Prevalence and Risk Factors of Metallo β-lactamase Producing Pseudomonas aeruginosa and Acinetobacter species in Burns and Surgical Wards in a Tertiary Care Hospital

ABSTRACT Introduction: The production of Metallo-β-lactamases (MBLs) is one of the resistance mechanisms of Pseudomonas aeruginosa and Acinetobacter species. There is not much Indian data on the prevalence of MBLs in burns and surgical wards. Materials and Methods: A total of 145 non-duplicate isolates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species, isolated from pus/wound swabs and endotracheal secretions from burns and surgical wards, were tested for MBL production by modified ethylene diamine tetra acetic acid (EDTA) disc synergy and double disc synergy tests. Results: Prevalence of MBLs was 26.9% by both the above tests. All MBL-positive isolates were multidrug resistant. Only 6.06% (2/33) P.aeruginosa and 16.67% (1/06) Acinetobacter species were susceptible to piperacillin-tazobactam and netilmycin, respectively. These patients had multiple risk factors like >8 days hospital stay, catheterization, IV lines, previous antibiotic use, mechanical ventilation, etc. Graft application and surgical intervention were significant risk factors in MBL-positive patients. Overall mortality in MBL-positive patients was 34.21%. Conclusion: Emergence of MBL-producing Pseudomonas aeruginosa and Acinetobacter species in this hospital is alarming, which reflect excessive use of carbapenems and at the same time, pose a therapeutic challenge to clinicians as well as to microbiologists. Therefore, a strict antibiotic policy and implementation of proper infection control practices will go a long way to prevent further spread of MBLs. Detection of MBLs should also become mandatory in all hospitals.

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Coexistence of multidrug resistance mechanisms and virulence genes in carbapenem-resistant Pseudomonas aeruginosa strains from a tertiary care hospital in South India

Journal of Global Antimicrobial Resistance ◽

10.1016/j.jgar.2017.08.018 ◽

2018 ◽

Vol 12 ◽

pp. 37-43 ◽

Cited By ~ 7

Author(s):

Kalaiarasan Ellappan ◽

Harish Belgode Narasimha ◽

Saravana Kumar

Keyword(s):

Pseudomonas Aeruginosa ◽

Multidrug Resistance ◽

South India ◽

Virulence Genes ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Resistance Mechanisms ◽

Care Hospital ◽

Carbapenem Resistant

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Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

Journal of Laboratory Physicians ◽

10.4103/0974-2727.163123 ◽

2015 ◽

Vol 7 (02) ◽

pp. 108-111 ◽

Cited By ~ 1

Author(s):

Tuhina Banerjee ◽

Shampa Anupurba ◽

Joel Filgona ◽

Dinesh K Singh

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Tertiary Care ◽

Significant Risk ◽

Antibiotic Use ◽

Antibiotic Usage ◽

Hospitalized Patients ◽

University Hospital ◽

North India ◽

Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

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Reduction in Fluoroquinolone Use following Introduction of Ertapenem into a Hospital Formulary Is Associated with Improvement in Susceptibility of Pseudomonas aeruginosa to Group 2 Carbapenems: a 10-Year Study

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00742-11 ◽

2011 ◽

Vol 55 (12) ◽

pp. 5597-5601 ◽

Cited By ~ 20

Author(s):

Paul P. Cook ◽

Michael Gooch ◽

Shemra Rizzo

Keyword(s):

