Molecular Characterization of Extended Spectrum β-lactamase and Carbapenemase Producing Klebsiella pneumoniae from a Tertiary Care Hospital.

Beena Hosdurg Bhaskar,Shalini Shenoy Mulki,Sangeetha Joshi

doi:10.5005/jp-journals-10071-23118

Abstract

ABSTRACTObjectiveThe extended-spectrum beta-lactamase (ESBL) and carbapenemase producing gram-negative bacteria among the members of Enterobacteriaceae are of major health concern globally. The present study was carried out to determine proportion and genetic characterization of ESBL and carbapenemase producing Klebsiella pneumoniae strains isolated from intensive care units of a tertiary care hospital.Materials and methodsA total of 250 non-duplicate K. pneumoniae isolates were recovered from various clinical specimens from our intensive care units from May 2014 to May 2015. Antibiotic susceptibility testing was performed as recommended by Clinical and Laboratory Standard Institute. Phenotypic identification of ESBL and carbapenemase producing isolates were confirmed by the double-disk synergy test, modified Hodge test, imipenem and imipenem-EDTA combined test, respectively. Molecular characterization of β-lactamase genes were performed by polymerase chain reaction.ResultsOut of 250 Klebsiella pneumonaie, 84% isolates were ESBL producers, 66% were carbapenem resistant based on their reduced susceptibility to imipenem, meropenem and ertapenem. Among these 165 carbapenem resistant isolates, 9.7% were positive for bla NDM-1 and these isolates were also found to be positive for one or more bla genes. Co-carriage of AmpC in ESBL and carbapenem resistant isolates were 7.8% and 3.6%, respectively and were negative for blaKPC genes.ConclusionThe study indicated the prevalence of ESBLs and blaNDM-1, with additional bla genes and AmpC among the K. pneumoniae isolates in our intensive care units. NDM-1 producing Enterobacteriaceae is a growing health care problem. Detection of the prevalence of antibacterial resistance pattern helps towards improved antibiotic policy and empirical antibiotic treatment.How to cite this articleBeena HB, Shenoy SM, et al. Molecular Characterization of Extended Spectrum β-lactamase and Carbapenemase Producing Klebsiella pneumoniae from a Tertiary Care Hospital. Indian J of Crit Care Med 2019;23(2):61-66.

Highlights

Infections due to multidrug resistant (MDR) Enterobacteriaceae are an important cause of morbidity and mortality worldwide
The study indicated the prevalence of extended-spectrum beta-lactamase (ESBL) and blaNDM-1, with additional bla genes and AmpC among the K. pneumoniae isolates in our intensive care units
In our study we found 9.7% of NDM-1 which is similar to a study from tertiary care hospital of Northeast India where they found 8.67% of NDM pocessing Klebsiella pneumoniae isolates[39]

Summary

Introduction

Infections due to multidrug resistant (MDR) Enterobacteriaceae are an important cause of morbidity and mortality worldwide. The emergence of resistance to these agents has become a serious health concern globally[1]. Klebsiella pneumoniae is one of the most common Gramnegative bacteria showing resistance to multiple antibiotics. The development of extended-spectrum cephalosporins in the early 1980s was regarded as a major addition to our therapeutic armamentarium in the fight against beta-lactamase mediated bacterial resistance. The emergence of enzymes that have the ability to hydrolyze this cephalosporin’s seriously compromised the efficacy of these lifesaving antibiotics. These enzymes were called extended spectrum beta lactamases[2]. Extended spectrum beta-lactamases are plasmid-mediated enzymes that are capable of conferring bacterial resistance to the penicillins, first, second third, fourth generation cephalosporins and aztreonam

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