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Abstract Colonizations/Infections caused by carbapenem-resistant Enterobacterales are of great clinical and epidemiological importance due to their rapid dissemination and high mortality rates. In this scenario, the use of antibiotics intensified by the COVID-19 pandemic has brought about a great warning on the real impact that this pandemic could have on antimicrobial management programs and long-term antimicrobial resistance rates. The objective of this study was to evaluate the increase of New Delhi Metallo β-Lactamase (NDM)-producing Enterobacterales cases in COVID-19 units of a complex Brazilian tertiary hospital. This retrospective observational study included all patients admitted to the hospital identified as colonized or infected by NDM-producing Gram negative bacilli (GNB), from January 2017 to April 2021. Forty-two NDM-producing Enterobacterales were identified in 39 patients. The rate of NDM cases per total surveillance cultures increased progressively between 2017 and 2021 (chi-2 for trend, p < 0.0001) and was associated with a higher occurrence specifically in COVID units (Fisher exact, p < 0.0001). The molecular investigation of the NDM-producing Klebsiella pneumoniae strains revealed the emergence of diverse clones during the COVID-19 period, also with possible evidence of horizontal transmission among patients within COVID units. NDM-producing Enterobacterales with multiple and different clonalities in the COVID-19 units also raised questions about the importance of other factors besides horizontal clonal transfer, including the increase of antimicrobial consumption by these patients.
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Background: There is minimal information about the association of head growth at different stages of childhood with cognitive ability. Objective: To determine the relationship of newborn head size and head growth during infancy, childhood and adolescence with attained education, a proxy for cognitive ability. Study design: Prospective birth cohort study. Setting: Married women living in South Delhi between 1969 and 1973. Participants: The New Delhi Birth Cohort study followed up 8030 newborns born in 1969-1973 with head circumference, weight and height measurements at birth and 6-12 monthly until adulthood. Of these, 1526 men and women were followed up at the age of 26-32 years. Outcomes: Association between years of schooling, as an indicator of cognitive ability, and newborn head circumference and conditional measures of head growth during infancy, childhood and adolescence. Results: In unadjusted analyses, newborn head size was positively associated with years of education [(? (95% CI)=0.30 (0.14 to 0.47) years per SD head circumference], as was head growth from birth to 6 months [? (95% CI)=0.44 (0.28 to 0.60) years per SD conditional head growth], 6 months to 2 years [? (95% CI)=0.31 (0.15 to 0.47) years per SD conditional head growth] and 2 to 11 years [? (95% CI)=0.20 (0.03 to 0.36) years per SD conditional head growth]. There were similar findings for height and body mass index (BMI). In the adjusted model containing all growth measures, gestational age, and socioeconomic status (SES) at birth as predictors, only SES was positively associated with educational attainment. Conclusion: Educational attainment in this population is positively associated with socioeconomic status and its influence on inter-related early life (fetal, infant and childhood) factors like nutritional status and brain growth.
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Background: Emergency contraceptive pills (ECs) are a safe female-controlled method of post-coital contraception; however, the knowledge about them is low among general population.Methods: This cross-sectional study was done among the adult females, aged 18 years and above, who visited the various out-patient departments (OPD) of a tertiary care hospital in July 2017. A total of 640 adult females, who visited the OPDs of medicine, surgery, orthopedics and gynecology were included in this study. Data were entered and analyzed using SPSS ver 16. Chi-square test was used to test association. A p-value of less than 0.05 was considered as significant association.Results: Of the 640 participants, mostly were Hindu, aged between 20-29 years, married and had more than one child. Only, 52% females were aware of the term ‘contraception’ and 17.7% about ‘emergency contraception’. The only method of ECs they were aware of was i-pill. Commonest source of their knowledge was friends, relatives and spouse. Only 70 women knew that it can be used after unprotected intercourse and 25 knew that it can be used after failure of barrier method. Just 41.2% women used any kind of contraceptive and 5.3% women have ever used an EC. Around 28% women reported not using contraception due to lack of knowledge.Conclusions: Despite of their availability since many years, awareness about emergency contraception is low. More efforts are required to generate awareness about regular use of effective contraception and emergency contraception if required.
