Rapid Detection of Carbapenemase-Producing Multidrug-Resistant (MDR) Pathogens by Modified Carba NP Test in Ventilator-Associated Pneumonia (VAP) in Elderly Patients (original) (raw)
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Background: The emergence and spread of carbapenem resistant enterobacteriaceae in association with conditions like ventilator associated pneumonia which becomes a significant and a major public health concern in the hospital settings. The main objectives of this study is to analyse the microbiological profile of ventilator associated pneumonia in patients attending the tertiary care hospital and study the occurrence of CRE, also to determine the efficacy of modified Hodge test for detection of carbapenemase producing gram negative rods. Materials and method:The study has been conducted for a period of three months with a sample size of 50. The Endotracheal aspirate (ETA) samples were collected with proper aseptic precautions and sent immediately to microbiology laboratory for processing and identified based on standard microbiological techniques. Modified Hodge Test is then performed on positive sample to study its efficacy. Report:A total of 123 patients were prospectively reviewed for the 3 months study period and among them only 53 patients were infected. Metallo-betalactamases was produced by 48.1% and ESBL by 51.9% of non-fermenters. 1.8% of the pathogens in our study were MDR. These MDR pathogens included Gram-negative bacteria producing ESBL and MBL. 21 isolates (38.1%) showed resistance to carbapenem group of drugs (meropenem and imipenem). Among them maximum resistance was shown by Acenitobactor baumannii (47.6%), followed by Klebsiella pnuemoniae (33.3%) and Pseudomonas aeruginosa (19.1%). Among the 21 isolates which showed carbapenem resistance only 16 of them were found to be positive by modified Hodge test (76.1%). Conclusion: The emergence of carbapenemase-producing multidrug resistant (MDR) gram-negative bacteria is major public health problem particularly in the hospital settings. Prevention of VAP may be carried out by early isolation and decreasing the length of stay along with proper knowledge of the MDR organisms and during the shorter duration of this study we did not come across any VAP cases which can be considered as a successful hospital infection control impact. A detailed study on VAP for longer duration is required to determine for a proper understanding Also knowledge of the susceptibility pattern of the local pathogens should guide the choice of antibiotics, in addition to the likelihood of organisms, as there is an increasing prevalence of MDR, MBL and ESBL pathogens.Testing all isolates showing intermediate or sensitive zone diameter on disc diffusion for production of carbapenemases by Modified Hodge test will avoid treatment failures and development of resistance due to unnecessary use of this class of antibiotic for a better future.
Journal of Pure and Applied Microbiology, 2022
There is an alarming rise in carbapenem-resistant Enterobacteriaceae (CRE) causing nosocomial infections such as ventilator-associated respiratory infections (VARIs). The use of rapid phenotypic methods for the detection and differentiation of carbapenemases elaborated by these CRE would be helpful in providing timely empirical therapeutic options for management of these infections and preventing spread of these CRE strains in hospital settings. Hence, this study aimed to detect CRE among pathogens isolated from the endotracheal secretions received from suspected cases of VARIs and differentiate carbapenemases elaborated by these CRE using combined phenotypic methods, such as the modified carbapenem inactivation method (mCIM) and EDTA modified CIM (eCIM). This observational study was conducted over a period of 1 year in the Department of Microbiology and the intensive care unit of a tertiary care center. Carbapenem resistance was found in 75% of Klebsiella pneumoniae isolates and 50% of Escherichia coli isolates, of which 58.4% were metallo-β-lactamases and 41.6% were serine carbapenemase producers. In conclusion, the combination of the mCIM and eCIM could be useful as an epidemiological tool and be considered essential in deciding the initial antibiotic therapy, help reduce morbidity and mortality associated with VARIs, and guide hospital infection control practices.
IP innovative publication pvt. ltd, 2019
Introduction: The spread of carbapenemase producers is the most important clinical issue in antibiotic resistance in gram negative bacteria particularly Enterobacteriaceae. There is an utmost importance of rapid detection. Several phenotypic and genotypic tests are present for detection of carbapenemases but are time consuming, require expertise and well established laboratory. Our study aims at detection of carbapenemase production by rapid Carba NP test Materials and Methods: A prospective study of two months duration was done among 150 Enterobacteriaceae species (Escherichia coli 88, Klebsiella pneumonia 49 and others 13) isolated from various cli nical samples in a teritiary care Hospital. Strains were first identified by standard phenotypic methods. Resistance to carbapenems was detected using Ertapenem (10mcg) disk by Kirby Bauer disk diffusion method and Carba NP test as per the CLSI standards. Carba NP test is based on the detection of Imipenem hydrolysis by carbapenemase producing bacteria. Hydrolysis acidifies the medium which results in colour change of the pH indicator. Results: Among 150 isolates, Carba NP positive 34(22.6%) and negative 116(77.3%). Ertapenem disk diffusion detected 122(81.3%) as susceptible, 8(5.3%) as intermediate and 20(13.3 %) as resistant. Carba NP has a sensitivity (61.76%), specificity (93.97%), PPV (75%), NPV (89.34%), accuracy (86.67%) which are statistically significant with ‘p’ value <0.05. Conclusion: CNP detects larger number of carbapenemases within shorter time (<2h) compared to disk diffusion (16-18h) which is rapid, highly specific, accurate and gives result in single day with minimal reagents.
