Abstract
The aim of the study was to determine the prevalence of New Delhi metallo-β lactamase-1 (NDM-1) producing Enterobacteriaceae in Kuwait over a one year period. Consecutive Enterobacteriaceae isolates with reduced susceptibility to carbapenems were collected from four government hospitals in Kuwait from January–December 2014. Their susceptibility to 18 antibiotics was performed by determining the minimum inhibitory concentration. Isolates resistant to carbapenems were tested by PCR for resistant genes. Finger printing of the positive isolates was done by DiversiLab®. Clinical data of patients harboring NDM-1 positive isolates were analyzed. A total of 764 clinically significant Enterobacteriaceae isolates were studied. Of these, 61 (8%) were carbapenem-resistant. Twenty one out of these 61 (34.4%) were NDM-1-producers. All patients positive for NDM-1-carrying bacteria were hospitalized. About half were females (11/21 [52.3%]), average age was 53.3 years and the majority were Kuwaitis (14/21 [66.6%]). Six patients (28.5%) gave a history of travel or healthcare contact in an endemic area. Mortality rate was relatively high (28.6%). The predominant organism was Klebsiella pneumoniae (14 [66.6%]) followed by E. coli (4 [19%]). All NDM-1-positive isolates were resistant to meropenem, ertapenem, cefotaxime, cefoxitin and ampicillin, while 95.2% were resistant to imipenem, cefepime, and piperacillin-tazobactam. They were multidrug resistant including resistance to tigecycline, but 90% remained susceptible to colistin. About two-thirds of isolates (61.9%) co-produced-extended spectrum β-lactamases. During the study period, an outbreak of NDM-1 positive K. pneumoniae occurred in one hospital involving 3 patients confirmed by DiversiLab® analysis. In conclusion, NDM-1-producing Enterobacteriaceae is a growing healthcare problem with increasing prevalence in Kuwait, especially in hospitalized patients, leaving few therapeutic options. A high prevalence of NDM-1 necessitates the implementation of strict infection control to prevent the spread of these organisms.
Highlights
Infections due to Enterobacteriaceae are an important cause of morbidity and mortality worldwide
New Delhi metallo-βlactamase-1 (NDM-1), a relatively newly described MBL, can hydrolyze all β-lactams including carbapenems except monobactam. It was first identified in Klebsiella pneumoniae and Escherichia coli isolated from a Swedish patient who was hospitalized in India in 2008 [4]
All the patients with NDM-1 positive isolates were infected except two patients who were colonized in the rectum, and throat
Summary
Infections due to Enterobacteriaceae are an important cause of morbidity and mortality worldwide. New Delhi metallo-βlactamase-1 (NDM-1), a relatively newly described MBL, can hydrolyze all β-lactams including carbapenems except monobactam. It was first identified in Klebsiella pneumoniae and Escherichia coli isolated from a Swedish patient who was hospitalized in India in 2008 [4]. NDM-1 producing bacteria are important because the gene encoding this enzyme is found on transferable plasmid (of varying size) so that resistance can be transferred from one bacterium to another. These bacteria are usually multi-drug resistant making treatment difficult. NDM-1 enzyme is present in E. coli, the most common cause of urinary tract infection in the community and hospital [7, 8]
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