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Objective@#To analyze the molecular epidemiological characteristics of Escherichia coli producing NDM-5 carbapenemase in the neonatal department of our hospital. @*Methods@#Three carbapenem-resistant Escherichia coli strains（E1, E2 and E3） isolated from neonatal ward of our hospital from August to September of 2017 were collected. Vitek 2 Compact system combined with K-B disk method was used for drug sensitivity test. The resistance genes were detected by PCR amplification. Plasmid replicon typing was detected by PCR. Plasmid conjugation tests were performed to explore the conjugating transfer of plasmids in the three strains. The homology of the three strains was analyzed by multiple locus sequence typing (MLST) and pulse field gel electrophoresis (PFGE). @*Results@#Drug susceptibility test showed that the three bacteria were resistant to most β-lactam antibiotics except Aztreonam, and resistant to quinolones and SMZ-TMP, but sensitive to aminoglycosides drugs. PCR and sequencing results indicated that the three strains carried bla SHV gene and extended-spectrum beta-lactamase gene (bla SHV , bla TEM and bla CTX-M ). The plasmid replicon type was IncX3. Transfer test of E1 strain was successful. MLST results indicated that all the three strains were ST1642 type. MLST and PFGE results indicated that the bands of the three bacteria were identical. @*Conclusion@#Both NDM-5 carbapenemase and extended-spectrum beta-lactamase were detectable in the three strains of carbapenem-resistant bacteria from neonatal department. MLST and PFGE results suggested that the three strains were from the same clonal source.
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Background@#Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the important pathogens causing pneumonia. This study aimed to investigate the clinical characteristics and molecular epidemiology of ESBL-producing E. coli and K. pneumoniae causing pneumonia at a large teaching hospital in China.@*Methods@#We collected patient’s clinical data and ESBL-producing E. coli and K. pneumoniae strains causing pneumonia (from December 2015 to June 2016) at a hospital in Wuhan. The susceptibilities, multi-locus sequence typing, homologous analysis, ESBL genes by polymerase chain reaction and sequencing were determined.@*Results@#A total of 59 ESBL-producing strains (31 E. coli and 28 K. pneumoniae) isolated from patients with pneumonia were analyzed. The majority of strains were isolated from patients were with hospital-acquired pneumonia (37/59, 62.7%), followed by community-acquired pneumonia (13/59, 22.0%), and ventilator-related pneumonia (9/59, 15.3%). The E. coli ST131 (9 isolates, 29.0%) and K. pneumoniae ST11 (5 isolates, 17.9%) were the predominant sub-types. The most prevalent ESBL gene was CTX-M-14, followed by SHV-77, CTX-M-3, SHV-11, and CTX-M-27. At least 33 (55.9%) of the ESBL-producing strains carried two or more ESBL genes. The ISEcp1 and IS26 were found upstream of all blaCTX-M (CTX-Ms) and of most blaSHV (SHVs) (57.6%), respectively. Moreover, three ESBL-producing K. pneumoniae ST11 strains which were resistant to carbapenems carried the blaNDM-1 and blaKPC-2, two of which also bearing blaOXA-48 were resistant to all antibiotics (including Tigecycline).@*Conclusions@#Hospital-acquired pneumonia is more likely correlated with ESBL-producing E. coli and K. pneumoniae. ESBL-producing E. coli ST131 and multi-drug resistance ESBL-producing, as well as New Delhi metallo-β-lactamase-1 (NDM-1) and Klebsiella pneumoniae carbapenemases-2 (KPC-2) bearing K. pneumoniae ST11 are spreading in patients with pneumonia in hospital.
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Background: Resistance due to New Delhi metallo-?-lactamase (NDM) and OXA-48/181 continues to emerge as a threat which is associated with nosocomial outbreaks and is a serious healthcare concern. Phenotypic detection being laborious and time-consuming requires rapid detection of NDM and OXA-48/181, which is achieved through real-time polymerase chain reaction (RT-PCR). Materials and Methods: In this study, RT-PCR assay was developed to simultaneously detect NDM and OXA-48/181. The assay was validated on 102 non-duplicate, phenotypically characterised clinical samples. Results: The assay showed a sensitivity and specificity of 97% and 100% for the detection of carbapenemases in comparison to conventional PCR. The in-house developed multiplex RT-PCR would help to rule-in the presence of NDM and OXA-48/181. Conclusions: Rapid detection of these carbapenemases would be assist in better patient management, in terms of accurate antimicrobial treatment, help in cohorting infected from uninfected patient to prevent spread.
