Prevalence Of Carbapenem Resistance Research Articles

Prevalence of Carbapenem Resistance and Antibacterial Potential of Nanoparticles in Pseudomonas aeruginosa Isolated from Burn Units in Egypt

Prevalence of Carbapenem Resistance and Antibacterial Potential of Nanoparticles in Pseudomonas aeruginosa Isolated from Burn Units in Egypt

Detection Sequencing NDM and blaOXA Genes in Metallo-$\beta$-Lactamase Producing Klebsiella Pneumoniae

The prevalence of Carbapenem-resistance in Enterobacteriaceae is rising worldwide and poses a treatment challenge for healthcare facilities. This study aims to detect a sequence of New Delhi metallo- -lactamase (NDM) and bla OXA-48 gene in metalo-beta-lactamase-producing Klebsiella pneumoniae isolated from a few hospitals in the city of Baghdad. 74 Klebsiella pneumoniae were isolated from 320 clinical samples that were routinely submitted to the diagnostic laboratory of the chosen hospital. These samples included sputum, tissue swabs, folly tips, urine, ear swabs, bloodstream, pus, wound swabs, endotracheal tubes, and body fluids. In this study, 74 isolates were examined for expression of carbapenemase by phenotyping method. The modified Hodge Test (MHT) is utilized for phenotypic detection. MHT was positive for 24 carbapenem-resistant Klebsiella pneumoniae. Genotyping was accomplished by using polymerase chain reaction (PCR) to amplify target genes by employing particular primers. The NDM gene was detected in 19/24 isolates, and the blaOXA-48 gene was detected in 5/24 isolates. The presence of bla NDM and the dangerously high frequency of MBL in the Klebsiella pneumoniae strain are both concerning, and it has been demonstrated to be challenging to treat and inhibit infection.

Emergence of Carbapenem-Resistant Gram-Negative Isolates in Hospital Settings in Djibouti.

Introduction: The antimicrobial resistance (AMR) of bacteria is increasing rapidly against all classes of antibiotics, with the increasing detection of carbapenem-resistant isolates. However, while growing prevalence has been reported around the world, data on the prevalence of carbapenem resistance in developing countries are fairly limited. In this study, we investigated and determined the resistance rate to carbapenems among multidrug-resistant Gram-negative bacteria (MDR-GNB) isolated in Djibouti and characterized their resistance mechanisms. Results: Of the 256 isolates, 235 (91.8%) were identified as Gram-negative bacteria (GNB). Of these GNBs, 225 (95.7%) isolates exhibited a multidrug resistance phenotype, and 20 (8.5%) isolates were resistant to carbapenems, including 13 Escherichia coli, 4 Acinetobacter baumannii, 2 Klebsiella pneumoniae and 1 Proteus mirabilis. The most predominant GNB in this hospital setting were E. coli and K. pneumoniae species. Carbapenemase genes such as blaOXA-48 and blaNDM-5 were identified, respectively, in six and four E. coli isolates, whereas the carbapenemase blaNDM-1 was identified in three E. coli, two K. pneumoniae, one P. mirabilis and one A. baumannii. Moreover, three A. baumannii isolates co-hosted blaOXA-23 and blaNDM-1. Materials and Methods: A total of 256 clinical strains collected between 2019 and 2020 were identified using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF). Antibiotic susceptibility testing was performed using disk diffusion and E-test methods. Real-time polymerase chain reaction (RT-PCR), standard PCR and sequencing were used to investigate genes encoding for extended-spectrum-β-lactamases, carbapenemases and colistin resistance genes. Conclusions: We report, for the first time, the presence of MDR-GNB clinical isolates and the emergence of carbapenem-resistant isolates in Djibouti. In addition to performing antimicrobial susceptibility testing, we recommend phenotypic and molecular screening to track the spread of carbapenemase genes among clinical GNB isolates.

