Carbapenem Resistance in Non-Fermentative Gram-Negative Bacilli Isolated from Intensive Care Unit Patients of a Referral Hospital

Background: Non-fermentative Gram-negative bacilli or non-fermenters are opportunistic pathogens associated with serious infections in intensive care unit patients. Although carbapenems were considered as a backbone of treatment for life-threatening infections, these bacteria are increasingly acquiring resistance to carbapenems. Carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa are prioritized as critical pathogens by the World Health Organization. The objective of the study was to document the status of carbapenem-resistant and carbapenemase-producing non-fermenters isolated from intensive care unit patients.Methods: This study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The clinical specimens collected from intensive care unit patients were processed for isolation and identification of non-fermenters and antibiotic susceptibility profile of bacterial isolates was determined. The multidrug-resistant isolates were identified and carbapenemase enzyme was detected in the carbapenem-resistant isolates.Results: A total of 157 non-fermenters were isolated from 1063 samples which included Acinetobacter species (n=85), Pseudomonas aeruginosa (n=55), Burkholderia cepacia complex (n=15), and Stenotrophomonas maltophilia (n=2). Carbapenem resistance was reported in 85.9%, 72.7%, and 33.3% of Acinetobacter species, Pseudomonas aeruginosa, and Burkholderia cepacia complex, respectively. Among total non-fermenters, 91.1% isolates were multidrug-resistant and 60.8% carbapenem-resistant isolates were carbapenemase producers. The carbapenem-resistant isolates demonstrated an extremely high degree of resistance than carbapenem-susceptible isolates towards other antimicrobial classes.Conclusions: This study reported high rates of carbapenem-resistant, carbapenemase-producing, and multidrug-resistant non-fermenters isolates. Therefore, preventing the spread of these superbugs among the critically ill patients in intensive care units should be a major initiative in hospitals.Keywords: Carbapenem-resistant; carbapenemase; intensive care unit; non-fermentative Gram-negative bacilli

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Potency and Spectrum of Activity of AN3365, a Novel Boron-Containing Protein Synthesis Inhibitor, Tested against Clinical Isolates of Enterobacteriaceae and Nonfermentative Gram-Negative Bacilli

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00160-13 ◽

2013 ◽

Vol 57 (6) ◽

pp. 2849-2857 ◽

Cited By ~ 23

Author(s):

Rodrigo E. Mendes ◽

M. R. K. Alley ◽

Helio S. Sader ◽

Douglas J. Biedenbach ◽

Ronald N. Jones

Keyword(s):

Pseudomonas Aeruginosa ◽

Burkholderia Cepacia ◽

Stenotrophomonas Maltophilia ◽

Multidrug Resistant ◽

Protein Synthesis Inhibitor ◽

Wild Type ◽

Synthesis Inhibitor ◽

Gram Negative ◽

Content Type ◽

Carbapenem Resistant

ABSTRACTAN3365 (MIC50/90, 0.5/1 μg/ml) was active againstEnterobacteriaceae, including a subset ofKlebsiella pneumoniaecarbapenemase (KPC)-producingK. pneumoniaestrains (MIC50/90, 1/2 μg/ml). AN3365 inhibited 98.0 and 92.2% of wild-type (MIC50/90, 2/8 μg/ml) and carbapenem-resistant (MIC50/90, 4/8 μg/ml)Pseudomonas aeruginosastrains, respectively, at ≤8 μg/ml. AN3365 also demonstrated activity against wild-typeAcinetobacter baumannii(MIC50/90, 2/8 μg/ml) andStenotrophomonas maltophilia(MIC50/90, 2/4 μg/ml), while it was less active against multidrug-resistantA. baumannii(MIC50/90, 8/16 μg/ml) andBurkholderia cepacia(MIC50/90, 8/32 μg/ml).

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Emergence of multidrug-resistant Gram-negative bacteria during selective decontamination of the digestive tract on an intensive care unit

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkl316 ◽

2006 ◽

Vol 58 (4) ◽

pp. 853-856 ◽

Cited By ~ 37

Author(s):

N. Al Naiemi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Digestive Tract ◽

Multidrug Resistant ◽

Selective Decontamination ◽

Gram Negative Bacteria ◽

Gram Negative

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Mechanisms of carbapenem resistance in endemic Pseudomonas aeruginosa isolates after an SPM-1 metallo-β-lactamase producing strain subsided in an intensive care unit of a teaching hospital in Brazil

Memórias do Instituto Oswaldo Cruz ◽

10.1590/0074-02760160116 ◽

2016 ◽

Vol 111 (9) ◽

pp. 551-558 ◽

Cited By ~ 10

Author(s):

Luciana Camila Cacci ◽

Stephanie Gomes Chuster ◽

Natacha Martins ◽

Pâmella Rodrigues do Carmo ◽

Valéria Brígido de Carvalho Girão ◽

...

Keyword(s):

Intensive Care Unit ◽

Pseudomonas Aeruginosa ◽

Intensive Care ◽

Teaching Hospital ◽

Carbapenem Resistance

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

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.715821 ◽

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.

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