Pseudomonas Aeruginosa ◽

Pearson Correlation ◽

Tertiary Care ◽

Carbapenem Resistance ◽

Antibiotic Use ◽

Care Hospital ◽

Hospital Formulary ◽

Content Type ◽

Carbapenem Resistant ◽

Group 2

ABSTRACTWe examined the effect of the addition of ertapenem to our hospital formulary on the resistance of nosocomialPseudomonas aeruginosato group 2 carbapenems (imipenem, meropenem, and doripenem). This was a retrospective, observational study conducted between 1 January 2000 and 31 January 2009 at a large, tertiary-care hospital. Autoregressive integrated moving average (ARIMA) regression models were used to evaluate the effect of ertapenem use on the susceptibility ofPseudomonas aeruginosato group 2 carbapenems as well as on the use of the group 2 carbapenems, ciprofloxacin, and other antipseudomonal drugs (i.e., tobramycin, cefepime, and piperacillin-tazobactam). Resistance was expressed as a percentage of total isolates as well as the number of carbapenem-resistant bacterial isolates per 10,000 patient days. Pearson correlation was used to assess the relationship between antibiotic use and carbapenem resistance. Following the addition of ertapenem to the formulary, there was a statistically significant decrease in the percentage ofPseudomonas aeruginosaisolates resistant to the group 2 carbapenems (P= 0.003). Group 2 carbapenem use and the number of carbapenem-resistantPseudomonas aeruginosaisolates per 10,000 patient days did not change significantly over the time period. There was a large decrease in the use of ciprofloxacin (P= 0.0033), and there was a correlation of ciprofloxacin use with the percentage of isolates resistant to the group 2 carbapenems (ρ = 0.47,P= 0.002). We suspect that the improvement in susceptibility ofPseudomonas aeruginosato group 2 carbapenems was related to a decrease in ciprofloxacin use.

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Prevalence, Risk Factors, and Molecular Epidemiology of Intestinal Carbapenem-Resistant Pseudomonas aeruginosa

Microbiology Spectrum ◽

10.1128/spectrum.01344-21 ◽

2021 ◽

Author(s):

Yanyan Hu ◽

Yan Qing ◽

Jiawei Chen ◽

Congcong Liu ◽

Jiayue Lu ◽

...

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Gastrointestinal Tract ◽

Resistance Genes ◽

Acquired Resistance ◽

Multidrug Resistant ◽

Resistance Mechanisms ◽

Human Gastrointestinal Tract ◽

Content Type ◽

Carbapenem Resistant

Pseudomonas aeruginosa may become multidrug-resistant (MDR) due to multiple inherited and acquired resistance mechanisms. The human gastrointestinal tract is known as a reservoir of P. aeruginosa and its resistance genes.

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Evaluation of Hospital Room Assignment and Acquisition of Clostridium difficile Infection

Infection Control and Hospital Epidemiology ◽

10.1086/658669 ◽

2011 ◽

Vol 32 (3) ◽

pp. 201-206 ◽

Cited By ~ 203

Author(s):

Megan K. Shaughnessy ◽

Renee L. Micielli ◽

Daryl D. DePestel ◽

Jennifer Arndt ◽

Cathy L. Strachan ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Clostridium Difficile ◽

Tertiary Care ◽

Significant Risk ◽

Extended Period ◽

Significant Risk Factor ◽

Antibiotic Use ◽

Care Hospital ◽

Icu Discharge

Background and Objective.Clostridium difficile spores persist in hospital environments for an extended period. We evaluated whether admission to a room previously occupied by a patient with C. difficile infection (CDI) increased the risk of acquiring CDI.Design.Retrospective cohort study.Setting.Medical intensive care unit (ICU) at a tertiary care hospital.Methods.Patients admitted from January 1, 2005, through June 30, 2006, were evaluated for a diagnosis of CDI 48 hours after ICU admission and within 30 days after ICU discharge. Medical, ICU, and pharmacy records were reviewed for other CDI risk factors. Admitted patients who did develop CDI were compared with admitted patients who did not.Results.Among 1,844 patients admitted to the ICU, 134 CDI cases were identified. After exclusions, 1,770 admitted patients remained for analysis. Of the patients who acquired CDI after admission to the ICU, 4.6% had a prior occupant without CDI, whereas 11.0% had a prior occupant with CDI (P = .002). The effect of room on CDI acquisition remained a significant risk factor (P = .008) when Kaplan-Meier curves were used. The prior occupant's CDI status remained significant (P = .01; hazard ratio, 2.35) when controlling for the current patient's age, Acute Physiology and Chronic Health Evaluation III score, exposure to proton pump inhibitors, and antibiotic use.Conclusions.A prior room occupant with CDI is a significant risk factor for CDI acquisition, independent of established CDI risk factors. These findings have implications for room placement and hospital design.

