Epidemiology and Clinical Characteristics ofAcinetobacterPeritoneal Dialysis-Related Peritonitis in Hong Kong—with a Perspective on Multi-Drug and Carbapenem Resistance

BackgroundAcinetobacter spp. is an important cause of peritoneal dialysis (PD)-related peritonitis, but studies on Acinetobacter peritonitis have been scarce. In view of the rising concern of carbapenem-resistant Acinetobacter (CRA) and multidrug-resistant Acinetobacter (MDRA) infections, we conducted this study on the incidence of Acinetobacter peritonitis and the impact of CRA and MDRA on its outcome.MethodsWe retrospectively evaluated the clinical characteristics, prevalence, antibiotic sensitivity patterns, outcomes, and factors associated with treatment failure over the past 16 years in our patients with Acinetobacter PD-related peritonitis.ResultsOut of 2,389 episodes of peritonitis, there were 66 episodes (3%) of Acinetobacter peritonitis occurring in 59 patients. Twelve episodes were caused by MDRA (18%), of which 5 were CRA (8%). There was a progressive increase in the incidence of MDRA and CRA infections over the study period. Most isolates were sensitive to sulbactam combinations (ampicillin-sulbactam [95.4%] and cefoperazone-sulbactam [93.9%]), aminoglycosides (amikacin [92.4%], tobramycin [90.9%], and gentamicin [89.4%]), and carbapenems (imipenem [92.2%]). There was 1 case of relapse. Fifteen episodes resulted in catheter removal (23%), and 7 patients died (11%). Hypoalbuminemia (odds ratio [OR] = 0.85, p = 0.006) and carbapenem resistance (OR = 18.2, p = 0.049) were significantly associated with higher rates of treatment failure.ConclusionBoth carbapenem resistance and hypoalbuminemia were significantly associated with treatment failure. Up to 80% of peritonitis episodes by CRA resulted in catheter loss or mortality. Sulbactam combinations and/or aminoglycosides remained effective for the majority of Acinetobacter isolates. There seemed to be an increasing relative incidence of MDRA and CRA infections over the past 16 years.

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Co-occurrence of Plasmid-Mediated Tigecycline and Carbapenem Resistance in Acinetobacter spp. from Waterfowls and Their Neighboring Environment

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02502-19 ◽

2020 ◽

Vol 64 (5) ◽

Cited By ~ 9

Author(s):

Chao-Yue Cui ◽

Chong Chen ◽

Bao-Tao Liu ◽

Qian He ◽

Xiao-Ting Wu ◽

...

Keyword(s):

Sequence Comparison ◽

Resistance Mechanism ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Inverse Pcr ◽

Content Type ◽

Carbapenem Resistant ◽

Carbapenemase Gene ◽

Acinetobacter Spp ◽

Plasmid Backbone

ABSTRACT Tigecycline serves as one of the antibiotics of last resort to treat multidrug-resistant (including carbapenem-resistant) pathogens. However, the recently emerged plasmid-mediated tigecycline resistance mechanism, Tet(X), challenges the clinical efficacy of this class of antibiotics. In this study, we detected 180 tet(X)-harboring Acinetobacter isolates (8.9%, n = 180) from 2,018 samples collected from avian farms and adjacent environments in China. Eighteen tet(X)-harboring isolates (10.0%) were found to cocarry the carbapenemase gene blaNDM-1, mostly from waterfowl samples (94.4%, 17/18). Interestingly, among six Acinetobacter strains, tet(X) and blaNDM-1 were found to colocalize on the same plasmids. Moreover, whole-genome sequencing (WGS) revealed a novel orthologue of tet(X) in the six isolates coharboring tet(X) and blaNDM-1. Inverse PCR suggested that the two tet(X) genes form a single transposable unit and may be cotransferred. Sequence comparison between six tet(X)- and blaNDM-1-coharboring plasmids showed that they shared a highly homologous plasmid backbone even though they were isolated from different Acinetobacter species (three from Acinetobacter indicus, two from Acinetobacter schindleri, and one from Acinetobacter lwoffii) from various sources and from different geological regions, suggesting the horizontal genetic transfer of a common tet(X)- and blaNDM-1-coharboring plasmid among Acinetobacter species in China. Emergence and spread of such plasmids and strains are of great clinical concern, and measures must be implemented to avoid their dissemination.

