergence of CR-Kp took place in Hospital Cayetano Heredia (HCH), a tertiary care hospital in Lima. Here, we provide a description of clinical, microbiological and molecular characteristics of CR-Kp isolates recovered at HCH. Methods Retrospective review of all CR-Kp clinical isolates recovered at HCH until December 2017. Antibiotic susceptibility data were obtained during routine care (Vitek or disc diffusion) and was assessed using CLSI breakpoints. DNA extraction was performed by heat shock, and PCR was performed to assess carriage of blaNDM gene. String test was performed to detect hypermucoviscosity. Results The first case of CR-Kp in HCH dated from July 2015. Since then, a total of 69 CR-Kp clinical isolates, from 60 patients have been recovered until December 2017. A significant increase in the number of cases was observed during 2017 (Figure 1). The average age of patients was 55. Urinary, and respiratory sources of infection or colonization were the most common ones (35% and 30%, respectively), followed by blood stream (17%) and intraabdominal (10%) infections. Isolate recovery and DNA extraction was achieved in 40 cases. Of these, 15 (38%) had a positive PCR for blaNDM carbapenemase gene (Figure 2). Antibiotic susceptibility testing revealed that amikacin was the most effective antimicrobial with the rest of antimicrobials having extremely high rates of resistance (Figure 3). String test was positive in two of these isolates, suggesting that hypervirulent CR-KP might be emerging in this region. Conclusion An epidemic of CR-Kp has established in our hospital, representing the first one reported in Peru. The different mechanisms of carbapenem resistance found suggest a polyclonal expansion. Amikacin remains the only active antimicrobial within the routinely tested antibiotics, highlighting the need to add other antimicrobials to the routine panel. Disclosures All authors: No reported disclosures.

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 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 Clinico-etiological profile of childhood stroke in a Tertiary Care Hospital in Eastern India

2015 ◽  
Vol 06 (04) ◽  
pp. 515-519 ◽  
Author(s):  
Chaitali Patra ◽  
Shatanik Sarkar ◽  
Debasree Guha ◽  
Malay K. Dasgupta
Keyword(s):  
Tertiary Care Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Geographical Location ◽  
Care Hospital ◽  
Childhood Stroke ◽  
Intracranial Infection ◽  
Radio Imaging ◽  
Common Etiology ◽  
Neurological Insult

ABSTRACT Background: The clinical pattern and etiology of stroke may vary over time or with geographical location. In Asian countries, specific etiology and outcome of childhood stroke have been rarely reported. Objective: To determine the clinical and etiological pattern of childhood stroke and their outcome in a Tertiary Care Center. Materials and Methods: This study was conducted in a Tertiary Care Hospital of Kolkata over a period of 3 years. All children from 6 months to 12 years, diagnosed as childhood stroke by radio-imaging were included in our study. Children presenting with paraplegia/paraparesis were excluded. Etiologies were determined on the basis of clinical examination, related blood investigations and radio-imaging findings. Data gathered from the stroke patients were entered into a preformed proforma and appropriate statistical analyses were done. Result: Most commonly found clinical presentation was hemiparesis (70.6%). Next in place was a seizure (61.8%) and alteration of consciousness (58.8%). The most common etiology of childhood stroke in our hospital was found to be an intracranial infection (41.2%), followed by vascular etiology. Stroke was ischemic in nature in 91.2% of cases. Among the clinical features, vomiting, alteration of sensorium, and fever were significantly (P < 0.01) more in infectious cases of stroke, but hemiparesis was significantly (P < 0.05) more common in noninfectious etiology. Most of the cases of noninfectious etiology (95%) completely recovered without any persistent neurodeficit or mortality. Conclusion: Intracranial infection is the commonest etiology of stroke in pediatric patients presenting at our hospital. Commonest type is an ischemic stroke. The most of the patients completely recovered from the acute neurological insult after proper and timely management.

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