Detection of Β-Lactamase OXA Genes and Biofilm Production in Carbapenem Resistant Gram-Negative Bacilli

Objectives: The emergence of carbapenem resistance in biofilm producer Gram-negative bacteria poses a substantial challenge to manage infections. This study aimed to evaluate biofilm production and molecular characterization of carbapenem resistance Gram-negative rods. Methods: Total of 46 bacteria were isolated from various clinical samples, including blood, CSF, urine, sputum, saliva, tracheal secretion, and pus. Following the standard guidelines for bacterial identification (CLSI), bacterial pathogens are isolated and identified. The antibiotic susceptibility profile was obtained against commercially available antibiotics including Amoxicillin, Amikacin, Ceftazidime, Cefepime, Imipenem, Meropenem, Gentamycin, Tobramycin, Doxycycline, Minocycline, Tazobactam, Ciprofloxacin, and Levofloxacin following CLSI guidelines. Biofilm production potential was quantified by using 96-well flat bottom microtiter plates. Phenotypic and molecular characterization of carbapenem-resistant bacteria was performed. The genotypic resistance to carbapenem was determined using OXA-23, OXA-24, OXA-51 and OXA-58 gene primers. Results: The Gram-negative bacterial strains were found as Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Serratia marcescens. The phenotypic resistance against carbapenem drugs was 95%. DNA of carbapenem-resistant bacteria isolated by commercially available kit and polymerase chain reaction assay was performed and optimized to identify OXA-23 (84%), OXA-24(90%), OXA-51(83%) and OXA-58(80%) gene in bacterial strains. Practical Implication: For better and prompt management of antimicrobial resistance further work on genetics is required and warranted to produce gene effective drugs to enhance antimicrobial effect of carbapenems. Conclusion: The prevalence of carbapenem resistance among Gram-negative bacilli was high. OXA genes have raised clinical concern and further study is required to detect carbapenemase-producing bacteria. Keywords: Antibiotic Resistance, Biofilm, Carbapenem-resistance, Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Serratia marcescens, β-lactamases, OXA-23, OXA-24, OXA-51 and OXA-58

The Prevalence of Colonization with Carbapenem-resistant Enterobacteriaceae, Escherichia coli, Klebsiella and Enterobacter, and Related Risk Factors in Children

Background: Carbapenems are broad-spectrum antibiotics used to treat the family of gram-negative Enterobacteriaceae, especially those that are resistant to first-line antibiotics. Because these drugs are usually prescribed as the last line of treatment, resistance to these antibiotics carries irreparable risks to treatment systems, and screening high-risk individuals in medical centers and using infection control measures are critical strategies for eliminating them. Objectives: We investigated the prevalence of colonization of different strains of Enterobacteriaceae, Klebsiella, Enterobacter, and Escherichia coli and their risk factors in hospitalized children. Methods: In this descriptive cross-sectional study, stool samples were taken from patients during the first 48 hours of hospitalization in a tertiary children’s hospital and were cultured on Makcanki culture medium or EMB. Cultured Enterobacteriaceae samples were transferred to Müller-Hinton agar medium, and their antibiotic susceptibility was evaluated with meropenem and imipenem discs by disc diffusion method. In the next step, five common carbapenemase genes, including (VIM, IMP, OXA-48, NDM-1, and SPM-1) were examined by PCR method and reported accordingly. Results: Two hundred and ninety-five stool samples were examined, of which 242 (82%) samples were cultured positively with Enterobacteriaceae. The prevalence of carbapenem resistance was reported to be 37% among 295 samples using the phenotypic method. Resistance rates were high in patients with a history of antibiotic use, with frequent hospitalizations (more than two episodes in the last six months), and in patients with an underlying disease) malignancy, GI diseases, immunodeficiency, neurologic diseases such as cerebral palsy and epilepsy, endocrine diseases. Most of the genes found were OXA-48, followed by IMP and VIM. NDM-1 was found in 3 samples, and SPM was not found in any of the samples. In 13% of resistant samples, more than one carbapenemase gene was found. Conclusions: The results of this study showed that the frequency of carbapenem resistance in stools colonized with Enterobacteriaceae is high in our patients. On the other hand, the presence of carbapenemase genes in these bacteria, which are located on the plasmids that can be rapidly spread in the hospital environment, is an alarm for the hospital infection control committee to take preventive measures in order to prevent the spread of these bacteria in the hospital.

