Abstract
Carbapenemases are the enzymes that catalyze β–lactam groups of antibiotics. The carbapenemase producers are resistant to β–lactam antibiotics and are usually multidrug-resistant bacteria challenging widely used therapeutics and treatment options. Therefore, the detection of carbapenemase activity among clinical isolates is of great therapeutic importance. We aimed to study the MDR and carbapenemase-producing Klebsiella pneumoniae and Pseudomonas aeruginosa isolated from various clinical samples at a tertiary care hospital in Nepal. A total of 3,579 clinical samples were collected from the patients visiting the Department of Microbiology, B&B Hospital, Gwarko, Lalitpur. The samples were processed to isolate K. pneumoniae and P. aeruginosa and then subjected to antibiotic susceptibility testing (AST) by the Kirby-Bauer disk diffusion method. Phenotypic detection of carbapenemase activity was performed in the imipenem-resistant isolates by the modified Hodge test (MHT). Of the total samples, 1,067 (29.8%) samples showed significant growth positivity, out of which 190 (17.3%) isolates were K. pneumoniae and 121 (11.3%) were P. aeruginosa. Multidrug resistance was seen in 70.5% of the K. pneumoniae isolates and 65.3% of the P. aeruginosa isolates. Carbapenemase production was confirmed in 11.9%, and 12.2% of the imipenem-resistant K. pneumoniae and P. aeruginosa isolates, respectively, by the MHT. This study determined the higher prevalence of MDR among K. pneumoniae and P. aeruginosa; however, carbapenemase production was relatively low.
Highlights
Carbapenems are antibiotics widely used to treat infections caused by bacterial pathogens suspected to be multidrug-resistant (MDR).[1]
This study aims to study the antibiotic resistance pattern of the K. pneumoniae and P. aeruginosa isolated from clinical samples in the tertiary care hospital in Nepal and identify the carbapenemaseproducing isolates using a low-cost phenotypic method
The highest number of K. pneumoniae and P. aeruginosa isolates were obtained from wound pus samples followed by urine (Table 1)
Summary
Carbapenems are antibiotics widely used to treat infections caused by bacterial pathogens suspected to be multidrug-resistant (MDR).[1] Among the β- lactams, carbapenems possess the broadest spectrum of antimicrobial activity and are more effective even against general antibiotic resistance mechanisms; they are used as “last-line antibacterial agents”.2,3. Bacterial pathogens are ever-evolving and often evolve into carbapenemase-producing virulent strains. Carbapenemases are β-lactamases with versatile hydrolytic capacities, providing resistance against the existing carbapenem antibiotics and are the significant contributors of multidrug resistance.[2,4] Infections caused by carbapenemase-producing bacteria have been associated with higher mortality rates and severe outbreaks.[5] Concern has arisen in recent years over the increasing trend of carbapenem resistance, as the therapeutic options for treating infections caused by carbapenem-resistant bacteria are limited.[6] The rapid transmission and the lack of alternative antimicrobial drugs against carbapenemresistant organisms have become a worrying public health issue worldwide.[7,8] It is mainly because these enzymes hydrolyze virtually all types of antimicrobial β-lactamases and are often resistant to commercially available β-lactamases inhibitors.[9]
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