Fecal carriage of carbapenem resistant Enterobacteriaceae among the intensive care unit patients

Authors

  • Naina . Department of Microbiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
  • Antariksh Deep Department of Microbiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
  • Dhruva Chaudhry Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
  • Aparna Yadav Department of Microbiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20193376

Keywords:

Carbapenemase producers, Carbapenem resistant enterobacteriaceae, Faecal carriage, Intensive care unit patients, Imipenem- ethylenediaminetetraacetic acid test, Modified Hodge test

Abstract

Background: The war against multidrug-resistant bacteria is challenging and of global concern. Hospitals are increasingly plagued by resistant gram negative pathogens. Bacteria of the family Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae are part of the normal human intestinal flora but are also often responsible for community- and healthcare-associated infections. These bacteria are prone to acquiring resistance genes.

Methods: Rectal swabs/swabs from the peri-anal area of the patients who were admitted in the Intensive Care Unit (ICU) of the accident and emergency department of this teaching hospital. Swabs were collected first on day 1 of admission, then day 4, and thereafter weekly during the period of stay in the ICU. All the swabs were immediately inoculated into trypticase soy broth with one 10μg  meropenem disc and were incubated overnight at 35±2ºC, ambient air. Next day, the broth was vortexed, and then sub-cultured onto a MacConkey agar plate. On the third day, MacConkey agar plates were examined for lactose fermenting (pink-coloured) colonies. The representative isolated colonies were subjected to conventional antimicrobial susceptibility testing by the Kirby Bauer Disc diffusion method following the CLSI guidelines to know the susceptibility to carbapenem and other antimicrobial agents. Carbapenemase production was done by a Modified Hodge Test (MHT) and Imipenem-EDTA test.

Results: Out of 89 patients, carbapenem resistant Klebsiella pneumoniae and E. coli isolates were recovered from 35 (39.3%) patients i.e. Klebsiella pneumoniae isolates from fifteen patients and carbapenem resistant E. coli isolates from twenty patients. Prevalence of carbapenemase producing isolates was found to be 1.42%.  

Conclusions: Surveillance for CRE can definitely help reduce rates of healthcare associated infections. 

References

Logan LK. Carbapenem-resistant enterobacteriaceae: an emerging problem in children. Clin Infect Dis. 2012;55(6):852-9.

Rice LB. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J Infect Dis. 2008;197:1079-81.

Queenan AM, Bush K. Carbapenemases: the versatile beta-lactamases. Clin Microbiol Rev. 2007; 20(3):440-58.

Bonomo RA, Burd EM, Conly J, Limbago BM, Poirel L, Segre JA, et al . Carbapenemase-producing organisms: a global scourge. Clin Infect Dis. 2017;66(8):1290-7.

Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Disc Susceptibility Test: 26th Edition, Wayne, PA;USA. 2016:M100S;1-251.

Behera B, Mathur P, Das A, Kapil A, Sharma V. An evaluation of four different phenotypic techniques for detection of metallo-beta lactamase producing Pseudomonas aeroginosa. Indian J Med Microbiol. 2008 Jul 1;26(3):233-7.

Ministry of Environment and Forests. Biomedical waste (Management and handling) rules. New Delhi, 2016. Available at: http://www.moef.nic.in/downloads/public-information/salient-features-draft- bmwmh.pdf.

Chow JW, Shlaes DM. Imipenem resistance associated with the loss of a 40 kDa outer membrane protein in Enterobacter aerogenes. J Antimicrob Chemother. 1991;28(4):499-504.

Hariharan P, Bharani T, Franklyne JS, Biswas P, Solanki SS, Satyaseela MP. Antibiotic susceptibility pattern of Enterobacteriaceae and non-fermenter Gram-negative clinical isolates of microbial resource orchid. J Nat Sc Biol Med. 2015;6(1):198-201.

Khan MMA, Faiz A. Frequency of Carbapenemase producing Klebsiella pneumoniae in Makkah, Saudi Arabia. JMID. 2016;6(3):121-7.

Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: twentieth informational supplement. M100_S20. June 2010 update. Wayne, PA: Clinical and Laboratory Standard Institute, 2010.

Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008;29(12):1099-106.

Gomez-Simmonds A, Nelson B, Eiras DPA, Loo Jenkins SG, Whittier S, Calfee DP, et al. Combination regimens for treatment of carbapenem-resistant Klebsiella pneumoniae bloodstream infections. Antimicrob Agents Chemother. 2016;60(6):3601-7.

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Published

2019-07-25

How to Cite

., N., Deep, A., Chaudhry, D., & Yadav, A. (2019). Fecal carriage of carbapenem resistant Enterobacteriaceae among the intensive care unit patients. International Journal of Research in Medical Sciences, 7(8), 2956–2961. https://doi.org/10.18203/2320-6012.ijrms20193376

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Original Research Articles