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Informing Antibiotic Treatment Decisions: Evaluating Rapid Molecular Diagnostics To Identify Susceptibility and Resistance to Carbapenems against Acinetobacter spp. in PRIMERS III

Journal of Clinical Microbiology ◽

10.1128/jcm.01524-16 ◽

2016 ◽

Vol 55 (1) ◽

pp. 134-144 ◽

Cited By ~ 16

Author(s):

Scott R. Evans ◽

Andrea M. Hujer ◽

Hongyu Jiang ◽

Carol B. Hill ◽

Kristine M. Hujer ◽

...

Keyword(s):

Molecular Diagnostics ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Ionization Mass ◽

Predictive Values ◽

Content Type ◽

Esi Ms ◽

Carbapenem Resistant ◽

Acinetobacter Spp ◽

Susceptibility And Resistance

ABSTRACT The widespread dissemination of carbapenem-resistant Acinetobacter spp. has created significant therapeutic challenges. At present, rapid molecular diagnostics (RMDs) that can identify this phenotype are not commercially available. Two RMD platforms, PCR combined with electrospray ionization mass spectrometry (PCR/ESI-MS) and molecular beacons (MB), for detecting genes conferring resistance/susceptibility to carbapenems in Acinetobacter spp. were evaluated. An archived collection of 200 clinical Acinetobacter sp. isolates was tested. Predictive values for susceptibility and resistance were estimated as a function of susceptibility prevalence and were based on the absence or presence of beta-lactamase ( bla ) NDM, VIM, IMP, KPC, and OXA carbapenemase genes (e.g., bla OXA-23 , bla OXA-24/40 , and bla OXA-58 found in this study) against the reference standard of MIC determinations. According to the interpretation of MICs, 49% ( n = 98) of the isolates were carbapenem resistant (as defined by either resistance or intermediate resistance to imipenem). The susceptibility sensitivities (95% confidence interval [CI]) for imipenem were 82% (74%, 89%) and 92% (85%, 97%) for PCR/ESI-MS and MB, respectively. Resistance sensitivities (95% CI) for imipenem were 95% (88%, 98%) and 88% (80%, 94%) for PCR/ESI-MS and MB, respectively. PRIMERS III establishes that RMDs can discriminate between carbapenem resistance and susceptibility in Acinetobacter spp. In the context of a known prevalence of resistance, SPVs and RPVs can inform clinicians regarding the best choice for empiric antimicrobial therapy against this multidrug-resistant pathogen.

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Phenotypic characterization and colistin susceptibilities of carbapenem-resistant of Pseudomonas aeruginosa and Acinetobacter spp.

The Journal of Infection in Developing Countries ◽

10.3855/jidc.2924 ◽

2013 ◽

Vol 7 (11) ◽

pp. 880-887 ◽

Cited By ~ 15

Author(s):

Srujana Mohanty ◽

Vijeta Maurya ◽

Rajni Gaind ◽

Monorama Deb

Keyword(s):

Pseudomonas Aeruginosa ◽

Susceptibility Testing ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Resistance Mechanisms ◽

Phenotypic Characterization ◽

Antibiotic Susceptibility Testing ◽

Colistin Resistance ◽

Carbapenem Resistant ◽

Acinetobacter Spp

Introduction: Pseudomonas aeruginosa and Acinetobcter spp. are important nosocomial pathogens and carbapenem resistance is an emerging threat. Therapeutic options for infections with these isolates include colistin. This study was conducted to determine the prevalence of carbapenem resistance in P. aeruginosa and Acinetobacter spp. bloodstream isolates, phenotypically characterize the resistance mechanisms and evaluate the invitro activity of colistin. Methodology: Consecutive 145 (95 P.aeruginosa and 50 Acinetobacter spp.) non-repeat isolates were included. Antibiotic susceptibility testing was performed per CLSI guidelines. MIC for carbapenems and colistin was performed using Etest. Isolates showing reduced susceptibility or resistance to the carbapenems were tested for metallo-β-lactamase (MBL) production using imipenem-EDTA combined disk and MBL Etest. Results: Carbapenem resistance was observed in 40% P. aeruginosa and 66.0% Acinetobacter spp. Carbapenem-resistant (CA-R) isolates were significantly (p< 0.05) more frequently resistant to the other antibiotics than carbapenem-susceptible isolates. Approximately half of the CA-R strains were multidrug-resistant, and 3.1-5.5% were resistant to all antibiotics tested. MBL was found in 76.3% and 69.7% of the P. aeruginosa and Acinetobacter spp., respectively. Colistin resistance was observed in three (6.0%) Acinetobacter isolates and eight (8.4%) P. aeruginosa. MIC50 for carbapenems were two to four times higher for MBL-positive compared to MBL-negative isolates, but no difference was seen in MIC for colistin. Conclusion: Carbapenem resistance was observed to be mediated by MBL in a considerable number of isolates. Colistin is an alternative for infections caused by CA-R isolates; however, MIC testing should be performed whenever clinical use of colistin is considered.