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Anthropometric changes take place with increasing age. Progressive loss of height makes it difficult to use height for calculation of body mass index in nutritional screening of elderly persons. There is a need to find other alternative methods which could be used as proxy measurements of height in them. To assess the relationship of height and arm span and among elderly persons. A community-based cross-sectional study was conducted among elderly persons in urban colony of Delhi. Height and arm span of persons aged 60 years and above (n = 711) were measured according to standard methods. Correlation between arm span and height was calculated. The mean arm span was seen to be more than the mean height in all age-groups and both sexes. There was a linear relationship between height and arm-span in all age-groups. There was a strong correlation between arm span and height in all age groups. Arm span could be used instead of height as an alternative in the conventional body mass index in elderly persons.
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ABSTRACT Carbapenemases have great importance in the global epidemiological scenario since infections with carbapenemase-producing bacteria are associated with high mortality, especially in hospitalized patients in intensive care units. This study describes two microorganisms producers of the New Delhi Metallo-b-lactamase, Klebsiella pneumoniae and Citrobacter freundii, from two patients admitted to a public hospital in Salvador, Bahia. These are the first clinical cases of New Delhi Metallo-b-lactamase described in microorganisms in the north and northeast Brazil. The isolates were characterized by antimicrobial susceptibility test, with resistance to all β-lactams including carbapenems, negative Modified Hodge Test and the synergy test with Ethylenediaminetetraacetic acid, Phenylboronic Acid and Cloxacillin was positive only with Ethylenediaminetetraacetic acid (difference of >5 mm in the inhibition zone between the disk without and with the inhibitor). Analysis by multiplex PCR for blaIMP, blaVIM, blaNDM, blaKPC and blaOXA-48 enzymes confirmed the presence of blaNDM gene. This report of two different New Delhi Metallo-b-lactamase-producing microorganisms in a different region of Brazil confirms the risk of spreading resistance genes between different species and emphasizes the need for prevention and control of infections caused by these pathogens, which have limited treatment options and have been linked to high mortality rates.
Subject(s)
Humans , Male , Adult , Aged , Bacterial Proteins/metabolism , beta-Lactamases/metabolism , Enterobacteriaceae/enzymology , Enterobacteriaceae Infections/microbiology , Bacterial Proteins/drug effects , beta-Lactamases/drug effects , Brazil , Carbapenems/pharmacology , Fatal Outcome , Drug Resistance, Bacterial , Enterobacteriaceae/isolation & purification , Enterobacteriaceae/drug effects , Multiplex Polymerase Chain Reaction , Hospitals, PublicABSTRACT
Background & objectives: New Delhi metallo-?-lactamase 1 (NDM-1) cleaves the beta-lactam ring, and confers bacterial resistance against most of the beta-lactam antibiotics, except tigecycline and colistin. Among these two antibiotics, colistin is considered toxic, and therefore, its clinical use and dosage need cautious approach. In the present study, six organic acids were screened individually and in combination of two acids for their effectiveness against NDM-1 Escherichia coli and a combination of colistin and oxalic or succinic acid was tested to find out the potential of combination therapy for reducing the dose of toxic colistin. Methods: Antibacterial activity of the organic acid and their combinations was tested by disc diffusion method against NDM-1 E. coli, and minimum inhibitory concentration (MIC) was determined by broth dilution method. Synergistic effect between organic acids and colistin was tested by checkerboard method. Results: Oxalic acid showed the highest zone of inhibition (15�mm) followed by succinic acid, tartaric acid, fumaric acid, citric acid and malic acid. The combination of two acids did not increase the zone of inhibition significantly. MIC was found to be the lowest with oxalic acid and succinic acid (320 ?g/ml). In the presence of 160 ?g/ml oxalic acid or succinic acid, MIC of colistin was reduced from 8 to 4 ?g/ml, indicating synergistic effect. Interpretation & conclusions: Our findings showed that combination therapy using colistin and oxalic acid or succinic acid might find safe clinical application of this antibiotic in controlling infections due to NDM-1 bacteria.
