Molecular epidemiology of beta-lactamase producing nosocomial Gram-negative pathogens from North and South Indian hospitals

Surbhi Khurana; Purva Mathur; Arti Kapil; Chithra Valsan; Bijayini Behera

doi:10.1099/jmm.0.000513

Volume 66, Issue 7

Research Article

Free

Molecular epidemiology of beta-lactamase producing nosocomial Gram-negative pathogens from North and South Indian hospitals

Surbhi Khurana¹, Purva Mathur¹, Arti Kapil², Chithra Valsan³ and Bijayini Behera^4,†
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Affiliations: ¹ Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India ² Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India ³ Department of Microbiology, Jubilee Mission Medical College & Research Institute, Thrissur, Kerala, India ⁴ Department of Microbiology, Consultant Clinical Microbiologist, Yashoda Hospital, Secunderabad, Telangana, India ^† Present address: Department of Microbiology, AIIMS, Bhubaneswar, Sijua, Bhubaneswar, India.
*Correspondence: Purva Mathur, [email protected]
Published: 01 July 2017 https://doi.org/10.1099/jmm.0.000513

Abstract

Purpose. Resistant Gram-negative bacterial (GNB) infections, apart from tremendously escalating the cost of treatment, are a cause for substantial morbidity and mortality among hospitalized patients. Such bacteria are rapidly acquiring resistance to many antimicrobial agents, especially the beta-lactams which are the most frequently prescribed antimicrobials in hospital and community patient care settings, and now also to colistin; a last-line drug to treat infections with such bacteria. The greatest threat to antimicrobial treatment is the production of metallo beta-lactamases, and plasmid-mediated serine carbapenemases.

Methodology. We conducted a two-year study to observe the pattern of beta-lactamase enzyme production (extended spectrum beta-lactamases (ESBLs), AmpC and carbapenemases) among the nosocomial GNB isolated from intensive care units (ICUs) of North and South Indian hospitals. A total of 761 non-duplicate GNB were included in the study from North (554; 73 %) and South India (207; 27 %). All strains were subjected to Clinical and Laboratory Standards Institute (CLSI) recommended screening tests for detection of beta-lactamase production, followed by polymerase chain reaction (PCR)-based detection of clinically important beta-lactamase genes mediating resistant phenotypes among these isolates.

Results. Out of the 761 GNB, Acinetobacter spp., Klebsiella spp., Pseudomonas spp., Enterobacter spp. and others were 27, 23 , 21 , 17 , 5 and 7 % respectively. A high prevalence of ESBL was found across all genera in these strains. The carbapenem resistance was higher in North than in South Indian GNB. The level of AmpC production was comparatively lower in both North and South Indian strains.

Conclusion. Beta-lactamases showed tremendous variation in geographic distribution. Thus, their detection and characterization is important from a clinical-epidemiological, laboratory and infection control point of view. Knowledge of this epidemiology can predict the empiric antimicrobial treatment.

Received: 15/11/2016
Accepted: 09/05/2017
Published Online: 01/07/2017

Keyword(s): AmpC , carbapenemases , ESBLs , Gram-negative bacteria and multi-drug resistance

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References

Liu YY, Wang Y, Walsh TR, Yi LX, Zhang R et al. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. Lancet Infect Dis 2016; 16:161–168 [View Article][PubMed]
[Google Scholar]
58th Annual report of AIIMS All India Institute of Medical Sciences, New Delhi; Annual report 2013-14. www.aiims.edu/aiims/annual-report
Jorgensen JH, Turnidge JD. Susceptibility test methods: dilution and disk diffusion methods. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S. et al. (editors) Manual of Clinical Microbiology Washington, DC: ASM Press; 2015 pp. 1253–1273 [CrossRef]
[Google Scholar]
Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, 2009; 19th informational supplements M100-S16. Wayne, PA, USA: CLSI; 2006 http://clsi.org/
Moland ES, Hanson ND, Black JA, Hossain A, Song W et al. Prevalence of newer β-lactamases in gram-negative clinical isolates collected in the United States from 2001 to 2002. J Clin Microbiol 2006; 44:3318–3324 [View Article][PubMed]
[Google Scholar]
Goyal A, Prasad KN, Prasad A, Gupta S, Ghoshal U et al. Extended spectrum β-lactamases in Escherichia coli & Klebsiella pneumoniae & associated risk factors. Indian J Med Res 2009; 129:695–700[PubMed]
[Google Scholar]
Pérez-Pérez FJ, Hanson ND. Detection of plasmid-mediated AmpC β-lactamase genes in clinical isolates by using multiplex PCR. J Clin Microbiol 2002; 40:2153–2162 [View Article][PubMed]
[Google Scholar]
Queenan AM, Bush K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev 2007; 20:440–458 [View Article][PubMed]
[Google Scholar]
Mulvey MR, Grant JM, Plewes K, Roscoe D, Boyd DA. New Delhi metallo-β-lactamase in Klebsiella pneumoniae and Escherichia coli, Canada. Emerg Infect Dis 2011; 17:103–106 [View Article][PubMed]
[Google Scholar]
Behera B, Mathur P. High levels of antimicrobial resistance at a tertiary trauma care centre of India. Indian J Med Res 2011; 133:343–345[PubMed]
[Google Scholar]
Rajkumari N, John NV, Mathur P, Misra MC. Antimicrobial resistance in Pseudomonas sp. causing infections in trauma patients: a 6 year experience from a South Asian country. J Glob Infect Dis 2014; 6:182–185 [View Article][PubMed]
[Google Scholar]
Sekar R, Mythreyee M, Srivani S, Amudhan M. Prevalence of antimicrobial resistance in Escherichia coli and Klebsiella spp. in rural South India. J Glob Antimicrob Resist 2016; 5:80–85 [View Article][PubMed]
[Google Scholar]

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Molecular epidemiology of beta-lactamase producing nosocomial Gram-negative pathogens from North and South Indian hospitals

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Volume 66, Issue 7

Research Article

Free

Molecular epidemiology of beta-lactamase producing nosocomial Gram-negative pathogens from North and South Indian hospitals

Abstract

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