Bacteriological spectrum, extended-spectrum β-lactamase production and antimicrobial resistance pattern among patients with bloodstream infection in Addis Ababa

Bloodstream infection coupled with drug resistance in bloodborne bacteria is a major health problem globally. The current study sought to identify the bacterial spectrum, extended-spectrum -lactamase production, and antimicrobial resistance pattern in patients with bloodstream infection. This prospective cross-sectional study was conducted at Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia from January 2019- until July 2020. Blood collected from patients was inoculated into blood culture bottles and incubated appropriately. Identification, antimicrobial susceptibility testing, and extended-spectrum β-lactamase-production were determined with the VITEK 2 compact system. Of the samples collected, 156 (18.5%) were culture-positive. Klebsiella pneumoniae and Staphylococcus epidermidis were the dominant isolates. In Gram-negative bacteria, the prevalence of drug resistance was the highest against ampicillin (80.8%) and the lowest against imipenem (5.2%). While in Gram-positive bacteria it was the highest against clindamycin and the lowest against vancomycin and daptomycin. The prevalence of multi-drug resistance and extended-spectrum β-lactamase production of Gram-negative bacteria were 41.6% and 34.2%, respectively. The prevalence of bloodstream infection was 18.5%. Serious life-threatening pathogens including S. aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, and Enterobacter spp was predominant. The prevalence of multi-drug resistance to both Gram-positive and Gram-negative bacteria and extended-spectrum β-lactamase-production were high but prevalence of carbapenem resistance was low. All these situations call for the establishment of strong infection control strategies, a drug regulatory system, and established antibiotic stewardship in healthcare settings.

Geographic patterns of Acinetobacter baumannii and carbapenem resistance in the Asia-Pacific Region: results from the Antimicrobial Testing Leadership and Surveillance (ATLAS) program, 2012-2019

This study aimed to investigate the geographic distribution of carbapenem-resistant Acinetobacter baumannii (CR-AB) isolates in the Asia-Pacific region. We collected A. baumannii isolates using the Antimicrobial Testing Leadership and Surveillance program from 2012 to 2019. The minimum inhibitory concentrations (MICs) of the isolates were determined using the broth microdilution method. The major carbapenemase genes were identified using multiplex polymerase chain reaction assays for the isolates collected between 2012 and 2014. CR-AB was defined as isolates with meropenem MICs ≥8 mg/l. In total, 2674 A. baumannii isolates were collected from 13 countries, of which 1918 (71.7%) were CR-AB. The carbapenem resistance rates among A. baumannii isolates were as low as 2.8% and 6.5% in Japan and Australia, respectively, but as high as 88% and 87.2% in South Korea and India, respectively. Of the 232 CR-AB isolates that underwent carbapenemase gene screening, 224 (96.6%) harbored at least one carbapenemase gene. A total of 226 carbapenemase genes were detected, with blaOXA-23 (94.7%, 214/226) being the most dominant, followed by blaOXA-72 (2.7%, 6/226), blaOXA-58 (2.2%, 5/226), and blaNDM-1 (0.4%, 1/226). CR-AB isolates had >80% resistance to amikacin, ampicillin/sulbactam, cefepime, ceftazidime, ciprofloxacin, levofloxacin, and piperacillin/tazobactam. The rates of CR-AB resistance to minocycline and colistin were 7.2% (31/429) and 1.7% (23/1368). For cefoperazone/sulbactam and tigecycline, 50.2% (527/1049) and 93.3% (1789/1918) of CR-AB isolates had an MIC ≤16 mg/l and ≤2 mg/l, respectively. The prevalence of carbapenem resistance in A. baumannii showed significant differences among countries in the Asia-Pacific region, and the treatment options were limited.

Prevalence of Carbapenem-Resistant Escherichia coli and Klebsiella pneumoniae in Rural Uttar Pradesh