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ObjectiveThe nucleic acid technology for detecting drug-resistant genes has become one of the powerful tools for monitoring and controlling the spreading of drug-resistant bacteria. This study was to establish a method for rapid detection of the drug-resistant genes KPC and NDM and provide some guidance in clinical drug use and monitoring the prevalence of drug-resistant bacteria in the hospital.MethodsAccording to the conserved regions of Klebsiella pneumoniae carbapenemase (KPC) and New Delhi metallo-β-lactamase (NDM), we designed the primers of duplex PCR, optimized the amplification system and established a method for simultaneous detection of the drug-resistant genes KPC and NDM. Then, we analyzed the sensitivity and specificity of the method and applied it to the detection of Pseudomonas aeruginosa and Klebsiella pneumoniae.ResultsThe sequences of KPC and NDM exhibited a 100% consistency with those of the original ones. Target fragments of the desired size of 151 bp were detected in the KPC-2 positive standard and Klebsiella pneumoniae ATCC BAA 1705 standard strains, and those of the desired size of 261 bp were observed in the NDM-2 positive standard strain and NDM-positive pneumococcal bacteria, neither with non-specific amplification. Sequencing of the PCR products showed a 100% consistency between the sequences of the products and those of the drug-resistant genes KPC-2 and NDM-1. The detectable limits of KPC and NDM for duplex PCR were 7×102 and 5×102 copies per reaction respectively. Drug-resistant genes were detected in 12 (92.3%) of the 13 carbapenems-resistant strains, including 10 KPC-positive (83.3%) and 2 NDM positive ones (16.7%), but neither KPC nor NDM in the other 10 carbapenems-sensitive strains. In the 13 strains of Pseudomonas aeruginosa, KPC was detected in 2 (33.3%) of the 6 carbapenems-resistant ones, but neither KPC nor NDM in the other 7.ConclusionThe duplex PCR method can be used for rapid and effective detection of the drug-resistance genes KPC and NDM, with the advantages of high sensitivity and specificity, and is therefore of great significance for guiding clinical drug use and monitoring the spreading of carbapenems-resistant bacteria in the hospital.
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RESUMEN La emergencia de enterobacterias productoras de carbapenemasas de tipo Nueva Delhi Metalo beta-lactamasas (NDM), representan, hoy en día, un verdadero problema de salud pública mundial. La presencia de este mecanismo de resistencia limita o anula las opciones terapéuticas para combatir a estas bacterias. En Latinoamérica, las cifras son cada vez más elevadas, pues se reportan en Guatemala, Colombia, Chile, Argentina, entre otros. Perú no ha descrito, hasta la fecha, la presencia de este patrón de resistencia; sin embargo, desde hace varios años se presume de su existencia. Se describen nueve casos de Klebsiella pneumoniae NDM, como agentes infecciosos o colonizantes, en pacientes críticamente enfermos, en su mayoría con patología neuroquirúrgica, del Hospital Nacional Dos de Mayo, en Lima - Perú. Los pacientes de la serie descrita a continuación, representan los primeros reportes de Klebsiella pneumoniae NDM en el Perú.
ABSTRACT The emergence of Enterobacteria producing carbapenemases of type New Delhi Metalo beta-lactamases (NDM), >represent, today, a real problem of world public health. The presence of this resistance mechanism limits or nullifies the therapeutic options to combat these bacteria. In Latin America, the figures are getting higher, as they are reported in Guatemala, Colombia, Chile, Argentina, among others. Peru has not, to date, described the presence of this resistance pattern; however for several years it has been presumed to exist. Nine cases of Klebsiella pneumoniae NDM are described, as infectious or colonizing agents, in critically ill patients, mostly with neurosurgical pathology, of Hospital Nacional Dos de Mayo in Lima - Peru. The patients in the series described below represent the first reports of Klebsiella pneumoniae NDM in Peru.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bacterial Proteins/biosynthesis , beta-Lactamases/biosynthesis , Klebsiella pneumoniae/classification , Klebsiella pneumoniae/enzymology , Peru , Microbial Sensitivity Tests , HospitalsABSTRACT
Notificamos un caso de infección por Escherichia coli productora de Nueva Delhi metalo-b-lactamasa (NDM) en un paciente que desarrolló un absceso subcapsular hepático como complicación de una colecistectomía laparoscópica. La NDM es una carbapenemasa adquirida tipo Ambler B, que confiere resistencia a todos los b-lactámicos, excepto al aztreonam, aunque existen reportes de resistencia a este último. En Colombia, la primera descripción de cepas productoras de NDM se realizó en aislamientos de Klebsiella pneumoniae en una unidad de cuidados intensivos neonatales en Bogotá. Desde entonces se han realizado reportes de distintas cepas, siendo esta la primera reportada en el país relacionada con Escherichia coli productora de NDM.
