Abstract
Objective:Extensive drug resistant Gram-negative bacilli, harboring New Delhi metallo-β-lactamase-1 (blaNDM-1) having the ability to hydrolyze β-lactams, have become a vital global clinical threat. The present study was, therefore, designed to investigate the prevalence and epidemiology of NDM-1 producers in Quetta, Pakistan.Methods:This study was carried out in Microbiology Laboratory, Bolan Medical Complex Hospital Quetta, Biotechnology laboratory, BUITEMS Quetta and Hi-tech laboratory, CASVAB, University of Balochistan, Quetta, from March to June 2018, during the hot season. Biochemical and molecular approaches were applied for the identification of bacterial isolates. Minimum Inhibitory Concentrations (MICs) were determined using E-test method. Carbapenemase activity was ascertained by Modified Hodge Test (MHT) and the presence of blaNDM-1 gene was recognized by Polymerase Chain Reaction (PCR).Results:We isolated five blaNDM-1 harboring isolates of three different species namely Morganella morganii (n=2) Enterobacter cloacae (n=2) and Citrobacter freundii (n=1), from 300 pus samples. These isolates were found extensive drug resistant (XDR). Strikingly, two isolates of M. morganii were displaying resistance against 23 antibiotics of sulphonamides, aminoglycosides, polypeptide, monobactams, tetracyclines, quinolones, macrolides, cephalosporins, phosphonic acid and β-lactams groups, suggesting Pan Drug Resistance (PDR).Conclusion:This is the first report on emergence of PDR strain of M. morganii producing NDM-1 in the province of Balochistan, Pakistan. The presence of blaNDM-1 in different bacterial species and their extensive rather pan drug resistance pattern poses a momentous clinical threat.
Highlights
Carbapenem group of antibiotics is one of the most effective drugs that has been used as a last remedy for the treatment of infections caused by Multi Drug Resistant (MDR) Gram negative bacilli.[1]
Susceptibility testing: All Gram-negative isolates of different spp. subjected to antibiogram were sensitive to a range of antibiotics except, Morganella morganii, (n=2), Enterobacter cloacae (n=2) and Citrobacter freundii (n=1)
These five isolates were tested against twenty-three available antibiotics from, aminoglycosides, tetracyclines, quinolones, β-lactams, monobactams, sulphonamides, macrolides, cephalosporins, phosphonic acid and polypeptide classes of antimicrobials, showed increased resistance
Summary
Carbapenem group of antibiotics is one of the most effective drugs that has been used as a last remedy for the treatment of infections caused by Multi Drug Resistant (MDR) Gram negative bacilli.[1]. Pak J Med Sci July - August 2019 Vol 35 No 4 www.pjms.org.pk 1155 reports on antimicrobial resistance βlactamases are suggested to contribute to resistance.[3] M. morganii and E. cloacae which are members of Enterobacteriaceae family play a significant role in causing nosocomial infections like, wounds, skin, soft tissue, urinary tract, respiratory tract, and biliary tract, mostly in immunocompromised patients. NDM-1 was reported from different hospitals in the UK in Morganella morganii, Citrobacter freundii, Enterobacter cloacae, Providencia, Klebsiella pneumonia and Escherichia coli.[4,5] It was initially discovered in 2008 in a Swedish patient of Indian origin, but has claimed its presence globally including India and Pakistan.[5,6]
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