Introduction: In recent years, increased incidences of carbapenem resistance among Escherichia coli and Klebsiella pneumoniae have been reported worldwide. Due to the higher prevalence and wide range of clinical infections, E. coli and K. pneumoniae are considered great risks for public health. Furthermore, carbapenem resistance limits the treatment options in individuals infected with E. coli and K. pneumoniae. Thus, rapid detection of carbapenem resistance is essential to initiate appropriate treatment and effective management and prevent further dissemination. In the present study, we aimed to explore the prevalence of carbapenem-resistant E. coli and K. pneumoniae at a tertiary care hospital in rural Uttar Pradesh. Materials and Methods: A cross-sectional study was performed at Government Medical College, Azamgarh, in collaboration with Santosh Medical College, Ghaziabad. A total of 2736 clinical specimens comprising urine (1939), pus and wound swabs (486), sputum and throat swabs (257), and other samples (54) were collected following the standard guidelines and were processed for culture by standard bacteriological methods. After obtaining the growth, Gram staining and standard biochemical reactions were performed for the identification of E. coli and K. pneumoniae. All these isolates were subjected to antibiotic sensitivity testing for carbapenem by Kirby–Bauer disc diffusion method. Results: Of the 2736 specimens, 48.57% showed the growth of various organisms. Of these, 59.51% of isolates showed the growth of Enterobacteriaceae, of which 60.93% among them were E. coli whereas 26.92% were K. pneumoniae. The overall prevalence of carbapenem resistance in the present study was found to be 29.35%. Among the carbapenem-resistant isolates, 68.13% were E. coli whereas 31.86% were identified as K. pneumoniae. Conclusion: Carbapenem resistance in E. coli and K. pneumoniae isolates in the present study was found to be higher compared to previous studies from India. Our study highlights the urgent need of proper monitoring, judicious use of antibiotics, and implementation of strict infection control practices in this region.

Comparative Genomics Revealed Fluoroquinolone Resistance Determinants and OmpF Deletion in Carbapenem-Resistant Escherichia coli.

Escherichia coli (E. coli) is a major causative organism of complicated urinary tract infections, bloodstream infections, and pneumonia. With the widespread use of antimicrobial agents, the prevalence of carbapenem resistance in E. coli has been increasing with limited therapeutic options. Fluoroquinolone remains a choice in carbapenem-resistant E. coli (CREc) that were once susceptible to the drug. Despite robust studies on the fluoroquinolone-resistant mechanisms of E. coli, few studies focused specifically on the group of CREc. In this study, we used comparative genomics to identify the fluoroquinolone-resistant mechanisms of CREc and detected gyrA D87N mutation in all the fluoroquinolone-resistant and CREc. Moreover, to investigate the mechanism underlying non-carbapenemase-producing carbapenem-resistant E. coli, we targeted the complete genome sequences for in-depth analysis and found a deletion in OmpF (DEL264-269) that might contribute to carbapenem resistance, which has not been reported before. Further studies focusing on the impact of these mutations on the expression levels are warranted. We further investigate the MLST, serotype, fimH type, phylogroup, and clinical characteristics of the CREc. Combination analysis of clinical and genomic characteristics suggests the polyclonal and highly diverse nature of the CREc in Taiwan. This study provides an insight into the molecular epidemiology of CREc in Taiwan.

Prevalence of carbapenem resistance and its potential association with antimicrobial use in humans and animals in rural communities in Vietnam.

BackgroundVietnam and Southeast Asia are hotspots for antimicrobial resistance; however, little is known on the prevalence of carriage of carbapenem resistance in non-hospitalized humans and in animals. Carbapenem-resistant Enterobacteriaceae (CRE), particularly Escherichia coli (CREC) and Klebsiella pneumoniae (CRKP) and also Acinetobacter baumannii (CRAB) are emerging threats worldwide.MethodsWe investigated healthy humans (n = 652), chickens (n = 237), ducks (n = 150) and pigs (n = 143) in 400 small-scale farms in the Mekong Delta of Vietnam. Samples (rectal swabs, faecal swabs) were investigated for carriage of CRE/CRAB and were further characterized phenotypically and genotypically.ResultsIn the Mekong Delta of Vietnam, the prevalence of CRE isolates in human rectal swabs was 0.6%, including 4 CREC and 1 CRKP. One pig was infected with CREC (prevalence 0.7%). CRAB was isolated from chickens (n = 4) (prevalence 2.1%) and one duck (prevalence 0.7%). CRKP was isolated from a human who was also colonized with CREC. The CRKP strain (ST16), from an 80 year-old person with pneumonia under antimicrobial treatment, genetically clustered with clinical strains isolated in a hospital outbreak in southern Vietnam. The prevalence of CRE was higher among humans that had used antimicrobials within 90 days of the sampling date than those had not (4.2% versus 0.2%) (P = 0.005). All CRE/CRAB strains were MDR, although they were susceptible to colistin and neomycin. The carbapenemase genes identified in study strains were blaNDM and blaOXA.ConclusionsThe finding of a CRKP strain clustering with previous hospital outbreak raises concerns about potential transmission of carbapenem-resistant organisms from hospital to community settings or vice-versa.

