Emergence of blaNDM-1 and blaVIM producing Gram-negative bacilli in ventilator-associated pneumonia at AMR Surveillance Regional Reference Laboratory in India

Abstract

Introduction Ventilator-associated pneumonia (VAP) may be a life threatening nosocomial infection encountered in intensive care units. Currently the emergence of carbapenem-resistant Gram-negative pathogens has become worrisome threat worldwide. Material and methods Endotracheal aspirates samples were collected from patients who were under mechanical ventilation for > 48 h. The bacterial isolates were identified by MALDI-TOF-MS and antibiotic susceptibility testing performed. All carbapenem resistant isolates were tested by Modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), and EDTA-CIM (eCIM) and PCR were performed to detect blaIMP, blaVIM and blaNDM producing MBL genes. Results VAP occurred in 172/353(48.7%), 23.3% had early-onset VAP and 76.7% had late-onset VAP. Males (69.2%) were found to suffer more from VAP. Prior antibiotic therapy, CPI>6, prior surgery and tracheostomy were associated with VAP. The mortality in VAP (58.1%) contrasted with non-VAP (40%). 99/169 (58.6%) Gram-negative isolates were resistant to carbapenems. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae were common pathogens found in late onset VAP, whereas K. pneumoniae, A. baumannii and Staphylococcus aureus were common in early onset VAP. The PCR results detected blaNDM in 37/172(21.5%) and blaVIM in 30/172(17.4%); 15/172(8.7%) isolates carried both genes. Conclusion The blaNDM-1 and blaVIM genes are the main antibiotic-resistance genes that induce resistance patterns to carbapenems in VAP, highlighting CRE strains of potential public health concern and therapeutic challenge. Diagnostic laboratories in India must get on high caution for early MBL detection as it may limit the wide dispersal of MBL genes.

Evaluation of the BioFire FilmArray Pneumonia Panel Plus to the Conventional Diagnostic Methods in Determining the Microbiological Etiology of Hospital-Acquired Pneumonia

“…In terms of its accuracy in detecting antimicrobial resistance genes, BFPP showed relatively high agreement when compared to VITEK-2 breakpoints, with PPA [100%, 93%, not applicable], NPA [97%, 85%, 90%], and OPA [98%, 90%, 90%] for carbapenemase producers, ESBLs, and MRSA, respectively. In comparison to other studies [28,[39][40][41] that reported on the prevalence of carbapenemase producers and ESBLs among HAP patients, our results revealed a higher rate of detection. This higher resistance rate could be attributed to the large use of antimicrobial agents among ICU patients, leading to more selective pressure and the appearance of different resistant phenotypes.…”

Characteristics of Carbapenem-Resistant Gram-Negative Bacilli in Patients with Ventilator-Associated Pneumonia

“…In this study, bla NDM was the most prevalent gene among K. pneumoniae isolates. Concurring with our finding, a study in India found bla NDM in 28.8% and bla VIM in 17.7% of K. pneumoniae isolates among VAP patients [ 32 ]. However, a study from Iran revealed that bla VIM was the most prevalent gene (13.6%), while both bla IMP and bla NDM were only detected in two K. pneumoniae isolates [ 33 ], which is not in concordance with our findings.…”

“…Of their 172 isolates, 21.5% exhibited the presence of bla NDM genes, 17.4% exhibited the presence of bla VIM gene and 8.7% isolates harbored both bla NDM and bla VIM genes. None of the isolates contained bla IMP gene [ 32 ]. Sękowska et al confirmed that bla NDM and bla VIM genes are the main antibiotic-resistance genes that induce resistance patterns to carbapenems among VAP patients in Poland [ 9 ].…”

Carbapenem-Resistant Gram-Negative Bacilli Causing Ventilator Associated Pneumonia: Study of MASTDISCS Combi Carba Plus for Detection of Carbapenemase Producing Enterobacterales

“…36,37 Meanwhile, Chen et al, Kumari et al, and Sadigov et al reported that A. baumannii was the most prevalent CR-GNB pathogen, accounting for 78.7%, 37.4%, and 37.1%, respectively. [38][39][40] This variation could be the result of geographical differences between the countries, patient population and clinical setting. 20 Determination of whether the gram-negative isolate is a carbapenemase producer is essential for epidemiological studies and also for selection of the appropriate treatment for infections.…”