Epidemiology of carbapenem-resistant Enterobacteriaceae colonization in ICU: a pilot study from a tertiary care hospital in Western Rajasthan, India (original) (raw)
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IP Innovative Publication Pvt. Ltd., 2018
Introduction: In last few years, Gram-negative bacilli are isolated capable of producing various classes of carbapenemases with ability of hydrolyzing the ?-lactam antimicrobial. Carbapenem Resistant Enterobacteriaceae (CRE) have been reported worldwide. There is a serious threat to public health due to the emergence and rapid spread of CRE. Aims: To find prevalence and bacterial profile of CRE in clinical isolates in indoor patients from a rural tertiary care centre. Materials and Methods: The study was conducted in a tertiary care teaching hospital in Western India, June 2016 to April 2018. The clinical specimens received in microbiology laboratory were processed by the standard method. Bacteria were identified by VITEK 2 compact (Biomerieux) automation system, and antimicrobial susceptibility testing was done with the same system to detect minimum inhibitory concentrations for carbapenem group of antimicrobials. CLSI 2016 guidelines were used to detect CRE. Results: Total 535 Enterobactericaeae clinical isolates were included in the study. Of these, 31.77% (n=170) were CRE. Specimens like urine, pus/ wound swab and endotracheal tube secretion were the major contributors for CRE isolates.82% of CRE were Klebsiella pneumoniae (63%) and E.coli (19%). Conclusions: A high prevalence of 31.77% carbapenem resistance was observed among Enterobacteriaceae isolates. Early detection, isolation and contact precaution of CRE patients will help to prevent rapid dissemination of CRE infection. Keywords: Carbapenem Resistant Enterobacteriaceae, CRE, Carbapenemase, Klebsiella pneumoniae.
Prevalence of Carbapenem Resistant Enterobacteriaceae- a Study in a Tertiary Care Hospital in Mumbai
BACKGROUND The global incidence of carbapenem resistant organisms is on the rise and can be attributed to indiscriminate use of carbapenem to tackle the Extended Spectrum Beta Lactamase (ESBL) producing organisms. Carbapenem resistance is associated with resistance to other group of antibiotics. The spread of resistance from one bug to another is not uncommon. The organism persists in the hospital environment and is identified as cause of hospital-acquired infections. This is not only a major concern in the healthcare setting but is also increasingly being recovered from community settings also. Limited availability of drugs to treat these infections is the biggest concern. Identifying carbapenem resistant organisms and implementing measures to prevent the spread is need of the hour. The aim of this study is to determine the prevalence and susceptibility pattern of Carbapenem resistant Enterobacteriaceae.
BMC microbiology, 2016
Resistance amongst the commensal flora is a serious threat because a very highly populated ecosystem like the gut, may at a later stage, be a source of extra intestinal infections, resistant strains may spread to other host or transfer genetic resistance element to other members of micro-biota including pathogens. This study was carried out to assess fecal colonization by carbapenemase producing Enterobacteriaceae (CPE) and associated risk factors among 100 patients admitted to intensive care unit (ICU). The phenotypic and molecular characterizations of CPE were also included. Colonization with CPE was observed in 6.6 % (8/122) controls. Among ICU patients, fecal carriage of CPE was significantly higher on day 4 (D4) (22 %) as compared to day 1 (D1) (11 %) (p value 0.002). The carbapenemase genes detected included OXA- 48, 181, KPC and NDM-1 with NDM-1 being the predominant carbapenemase in both ICU D1 and D4. Among the 50 CPE isolates, 8 (16 %) were susceptible to meropenem and imi...
Prevalence of carbapenem-resistant Enterobacteriaceae in in- and out-of-hospital environments
Brazilian Journal of Health and Biomedical Sciences, 2023
Introduction: Healthcare is recognized as a condition of high selective pressure (SP) due to the use of antimicrobials. The emergence of community bacterial species resistant to the antimicrobials most extensively used in hospitals is of concern, as is the case with Gram-negative rods producing extended-spectrum beta-lactamases (ESBL). Hospital colonization by carbapenem-resistant Enterobacteria (CRE) can persist for many months after hospital discharge, and their encoding genes can be transferred among different species. Methodology: Because of the scarcity of options due to resistance to carbapenems, we sought to evaluate the occurrence of CRE in stool samples from outpatients and inpatients of a University Hospital, for whom clinical and epidemiological data were obtained from the analysis of medical records. After parasitological examination, stool samples from outpatients and inpatients were diluted in saline (1:20, 1:1000 and 1:2000) solution and 0.1 mL seeding was performed on MacConkey Agar (MA) containing gentamicin 8 μg/mL and MA containing cephalexin 32 μg/mL. Once isolated, strains were identified by biochemical tests and AST (with imipenem, ertapenem, and meropenem) was performed according to CLSI (2020). Results: We isolated carbapenem-resistant strains of enterobacteria in 13 (43.3%) of the 30 inpatients and in 13 (29%) of the 31 outpatients (p>0.05). In 7 (23.3%) of the 30 inpatients and in 5 (16.1%) of the 31 outpatients, we isolated CRE at 1:1000 or 1:5000 dilutions of stool samples, which correspond to "microbial loads". Ten bacterial species were isolated in the CRE related to the 13 inpatients and 13 outpatients, among whom we identified two or more species in 9 (69.2%) and 10 (76.9%), respectively. Even taking into account the limitations of the study due to the possibility of
Update Dental College Journal, 2023
