Detection of carbapenemase production in gram negative bacilli in medical and surgical intensive care unit patients in a tertiary care hospital

Kadel S, Bilolikar AK, Eswaran SP, Krishnaveni M, Fatima R, Sahu S

Pdf Page Numbers :- 301-309

Sourabh Kadel^1*, Anil Kumar Bilolikar¹, Shiv Priya Eswaran¹, Krishnaveni M¹, Rafath Fatima¹ and Sambit Sahu²

¹Department of Microbiology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-500003, Telangana, India

²Department of Critical Care, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-500003, Telangana, India

*Corresponding author: Dr. Sourabh Kadel, Department of Microbiology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-500003, Telangana, India. Email: drsourabhkadel@gmail.com

Received 19 July 2023; Revised 23 August 2023; Accepted 1 September 2023; Published 11 September 2023

Citation: Kadel S, Bilolikar AK, Eswaran SP, Krishnaveni M, Fatima R, Sahu S. Detection of carbapenemase production in gram negative bacilli in medical and surgical intensive care unit patients in a tertiary care hospital. J Med Sci Res. 2023; 11(4):301-309. DOI: http://dx.doi.org/10.17727/JMSR.2023/11-56

Copyright: © 2023 Kadel S et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: Carbapenem-resistant Enterobacterales (CRE) are an urgent global public health problem. CRE infections are associated with high mortality and have limited available effective treatment. Carbapenemase enzymes are encoded by genes on mobile genetic elements, such as plasmids, which are highly transmissible between organisms and increase the potential spread of resistance. The study aim was to detect carbapenemase production in Gram negative bacilli by phenotypic (CarbaNP and mCIM only or in conjunction with eCIM) and genotypic (Xpert Carba-R) methods.

Material and methods: The various clinical samples were processed as per standard recommended procedures. Identification and antibiotic susceptibility test were done by using GN cards and AST N280 & AST N281 cards of Vitek 2 Compact (bioMérieux) respectively. Phenotypic (CarbaNP and mCIM only or in conjunction with eCIM) and genotypic (Xpert Carba-R) methods were used for detection of carbapenemases.

Result: 144 carbapenem-resistant Gram-negative bacilli isolated from various ICUs includes Klebsiella pneumoniae 52.7% (76/144) followed by Escherichia coli 18.05% (26/144) and 15.9% (23/144) Acinetobacter baumannii. Phenotypic test (CarbaNP and mCIM and or in conjunction with eCIM) showed sensitivity of 90%, 100% and 93.75% respectively. Genotypic test of 40 isolates showed predominant expression of NDM in 82.5% (33/40) isolates followed by OXA-48 in 40% (16/40).

Conclusion: The study showed mCIM as the most useful diagnostic test with less economic burden to the patients. There is an urgent need for more sensitive, rapid, highly precise and accurate genotypic test which is less expensive and less labor-intensive.

Keywords: carbapenem resistant; Enterobacterales; mCIM; eCIM; Xpert Carba-R