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Comparison of Epidemiological and Antibiotic Susceptibility Pattern of Metallo-Beta-Lactamase-Positive and Metallo-Beta-Lactamase-Negative Strains of Pseudomonas Aeruginosa

Journal of Laboratory Physicians ◽

10.4103/0974-2727.141509 ◽

2014 ◽

Vol 6 (02) ◽

pp. 109-113 ◽

Cited By ~ 3

Author(s):

Shikha Ranjan ◽

Banashankari GS ◽

PR Sreenivasa Babu

Keyword(s):

Pseudomonas Aeruginosa ◽

Tertiary Care ◽

Antibiotic Use ◽

Total Sample ◽

Multidrug Resistant ◽

Adverse Outcomes ◽

Infection Prevention And Control ◽

Care Hospital ◽

Beta Lactamase

ABSTRACT Background: The infections caused by metallo-beta-lactamases (MBLs) producing Pseudomonas aeruginosa are associated with higher rates of mortality, morbidity, and overall healthcare costs compared to non-MBL P. aeruginosa infections. Purpose: To compare the epidemiologic factors and antibiograms of MBL-positive and MBL-negative P. aeruginosa isolates in a tertiary care hospital. Methods: In an observational study, from January 2011 to December 2012, all non-duplicate P. aeruginosa isolates were subjected to an antimicrobial sensitivity test against 10 antibiotics of five different classes. All P. aeruginosa strains showing resistance to at least one of the carbapenems were subjected to the MBL-E test. Epidemiological features and antibiograms of MBL-positive and MBL-negative strains were compared and statistically analyzed. Results: Out of 350 isolates (total sample = 5330) of P. aeruginosa, MBL was detected in 58 isolates by the E-test, resulting in a prevalence of 16.57%. Resistance to most of the antibiotics was significantly higher in the MBL-positive strains with 100% resistance to ciprofloxacin, tobramycin, and meropenem, followed by imipenem (93.10%) and gentamicin (89.66%). The prevalence of multidrug-resistant and pandrug-resistant strains was significantly higher among the MBL group as compared to that in the non-MBL group ((55.17 vs. 7.88% (P < 0.0001) and 8.62 vs. 0.68% (P = 0.0006)), respectively. Conclusions: MBL-positive P. aeruginosa strains showed very high resistance to various antibiotics, as compared to the non-MBL strains. Increasing prevalence of MBL-producing isolates in hospital settings makes it important to perform routine detection of MBL-positive P. aeruginosa strains by in vitro testing before antibiotic use, for the purposes of infection prevention, and control, and for minimizing the adverse outcomes of infections with MBL-producing strains.

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Characterization of antimicrobial resistance mechanisms of multidrug resistant Gram negative bacterial wound infections and their clinical epidemiology from a tertiary care hospital in Karnataka, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20170535 ◽

2017 ◽

Vol 5 (3) ◽

pp. 824 ◽

Cited By ~ 1

Author(s):

Anusha Gopinathan ◽

Chiranjay Mukhopadhyay ◽

Vandana K. E.

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Resistance ◽

Multidrug Resistant ◽

Resistance Mechanisms ◽

Care Hospital ◽

Wound Infections ◽

Specific Therapy ◽

Acinetobacter Species ◽

Gram Negative ◽

Common Diagnosis

Background: Extended spectrum beta lactamases, AmpC and Metallo-betalactamases in GNB isolates are a common occurrence in most Indian hospitals. The presence of these antimicrobial resistance mechanisms contributes to prolonged hospital stay, poor quality of life, increased morbidity and mortality among patients with these infections. The aim of the study was to analyse the antimicrobial resistance mechanisms of multidrug resistant Gram negative bacterial wound infection and their clinical epidemiology.Methods: A prospective study was conducted for one year among 100 patients of Kasturba Medical College, Manipal admitted with MDR GNB wound infections. The antibiogram and phenotypic resistance mechanisms of the bacterial isolate from these infections were identified using phenyl boronic acid and ethyl diacetate. The empirical therapy, specific therapy and clinical outcome of the patients were also analyzed.Results: Out of 100 study patients, 152 MDR GNB isolates were obtained. 73% patients were admitted in the surgical wards. 43% patients had diabetes. Ulcers (27%) and abscess (25%) were the most common diagnosis. Escherichia coli (39%), Klebsiella pneumoniae (24%) and Pseudomonas aeruginosa (19%) were the most common isolates. Maximum number of ESBL was seen among Enteric Gram negative bacilli (36%), MBL was seen among Pseudomonas aeruginosa and Acinetobacter species (55% each), AmpC was seen among enteric GNB (10%) and Acinetobacter species (18%). Cefaperazone sulbactam, amikacin and meropenem were the most common antibiotics given as specific therapy. Clinical response was observed among 93% patients.Conclusions: The determination of the antimicrobial resistance mechanisms of GNB isolates from wound infections plays a major role in establishing an antibiotic policy for the treatment of these infections.

