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New Delhi metallo-beta-lactamase (NDM)-mediated carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii is a major concern. We investigated the presence of NDM and its variants in P. aeruginosa and A. baumannii at a tertiary hospital in North India. A total of 236 isolates (130 P. aeruginosa and 106 A. baumannii) were included; 38 (29.23%) P. aeruginosa and 20 A. baumannii isolates (18.8%) were resistant to carbapenems and all of them were bla positive. All 38 carbapenem-resistant P. aeruginosa harbored bla while 12 (60%) of 20 A. baumannii harbored bla. Pulsed-field gel electrophoresis showed that all 58 isolates were clonally unrelated. By Southern blot analysis, bla was located on chromosome. The bla-positive isolates were more frequently recovered from tracheal aspirate (67% vs.16%; p = 0.02) and intensive care unit (67% vs. 20%; p = 0.001) than bla. Among other carbapenemases, VIM was significantly associated with bla than bla (61% vs. 17%; p = 0.006). Mortality between bla- and bla-infected patients was comparable. When expressed in Escherichia coli, bla transformant conferred one doubling dilution higher MIC value for cefotaxime, piperacillin/tazobactam than bla. The study shows the emergence of blamediated resistance among P. aeruginosa and A. baumannii and rapid evolution of bla in A. baumannii with its chromosomal localization.

T he transmissible colistin resistance gene mcr-1 has breached one of the last lines of defense against infections caused by carbapenem-resistant Enterobacteriaceae. In 2016, Liu et al. (1) reported a plasmid-mediated gene, mcr-1, that encodes a protein conferring resistance to colistin in Escherichia coli and Klebsiella pneumoniae isolates from animals and patients in China. Since then, mcr-1 producers have been isolated worldwide from animal as well as human samples (2-4). In this study, we analyzed the emergence of mcr-1 in clinical isolates of K. pneumoniae from a North Indian hospital to evaluate the threat of colistin resistance in the country. A total of 200 K. pneumoniae isolates were collected between January and February 2016 from various clinical isolates, like pus, blood, sputum, and urine, at the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India, an 800-bed tertiary care referral center located in North India. An E-strip test followed by antibiotic susceptibility profiling revealed that a total of 21 isolates (10.5%) were resistant to colistin (Table 1). PCR screening and Sanger sequencing revealed that 4 isolates (designated CRL3, CRL5, CRL7, and CRL8) harbored the mcr-1 gene. Strains CRL5, CLR7, and CLR8 were negative when screened for the presence of additional carbapenemases (NDM, KPC, and OXA-48) by PCR; however, CRL4 was found to carry the bla NDM-1 gene. Antibiotic susceptibility testing by the broth microdilution method demonstrated that all mcr-1-positive isolates were resistant to carbapenems, third-generation cephalosporins, aminoglycosides, and ciprofloxacin but susceptible to tigecycline (Table 1).

The rapid changes taking place in the health care sector have prompted health care organizations to pay more attention to the satisfaction of their patients. Many healthcare providers are therefore looking for ways to improve their performance as perceived by patients. This article points out the growing importance of the concept of patient satisfaction, and suggests that one of the ways to improve patient satisfaction rating is to put more emphasis on the use of appropriate information technology in the delivery of healthcare. A framework through which improvement can happen is designed to help managers conceptualize the process.

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