Prevalence Of Carbapenem-resistant Bacteria Research Articles

Prevalence of carbapenemase-producing Klebsiella pneumoniae at a tertiary care hospital in Kathmandu, Nepal

AimAlthough carbapenem is the last-resort drug for treating drug-resistant Gram-negative bacterial infections, prevalence of carbapenem-resistant bacteria has substantially increased worldwide owing to irrational use of antibiotics particularly in developing countries like Nepal. Therefore, this study was aimed to determine the prevalence of carbapenemase-producing K. pneumoniae and to detect the carbapenemase genes (blaNDM-2 and blaOXA-48) in at a tertiary care hospital in Nepal.Materials and methodsA hospital-based cross-sectional study was carried out from June 2018 to January 2019 at the Microbiology Laboratory of Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal. Different clinical samples were collected and cultured in appropriate growth media. Biochemical tests were performed for the identification of K. pneumoniae. Antibiotic susceptibility testing (AST) was performed by the Kirby–Bauer disc diffusion method. The modified Hodge test (MHT) was performed to detect carbapenemase producers. The plasmid was extracted by the modified alkaline hydrolysis method. Carbapenemase-producing K. pneumoniae were further confirmed by detecting blaNDM-2 and blaOXA-48 genes by PCR using specific forward and reverse primers followed by gel electrophoresis.ResultsOut of the total 720 samples, 38.9% (280/720) were culture positive. K. pneumoniae was the most predominant isolate 31.4% (88/280). Of 88 K. pneumoniae isolates, 56.8% (50/88) were multi-drug resistant (MDR), and 51.1% (45/88) were MHT positive. Colistin showed the highest sensitivity (100%; 88/88), followed by tigecycline (86.4%; 76/88). blaNDM-2 and blaOXA-48 genes were detected in 24.4% (11/45) and 15.5% (7/45) of carbapenemase-producing K. pneumoniae isolates, respectively.ConclusionThe rate of MDR and carbapenemase production was high in the K. pneumoniae isolates. Colistin and tigecycline could be the drug of choice for the empirical treatments of MDR and carbapenemase-producing K. pneumoniae. Our study provides a better understanding of antibiotic resistance threat and enables physicians to select the most appropriate antibiotics.

Carbapenem-resistant bacteria over a wastewater treatment process: Carbapenem-resistant Enterobacteriaceae in untreated wastewater and intrinsically-resistant bacteria in final effluent

Although urban wastewater treatment plants (UWWTPs) are important sites for antibiotic resistance elimination, their limitation in producing resistance-free effluents is recognized. Despite the critical importance of carbapenems to human health, the fate and diversity of carbapenem-resistant bacteria (CRB) in UWWTPs is still poorly understood. We analysed CRB from different treatment stages in a UWWTP applying UV-C radiation. After secondary treatment, bacteria grown in mFC medium reduced in 1.9-log units (p < 0.0001), while CRB counts reduction (0.2-log units) was not significant. UV-C reduced the abundance of total bacteria and CRB (1.8 and 2.4-log units, respectively, relative to values after secondary treatment). Yet after incubation in the dark, CRB increased (0.6-log units) in UV-treated samples. Albeit in low amounts, carbapenem-resistant Enterobacteriaceae (CRE) were detected in raw wastewater being absent from the final effluent. Thirty-four CRE isolates were identified as Citrobacter, Enterobacter, Leclercia and Lelliottia. These were multiresistant and yielded classes 1, 2 and 3 integrons (94%, 88% and 88%, respectively). In all CRE isolates, blaGES-5 was found in integrons. Three isolates were selected for whole-genome sequencing; in Citrobacter braaki (n = 2) blaGES-5 was part of class 3 integrons, while in Lelliotia sp. RWM.1 blaGES-5 was in a class 1 integron with a novel cassette array (blaOXA-10/aacA4-blaGES-5-blaBEl-1). These integrons were in contigs with high similarity with mobilizable plasmids. Genes encoding resistance to other antibiotics were detected in these isolates. In the final effluent, CRB were predominantly affiliated with Stenotrophomonas maltophilia.UV-C radiation significantly reduced the abundance and prevalence of CRB. Bacteria intrinsically-resistant to carbapenems were cultivated after all treatment stages, while CRE only in raw wastewater. In these samples, we detected CRE with blaGES-5, in integrons and plasmids. This raises concern as horizontal gene transfer may occur within these systems. Carbapenem resistance surveillance in UWWTPs is essential to implement mitigation measures in a timely manner.

