Descriptive Study for Detection of Carbapenem Resistant Enterobacteriaceae by the Modified Carbapenem Inactivation Method in a Tertiary Care Hospital of Western Maharashtra (original) (raw)
Related papers
International Journal of Current Microbiology and Applied Sciences
Carbapenem antibiotics are very often used against multidrug resistant strains clinically troublesome pathogens which developed and proved that the resistance and metallo-βlactamases (MBL) production were a disaster in treating infections. The identification and detection of MBL-producing bacterial strains were having crucial importance for the prevention of nosocomial infections. Therefore the present study was undertaken for screening MBL production Gram Negative bacteria. One hundred twenty two 122 consecutive Non-repetitive isolates of gram negative bacilli clinical isolates were subjected to susceptibility testing by disc-diffusion test on Mueller Hinton Agar. Meropenem resistant (MR) strains MBL production among MR stains were further screened by Meropenem-EDTA combined disc synergy test (M-CDST) and Meropenem-EDTA double-disc synergy test (M-DDST). A total of 31 isolates showed resistance to Meropenem which were screened and 29 (93.55%) isolates gave positive result by M-DDST whereas 27 (87%) were MBL producers by M-CDST. Escherichia coli isolates recorded highest as MR strains were identified. For the treatment, implementation of effective infection control and prevention of nosocomial dissemination used the procedure for detection and identification of carbapenem resistant by most reliable method for study of MBLs produced isolates. The more effective method was M-DDST in comparison of other method as M-CDST.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018
Introduction: Carbapenems have become one of the last resort of antimicrobials. But in last few years, Carbapenem Resistant Enterobacteriaceae (CRE) have been reported worldwide. Various phenotypic tests have been proposed for detection of carbapenemase activity including the newer modified Carbapenem Inactivation Method (mCIM) as advised by Clinical Laboratory Standard Institute (CLSI) 2017 guidelines. Aim: Detection of CRE from clinical specimens with new mCIM method and its comparative evaluation with phenotypic and genotypic methods. Materials and Methods: Study was conducted between January 2017 and December 2017 at KIMS, Karad. Total 66 CRE, isolated from 1634 clinical specimens and identified by VITEK 2 (Biomerieux, France) were included in the study. Phenotype screening was done by mCIM (CLSI 2017) method and was compared with Modified Hodge test (MHT) and Combined Disc Test (CDT) methods. Klebsiella pneumoniae ATCC BAA-1705 and Klebsiella pneumoniae ATCC BAA-1706 were used as positive and negative controls respectively. Molecular confirmation of these isolates for carbapenemase producing genes bla NDM-1 , bla OXA-48 , bla KPC was done by multiplex Polymerase Chain Reaction (PCR) study. Results: Klebsiella pneumoniae (n=35) outnumbered the other bacterial species among 66 CRE included in the study. mCIM was positive for 65 (98.48%) out of 66 isolates while MHT and CDT was positive for 50 (75.75%) and 59 (89.39%) of CRE isolates respectively. All the CRE isolates showed presence of at least one carbapenemase producing gene. Conclusion: The mCIM method is simple, less subjective, cost effective, reproducible and most sensitive method and plays important role in detection and prevention of spread of CRE, thereby, reducing morbidity and mortality, especially where there is lack of automation and molecular diagnostic facility.
Egyptian Academic Journal of Biological Sciences. C, Physiology and Molecular Biology
Carbapenem resistance Gram-Negative bacteria (CR-GNB) impose life-threatening infections with limited treatment options. Rapid detection of CR-GNB-associated infections is usually associated with proper treatment and better disease prognosis. The aim of this study was to evaluate the efficacy of the Phoenix automated system, Modified Hodge Test (MHT) and X΄pert Carba-R assay for the detection of CR-GNB. A panel of 167 nonrepetitive CR-GNB with reduced susceptibility to carbapenems which was identified by the Kirby-Bauer method was analyzed by means of 1) Phoenix automated system, 2) MHT, and 3) X΄pert Carba-R assay. The most accurate identification of resistance determinants was obtained with the Phoenix automated system that diagnosed and confirmed all carbapenem-resistant isolates (n=167/167, 100%). Just 57% of CR-GNB were identified by X΄pert Carba-R Assay whereas seventy-nine (n=79/99, 79.8%) of CR Klebsiella spp., (n=5/23, 21.7%) of CR Pseudomonas spp., (n=10/32, 31.25%) of CR Acinetobacter baumannii, and (n=4/13, 30.8%) of CR other bacteria were identified. MHT correctly identified 56/99 (56.6%) strains of CR Klebsiella spp., 12/23 (52.2%) strains of CR Pseudomonas spp., 18/32 (56.25%) strains of CR A. baumannii, and 2/13 (15.4%) strains of other CR bacteria. While according to carbapenemase producers' genes, MHT most successfully identified blaNDM+blaOXA pattern of carbapenem resistance strains (n=25/26, 96.2%), then sensitivity lowered when testing blaOXA positive strain with (n=17/30, 56.7%), and less than half blaNDM positive samples were recognized by MHT with (n=19/42, 45.2%), sensitivity and specificity of MHT to detect carbapenemase producers' bacteria were 69.3% and 60.9%, respectively. Phoenix automated system diagnosed all the carbapenemase producers' bacteria in all genetic patterns as carbapenem resistance isolates with one hundred percent sensitivity but without any specificity to carbapenmase mechanism among other CR mechanisms. In conclusion, to detect and control the spread of CR-GNB with complicated resistance mechanisms, phenotypic automated assays are recommended in the routine diagnostic of clinical laboratories, but genotypic assays are recommended in nosocomial infection control to detect carbapenemase producers.
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.
Journal of Laboratory Physicians
Objective Carbapenems are last resort antibiotics for multidrug-resistant Enterobacteriaceae. However, resistance to carbapenem is increasing at an alarming rate worldwide leading to major therapeutic failures and increased mortality rate. Early and effective detection of carbapenemase producing carbapenem-resistant Enterobacteriaceae (CRE) is therefore key to control dissemination of carbapenem resistance in nosocomial as well as community-acquired infection. The aim of present study was to evaluate efficacy of Modified strip Carba NP (CNP) test against Modified Hodge test (MHT) for early detection of carbapenemase producing Enterobacteriaceae (CPE). Material and Methods Enterobacteriaceae isolated from various clinical samples were screened for carbapenem resistance. A total of 107 CRE were subjected to MHT and Modified strip CNP test for the detection of CPE. Statistical Analysis It was done on Statistical Package for the Social Sciences (SPSS) software, IBM India; version V26. N...
BMC Microbiology
Background Carbapenemase-resistant Enterobacteriaceae (CRE) cause many serious infections resulting in increasing treatment cost, prolonged hospitalization, and mortality rate. Reduced expression and/or mutations of porins and the presence of carbapenemase promote Enterobacteriaceae survival under carbapenem treatments. Development of accurate methods for the detection of antimicrobial resistance is required not only for therapy but also to monitor the spread of resistant bacteria or resistance genes throughout the hospital and community. In this study, we aimed to evaluate the phenotypic methods, Modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), and EDTA-CIM (eCIM) for the detection of carbapenemase-producing Enterobacteriaceae (CPE). Results The results showed that mCIM had a sensitivity of 100% and a specificity of 100%, whereas the MHT had a sensitivity of 84.8% and a specificity of 97.8% for the 195 CRE isolates tested (105 CPE and 90 non-CPE isolates)....
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.
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.
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.