Journal of Medical Science And clinical Research, 2016
The emerging resistance to Carbapenems which are generally considered as life saving drugs to treat infections caused by ESBL and AmpC producing bacteria, has become a serious issue worldwide. It is therefore necessary to detect Carbapenemases to limit the spread of multidrug resistant organisms for effective Antibiotic surveillance and Infection Control in the Hospital. Aim & Objectives: To detect the presence of MBL, KPC Carbapenemase and their CoExistence among the Carbapenem resistant clinical isolates of Gram Negative Bacilli Materials & Methods: The present study was carried out in a Tertiary care hospital; to detect Carbapenamases among Gram Negative Bacilli by Inhibitor based combined Disc tests in which Phenylboronic Acid and Dipicolinic acid are incorporated onto Meropenem discs. Results: A Total of 718 strains of Gram Negative Bacilli comprising of 516 strains of Enterobacteriaceae and 202 Non-fermenters were included in the study. Out of these 718 strains, 89 strains were resistant to carbapenems, of which 2.5% (18 /718) were KPC (Klebsiella Pneumoniae Carbapenemase-class A) producers, 8.08%(58/718) were MBL (Metallo Beta Lactamases-class B) producers .Co-existence of MBL and KPC was observed in 1.25% (9 /718) of isolates and no mechanism was detected in 4 isolates. Conclusion: Inhibitor based combined disc test is simple and cost effective phenotypic test for detecting Carbapenem resistance in the Laboratory. Antibiotic stewardship programme has to be implemented in Hospital to achieve good Infection control for better patient outcome and reduce the health care costs.
Infection and Drug Resistance
Ventilator-associated pneumonia (VAP) caused by carbapenem-resistant gram-negative bacteria has been proven to be an escalating public health challenge in Egypt owing to its high mortality rate and raised health care costs. Purpose: Detection of carbapenem-resistant gram-negative bacilli among VAP patients, genotypic identification of carbapenemase genes in the isolated strains with evaluation of their impact on patient outcome and detection of carbapenemase-producing enterobacterales by MASTDISCS combi Carba plus disc system. Methods: Broncho-alveolar lavage fluid (BALF) and endotracheal aspirate were collected aseptically from clinically suspected VAP patients. Pathogen identification and antibiotic sensitivity testing were done. Carbapenemase-encoding genes (bla KPC , bla NDM , and bla OXA-48) were tested by PCR in all carbapenem-resistant gram-negative isolates. Performance of MASTDISCS combi Carba plus in isolated Enterobacterales was assessed in relation to the PCR results. Results: Eighty-three carbapenem-resistant gram-negative isolates were detected. The most frequent pathogens were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa representing 34.9%, 20.5% and 18.1%, respectively. bla KPC was the predominant gene. Patients with persistent mechanical ventilation less than 15 days and Pseudomonas aeruginosa infection were significantly associated with a higher death rate. MAST-Carba plus had the highest sensitivity, specificity, positive and negative predictive values for detecting OXA-48 carbapenemases representing 81.8%, 92.5%, 75% and 94.9%, respectively. Conclusion: Worse outcome in VAP patients was associated with carbapenem-resistant gram-negative bacilli. MASTDISCS combi Carba plus is an efficient simple method for identification of different carbapenemases among enterobacterales.
Background and Objectives: Resistance among bacterial isolates is the leading cause of increased mortality and morbidity worldwide. Carbapenems once thought to be effective are becoming ineffective mostly due to the emergence of carbapenemase. This study was designed to determine in vitro efficacy of Modified Hodge test for detection of carbapenemase production in Gram negative rods.(klebsiella pneumonia) Material and Methods: The study was done in the A total of 200 Gram negative rods from different clinical samples were taken. Those isolates which showed intermediate or susceptible zones i.e 16mm-21mm on disc diffusion were included in the study. These isolates were then subjected to Modified Hodge test. Result: Out of 200 isolates, 28 were positive for carbapenemase production by Modified Hodge test. The incidence of Klebsiella pneumonia producing carbapenemase was 14%. Conclusion: Modified Hodge test is a simple test which can be performed in the routine lab for detection of carbapenemases in isolates showing intermediate or sensitive zone diameter on disc diffusion.It is imperative that all isolates showing intermediate or sensitive zone diameter on disc diffusion be tested for production of carbapenemases by Modified Hodge Test and further confirmed by PCR.