We report a case of infection by New Delhi metallo-β-lactamase (NDM)-producing Escherichia coli in a patient who developed a subcapsular hepatic abscess as a complication of laparoscopic cholecystectomy. NDM is an acquired carbapenemase Ambler class B, which confers resistance to all b-lactams except aztreonam, although there are reports of resistance to the latter. In Colombia, the first report of NDM-producing strains was made on isolates of Klebsiella pneumoniae in a neonatal intensive care unit in Bogota. There have since been reports of different strains, marking the first reported in the country of NDM-producing Escherichia coli.
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Humans , Male , Middle Aged , beta-Lactamases , Enterobacteriaceae , Escherichia coli , Penicillinase , Colombia , Carbapenem-Resistant EnterobacteriaceaeABSTRACT
Objective To investigate the drug resistant mechanism and homology of three strains of carbapenem-resistant Klebsiella pneumoniae (K.pneumoniae) isolated from different sites of one patient.Methods Three strains of carbapenem-resistant K.pneumoniae were isolated from femoral vein catheter tip,wound secretions and sputum of a patient with severe burns,respectively.Their carbapenemase,metallo-β-lactamase (MBL) and drug resistance genes were detected by modified Hodge test,double-disk synergy test and combination disk diffusion and PCR,respectively,and homology and biological typing were analyzed by enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) assay and multilocus sequence typing (MLST) technology,respectively.Results The carbapenemase and MBL of three strains of carbapenem-resistant K.pneumoniae were negative and positive,respectively.The blaNDM-1 gene was identified from the three strains,but other drug resistance genes such as blanC,blaGES,blaIMP,blaSPM,blaVIM,blaGIM and blaOXA-48 were not detected.ERIC-PCR showed that three isolates belonged to the same genotype,and MLST showed that they were type ST17.Conclusion Carring blaNDM-1 gene is the main cause leading to the drug resistance of three strains of carbapenem-resistant K.pneumoniae,and they belong to the same genotype.
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Background: The adeB gene in Acinetobacter baumannii regulates the bacterial internal drug effluxpump that plays a significant role in drug resistance. The aim of our study was to determine theoccurrence of adeB gene in multidrug resistant and New Delhi metallo-beta-lactamase-1 (NDM-1) gene in imipenem resistant Acinetobacter baumannii isolated from wound swab samples in atertiary care hospital of Bangladesh. Methods: A total of 345 wound swab samples were testedfor bacterial pathogens. Acinetobacter baumannii was identified by culture and biochemical tests.Antimicrobial susceptibility pattern was determined by the disc diffusion method according toCLSI standards. Extended spectrum beta-lactamases were screened using the double disc synergytechnique. Gene encoding AdeB efflux pump and NDM-1 were detected by Polymerase ChainReaction (PCR). Results: A total 22 (6.37%) Acinetobacter baumannii were identified from 345wound swab samples and 20 (91%) of them were multidrug resistant. High resistance rates to someantibiotics were seen namely, cefotaxime (95%), amoxyclavulanic acid (90%) and ceftriaxone (82%).All the identified Acinetobacter baumannii were sensitive to colistin and 82% to imipenem. Two(9%) ESBL producing Acinetobacter baumannii strains were detected. adeB gene was detectedin 16 (80%) out of 20 multidrug resistant Acinetobacter baumannii. 4 (18%) of 22 Acinetobacterbaumannii were imipenem resistant. NDM-1 gene was detected in 2 (50%) of the imipenem resistantstrains of Acinetobacter baumannii. Conclusion: The results of this study provide insight into the roleof adeB gene as a potential regulator of drug resistance in Acinetobacter baumanni in Bangladesh.NDM-1 gene also contributes in developing such resistance for Acinetobacter baumannii.
