scholarly journals Alarming emergence, molecular characterization, and outcome of blaNDM-1 in patients infected with multidrug-resistant Gram-negative bacilli in a tertiary care hospital

2017 ◽  
Vol 9 (03) ◽  
pp. 170-176 ◽  
Author(s):  
Huma Naim ◽  
Meher Rizvi ◽  
Mohd Azam ◽  
Richa Gupta ◽  
Neelam Taneja ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Care Hospital ◽  
Gram Negative ◽  
Beta Lactamases ◽  
Robust Immune Response ◽  
Number Of Patients ◽  
Synergy Test

Abstract INTRODUCTION: This study was conducted to assess the prevalence of metallo-beta-lactamases (MBLs) in general and blaNDM-1 in particular. It also aimed at evaluating clinical characteristics and outcome in patients infected with MBLs. MATERIALS AND METHODS: A total of 116 carbapenem-resistant Gram-negative bacilli (CRGNB) were evaluated in the study. These CRGNB were tested for MBL production both phenotypically for MBLs and genotypically for blaNDM-1 gene by polymerase chain reaction (PCR). Representative stains of NDM-1 isolates were further sequenced by Triyat Scientific Co., (Nagpur, India). RESULTS: Among 116 CRGNB Citrobacter species 28 (24.13%) was the most common pathogen. Phenotypically, MHT, imipenem-EDTA (IPM-EDTA) double‑disk synergy test and IPM-EDTA combined disk synergy test (CDST) detected MBL production in 105 (90.51%), 96 (81.03%), and 87 (75%) CRGNB, respectively. However, blaNDM-1 genes were detected in 66 (56.89%) isolates. The prevalence of blaNDM-1 gene was highest among Escherichia coli 26 (100%). Considering PCR as gold standard, it was observed that IMP-EDTA CDST was most specific (78.38%) while MHT was most sensitive (97.47%). Results of blaNDM-1 gene by PCR were further confirmed by sequencing (Triyat genomics, Nagpur). All the 11 representative strains were confirmed to be an NDM-1 gene. The presence of MBLs in our group of patients (non-Intensive Care Unit patients) is a cause for concern. However, on tracing their outcome, it was interesting to note that while the duration of stay lengthened in a large number of patients 112 (96.5%), mortality was relatively low 5 (4.31%). CONCLUSION: The results of this study provide insight into the prevalence of MBLs, including blaNDM-1, in a tertiary care hospital. Antibiotic stewardship implemented in all seriousness may to a great extent stave off the impending pan-drug resistance. The surprising outcome of our patients suggests either that the bacteria trade off virulence for drug resistance or the relatively robust immune response of non ICU patients fights back.

scholarly journals Detection of SHV Gene from Extended-Spectrum Beta-Lactamases (ESBLs) Producing Isolates in a Tertiary Care Hospital

2017 ◽  
Vol 8 (2) ◽  
pp. 14-18
Author(s):  
Mili Rani Saha ◽  
Sanya Tahmina Jhora ◽  
Tarek Mahbub Khan ◽  
Shikha Paul ◽  
Durdana Chowdhury
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Gram Negative ◽  
Beta Lactamases ◽  
Medical College ◽  
Extended Spectrum Beta Lactamases ◽  
Synergy Test ◽  
Gram Negative Organisms ◽  
Klebsiella Spp

Most ESBL Extended-Spectrum beta-lactamases (ESBLs) producing isolates carry TEM and SHV type betalactamases. Among these two types beta-lactamases SHV type was reported nosocomial infection outbreak in many countries in the world. The goal of this study was to see the rate of ESBLs production and also to detect SHV gene in those isolates recovered from a tertiary care hospital. A total of 354 samples were collected from Sir Salimullah Medical College and Mitford Hospital and from Burn Unit of Dhaka Medical College Hospital from January 2011 to December 2011. To detect ESBLs, Gram-negative organisms were subjected to Double Disc Synergy Test and SHV gene was detected from those ESBLs producing microorganisms by PCR. In this study, out of 354 different clinical samples 186 (89%) were Gram-negative organisms. Among of these Gramnegative organisms 77 (41.40%) were ESBL producing isolates detected by Double Disc Synergy Test. Out of these 77 isolates, 8 isolates (10.38%) carried bla SHV gene. Among those ESBL producing 26.26% Klebsiella spp. (4 out of 15 isolates) had SHV gene. Our findings showed that the majority of the ESBLs positive clinical isolates were Klebsiella spp. and high frequency of SHV genes were found in Klebsiella spp.Bangladesh J Med Microbiol 2014; 08 (02): 14-18

scholarly journals Prevalence of multidrug-resistant and extended-spectrum beta-lactamase producing Gram-negative isolates from clinical samples in a tertiary care hospital of Nepal