Antimicrobial susceptibility and molecular species identification of clinical carbapenem-resistant bacteria

Abstract. Inggraini M, Nurfajriah S, Priyanto JA, Ilsan NA. 2021. Antimicrobial susceptibility and molecular species identification of clinical carbapenem-resistant bacteria. Biodiversitas 22: 555-562. Antibiotic is the first option treatment for infectious diseases both in human and animal. However, the excessive usage and misuse of antibiotics have driven antibacterial resistances worldwide and the increasing case of antibiotic resistance leads to limited options for treatment. This study aimed to observe antimicrobial susceptibility and molecular identification of carbapenem-resistant human clinical bacteria. A total of nine isolates in this study were collected in 2020 from a teaching hospital in Indonesia. All isolates were originated from various human clinical specimens, including urine, blood, pus, and sputum. Identification using 16s rRNA-based showed that these isolates were closely related to Klebsiella pneumoniae (1/9), A. baumannii (5/9), Escherichia coli (2/9), and Lysinibacillus fusiformis (1/9). According to minimum inhibitory concentration using Vitek Automated Machine, four isolates of multi-drug resistant (MDR) bacteria were found. In contrast, five of them were categorized as extensively-drug resistant (XDR). Interestingly, all of the XDR isolates belonged to A. baumannii. These isolates were resistant to at least seven different antimicrobial classes. A comparison of partial 16s rRNA showed two E. coli had similar variance. While in A. baumannii isolates, we found one of five isolates had a different variance sequence, which suggests different clonality among this species. This study gives an insight into the prevalence of carbapenem-resistant bacteria with XDR criteria in Indonesia.

Epidemiology and Antibiotic Susceptibility Patterns of Carbapenem Resistant Gram Negative Bacteria Isolated from Two Tertiary Care Hospitals in North Lebanon

Background. Antimicrobial resistance is a major public health problem worldwide. Numerous epidemiological studies reported that Lebanon is affected with high levels of antibiotic resistance. The aim of this study is to determine the prevalence and antibiotic susceptibility patterns of carbapenem resistant Gram negative bacteria in North Lebanon during the period 2015-2017.&#x0D; Methods. Carbapenem resistant Gram negative bacteria were isolated from patients referring to Nini hospital and Youssef hospital center. Identification and antibiotic susceptibility testing were performed through conventional tools according to the manufacturer’s recommended procedures and the recommendations of the European Committee on Antimicrobial Susceptibility Testing, respectively.&#x0D; Results. Overall, a total of 290 carbapenem resistant Gram negative bacteria were isolated. Escherichia coli was predominant and represented 39.3% of all isolates, followed by Pseudomonas aeruginosa (24.8%), Acinetobacter baumannii (22.8%), Klebsiella spp. (8.6%), Enterobacter spp. (6.6%), Pantoea spp. (1%), and Proteus vulgaris (0.3%). Our findings showed an alarming increase in the prevalence of carbapenem resistant bacteria every year. On the other hand, colistin, tigecycline, amikacin and fosfomycin remain the most effective agents against carbapenem resistant Gram negative bacteria.&#x0D; Conclusion. This study provided important new laboratory data that could support specialists in infectious diseases in North Lebanon to take the appropriate decision in the treatment of patients at risk for infections with carbapenem resistant Gram negative germs.

Prevalence, antibiotic susceptibility and characterization of antibiotic resistant genes among carbapenem-resistant Gram-negative bacilli and yeast in intestinal flora of cancer patients in North Lebanon.

The emergence and spread of carbapenem-resistant bacteria are a significant clinical and public health concern. The aim of the study is to determine the prevalence of intestinal carriage of carbapenem-resistant bacteria and yeasts in cancer patients under chemotherapy. 41 stool samples collected from cancer patients in Nini hospital in Tripoli, North Lebanon have been analyzed. After isolating yeasts and carbapenem-resistant bacteria, a biochemical identification and antimicrobial susceptibility profile were determined. The mechanism of enzymatic carbapenem-resistance was detected by searching for carbapenemases by both Hodge test and PCR assays. The association of several mechanisms of resistance was also searched. 46.3% (19/41) of patients were colonized by yeast. Candida glabrata (6/19) was the major species. The prevalence of carbapenem-resistant bacteria was 24.4% (10/41) including Escherichia coli (5/10), Enterobacter cloacae (1/10), Enterobacter aerogenes (1/10) Edwardsiella hoshinae (1/10) Pantoea agglomerans (1/10) and Pseudomonas stutzeri (1/10). PCR and sequencing of the amplified fragments revealed that Pseudomonas stutzeri (1/1) carried VIM gene and Enterobacter aerogenes (1/1) and E. coli (1/5) carried OXA-48 gene. The other Enterobacteriaceae were resistant to carbapenems by mechanisms other than a carbapenemase including hyperproduction of cephalosporinase (4/10), extended spectrum beta-lactamases (1/10) and both cephalosporinase and extended spectrum beta-lactamases (2/10). High prevalence of intestinal carriage of carbapenem-resistant bacteria and yeasts were detected in cancer patients under chemotherapy. In order to prevent the development of endogenous infection and the dissemination of antimicrobial resistance, an implementation of antibiotic stewardship programs and infection control measures is required in hospitals particularly in the department of chemotherapy.