1277. Colonization Rates for Antimicrobial-resistant Bacteria in Kenya: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study

BackgroundCharacterization of antimicrobial-resistant organism (ARO) colonization is critical to understand transmission dynamics and infection risk, however data in resource-limited settings are scare. We estimated the prevalence of Enterobacterales colonization with extended-spectrum cephalosporin-resistance (ESCrE), carbapenem-resistance (CRE) and methicillin-resistant Staphylococcus aureus (MRSA) among community residents and hospitalized patients in rural (Siaya County) and urban (Kibera) Kenya.MethodsCommunity-dwelling adults and children were enrolled via cluster randomized sampling. Inpatients of all ages were enrolled by simple random sampling. Stool/rectal and nasal swabs were collected and screened for ESCrE, CRE and MRSA, respectively, using HardyChrom™ media. Vitek2® was used for isolate confirmation and antibiotic susceptibility testing. Fisher’s exact tests were used to compare prevalence of AROs.ResultsThe prevalence of ESCrE was higher for the urban hospital (69.8%, 263/377) compared to rural hospitals (62.7%, 298/475, P=0.04); a similar pattern was evident for CRE (16.7%, 63/377 and 6.5%, 31/475, respectively, P< 0.01). The prevalence of MRSA was 3.2% for both urban and rural hospitals (P=0.99). For adults, the prevalence of ESCrE was higher in Kibera households (51.4%, 346/673) compared to Siaya (44.6%, 283/634, P=0.02) while the prevalence of both CRE and MRSA was < 3% for both areas and did not differ significantly (CRE, P=0.13, MRSA, P=0.14). There was no significant difference between urban and rural children for ESCrE (47.7%, 74/155 and 53.4%, 135/253, P=0.31); both CRE and MRSA were rarely detected (< 2%) with no difference across settings (CRE, P=1.0, MRSA, P=0.42). Among Enterobacteriaceae recovered, Escherichia coli and Klebsiella spp. predominated.ConclusionColonization with AROs were widespread in households and hospitals in urban and rural areas. Hospitals with elevated prevalence of highly transmissible AROs should consider whether implementation of colonization screening can be incorporated as part of their infection prevention and control programs. Risk factors for ARO colonization should be elucidated to identify novel prevention strategies.Disclosures All Authors: No reported disclosures

Prevalence of Carbapenem Resistance and their Genotypic Profile among Gram-Negative Bacteria in a Tertiary Care Hospital in Western India

Background: Resistance to carbapenems due to carbapenemases has been increasingly noticed worldwide. Detection of carbapenemases among Gram‑negative bacteria (GNB) is important for&#x0D; both clinicians and infection control practitioners. Both phenotypic and molecular methods can be used for detection of Carbapenemases production. Molecular methods although the gold standard for detection of carbapenemases are not used routinely as they might not be immediately available coupled with expertise required, cost and infrastructure incurred and limited by the number of targets detected.&#x0D; Methods: Consecutive non-repeat gram negative isolates isolated from various clinical specimens from intensive care unit (ICU) were included in the study. Antimicrobial susceptibility testing was done on Mueller Hinton’s agar by Kirby Bauer Disc diffusion method as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Isolates resistant to Meropenem were further screened for carbapenemase producing genes using multiplex polymerase chain reaction (PCR). The results were statistically analysed.&#x0D; Result: A total of 350 gram negative bacteria were screened for carbapenem resistance. Carbapenem resistance was found in 109 GNB. The metallo‑ β‑lactamases were most common carbapenemases followed by KPC.&#x0D; Conclusion: Carbapenemase producing bacteria are a major threat of the 21st century. Preventing emergence and spread of these pathogens through strict infection control practices, judicious use of antibiotics and early and timely detection will contribute in preserving carbapenems, the last resort antibiotics.

Maternal Vaginal Colonization and Extended-Spectrum Beta-Lactamase-Producing Bacteria in Vietnamese Pregnant Women.

Extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) resistance to commonly prescribed drugs is increasing in Vietnam. During pregnancy, ESBL-E may predispose women to reproductive tract infections and increases the risk for neonatal morbidity. Vaginal colonization and infections by Escherichia coli and Klebsiella pneumoniae are seldom studied in Vietnam. In this study, we investigated ESBL-producing Enterobacterales in the birth canal of pregnant women. Between 2016 and 2020, vaginal swabs were collected from 3104 pregnant women (mean gestational age of 31 weeks) and inoculated onto MacConkey agar plates. Colonies were subjected to direct identification and antimicrobial susceptibility testing using the VITEK®-2 automated compact system and disk diffusion. ESBL production was determined phenotypically. E. coli, Klebsiella species were identified in 30% (918/3104) of the vaginal swabs, with E. coli being the most common (73%; 667/918). ESBL-production was detected in 47% (432/918) of Enterobacterales, with frequent multidrug-resistant phenotype. The overall prevalence of carbapenem resistance was low (8%). Over 20% of Klebsiella spp. were carbapenem-resistant. Pregnant women had a high prevalence of colonization and may transmit ESBL-E to neonates at birth, an important risk factor to be considered. The high rate of ESBL-producers and carbapenem resistance in Enterobacterales in Vietnam emphasizes the need for consequent surveillance and access to molecular typing.

BlaOXA-48 Genotypic Detection of Carbapenem Resistance in Isolates of Pseudomonas Aeruginosa

Objective: To determine the prevalence of carbapenem resistance in strains of Pseudomonas aeruginosa at a molecular level by detecting OXA-48 gene which transcribe for resistance to the antibiotic carbapenem among indoor patients of a tertiary care hospital Karachi. Study Design and Setting: This observational cross-sectional study was conducted from September 2018 to May 2019 at PNS Shifa hospital of Karachi. Methodology: Total 140 strains of Pseudomonas aeruginosa were received and cultured from pus samples. These samples were collected from different wards like medicine, surgery, burn unit, ICU, ENT, plastic surgery, paedriatic and family ward. Carbapenem resistance was screened phenotypically by AST (Antibiotic susceptibility test), MHT (Modified Hodge test) and mCIM (Modified Carbapenem Inactivation Method) in all samples. Only in resistant cases OXA-48 gene was detected by real time PCR (polymerase chain reaction). Data was analyzed by following the proper loading sequence on product specification sheet. Data was statistically analyzed by SPSS version 23.0. Results were expressed as frequencies (percentages). Results: Out of 140, 17 (12%) were found to be resistant to carbapenem by AST, 20 (14%) by MHT, 25 (17.8%) by mCIM. Out of 25 resistant cases, 4 (16%) presence of OXA-48 gene by real time PCR were detected. Conclusion: OXA-48 gene showed 16% carbapenem resistance in this study. Pseudomonas aeruginosa is an opportunistic organism which causes multidrug resistance especially in hospitalized patients. Carbapenem is the last resort for serious infections

Urban Migrant Labourers as Potential Source for Transfer of Antimicrobial Resistance to Rural Community

The aim of the study was to investigate potential evidence for spread of antimicrobial resistance (AMR) from urban migrant labourers to labourers from local resident rural community due to sharing of common residential premises and other civic amenities. Two groups of unskilled labourers, enrolled for civil construction in a peri-urban area viz. (i) labourers having migrated from urban zone and (ii) labourers from local resident village community were compared in terms of demographic profile, history of various risk factors towards acquisition of AMR and prevalence of extended-spectrum beta-lactamase (ESBL), carbapenemase and New Delhi metallo-beta-lactamase type 1 (NDM-1) categories of AMR at enrolment and after one year of sharing of common residential premises with associated sanitation facilities using Escherichia coli as indicator organism. Higher percentage of urban migrant labourers were characterised by low literacy level, history of inhabitation in makeshift shelters without dedicated access to drinking water or cooking space, practice of defecation in open, episodes of illness suggestive of bacterial infections, faulty treatment seeking behaviour and intestinal carriage rate of E. coli with various categories of AMR compared to the non-migrant labourers from rural community. The later group showed an increase in the prevalence of carbapenem resistance with NDM-1 production during the duration of co-inhabitation with urban migrant labourers. The present study provided potential evidence for transfer of AMR by urban migrant labourers to non-migrant labourers from rural community that may serve as vehicle for further transmission of AMR to the rural community hitherto unexposed or less exposed to the problem.