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Aryatara Shilpakar ◽  
Mehraj Ansari ◽  
Kul Raj Rai ◽  
Ganesh Rai ◽  
Shiba Kumar Rai
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Confirmatory Test ◽  
Clinical Samples ◽  
Care Hospital ◽  
Gram Negative ◽  
Extended Spectrum ◽  
Esbl Producers

Abstract Background The existence of multidrug-resistant organisms, including extended-spectrum beta-lactamases (ESBLs), is on rise across the globe and is becoming a severe problem. Knowledge of the prevalence and antibiogram profile of such isolates is essential to develop an appropriate treatment methodology. This study aimed to study the prevalence of Gram-negative isolates exhibiting ESBL at a tertiary care hospital and study their antibiogram profile. Methods A cross-sectional study was conducted at Shahid Gangalal National Heart Centre, Kathmandu, Nepal, from June 2018 to November 2018. A total of 770 clinical samples were collected and identified using the conventional biochemical tests following the Clinical and Laboratory Standard Institute (CLSI) guidelines. Antimicrobial susceptibility testing (AST) was performed using the standardized Kirby-Bauer disk diffusion method. The screening test for ESBL producers was performed as recommended by the CLSI and the confirmatory test was performed phenotypically using the E-test. Results Out of the 92 isolates, 84 (91.3%) were multidrug-resistant, and 47 (51.1%) were found to be potential ESBL producers. Of these, 16 isolates were confirmed ESBL producers by the E-test. Escherichia coli and Klebsiella pneumoniae were the predominant isolates and were also the major ESBL producers. Besides polymyxin B (100% sensitive), meropenem and imipenem showed high efficacy against the ESBL producers. Conclusion Multidrug resistance was very high; however, ESBL production was low. Polymyxin B and carbapenems are the choice of drugs against ESBL producers but should be used only as the last line drugs.

scholarly journals Ventilator-associated pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens

2010 ◽  
Vol 4 (04) ◽  
pp. 218-225 ◽  
Author(s):  
Noyal Mariya Joseph ◽  
Sujatha Sistla ◽  
Tarun Kumar Dutta ◽  
Ashok Shankar Badhe ◽  
Desdemona Rasitha ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Multi Drug Resistance ◽  
P Value ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Candida Spp ◽  
Beta Lactamases

Background: Ventilator-Associated Pneumonia (VAP) is the most frequent intensive-care-unit (ICU)-acquired infection. The aetiology of VAP varies with different patient populations and types of ICUs. Methodology: A prospective study was performed over a period of 15 months in a tertiary care hospital to determine the various aetiological agents causing VAP and the prevalence of multidrug resistant (MDR) pathogens. Combination disk method, Modified Hodge test, EDTA disk synergy (EDS) test and AmpC disk test were performed for the detection of extended spectrum beta-lactamases (ESBL), carbapenemases, metallo-beta-lactamases (MBL) and AmpC β-lactamases respectively. Results: Enterobacteriaceae, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Candida spp. were more common in early-onset VAP, while non-fermenters (Pseudomonas spp. and Acinetobacter spp.) were significantly associated with late-onset VAP (P value 0.0267, Chi-square value 4.91). Thirty-seven (78.7%) of the 47 VAP pathogens were multidrug resistant. ESBL was produced by 50% and 67% of Escherichia coli and Klebsiella pneumoniae respectively. MBL was produced by 20% of P. aeruginosa. AmpC beta-lactamases were produced by 33.3% and 60.7% of the Enterobacteriaceae and non-fermenters respectively. Of the S. aureus isolates, 43% were methicillin resistant. Prior antibiotic therapy and hospitalization of five days or more were independent risk factors for VAP by MDR pathogens. Conclusions: VAP is increasingly associated with MDR pathogens. Production of ESBL, AmpC beta-lactamases and metallo beta-lactamases were responsible for the multi-drug resistance of these pathogens.  Increasing prevalence of MDR pathogens in patients with late-onset VAP indicate that appropriate broad-spectrum antibiotics should be used to treat them.

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