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Phenotypic Detection of Carbapenemase Production in Carbapenem-Resistant Enterobacteriaceae by Modified Hodge Test and Modified Strip Carba NP Test

Journal of Laboratory Physicians ◽

10.1055/s-0041-1723859 ◽

2021 ◽

Author(s):

Nisha Patidar ◽

Nitya Vyas ◽

Shanoo Sharma ◽

Babita Sharma

Keyword(s):

Carbapenem Resistance ◽

Nonparametric Test ◽

Multidrug Resistant ◽

Clinical Samples ◽

Chi Square ◽

Carbapenem Resistant ◽

The Social ◽

Significant Difference ◽

High Degree ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Objective Carbapenems are last resort antibiotics for multidrug-resistant Enterobacteriaceae. However, resistance to carbapenem is increasing at an alarming rate worldwide leading to major therapeutic failures and increased mortality rate. Early and effective detection of carbapenemase producing carbapenem-resistant Enterobacteriaceae (CRE) is therefore key to control dissemination of carbapenem resistance in nosocomial as well as community-acquired infection. The aim of present study was to evaluate efficacy of Modified strip Carba NP (CNP) test against Modified Hodge test (MHT) for early detection of carbapenemase producing Enterobacteriaceae (CPE). Material and Methods Enterobacteriaceae isolated from various clinical samples were screened for carbapenem resistance. A total of 107 CRE were subjected to MHT and Modified strip CNP test for the detection of CPE. Statistical Analysis It was done on Statistical Package for the Social Sciences (SPSS) software, IBM India; version V26. Nonparametric test chi-square and Z-test were used to analyze the results within a 95% level of confidence. Results Out of 107 CRE, 94 (88%) were phenotypically confirmed as carbapenemase producer by Modified strip CNP test and 46 (43%) were confirmed by Modified Hodge Test (MHT). Thirty-eight (36%) isolates showed carbapenemase production by both MHT and CNP test, 56 isolates (52%) were CNP test positive but MHT negative, eight (7%) isolates were MHT positive but CNP test negative and five (5%) isolates were both MHT and CNP test negative. There is statistically significant difference in efficiency of Modified CNP test and MHT (p < 0.05). Conclusion Modified strip CNP test is simple and inexpensive test which is easy to perform and interpret and gives rapid results in less than 5 minutes. It has high degree of sensitivity and specificity. Modified strip CNP test shows significantly higher detection capacity for carbapenemase producers as compared with MHT.

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Surgical Site Infection Following Caesarean Section by Acinetobacter Species: A Report from a Hyperendemic Setting in the Brazilian Amazon Region

Microorganisms ◽

10.3390/microorganisms9040743 ◽

2021 ◽

Vol 9 (4) ◽

pp. 743

Author(s):

Blenda Gonçalves Cabral ◽

Danielle Murici Brasiliense ◽

Ismari Perini Furlaneto ◽

Yan Corrêa Rodrigues ◽

Karla Valéria Batista Lima

Keyword(s):

Caesarean Section ◽

Surgical Site Infection ◽

Carbapenem Resistance ◽

Brazilian Amazon ◽

Amazon Region ◽

Site Infection ◽

Acinetobacter Species ◽

Brazilian Amazon Region ◽

Acinetobacter Spp ◽

The Impact

Surgical site infection (SSI) following caesarean section is associated with increased morbidity, mortality, and significant health care costs. This study evaluated the epidemiological, clinical, and microbiological features of Acinetobacter spp. in women with SSIs who have undergone caesarean section at a referral hospital in the Brazilian Amazon region. This study included 69 women with post-caesarean SSI by Acinetobacter spp. admitted to the hospital between January 2012 and May 2015. The 69 Acinetobacter isolates were subjected to molecular species identification, antimicrobial susceptibility testing, detection of carbapenemase-encoding genes, and genotyping. The main complications of post-caesarean SSI by Acinetobacter were inadequate and prolonged antibiotic therapy, sepsis, prolonged hospitalization, and re-suture procedures. A. baumannii, A. nosocomialis and A. colistiniresistens species were identified among the isolates. Carbapenem resistance was associated with OXA-23-producing A. baumannii isolates and IMP-1-producing A. nosocomialis isolate. Patients with multidrug-resistant A. baumannii infection showed worse clinical courses. Dissemination of persistent epidemic clones was observed, and the main clonal complexes (CC) for A. baumannii were CC231 and CC236 (Oxford scheme) and CC1 and CC15 (Pasteur scheme). This is the first report of a long-term Acinetobacter spp. outbreak in women who underwent caesarean section at a Brazilian hospital. This study demonstrates the impact of multidrug resistance on the clinical course of post-caesarean infections.

