Prevalence of Carbapenemases in Klebsiella pneumoniae in a North Indian Tertiary Care Hospital Nirupama Chatterjee1, Ashima Jain Vidyarthi2, Priyambada1 , Mohini Yadav1, Shivani Kaushik1 and Namita Jaggi*1 Department of Education and Research1 & Department of Microbiology2, Artemis Hospitals, Sector-1, Gurugram, Haryana (India), *Corresponding author
Results
Abstract Background: Resistance to carbapenems in gram negative bacteria Klebsiella pneumoniae (KP) is of serious concern as it is one of the last resort antibiotics. The main mechanism of carbapenem resistance is the enzymatic degradation by carbapenemases. Rationale: Many of the carbapenamase genes that are prevalent world-wide are located on plasmid or other Mobile genetic elements (MGE) which makes them easily transmissible. India has one of the highest prevalence of carbapenem resistance in the world and the most commonly reported carbapenemases genes are New Delhi Metallo Beta lactamase (NDM) and oxacillinase-48 (OXA-48). Strategy: In the present study, 145 clinical isolates of gram negative bacteria Klebsiella pneumoniae were tested for carbapenem resistance using VITEK 2 compact system for a period of two months (August 2018- October 2018). All carbapenem resistant isolates (67, 46.2%) were screened for the five common carbapenemases genes NDM, OXA-48, VIM, IMP and KPC by Polymerase Chain Reaction (PCR). 14 randomly selected NDM positive KP isolates were subjected to conjugation assay and sequencing to check transmissibility and NDM variant. Results: OXA-48 was the predominant carbapenamase. 31/45(68.88%) co-expressed the genes NDM and OXA-48 while 29 isolates and 5 isolates expressed OXA-48 and NDM genes respectively. Of the 14 NDM isolates randomly chosen for conjugation all formed trans-conjugants and NDM-5 variant observed in all the tans-conjugants Introduction • Antimicrobial resistance is a severe crisis in health care industry • Resistance to high end antibiotics like carbapenems is a worrying trend as it leads to increased morbidity, mortality and length of stay in hospitals • Molecular characterization of carbapenem resistance helps in appropriate choice of antibiotics as these enzyme have different substrates and inhibitors • Identification of location of the gene (plasmid/chromosomal) helps in formulating proper surveillance and infection control measures
Conclusions • The resistance to carbapenems in Klebsiella pneumoniae is high (46.2%) • Maximum number of K. pneumoniae were from the ICU. Blood, Sputum, Endotracheal Aspirate and Urine were the most common sample type • OXA-48 was the most common carbapenemase in the K. pneumonaie isolates which was found either alone (45%) or in combination with NDM (54.5%). NDM alone was detected in 5 isolates and VIM, IMP and KPC were absent in all isolates • The presence of plasmid based NDM-5 in all the randomly chosen isolates needs further investigation in plasmid type and strain type to understand the transmissibility
References • Jaggi N, Chatterjee N, Singh V, et al. Carbapenem resistance in Escherichia coli and Klebsiella pneumoniae among Indian and international patients in North India. Acta Microbiol Immunol Hung. 2019;66(3):367-376. • Taneja N, Balvinder M and Sharma M. Antimicrobial resistance in selected bacterialenteropathogens in north India. Ind J Med Res.2004;120:39-43 Conflict of Interest- None