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OBJECTIVE: To explore the bacteriostasis and plasmid elimination activities of different extracted parts of traditional Chinese medicine Radix Scutellariae Baicalensis on NDM-1 Acinetobacter calcoaceticus. METHODS: Thein vitro antibacterial effect of the extracts from Radix Scutellariae Baicalensis was studied. Inhibition zone and minimum inhibitory concentration(MIC) of the alcohol extract and water decoction were examined by using MH agar plates and microdilution susceptibility testing. The growth curve of the NDM-1 Acinetobacter calcoaceticus was tested after being incubated with alcohol extract and water decoction at sub-MIC. At three time points after incubation with different extracts at sub-MIC, photocopy dish method was used to screen plasmid-cured strains of NDM-1 Acinetobacter calcoaceticus. The plasmid-elimination rates and phenotypic changes were compared. RESULTS: Both the alcohol extract and water decoction of Radix Scutellariae Baicalensis inhibited the growth of NDM-1 Acinetobacter calcoaceticus. The MICs were 1.56 mg·mL-1 for the alcohol extract and 6.25 mg·mL-1 for the water decoction. The growth curve showed that the antibacterial effect of the alcohol extract was more obvious. Both the alcohol extract and water decoction of Radix Scutellariae Baicalensis had some degrees of plasmid elimination effect. The plasmid-elimination rates in the alcohol extract group were higher than those in the water decoction group. The plasmid-elimination rates were 61.27% for the alcohol extract and 49.78% for the water decoction, respectively. CONCLUSION: Radix Scutellariae Baicalensis can inhibit the growth of NDM-1Acinetobacter calcoaceticus and eliminate the drug-resistant plasmid effectively and has the potential to be used to control the spread of pan-drug resistant Acinetobacter strains or be an adjuvant treatment method for clinical infections. Its alcohol extract has better effect.
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ABSTRACT During the last 30 years there has been a dissemination of plasmid-mediated β-lactamases in Enterobacteriaceae in Brazil. Extended spectrum β-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in São Paulo, the largest city in Brazil. New Delhi metallo-β-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.
Subject(s)
Humans , Drug Resistance, Bacterial , Enterobacteriaceae/drug effects , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae Infections/epidemiology , Anti-Infective Agents/pharmacology , Plasmids/genetics , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , beta-Lactamases/genetics , beta-Lactamases/metabolism , Brazil/epidemiology , Polymyxins/therapeutic use , Polymyxins/pharmacology , beta-Lactams/therapeutic use , beta-Lactams/pharmacology , Enterobacteriaceae/enzymology , Enterobacteriaceae/genetics , Anti-Infective Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacologyABSTRACT
Introduction: Infections due to multidrug‑resistant (MDR) pathogens are a medical challenge. There is considerable apprehension among clinicians regarding pathogens reported as carrying New Delhi metallo‑β‑lactamase‑1 (NDM) and Klebsiella pneumoniae carbapenemase (KPC) genes from their patients. In the face of extremely high rates of antimicrobial resistance, it is essential to gauge the clinical significance of isolation of pathogens carrying these genes from clinical samples. This study compares the outcome of patients infected with pathogens carrying NDM/KPC genes versus those without these genes. Methods: The study was conducted over a 1‑year period at a Level‑1 trauma centre. Hospital‑acquired infections were diagnosed on the basis of CDC’s criteria. The correlation of isolation of a multi‑resistant pathogen carrying KPC or NDM genes with the clinical outcome was ascertained. Results: A total of 276 consecutive patients admitted to the Intensive Care Units/wards of the JPNA Trauma Centre were included in this study. Of the 371 isolates recovered from these patients, 116 were from patients who had a fatal outcome. The difference in prevalence of blaNDM and blaKPC was not significant in any genera of Gram‑negative pathogens isolated from patients who survived versus those who had a fatal outcome. Conclusion: Isolation of MDR pathogens carrying NDM/KPC genes from clinical samples is not always a harbinger of a fatal outcome. Efforts should be made to prevent cross‑transmission of these pathogens.