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IN INTRA-ABDOMINAL INFECTIONS AND PERITONITIS

Kharkiv Surgical School ◽

10.37699/2308-7005.2.2021.17 ◽

2021 ◽

pp. 90-96

Author(s):

A. V. Kotov ◽

V. I. Desyaterik ◽

S. P. Mikhno

Keyword(s):

Absolute Number ◽

Multidrug Resistant ◽

E Coli ◽

The Past ◽

Rational Therapy ◽

Acinetobacter Spp ◽

The Difference ◽

Abdominal Infections ◽

Staphylococcus Spp ◽

Klebsiella Spp

Summary. Purpose of the reserche. To study changes in microflora and sensitivity of isolated strains to antibiotics using bacteriological research methods for intra-abdominal infections and peritonitis to determine their resistance when planning antibiotic therapy. Results and discussion. The paper presents data from a retrospective analysis of the results of studies of microflora and its resistance in intra-abdominal infections (IAI) and peritonitis for 2 periods: I period — from january 2007 to december 2008, II period — from january 2018 to december 2019. The difference between period II and I was in the increase in the number of individual pathogenic strains of microorganisms. Thus, the number of Klebsiella spp. increased from 13.8 % to 23.8 %, which in absolute number of their total number amounted to a 73.5 %, ranking second in the overall structure among pathogens sown in IAI and peritonitis. The number of strains of Staphylococcus spp., Enterobacter spp., Acinetobacter spp. has also increased by 2.4–5.8 % respectively. Among the strains Klebsiella spp., E. coli and Staphylococcus spp. the number of poly- and multi-polyresistant forms has increased. Thus, the number of such forms among Klebsiella spp. increased from 19.2 to 44.5 %, Staphylococcus spp. — from 43.8 to 67.1 % and E. coli from 18.2 to 23.5 %, respectively. Conclusions. Over the past 10 years, with IAI and peritonitis, the most significant changes were revealed on the part of pathogenic strains of Klebsiella spp., Staphylococcus spp. and Acinetobacter spp. Multidrug resistant strains were predominantly susceptible to carbapenems, semisynthetic ureidopenicillins, aminoglycosides, glycopeptides, oxazalidinones, phosphonoic acid derivatives. In the context of changes in the microbial landscape observed over the past decade, an increase in the number of poly- and multi-resistant forms of pathogenic microorganisms in IAI and peritonitis, the choice of antibiotics for rational therapy should be based solely on bacterioscopy and antibiograms.

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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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Carbapenem Resistance, Initial Antibiotic Therapy, and Mortality inKlebsiella pneumoniaeBacteremia: A Systematic Review and Meta-Analysis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.197 ◽

2017 ◽

Vol 38 (11) ◽

pp. 1319-1328 ◽

Cited By ~ 25

Author(s):

Philipp P. Kohler ◽

Cheryl Volling ◽

Karen Green ◽

Elizabeth M. Uleryk ◽

Prakesh S. Shah ◽

...

Keyword(s):

