Showing papers on "New Delhi metallo-beta-lactamase 1 published in 2016"

Use of WGS data for investigation of a long-term NDM-1-producing Citrobacter freundii outbreak and secondary in vivo spread of blaNDM-1 to Escherichia coli, Klebsiella pneumoniae and Klebsiella oxytoca

Abstract: Objectives An outbreak of NDM-1-producing Citrobacter freundii and possible secondary in vivo spread of blaNDM-1 to other Enterobacteriaceae were investigated. Methods From October 2012 to March 2015, meropenem-resistant Enterobacteriaceae were detected in 45 samples from seven patients at Aalborg University Hospital, Aalborg, Denmark. In silico resistance genes, Inc plasmid types and STs (MLST) were obtained from WGS data from 24 meropenem-resistant isolates (13 C. freundii, 6 Klebsiella pneumoniae, 4 Escherichia coli and 1 Klebsiella oxytoca) and 1 meropenem-susceptible K. oxytoca. The sequences of the meropenem-resistant C. freundii isolates were compared by phylogenetic analyses. In vitro susceptibility to 21 antimicrobial agents was tested. Furthermore, in vitro conjugation and plasmid characterization was performed. Results From the seven patients, 13 highly clonal ST18 NDM-1-producing C. freundii were isolated. The ST18 NDM-1-producing C. freundii isolates were only susceptible to tetracycline, tigecycline, colistin and fosfomycin (except for the C. freundii isolates from Patient 2 and Patient 7, which were additionally resistant to tetracycline). The E. coli and K. pneumoniae from different patients belonged to different STs, indicating in vivo transfer of blaNDM-1 in the individual patients. This was further supported by in vitro conjugation and detection of a 154 kb IncA/C2 plasmid with blaNDM-1. Patient screenings failed to reveal any additional cases. None of the patients had a history of recent travel abroad and the source of the blaNDM-1 plasmid was unknown. Conclusions To our knowledge, this is the first report of an NDM-1-producing C. freundii outbreak and secondary in vivo spread of an IncA/C2 plasmid with blaNDM-1 to other Enterobacteriaceae.

Dissemination and spread of New Delhi Metallo-beta-lactamase-1 Superbugs in hospital settings.

Abstract: OBJECTIVE To find out frequency of isolation of carbapenem-resistant enterobacteriaceae and the predominantly responsible metallo-beta-lactamasegene in a hospital setting. METHODS The descriptive, cross-sectional study was conducted from May 2009 to June 2012 at the Aga Khan University Hospital, Karachi, and comprised non-duplicate clinical carbapenem-resistant enterobacteriaceae isolates obtained from different collection units across Pakistan. Kirby-Bauer disk diffusion screening of carbapenem-resistant enterobacteriaceae was confirmed by minimum inhibitory concentration using E-test. Polymerase chain reaction assay was performed to detect blaKPC, blaNDM-1, blaIMP, and blaVIM genes. In addition variable number tandem repeat typing was performed on selected cluster of New Delhi metallo-beta-lactamase-1-positive Klebsiella pneumoniae. RESULTS Of the 114 carbapenem-resistant enterobacteriaceae isolates, 104(94%) tested positive for blaNDM-1 gene. At 68(66%), Klebsiella pneumoniae was the most frequent species isolated, followed by E.coli 33(31%). Moreover, 89(78%) of the blaNDM-1 gene positive Klebsiella pneumonia isolates were from the clinical samples of patients admitted to the critical care units and 75(66%) were from neonates and the elderly. Of the 65(67%) patients suffering from bacteraemia and sepsis, 32(57%) had expired, of which 22(60%) were aged <1 month. Variable number tandem repeat analysis of hospital-acquired New Delhi metallo-beta-lactamase-1-positive Klebsiella pneumoniae showed similarities between the isolates. CONCLUSIONS New Delhi metallo-beta-lactamase-1-positive enterobacteriaceae was found widely disseminated in major hospitals across Pakistan. Patients at extreme ages and those in critical care units were found to be the most affected with fatal outcomes.

Distribution and Antimicrobial Susceptibility Pattern of Gram Negative Bacteria Causing Urinary Tract Infection (UTI) and Detection New Delhi Metallo-beta-lactamase-1 (NDM-1) Producing Isolates in Ahwaz

