Prevalence of carbapenemases with detection of NDM-1 gene in nonfermenters isolated from a tertiary care hospital of north India
Keywords:
Carbapenemases, Metallo-β-lactamases (MBL), Minimal inhibitory concentration (MIC).
Abstract
Background: Increasing multidrug resistance in nonfermenters is of great concern to mankind because the drugs left in pipeline are only a few for the serious infections in hospital ICU settings. The present study was performed to determine the prevalence of carbapenem resistance among nonfermenters and to characterize the most prevalent MBL genes (NDM-1) by polymerase chain reaction, among phenotypically MBL positive isolates in a tertiary care centre of north India.Methods: A total of 383 clinical isolates comprising of 181 A. baumanii and 182 P. aeruginosa were included in this study. The A. baumanii and P. aeruginosa were identified by using standard bacteriological techniques. All these isolates were screened for imipenem and meropenem resistance by Kirby-Bauer disk diffusion method and Minimal Inhibitory Concentration (MIC) methods according to CLSI guidelines.Results: In the present study, the two nonfermenters (A. baumanii and P. aeruginosa) showed highest susceptibility to polymyxin-B (78.2%) followed by meropenem (70.5%), imipenem (66.4%), tigecyclin (57.6%) and combination of piperacillin-tazobactam (51.5%) by using disc diffusion method.Conclusion: Treatment of infections caused by nonfermerters like P. aeruginosa and A. baumanii producing different carbampenemases including NDM-1 are now posing serious challenge as these infections are resistant to almost all available antimicrobial agents.References
1. Fass RJ, Barnishan J, Solomon MC, Ayers LW. In vitro activities of quinolones, β¬-lactams, tobramycin and trimethoprim sulfamethoxazol against nonfermentative gram -negative bacilli. Antimicrob. Agents. Chemother. 1996; 40: 1412-18.
2. Gladstone P, Rajendra P, Brahmthan KN. Incidence of carbapenem resistant nonfermenting gram negative bacilli from patients with respiratory infections in the intensive care units. Indi J Med Microbiol. 2005; 23: 189-91.
3. Fritsche TR, Sader HS, Toleman MA, Walsh TR, Jones RN. Emerging metallo-beta-lactamase-mediated resistances: a summary report from the worldwide SENTRY antimicrobial surveillance program. Clin Infect Dis. 2005; 41: 276 -278.
4. Collec JG, Miles RS, Wan B. Test for identification of bacteria. In: Collee JG, Marmion BP, Fraser AG, Simmons A, editors. Mackie & McCartney Practical Medical Microbiology. 14th edn. Edinburg: Churchill Livingstone. 1996; 131-150.
5. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; Clinical and Laboratory Standards Institute Wayne; (2014); 23rd Informational Supplement M100-S24
6. Yagi T, Wachino J, Kurokawa H, Suzuki S, Yamara K, Doi Y, Shibata N, Kato H, Shibayama K, and Arakawa Y. Practical methods using boronic acid compounds for identification of class C β-lactamase-producing Klebsiella pneumoniae and Escherichia coli. J Clin Microbiol. 2005; 43: 2551-58.
7. Lee K, Chong Y, Shin HB, Kim YA, Yonng D, Yum JH. Modified Hodge and EDTA-disk synergy tests to screen metallo-beta-lactamase-producing strains of Pseudomonas and Acinetobacter species. Clin Microbiol Infect. 2001; 7: 88–91.
8. Pasteran F, Mendez T, Guerriero L, Rapoport M, Corso A. Sensitive screening tests for suspected class A carbapenemase production in species of Enterobacteriaceae. J Clin Microbiol. 2009; 47: 1631–39.
9. Yong D, Lee K, Yum JH, Shin HB, Rossolini GM, Chong Y. Imipenem–EDTA disk method for differentiation of metallo-beta-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol. 2002; 40: 3798–3801.
10. Manoharan A, Chattergee S, Mathai D. Detection of Metallo beta lactamases producing Pseudomonas aeruginosa. Indian J Med Microbio. 2010; 28: 241-44.
11. Nordmann P, Carrer A. Carbapenemases in enterobacteriaceae. Arch Pediatr. 2010; 17(4): 154-62.
12. Kumarasamy KK, Toleman MA, Walsh TR, BagariaJ, Butt F, Balakrishnan R et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010; 10: 597-602.
13. Pfeifer Y, Wilharm G, Zander E, Wichelhaus TA, Gottig S, Hunfeld KP et al. Molecular characterization of blaNDM-1 in an Acinetobacter baumannii strain isolated in Germany in 2007. J Antimicrob Chemother. 2011; 66: 1998–2001.
14. Kaase M, Nordmann P, Wichelhaus T A, Gatermann S G, Bonnin RA, Poirel L. NDM-2 carbapenemase in Acinetobacter baumannii from Egypt. J. Antimicrob. Chemother. 2011; 66: 1260–62.
15. Chen Y, Zhou Z, Jiang Y, Yu Y. Emergence of NDM-1 producing Acinetobacter baumannii in China. J. Antimicrob. Chemother. 2011; 66: 1255–59.