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In this study, we evaluated the coexistence of extended‑spectrum beta‑lactamases (ESBL), AmpC and New Delhi metallo‑beta‑lactamase‑1 (NDM‑1) genes among carbapenem‑resistant Enterobacteriaceae (CRE) recovered prospectively from patients at multiple sites. The study included 285 CRE strains from 2782 Gram‑negative Bacilli collected from multiple centres during 2007–2010, of which 87 were characterised. Standard and reference laboratory methods were used for resistance determination. Detection of blaNDM‑1, blaAmpC, blaTEM, blaSHV and blaCTX‑M was done by polymerase chain reaction. High levels of antimicrobial resistance observed among study isolates. Co‑carriage of ESBLs, AmpC and NDM‑1 was 26.3%. Nosocomial origin among the co‑carriage isolates was 64.3%, with 9.2% associated mortality.
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Purpose: blaNDM genes are MBL genes that confer resistance to carbapenems. Globally, they are associated with diverse clones and plasmids. In this study, we characterised three isolates of Klebsiella pneumoniae‑harbouring blaNDM1 from patients undergoing chronic haemodialysis and renal transplantation. Materials and Methods: 3 blaNDM1‑producing K. pneumoniae were isolated from end‑stage renal disease patients undergoing haemodialysis and renal transplantation from a nephrology unit. All the three isolates were screened for clinically relevant resistant genes. Plasmid replicon content was analysed by polymerase chain reaction based replicon typing. Conjugation assays were done using azide‑resistant Escherichia coli J53 as the recipient strain. Multilocus sequence typing and variable number tandem repeat typing were done to find the clonality. Replicon sequence based typing was attempted to find the diversity of replicon‑associated sequences in IncHI3 plasmids. Results: All the 3 blaNDM positive isolates possessed the New Delhi metallo‑beta‑lactamase‑1 (NDM‑1) allele with an IncHI3 plasmid which was not transferable in one isolate. The isolates were found to be sequence type 14 (ST14; 2 nos) and ST38 both of which were previously reported to be the NDM‑producing K. pneumoniae STs prevalent in India. Replicon sequence analysis revealed limited sequence diversity within the repHI3 and repFIB locus. Conclusion: To the best of our knowledge, this is the first report of IncHI3, a newly assigned enterobacterial plasmid incompatibility group from India. This could either be a case of importation or a widely circulating NDM plasmid type in India.
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Background: The ability of microorganisms to evade antibiotic pressure is challenging in healthcare as patients have little or no drug treatment options. Detection of the prevalence of antibacterial resistance pattern helps towards improved antibiotic policy and empirical treatment. Objectives: We carried out antibiogram profiling and documented the prevalence and co-prevalence of New Delhi metallo-β-lactamase (NDM) and extended spectrum β-lactamases (ESBL) encoding genes in urinary Escherichia coli and Klebsiella pneumonia isolates. Materials and Methods: Antibiotic susceptibilities were tested for 241 isolates of E. coli and K. pneumoniae from urine samples collected from out- and hospitalised patients. Polymerase chain reaction (PCR) was carried out on isolates tested positive for phenotypic production of metallo-β-lactamase and ESBL. A multiplex PCR assay was designed to detect the genes. Results: Multiplex PCR assay designed had a limit of detection of 103 CFU/mL in vitro. NDM detected was significantly higher among K. pneumoniae compared to E. coli (69.2% vs. 18.2%; P = 0.001). Of 17, 14 NDM positive isolates also harboured ESBL genes. The co-production of CTX-M + TEM + NDM (3/9; 33.3% and 5/8; 62.5%) was most common in K. pneumoniae and E. coli, respectively while CTX-M + TEM + SHV + NDM was found in one isolate. Of the 156 phenotypically ESBL producing isolates, CTX-M, TEM and SHV was detected by PCR in 85, 53 and 24 isolates, respectively. Conclusion: NDM and ESBL co-producing isolates were both community (64.7%) and hospital (35.29%) acquired among E. coli. Antibiotic resistance can be effectively evaluated by a cost and time effective molecular method, such as the multiplex PCR used in this study, which complement culture and sensitivity tests.