Prevalence of Carbapenem-Resistance among Enterobacteriaceae Isolated from Patients Attending Uduth Sokoto, North West Nigeria

The major problem threatening the continued success of antimicrobial drugs is the development of resistant organisms. This study was designed to determine the occurrence and prevalence of carbapenem resistance among enterobacteriaceae isolated from in-patients attending Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, and also to determine the antimicrobial susceptibility patterns of the organisms isolated. The Methodology involves the use of trypticase soy broth containing 10 μg of carbapenem (imipenem) for primary isolation. The secondary isolation involves the use of MacConkey agar and biochemical (Simmon citrate Agar) for identification, and then antimicrobial susceptibility testing by the disk diffusion method. A total of 191 stool samples from male and female in-patients within the range of 2-60 years were screened for the gastrointestinal colonization of Carbapenem Resistance Enterobacteriacea (CRE). Data were analysed using Statistical Package for Social Sciences (SPSS) windows version 21. The overall prevalence was 15.7% The prevalence rate was found exclusively in males. The highest prevalence was found within the age group of 30-40 years. Escherichia coli, Klebsiella species, Pseudomonas species and salmonella species were the bacteria isolated. The most predominant bacteria isolated were Escherichia coli, accounting for 85 (9.4%) resistant strains, Klebsiella species accounting for 50 (8%) resistant strain, Pseudomonas aeruginosa 21% and Salmonella species accounting for 42 (0%) no resistant strain isolated. The misuse of antibiotics is a major factor responsible for the high rate of bacterial resistance. Improvement on the management and personal hygiene, as well as the appropriate use of antibiotics would reduce the prevalence of Nosocomial Carbapenem Resistance (NCR) especially among prolonged hospitalized patients.

Carbapenem-resistant Enterobacteriaceae (CRE) and gram-negative bacterial infections in south-west Nigeria: a retrospective epidemiological surveillance study.

BackgroundCarbapenem-resistant Enterobacteriaceae (CRE) are often responsible for severe, life-threatening infections and they represent a critical threat to the available antibiotic agents and to global health. An understanding of the epidemiology of these infections will be indispensable to the development of appropriate case management as well as infection prevention and control (IPC) measures in any healthcare setting.ObjectivesThe objective of this study was to investigate and describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) and other gram-negative bacteria in a tertiary hospital in south west Nigeria using routinely collected microbiological laboratory data.MethodsA retrospective collection of microbiological laboratory records from the January to June 2018 was performed. All culture and antimicrobial susceptibility test results of patients who required laboratory tests were collected. Other information collected include: patient demographics, clinical specimen types and the requesting hospital department. The data was analyzed using SPSS Windows version 24. Comparison between categorical variables was done using chi-square tests while independent sample t-test was used to determine significant mean differences between groups. A p < 0.05 was taken to be statistically significant.ResultsThe prevalence of carbapenem-resistance among Enterobacteriaceae and gram-negative bacteria isolates was 22% (n = 39/177). Of these, 35.9% (n = 14) were Klebsiella pneumonia, 30.8% (n = 12) were Pseudomonas aeruginosa and 15.4% (n = 6) were Klebsiella oxytoca. 87.2% (n = 34) of these were also multi-drug resistant, with a mean total resistance score of 3.92 (SD = ± 1.44). There were differences observed in proportion of carbapenem-resistance across clinical specialties and age groups; however, these differences were not statistically significant. Independent sample t-test revealed that carbapenem-resistant isolates exhibited more drug resistance than carbapenem-sensitive isolates (3.93 vs. 2.30; p < 0.001).ConclusionCarbapenem resistance is an important threat to the current antibiotic armory. Active surveillance, particularly in the healthcare setting is required to identify high risk groups, inform better treatment options and infection prevention and control measures.

PREVALENCE OF CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII (CRAB) IN MEDICAL AND SURGICAL INTENSIVE CARE UNITS (ICUS) OF JPMC, KARACHI