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Genetic Diversity of Multidrug-Resistant Pseudomonas aeruginosa Isolates Carrying blaVIM–2 and blaKPC–2 Genes That Spread on Different Genetic Environment in Colombia

Frontiers in Microbiology ◽

10.3389/fmicb.2021.663020 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ana M. Rada ◽

Elsa De La Cadena ◽

Carlos A. Agudelo ◽

Christian Pallares ◽

Eliana Restrepo ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Control Strategies ◽

Tertiary Care ◽

Antibiotic Use ◽

Multidrug Resistant ◽

Class 1 Integron ◽

Carbapenem Resistant ◽

Class 1 ◽

Tertiary Care Hospitals ◽

Genetic Context

Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen with an increase in the frequency of infections caused by multidrug resistant (MDR) and extensively drug resistant (XDR) strains, limiting the available therapeutic options. The most troublesome resistance is the acquisition and production of carbapenemases such as Verona integron-encoded metallo-β-lactamases (VIM), the most frequent and widespread, and the Klebsiella pneumoniae carbapenemases (KPC), which has continuously spread in the last decade. Its dissemination is linked to their location on mobile genetic elements (MGEs). In Colombia, VIM and KPC have been increasing in its frequency showing major successful dissemination. In this article, we molecularly characterized and analyzed the genetic context of blaVIM and blaKPC in carbapenem-resistant P. aeruginosa (CRPA) isolates from infected and colonized patients in two tertiary-care hospitals, one in Medellín and the other in a municipality close to Medellín, both areas with high carbapenemase endemicity in Colombia (2013–2015). Using whole-genome sequencing (WGS), we identified a remarkable variety of genetic backgrounds in these MDR P. aeruginosa isolates carrying blaKPC–2 and blaVIM–2. There were a diversity of class 1 integron and variations in the gene cassettes associated to blaVIM–2, as well as a possible event of spread of blaKPC–2 mediated by a plasmid that contained part of Tn4401b in one infection case. The dissemination of blaVIM–2 and blaKPC–2 in P. aeruginosa in this area in Colombia has been strongly influenced by successful international clones, carrying these genes and additional determinants of resistance on MGEs, accompanied by gene rearrangement under an antimicrobial selection pressure. These findings emphasize the need to implement control strategies based on rational antibiotic use.

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Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.153 ◽

2016 ◽

Vol 37 (10) ◽

pp. 1219-1225 ◽

Cited By ~ 12

Author(s):

Anat Schwartz-Neiderman ◽

Tali Braun ◽

Noga Fallach ◽

David Schwartz ◽

Yehuda Carmeli ◽

...

Keyword(s):

Risk Factors ◽

Close Contact ◽

Conditional Logistic Regression ◽

Tertiary Care ◽

Patient Characteristics ◽

Index Patient ◽

Multidrug Resistant ◽

Resistant Organism ◽

Care Hospital ◽

Carbapenem Resistant

OBJECTIVECarbapenemase-producing carbapenem-resistantEnterobacteriaceae(CP-CRE) are extremely drug-resistant pathogens. Screening of contacts of newly identified CP-CRE patients is an important step to limit further transmission. We aimed to determine the risk factors for CP-CRE acquisition among patients exposed to a CP-CRE index patient.METHODSA matched case-control study was performed in a tertiary care hospital in Israel. The study population was comprised of patients who underwent rectal screening for CP-CRE following close contact with a newly identified CP-CRE index patient. Cases were defined as positive tests for CP-CRE. For each case patient, 2 matched controls were randomly selected from the pool of contacts who tested negative for CP-CRE following exposure to the same index case. Bivariate and multivariate analyses were conducted using conditional logistic regression.RESULTSIn total, 53 positive contacts were identified in 40 unique investigations (896 tests performed on 735 contacts) between October 6, 2008, and June 7, 2012.blaKPCwas the only carbapenemase identified. In multivariate analysis, risk factors for CP-CRE acquisition among contacts were (1) contact with an index patient for ≥3 days (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.0–48.9), (2) mechanical ventilation (OR, 4.1; 95% CI, 1.4–11.9), and (3) carriage or infection with another multidrug-resistant organism (MDRO; OR, 2.6; 95% CI, 1.0–7.1). Among patients who received antibiotics, cephalosporins were associated with a lower risk of acquisition.CONCLUSIONSPatient characteristics (ventilation and carriage of another MDRO) as well as duration of contact are risk factors for CP-CRE acquisition among contacts. The role of cephalosporins requires further study.Infect Control Hosp Epidemiol2016;1–7

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