Background: Carbapenem-resistant Enterobacter (CRE) is an emerging threat spread rapidly around the world in the past few years, posing substantial hazards to human health. Objective: The study was conducted to evaluate the prevalence of carbapenem resistance and to detect carbapenemase producers phenotypically from patients of a major tertiary care hospital, in Bangladesh. Methods: Prospective cross-sectional study was conducted from July 2018 to June 2019, at the Dhaka Medical College hospital. Patients admitted to different wards, and intensive care units, visited the outpatient department, and samples received in the microbiology department were included in this study. A total of 350 clinical samples were collected, inoculated, and incubated in accordance to the standard protocol. Identification was done using the standard biochemical method. Antimicrobial susceptibility testing of commonly used antibiotics including imipenem was done using Kirby Bauer disk diffusion method. All the clinical isolates of Enterobacter were screened for carbapenem resistance as per CLSI guidelines. Such strains were then subjected to phenotypic confirmation of carbapenemase production by the Modified Hodge test. All isolates that gave a positive screening test were further evaluated for Metallo-β lactamase (MBL) production. MBL was further detected by Combined Disc Test (CD) using a combination of Imipenem and Imipenem-EDTA and double disc synergy (DDS) test. Result: A total of 350 clinical specimens were analyzed, of which 224 (65.14%) isolates yielded growth. Among them, 28 (12.28%) Enterobacter were isolated of which 12 (42.86%) were found to be Imipenem resistant (14.25%) and were labeled 'Carbapenem-resistant Enterobacter" or CRE. Minimum inhibitory concentration (MIC) was determined among the carbapenem-resistant clinical isolates. Modified Hodge test (MHT) performed on the 12 carbapenemresistant isolates showed 9 (75%) isolates to be carbapenemase enzyme producers. Nine out of twelve carbapenem-resistant isolates are Metallobeta-lactamase producers detected by combined disc test (CDT) and eight (66.67%) MBL producers detected by DDS test. Conclusion: The finding from this study revealed a high prevalence of carbapenem resistance among isolated Enterobacter species in hospital settings as well as community levels. As there are limited treatment regimens, therefore, the timely and accurate detection of carbapenem-resistant Enterobacter species is essential for the clinical treatment and prevention of infections. Simple phenotypic methods like MHT can be used for the rapid detection of carbapenemases, and these are expected to be used routinely in clinical microbiology laboratories.
Carbapenem Resistance among Enterobacter Species in a Tertiary Care Hospital in Central India
Chemotherapy research and practice, 2014
Objective. To detect genes encoding carbapenem resistance among Enterobacter species in a tertiary care hospital in central India. Methods. Bacterial identification of Enterobacter spp. isolates from various clinical specimens in patients admitted to intensive care units was performed by routine conventional microbial culture and biochemical tests using standard recommended techniques. Antibiotic sensitivity test was performed by standard Kirby Bauer disc diffusion technique. PCR amplification and automated sequencing was carried out. Transfer of resistance genes was determined by conjugation. Results. A total of 70/130 (53.84%) isolates of Enterobacter spp. were found to exhibit reduced susceptibility to imipenem (diameter of zones of inhibition ≤13 mm) by disc diffusion method. Among 70 isolates tested, 48 (68.57%) isolates showed MIC values for imipenem and meropenem ranging from 32 to 64 mg/L as per CLSI breakpoints. All of these 70 isolates were found susceptible to colistin in...
Indian Journal of Microbiology Research, 2023
Introduction: Carbapenem Resistant Enterobacteriaceae (CRE) has gradually evolved as one of the serious global health concern due to its high mortality and limited treatment options. Overuse of the antibiotic and improper sanitation has led to its rapid spread. Aim: To determine the proportion of Carbapenem resistant Enterobacteriaceae from various clinical samples received in the Department of Microbiology, MIMS Mandya for Culture and sensitivity by using Meropenem and Imipenem disk. Materials and Methods: This is a retrospective study conducted over a period of 6 months from March 2021 to august 2021. The samples tested were all the clinical specimens like sputum, pus, urine, body fluids coming to our Microbiology laboratory. The specimens were processed by the standard laboratory methods. Bacteria was isolated and identified by standard biochemical reactions and antimicrobial susceptibility testing was done on Mueller Hinton Agar by Kirby Bauer disk diffusion method and interpreted according to CLSI guidelines. Results: total of 1624 samples were included in the study, among which 211 isolates were identified as members of Enterobacteriaceae family. 50 out of 211 isolates were confirmed as Carbapenem resistant giving a prevalence rate of 23.69%. Urine (42%) was the major contributor of CRE, followed by pus (34%). Among CRE, Escherichia coli (54%) was the major organism isolated followed by Klebsiella pneumoniae (20%). Conclusion: Our study showed high CRE prevalence rate of 23.69%, indicating the rapid emergence of CRE. Hence, a strict adherence to antibiotic policy and basic infection control measures to be applied in view of reducing the spread of CRE in the community. Keywords: Carbapenem resistant enterobacteriaceae, CRE, Escherichia Coli.
Prevalence of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital
International Journal of Current Microbiology and Applied Sciences, 2019
Introduction Carbapenem resistance among Enterobacteriaceae is one of the foremost challenges that the medical world is facing since the past few years. [1] Carbapenems were suggested as the final drug of choice for treatment during the emergence of ESBLs and AmpCs, due to their unique molecular structure and wide spectrum of activity. [2] But the origin of carbapenemase enzyme in Enterobacteriaceae poses a major threat, creating a dilemma in therapeutic methods. [3] These bacteria have the potential to cause wide spread transmission of resistance even between the intestinal bacteria [4] through various intrinsic or extrinsic mechanisms. [5] One major cause of resistance in bacteria is the production of carbapenem hydrolyzing enzyme with several variants, along with porin loss, production of AmpC and acquired MBL. [6] Detection of these organisms is a difficult task due to the wide diversity in their
Occurrence of Carbapenem-resistant Enterobacteriaceae - a three-year study
2020
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 nonfermenters. 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.