Background: Antimicrobial resistance is one of the research priorities of health organizations due to increased risk of morbidity and mortality. Outbreaks of nosocomial infections caused by carbapenem-resistant Acinetobacter Baumannii (CRAB) strains are at rise worldwide. Antimicrobial resistance to carbapenems reduces clinical therapeutic choices and frequently led to treatment failure. The aim of our study was to determine the prevalence of carbapenem resistance in A. baumannii isolated from patients in intensive care units (ICUs). Methods: This cross-sectional study was carried out in the Department of Microbiology, Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Centre (JPMC), Karachi, from December 2016 to November 2017. Total 63 non-repetitive A. baumannii were collected from the patients’ specimens, admitted to medical and surgical ICUs and wards of JPMC, Karachi. The bacterial isolates were processed according to standard microbiological procedures to observe for carbapenem resistance. SPSS 21 was used for data analysis. Results: Out of the 63 patients, 40 (63.5%) were male. The age of the patient ranged from 15-85 year, with average of 43 year. 34.9% patients had been hospitalized for 3 days. Chronic obstructive pulmonary disease was present in highest number with average of 58.7% for morbidity. Number of patients on mechanical ventilation was highest (65.1%). All isolates were susceptible to colistin. The resistance to ampicillin-sulbactam, ceftazidime, ciprofloxacin, amikacin, piperacillin- tazobactam and meropenem was 82.5%, 81%, 100%, 87.3%, 82.5% and 82% respectively. Out of 82% CRAB, 77% were obtained from ICUs. Conclusion: This study has revealed the high rate of carbapenem resistance in A. baumannii isolates in ICUs thus leaving behind limited therapeutic options.

Systematic Review and Meta-analysis of Carbapenem Resistance of Acinetobacter baumannii in Iran.

The prevalence of carbapenem resistance in Acinetobacter baumannii has been increasing worldwide, and therapeutic options are extremely limited. We performed a systematic review to evaluate the phenotypic and genotypic carbapenem resistance in A.baumannii reported in Iran. We systematically searched Pub Med, Web of Science Direct, and Google scholar databases to identify studies addressing the carbapenem resistance of A. baumannii. The selected papers were published between 2005 and 2016, but the sample collection period was between 2002 and 2016. To estimate the prevalence, the Der Simonian and Laird randomized models, a 95% confidence interval, was used. For the heterogeneity check, I2 test was used. The Egger test was used to check the propagation bias. Analysis of data indicates that there was an increase in resistance to carbapenems from 4.5% in 2005 to a 100% prevalence rate in 2016 (65.4 (95% CI: 58.8 - 71.6). According to the results of this study, the rate of resistance to carbapenem in A.baumannii has been increasing in Iran. The presence of carbapenem-resistant isolates is a major concern, because carbapenem is the main drug used against Multi Drug Resistant (MDR) isolates.

Molecular analysis of multi –drug resistant acintobacter baumannii isolated in baghdad hospital

Qurum sense is regulatory systems that enable bacteria to expretion for a specific set of genes by making collective decisions and regulation of virulence factors of pathogenic Acintobacter baumannii, the prevalence of carbapenem resistance among (8) different antibiotic groups pattern. In the MDR index, all isolates showed high MDR, ranged from (6-21) antibiotics. MDR index is between (0.29-1.0).Quantitative biofilm production assay showed that 118/124(95.1%)of isolates were biofilm-formers. Detection of QS genes showed that (97.6%)121/124,(98.3%)122\124 and (4.8%)of isolates carried luxR, rhlI and rhIR genes, respectivelly. All isolates possess rhIR gene are isolated from child meningococcal patients and characterized by the strong biofilm formation. Identification of abaI gene in A.baumannii producing the QS signal molecules detected in124\124(100%). The current study revealed a strong relationship between Q.S genes luxR,rhII,rhIR and oxacillinases presence OXA23, OXA69. While a strong negative correlation between OXA48 and OXA69 with the rhIR gene. All isolates carried Integron I(n=124)(100%) with a significant presence of (luxR, rhII) genes, while INT2,3 had a highly significant level with rhIR. Noteworthy, (n=105) 84.7% of OXA51 positive isolates have carried ISAbal-blaOXA-51, whereas all isolates which have OXA23 carried ISAbal-blaOXA-23(n=65)52.4% most of them revealed IMP&amp;MEM resistance phenotype. Insertion sequence(ISAbal-blaOXA-51) showed significant correlation with luxR, rhII genes, while there was no correlation among ISAbal25, ISAbal, ISAbal25-blaADC and luxR, rhII. Positive correlation recorded with all IS with rhIR, except ISAbal-blaADC.ads-a gene was observed in 77/124(62.1%) of isolates, which associated with aminoglycoside resistance, and included within the 93 XDR isolates. Studied isolates showed the same prevelance rate for ompA, smpA which was122\124(98.4%) of isolates.