Abstract
BackgroundA rising threat of the rapid spread of acquired metallo-beta-lactamases (MBLs) among major Gram-negative pathogens is a matter of public health concern worldwide. Hence, for a low income nation like Nepal, surveillance data on MBL producing clinical isolates via a cost effective technique is necessary to prevent their dissemination as well as formulation and regulation of antimicrobial stewardship policy.MethodsThe prospective study was conducted at Nepal Medical College, Kathmandu from May to October, 2014 to assess the prevalence of MBL production among ceftazidime-resistant Gram-negative rods (GNRs) isolates. The samples were processed according to standard microbiological procedure following the Manual of clinical Microbiology. Isolated GNRs were subjected to susceptibility testing against the selected panel of antibiotics by Kirby- Bauer disc diffusion method and interpretation made in conformity with the Clinical and Laboratory Standards Institute (CLSI) guidelines. Ceftazidime-resistant isolates were subjected to the detection of MBL production by imipenem—EDTA combined disc (CD) method.ResultsAmong the Gram-negative isolates, 5.80% (21/362) were found to be MBL positive with Acinetobacter spp. showing the highest prevalence i.e. 85.71% (18/21), followed by P. aeruginosa i.e. 14.29% (3/21). None of the other cefazidime resistant gram negative bacteria tested were found to be positive for MBL production with all the positive isolates determined to be Multidrug resistant (MDR) strains.ConclusionThis study demonstrated a higher rate of resistance among P. aeruginosa and Acinetobacter spp. to a wide variety of antibiotic categories with an additional burden of MBL production within them, warranting a need for strict surveillance and rapid detection of MBL production among the GNRs.
Highlights
A rising threat of the rapid spread of acquired metallo-beta-lactamases (MBLs) among major Gramnegative pathogens is a matter of public health concern worldwide
Design and study population The prospective study was conducted at Nepal Medical College, Kathmandu from May to October 2014 to assess the prevalence of metallo-beta-lactamase production among the ceftazidime-resistant Gram-negative rods (GNRs) isolated from different clinical samples
Control strains of P. aeruginosa American type culture collection (ATCC) 27853, and E. coli ATCC 25922 were used in parallel as a part of quality control as well as for validation of the test performed
Summary
A rising threat of the rapid spread of acquired metallo-beta-lactamases (MBLs) among major Gramnegative pathogens is a matter of public health concern worldwide. The knowledge about the types of enzymes that may be present can serve to guide the infectious disease physician toward choosing appropriate therapy without the need for extensive secondary testing, detection of MBL producing isolates is of paramount importance in clinical setting. Given the background, this epidemiological study was designed to generate updated information on the burden of metallo-beta-lactamase producing Gram negative bacteria from a tertiary care hospital in Nepal so that an effective antimicrobial stewardship policy can be formulated and implemented to circumvent the rising threat of antimicrobial resistance
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