Occurrence of blaNDM Variants Among Enterobacteriaceae From a Neonatal Intensive Care Unit in a Northern India Hospital

Abstract

Carbapenem-resistance among enterobacteriaceae has become a global health concern. The objective of this study was to understand NDM producing enterobacteriaceae and their genetic basis of resistance, spreading in neonatal intensive care unit. Carbapenem resistant NDM producing enterobacteriaceae isolates were recovered from rectal swab and blood sample of infants admitted in NICU. These were determined by using Carba-NP test. All isolates were identified using BD PhoenixTM−100 and MICs were determined by broth microdilution method. The blaNDM and associated resistant markers were checked by PCR followed by sequencing. Moreover, ERIC-PCR and genetic environment of blaNDM gene were also performed for the analysis of clonal relationship and genetic surrounding of the strains. We characterized 44 isolates with blaNDM variants in Escherichia coli (45.5%), Klebsiella pneumoniae (40.9%), Citrobacter freundii (4.5%), Citrobacter braakii (2.3%), Klebsiella oxytoca (2.3%), Enterobacter cloacae (2.3%), Enterobacter aerogenes (2.2%) from NICU, showing resistance against all antibiotics except colistin and polymixin B. ISAba125 and bleomycin gene were found surrounding all blaNDM variants, besides class I integron on plasmid. (ERIC)-PCR data revealed non-clonal relatedness among most of the isolates. The transfer of resistant markers was confirmed by conjugation experiment. The PCR-based replicon typing was carried out using DNA of transconjugants. These isolates carried NDM-1 (20.45%), NDM-4 (36.36%), NDM-5 (38.64%), NDM-7 (4.55%), along with OXA, CMY, and SHV variants on conjugative plasmid of IncFIA, IncFIC, IncF, IncK, IncFIB, IncB/O, IncHI1, IncP, IncY, IncFIIA, IncI1, and IncN types. An increased number of carbapenem-resistant NDM producing enterobacteriaceae isolates recovered from NICU which is alarming signal for health workers and policy makers. Hence, it is utmost important to think about infection control measures.

Resistance phenotype and clinical molecular epidemiology of carbapenem-resistant <em>Klebsiella pneumoniae</em> among pediatric patients in Shanghai

“…Most of NDM-5 producers were identified as ST48 (90%; 27/30). NDM-5 has mostly been found in E. coli , 27 and this is the first reported outbreak of NDM-5-producing ST48 K. pneumoniae in China. In addition, KPC-2, the predominant carbapenemase among adults in China, was detected in isolates from patients in the PICU and charity ward, and most of these isolates belonged to ST11, which is different from the pandemic sequence type ST258.…”

Co-existence of blaNDM-1 and blaVIM-1 producing Moellerella wisconsensis in NICU of North Indian Hospital

“…bringing about problems regarding treatment and control. Our previous study showed that bla NDM gene had disseminated in the NICU via different Gram-Negative Bacilli (E. coli, Citrobacter freundii, Citrobacter braakii, Klebsiella oxytoca, Enterobacter cloacae, Enterobacter aerogenes) harboring blaNDM [15]. An earlier study reported that the blaNDM is carried by various types of plasmids incompatibility such as IncA/C, IncF, IncN, IncL/M or untypable/IncR, and is rarely found to be chromosomally integrated [13].…”

Emergence of NDM-5-Producing Escherichia coli in a Teaching Hospital in Chongqing, China: IncF-Type Plasmids May Contribute to the Prevalence of blaNDM–5

“…Notably, one of the major reasons for the rapid emergence and spread of NDM-5 is its location on different incompatibility typing plasmids (Feng et al, 2018;Wang et al, 2018). Various plasmid incompatibility typing groups carrying bla NDM−5 have been reported worldwide with the most prevalent being IncFIA/B and IncX3 in Korea (Baek et al, 2019), IncFIA and IncFIB in Egypt (Gamal et al, 2016), IncFIA and IncFK in India (Ahmad et al, 2018), and IncFII in the United States (Rojas et al, 2017). Previous studies in China have shown several sporadic cases of clinical infections linked to ST167-type E. coli carrying the bla NDM−5 gene, which was mainly located on the IncX3 plasmid (Chen et al, 2014;Yang et al, 2014;Li et al, 2018;Sun et al, 2019).…”