NDM Production as a Dominant Feature in Carbapenem-Resistant Enterobacteriaceae Isolates from a Tertiary Care Hospital

Abstract

The worldwide spread and increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is of utmost concern and a problem for public health. This resistance is mainly conferred by carbapenemase production. Such strains are a potential source of outbreaks in healthcare settings and are associated with high rates of morbidity and mortality. In this study, we aimed to determine the dominance of NDM-producing Enterobacteriaceae at a teaching hospital in Karachi. A total of 238 Enterobacteriaceae isolates were collected from patients admitted to Jinnah Postgraduate Medical Centre (Unit 4) in Karachi, Pakistan, a tertiary care hospital. Phenotypic and genotypic methods were used for detection of metallo-β-lactamase. Out of 238 isolates, 52 (21.8%) were CRE and 50 isolates were carbapenemase producers, as determined by the CARBA NP test; two isolates were found negative for carbapenemase production by CARB NP and PCR. Four carbapenemase-producing isolates phenotypically appeared negative for metallo-β-lactamase (MBL). Of the 52 CRE isolates, 46 (88.46%) were blaNDM positive. Most of the NDM producers were Klebsiella pneumoniae, followed by Enterobacter cloacae and Escherichia coli. In all the NDM-positive isolates, the blaNDM gene was found on plasmid. These isolates were found negative for the VIM and IPM MBLs. All the CRE and carbapenem-sensitive isolates were sensitive to colistin. It is concluded that the NDM is the main resistance mechanism against carbapenems and is dominant in this region.

Prevalence and Molecular Characterization of Extended Spectrum β-Lactamase and Carbapenemase-Producing Enterobacteriaceae Isolates from Bloodstream Infection Suspected Patients in Addis Ababa, Ethiopia

“…Additionally, about 44.4% of carbapenem-resistant Enterobacteriaceae isolates were found to carry the carbapenemase gene. The metallo-β-lactamase, bla NDM was the predominant carbapenemase gene detected in our study which is in agreement with other reports from Pakistan 52 Turkey 58 and United Kingdom. 59 Therefore, strains producing the bla NDM are spreading widely across the globe and posing series public health threats mainly because of their wider range of resistance to clinically available antibiotic 58 and the plasmid associated with bla NDM is capable of wide rearrangement, widespread horizontal transmission and flexibility among bacterial species.…”

“…However, the prevalence of CPE in our study is lower than two previous reports from Ethiopia 12.12% 12 and 16.2%, 11 and much lower than report from Uganda 28.6%, 49 France 36.2%, 19 Germany 53.3% 50 and multicenter observational study from seven Latin American countries 20.8%. 51 From those CPE isolates Klebsiella pneumoniae was the major carbapenemase-producing isolate in our study and a similar magnitude was reported from Czech Republic, 48 Nepal, 4 Uganda 49 and Pakistan 52 . The fact that K. pneumonia is the major organism responsible for ESBL and carbapenemase production could be associated with its notorious ability to accumulate and transfer resistance determinants and this has made it a leading causative agent of hospital-acquired infections.…”

“…Klebsiella pneumoniae is an important nosocomial pathogen causing wide range of clinical infections in hospitalized and immune-compromised patients. Currently, the bacterium is acquiring/developing multi-resistance determining genes like bla NDM and becoming worldwide threats 17 as it was reported elsewhere in Netherland, 61 Thailand, 62 Pakistan 52 and Turkey 58 Klebsiella pneumoniae was the predominant Enterobacteriaceae producing bla NDM.…”

Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan

“…While the global data suggested the higher prevalence of K. pneumoniae , P. aeruginosa , E. coli and A. baumannii from Tanzania, Algeria, Nepal and Saudi Arabia [ 46 , 47 , 48 , 49 ], our study demonstrated 42.1% CR among Enterobacterales . This is higher than prevalences previously reported from Pakistan such as 21.84% [ 50 ], 25.5% [ 51 ], 9.6% [ 52 ] and 6.5% [ 45 ]. However, our results are in agreement with the global reports that CRE prevalence is at alarming rates, such as 65.0% from the USA [ 53 ], 42.6% from Cuba [ 54 ] and 34.3% from China [ 55 ].…”

Detection of NDM Variants (blaNDM-1, blaNDM-2, blaNDM-3) from Carbapenem-Resistant Escherichia coli and Klebsiella pneumoniae: First Report from Nepal

“…Gram-negative bacteria, especially those falling under the family Enterobacterales (eg, Escherichia, Klebsiella , and Enterobacter ) as well as pseudomonads and Acinetobacter serve as the potential pathogens in nosocomial and community-acquired infections in urinary and respiratory tracts, blood stream, intra-abdominal and surgical site infections. 1 , 2 Some of these Gram-negative bacilli are also included in ESKAPE—a group of six nosocomial pathogens ( Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa , and Enterobacter spp.) that are notorious for drug resistance and virulence.…”