Abstract
Background Carbapenems are considered as drugs of choice for the treatment of the infections caused by drug resistant bacteria. However, in the recent years the prevalence of carbapenem resistant gram negative bacteria has increased significantly. The main objective of this study was to determine the prevalence of carbapenemase producing gram negative bacteria among all the clinical isolates.Material and methods A total of 3246 non-repeated, different clinical specimens from patients attending Kathmandu Model Hospital, from July 2013 to January 2014 were cultured and the gram negative bacterial isolates obtained were subjected to identification with the help of colony morphology, Gram’s stain and conventional biochemical tests. Kirby-Bauer disk diffusion technique was used to perform antimicrobial susceptibility testing. Phenotypic confirmation of carbapenemase and AmpC beta-lactamase production was done by combined disc method.Results 890 samples showed the growth of bacterial pathogens. Out of total 769 gram negative bacteria, 57 were found to be carbapenem resistant. Of which, highest number (47) of the isolates were found to be metallo-β lactamase (MBL) producers. Six bacterial isolates produced both (Klebsiella pneumoniae carbapenemase) KPC and MBL, whereas only one isolate was found to be positive for both MBL and AmpC. Three bacterial strains showed carbapenem resistance due to over production of AmpC β-lactamase.Conclusion Among carbapenem resistant gram negative bacteria, MBL was present as the major enzyme responsible for resisting carbapenem antibiotics.
Highlights
The gram-negative bacteria are the leading causes of serious infections in human
Six bacterial isolates produced both (Klebsiella pneumoniae carbapenemase) KPC and MBL, whereas only one isolate was found to be positive for both MBL and AmpC
Among carbapenem resistant gram negative bacteria, MBL was present as the major enzyme responsible for resisting carbapenem antibiotics
Summary
The gram-negative bacteria are the leading causes of serious infections in human. Escherichia coli and Klebsiella spp. (among the members of Enterobacteriaceae family), and Pseudomonas spp. and Acinetobacter spp. (among the non-fermenting gram negative bacilli) are the major bacterial pathogens causing infections in human [1]. Among the β-lactam antibiotics, carbapenems are the antibiotics with very broad spectrum of activity [4]. They are stable to most of the β-lactamases, including extended spectrum beta lactamase (ESBL) and AmpC β-lactamase [5]. The carbapenem antibiotics are considered as the drugs of choice for the treatment of the infections caused by multidrug resistant (MDR) bacteria [6]. In terms of the β-lactam antibiotics, bacteria are mainly resistant by producing enzymes, such as extended spectrum beta lactamase (ESBL), AmpC-beta-lactamase and carbapenem hydrolyzing enzymes (carbapenemases) [10]. We determined the prevalence of carbapenemase and AmpC beta-lactamase producing gram-negative bacteria in causing human infections. The main objective of this study was to determine the prevalence of carbapenemase producing gram negative bacteria among all the clinical isolates
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