Antibiotics
Carbapenem-resistant Gram-negative bacilli (CR-GNB) has become a global threat. In hospital settings, the association of CR-GNB with ventilator-associated pneumonia (VAP) is a critical public health concern owing to their high resistance rate to most antibiotics. The present study aims to identify the frequency of carbapenem-resistance and to determine the rate of multidrug resistance (MDR), extensive drug resistance (XDR) and pan-drug resistance (PDR) among CR-GNB infections in VAP. Antimicrobial susceptibility testing was carried out using the disk diffusion method and the detection of carbapenemases was screened using the imipenem-E test and the modified carbapenem-inactivation method (mCIM). The isolates were verified by polymerase chain reaction (PCR) for the presence of blaNDM, blaSPM, blaVIM, blaIMP and blaGIM genes. 89.5%, 14%, 17.5%, 10.5%, 3.5% of isolates exhibited the presence of blaNDM, blaVIM, blaSPM, blaIMP and blaGIM, respectively. 76%, 17% and 7% of isolates were PD...
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Carbapenemases are one of the common β-lactamases seen in Klebsiella pneumoniae that are responsible for multi drug resistance. Detection of resistance in these bacteria is necessary for formulation of infection control policies. The hidden resistance of this bacteria is critical to diagnose. To address this problem, the present study aims to detect Carbapenemase production and antimicrobial susceptibility patterns in clinical isolates of Klebsiella pneumoniae at the present setting. Materials and Method: A total of 438 strains of Klebsiella pneumoniae were isolated and subjected to Carbapenemase detection by Screening method using Imepenem (10 µg) disc. Modified Hodge test and Combined disc diffusion test along with E-test was done to confirm carbapenemase production followed by antimicrobial susceptibility testing. E-test was considered to be gold standard. Results: Total 34/438 (7.76%) carbapenem resistant isolates were obtained. The carbapenemase positive isolates were predominantly isolated from Burns wards (14.61%). E-test considering it as gold standard test confirmed all 34 of these as carbapenemase producers. Out of 34, MHT detected 31and CDT detected 32 isolates as positive for carbapenemase production. They were highly resistant to cefotaxime, and ceftazidime (91.18%). Conclusion: Screening for Carbapenemase production needs to be carried out routinely in every clinical diagnostic facility. There is a need for rational use and strict adherence to the concept of " reserve drugs " to minimize the misuse of available antimicrobials. The findings of this study emphasize the need for a continuous surveillance in the ICUs and different hospital wards to detect the resistant strains.
Incidence of Gram-Negative Carbapenemase-Producing Bacteria from a TertiaryLevel Private Hospital
2021
Background and Objectives: This is a report of Gram-negative carbapenemase-producing bacteria (CPBs) in a tertiary-level private hospital in Davao City, Philippines. CPBs are placed in a high hazard level by the Centers of Diseases and Control (CDC) due to its capability of developing resistance to carbapenem antibiotics which are considered one of the last resort for many bacterial infections. Existence of such organisms will severely affect nosocomial infections and treatment modalities. This report shows the antibiotic-resistance profiles of Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae. Materials and Method: Collection of samples from different specimens were cultured and VITEK 2 System was used which optimizes a fluorogenic methodology for organism identification and a turbidimetric method for susceptibility testing. Results: Around 827 CPB were isolated. Among the specimen gathered, ETA displayed the highest number of isolates with A. baumannii showing the greatest predilection. For P. aeruginosa, 466 samples were identified with majority also obtained from ETA. Samples for K. pneumoniae reflected around 52 isolates with diverse sources. P. aeruginosa exhibited the highest rate of resistance among carbapenem drugs, ertapenem, imipenem, and meropenem. K. pneumoniae has the least resistance to ertapenem, imipenem, and meropenem. Conclusion: A significant number of CPBs were collected. This indicates a steady increase of antimicrobial resistance, and carbapenem-resistance has become a threat. Moreover, there exists significant species-only variance in antibiotic resistance, requiring more nuanced precautionary measures and control when handling patients who are positive for CPBs.
PloS one, 2016
Early institution of effective antibiotic therapy and source control are pivotal to improve survival of abdominal septic patients. Xpert® Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) responsible for carbapenem resistance. We performed an observational study investigating the clinical usefulness and applicability of Xpert® Carba-R to detect carbapenem resistance in abdominal septic patients admitted to intensive care unit. We compared the results of Xpert® Carba-R with standard microbiological culture. We collected a set of two rectal/stomia swabs and two swabs from abdominal drainage fluid for each patient. We included 20 patients for a total of 45 comparisons between the two methods. In our clinical setting, the overall performance of Xpert® Carba-R for detection of carbapenem resistance in the presence of genes detectable and non-detectable by the method was: sensitivity 5...