Abstract: Background: Urinary tract infection (UTI) is the commonest bacterial infectious disease in worldwide (especially in developing countries) with a high rate of morbidity and financial cost. The management of UTI infections has been jeopardized by increase in immergence of antimicrobial drug resistance. Knowledge of the local bacterial etiology and susceptibility patterns is required to trace any change that might have occurred in time so that updated recommendation for optimal empirical therapy of UTI can be made. The aim of this investigation was distribution and antimicrobial susceptibility pattern of gram negative bacteria causing urinary tract infection (UTI) and detection NDM-1 (new-delhi-metallo-betalactamase-1) producing isolates in Ahwaz. Materials and Methods: This cross-sectional study was done during a period of one year from April 2013 to March 2014. Clean catch midstream urine samples were collected from suspected patients to UTI. The isolates were identified based on morphological and biochemical testes. Culture was performed on routine microbiological media. Susceptibility testing was performed according CLSI (2013) guidelines. Detection of carbapenemase producing isolates was performed by modified hodge test (MHT). Metallobeta-lactamase isolates were detected by imipenem-EDTA combined disc test (CDT). Results: In this study 708 gram negative organisms were isolated from urine samples. E.coli was the most common isolated bacteria (67%) followed by Klebsiella spp. (26.5%) and Enterobacter spp. (2.5%). In antibiotic susceptibility testing more than 90% of isolates were sensitive to tetracycline, ceftazidime, meropenem, amikacin, cefotaxime, imipenem, and cefepime. Isolates were more resistant to cephalothin (32%), co-trimoxazol (30.5%), and nalidixic acid (25%). Conclusion: In our results isolated organisms from outpatients showed very high sensitivity to common antibiotics. Continuous and regular monitoring of susceptibility pattern of community isolated strains is necessary. Antimicrobial susceptibility is important to guide effective antibiotic therapy.

New Delhi metallo-beta-lactamase-1-producing Acinetobacter spp. infection: report of a survivor.

Abstract: New Delhi metallo-beta-lactamase-1 (NDM-1) is a bacterial enzyme that renders the bacteria resistant to a variety of beta-lactam antibiotics. A 20-year-old man was hospitalized several times for surgical treatment and complications caused by a right-sided vestibular schwannoma. Although the patient acquired several multidrug-resistant infections, this study focuses on the NDM-1-producing Acinetobacter spp. infection. As it was resistant to all antimicrobials tested, the medical team developed a 20-day regimen of 750mg/day metronidazole, 2,000,000IU/day polymyxin B, and 100mg/day tigecycline. The treatment was effective, and the patient recovered and was discharged from the hospital.

Characterisation of carbapenemase-producing Gram-negative bacilli among clinical isolates in a tertiary care centre in Kerala, South India

Abstract: Background: Infections caused by carbapenem-resistant Gram-negative bacteria are a cause for concern due to the limited choice of antibiotics available for their treatment. Aims, Settings and Design: This study screened multidrug-resistant (MDR) Gram-negative bacilli isolated from clinical samples over a period of one year, for carbapenem resistance and characterised them using phenotypic methods such as combined disc diffusion test (CDDT), modified Hodge test (MHT), E-test for metallo-beta-lactamase (MBL) and molecular method, PCR. Materials and Methods: Two hundred and ten MDR Gram-negative bacilli were screened for carbapenem resistance using Imipenem and Meropenem disc diffusion. These were further checked for carbapenemase production by CDDT, MHT and E-test for MBL. Those positive by E-test were subjected to PCR. Uniplex PCR for New Delhi metallo-beta-lactamase-1 was used for Escherichia coli and Klebsiella pneumoniae , and multiplex PCR for Imipenemase and Verona imipenemase was used for Pseudomonas aeruginosa and Acinetobacter baumannii isolates. Results: Twenty-three (11%) isolates were found to be carbapenem-resistant and included E. coli (six) K. pneumoniae (three), P. aeruginosa (five) and A. baumannii (nine). Seventeen (74%) isolates were positive by phenotypic methods and were subjected to PCR. Out of eight Enterobacteriaceae isolates subjected to PCR, all were positive for bla NDM gene. All were negative for bla KPC gene. All five A. baumannii isolates subjected to PCR were found to contain bla VIM gene. Two out of four P. aeruginosa isolates were positive for bla IMP , one was positive for bla VIM gene. One P. aeruginosa isolate was positive for both bla IMP and bla VIM gene. Conclusions: In view of the increasing resistance of Gram-negative bacilli to carbapenems, rational use of antibiotics needs to be emphasised.

Detection Of New Delhi Metallo Beta Lactamase-1 (BlaNDM-1) Gene among A Group of Carbapenem Resistant Acinetobacter Baumannii Isolates.

Abstract: Background: A variety of carbapenemases have been reported in Acinetobacter species. One of the most clinically significant carbapenemases is the recently described New Delhi metallo- β -lactamase (bla NDM-1 ). Objective: This study aimed to determine the presence of bla NDM-1 gene among a group of carbapenem resistant Acinetobacter baumanii isolates from hospitalized patients. Methodology: Thirty carbapenem resistant Acinetobacter baumanii isolates from different sites of nosocomial infections from ICU patients were included in the study. They were tested by real time PCR for the presence of bla NDM-1 gene. Results: None of the tested isolates in this study was positive for this gene. Conclusion: Further studies on larger numbers should be done to confirm or rule out the role of the bla NDM-1 gene in carbapenem resistance of Acinetobacter baumanii in nosocomial infections.