Systematic Review ◽

Antibiotic Therapy ◽

Meta Analysis ◽

Carbapenem Resistance ◽

Carbapenem Resistant ◽

Initial Antibiotic Therapy ◽

Meta Regression ◽

The Difference ◽

Meta Regression Analysis ◽

The Impact

BACKGROUNDMortality associated with infections caused by carbapenem-resistantEnterobacteriaceae(CRE) is higher than mortality due to carbapenem-sensitive pathogens.OBJECTIVETo examine the association between mortality from bacteremia caused by carbapenem-resistant (CRKP) and carbapenem-sensitiveKlebsiella pneumoniae(CSKP) and to assess the impact of appropriate initial antibiotic therapy (IAT) on mortality.DESIGNSystematic review and meta-analysisMETHODSWe searched MEDLINE, EMBASE, CINAHL, and Wiley Cochrane databases through August 31, 2016, for observational studies reporting mortality among adult patients with CRKP and CSKP bacteremia. Search terms were related toKlebsiella, carbapenem-resistance, and infection. Studies including fewer than 10 patients per group were excluded. A random-effects model and meta-regression were used to assess the relationship between carbapenem-resistance, appropriateness of IAT, and mortality.RESULTSMortality was higher in patients who had CRKP bacteremia than in patients with CSKP bacteremia (15 studies; 1,019 CRKP and 1,148 CSKP patients; unadjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.8–2.6; I2=0). Mortality was lower in patients with appropriate IAT than in those without appropriate IAT (7 studies; 658 patients; unadjusted OR, 0.5; 95% CI, 0.3–0.8; I2=36%). CRKP patients (11 studies; 1,326 patients; 8-year period) were consistently less likely to receive appropriate IAT (unadjusted OR, 0.5; 95% CI, 0.3–0.7; I2=43%). Our meta-regression analysis identified a significant association between the difference in appropriate IAT and mortality (OR per 10% difference in IAT, 1.3; 95% CI, 1.0–1.6).CONCLUSIONSAppropriateness of IAT is an important contributor to the observed difference in mortality between patients with CRKP bacteremia and patients with CSKP bacteremia.Infect Control Hosp Epidemiol2017;38:1319–1328

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A Cohort Study of the Impact of Carbapenem-Resistant Enterobacteriaceae Infections on Mortality of Patients Presenting with Sepsis

mSphere ◽

10.1128/msphere.00052-19 ◽

2019 ◽

Vol 4 (2) ◽

Cited By ~ 3

Author(s):

Sabrina Sabino ◽

Silvia Soares ◽

Fabiano Ramos ◽

Miriane Moretti ◽

Alexandre P. Zavascki ◽

...

Keyword(s):

Septic Shock ◽

Bacterial Infections ◽

Cox Regression ◽

Univariate Analysis ◽

Empirical Therapy ◽

Multidrug Resistant ◽

Diagnostic Methods ◽

Carbapenem Resistant ◽

Enterobacteriaceae Infections ◽

The Impact

ABSTRACT The objective of this study is to evaluate the impact of carbapenem-resistant Enterobacteriaceae (CRE) infection on sepsis 30-day mortality. A retrospective cohort of patients >18 years old with sepsis and organ dysfunction or septic shock was conducted. Univariate analysis was done for variables potentially related to 30-day mortality, and the ones with P values of <0.05 were included in a backward stepwise hierarchic Cox regression model. Variables that remained with P values of <0.05 were retained in the model. A total of 1,190 sepsis episodes were analyzed. Gram-negative bacterial infections occurred in 391 (68.5%) of 571 patients with positive cultures, of which 69 (17.7%) were caused by a CRE organism. Patients with CRE infections had significantly higher 30-day mortality: 63.8% versus 33.4% (P < 0.01). CRE infection was also associated with a lower rate of appropriate empirical therapy (P < 0.01) and with the presence of septic shock (P < 0.01). In the hierarchic multivariate model, CRE remained significant when controlling for demographic variables, comorbidities, and infection site but lost significance when controlling for septic shock and appropriate empirical therapy. Older age (P < 0.01), HIV-positive status (P < 0.01), cirrhosis (P < 0.01), septic shock (P < 0.01), higher quick sepsis-related organ failure assessment (quick-SOFA) (P < 0.01), and appropriate empirical therapy (P = 0.01) remained in the final model. CRE infections were associated with higher crude mortality rates. A lower rate of appropriate empirical therapy and late diagnosis were more frequent in this group, and improvement of stewardship programs is needed. IMPORTANCE The importance of this work relies on exploring the impact of multidrug-resistant bacterial infections such as those with carbapenem-resistant Enterobacteriaceae (CRE) on sepsis mortality. These infections are growing at alarming rates worldwide and are now among the most frequent and difficult-to-treat bacteria due to the very few options for susceptible antimicrobials available. This study examined 1,190 sepsis episodes, and the main findings were as follows: (i) the prevalence of CRE infections significantly increased over time, (ii) CRE infection was associated with higher 30-day mortality than that of patients with other infections (63.8% versus 33.4%), and (iii) the effect of CRE on mortality was probably influenced by the fact that those patients received lower rates of empirical therapy with active antibiotics and were also diagnosed in more advanced stages of sepsis (septic shock). Those findings point to the need for rapid diagnostic methods to identify these bacteria and the need to adjust therapeutic guidelines to this worrisome epidemiological scenario.

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

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_22_19 ◽

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.

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