16. Jovcic B, Lepsanovic Z, Suljagic V, Rackov G, Begovic J, Topisirovic L, et al. Emergence of NDM-1 Metallo-β-Lactamase in Pseudomonas aeruginosa Clinical Isolates from Serbia. Antimicrobial agents and chemotherapy. 2011; 55: 3929–31.
17. Lee A, Mao W, Warren MS, Mistry A, Hoshino K, Okumara R et al. Interplay between Efflux Pumps May Provide Either Additive or Multiplicative Effects on Drug Resistance. Journal of bacteriology . 2000; 182(11): 3142-50
18. Guillou MLJ, Kempf M, Cavallo JD, Chomarat M, Dubreuil L, Maugein J, et al. Comparative in vitro activity of Meropenem, Imipenem and Piperacillin/tazobactam against1071 clinical isolates using 2 different methods: A French multicentre study, BMC Infectious Diseases. 2010; 10:72.
19. Walsh TR. Clinically significant carbapenemases: An update. Curr Opin Infect Dis. 2008; 21: 367-71.
2. Gladstone P, Rajendra P, Brahmthan KN. Incidence of carbapenem resistant nonfermenting gram negative bacilli from patients with respiratory infections in the intensive care units. Indi J Med Microbiol. 2005; 23: 189-91.
3. Fritsche TR, Sader HS, Toleman MA, Walsh TR, Jones RN. Emerging metallo-beta-lactamase-mediated resistances: a summary report from the worldwide SENTRY antimicrobial surveillance program. Clin Infect Dis. 2005; 41: 276 -278.
4. Collec JG, Miles RS, Wan B. Test for identification of bacteria. In: Collee JG, Marmion BP, Fraser AG, Simmons A, editors. Mackie & McCartney Practical Medical Microbiology. 14th edn. Edinburg: Churchill Livingstone. 1996; 131-150.
5. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; Clinical and Laboratory Standards Institute Wayne; (2014); 23rd Informational Supplement M100-S24
6. Yagi T, Wachino J, Kurokawa H, Suzuki S, Yamara K, Doi Y, Shibata N, Kato H, Shibayama K, and Arakawa Y. Practical methods using boronic acid compounds for identification of class C β-lactamase-producing Klebsiella pneumoniae and Escherichia coli. J Clin Microbiol. 2005; 43: 2551-58.
7. Lee K, Chong Y, Shin HB, Kim YA, Yonng D, Yum JH. Modified Hodge and EDTA-disk synergy tests to screen metallo-beta-lactamase-producing strains of Pseudomonas and Acinetobacter species. Clin Microbiol Infect. 2001; 7: 88–91.
8. Pasteran F, Mendez T, Guerriero L, Rapoport M, Corso A. Sensitive screening tests for suspected class A carbapenemase production in species of Enterobacteriaceae. J Clin Microbiol. 2009; 47: 1631–39.
9. Yong D, Lee K, Yum JH, Shin HB, Rossolini GM, Chong Y. Imipenem–EDTA disk method for differentiation of metallo-beta-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol. 2002; 40: 3798–3801.
10. Manoharan A, Chattergee S, Mathai D. Detection of Metallo beta lactamases producing Pseudomonas aeruginosa. Indian J Med Microbio. 2010; 28: 241-44.
11. Nordmann P, Carrer A. Carbapenemases in enterobacteriaceae. Arch Pediatr. 2010; 17(4): 154-62.
12. Kumarasamy KK, Toleman MA, Walsh TR, BagariaJ, Butt F, Balakrishnan R et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010; 10: 597-602.
13. Pfeifer Y, Wilharm G, Zander E, Wichelhaus TA, Gottig S, Hunfeld KP et al. Molecular characterization of blaNDM-1 in an Acinetobacter baumannii strain isolated in Germany in 2007. J Antimicrob Chemother. 2011; 66: 1998–2001.
14. Kaase M, Nordmann P, Wichelhaus T A, Gatermann S G, Bonnin RA, Poirel L. NDM-2 carbapenemase in Acinetobacter baumannii from Egypt. J. Antimicrob. Chemother. 2011; 66: 1260–62.
15. Chen Y, Zhou Z, Jiang Y, Yu Y. Emergence of NDM-1 producing Acinetobacter baumannii in China. J. Antimicrob. Chemother. 2011; 66: 1255–59.
16. Jovcic B, Lepsanovic Z, Suljagic V, Rackov G, Begovic J, Topisirovic L, et al. Emergence of NDM-1 Metallo-β-Lactamase in Pseudomonas aeruginosa Clinical Isolates from Serbia. Antimicrobial agents and chemotherapy. 2011; 55: 3929–31.
17. Lee A, Mao W, Warren MS, Mistry A, Hoshino K, Okumara R et al. Interplay between Efflux Pumps May Provide Either Additive or Multiplicative Effects on Drug Resistance. Journal of bacteriology . 2000; 182(11): 3142-50
18. Guillou MLJ, Kempf M, Cavallo JD, Chomarat M, Dubreuil L, Maugein J, et al. Comparative in vitro activity of Meropenem, Imipenem and Piperacillin/tazobactam against1071 clinical isolates using 2 different methods: A French multicentre study, BMC Infectious Diseases. 2010; 10:72.
19. Walsh TR. Clinically significant carbapenemases: An update. Curr Opin Infect Dis. 2008; 21: 367-71.
Published
2016-11-06
Section
Original Article
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