Carbapenemase among Clinical Bacterial Isolates in Nepal

Abstract

Gram-negative isolates producing carbapenemase enzymes is a great public health problem in developing countries and their control is challenging task due to the involvement of multiple factors including the practice of self-medication, use of antibiotics on animal farms, poor hospital hygiene, etc. During this study, we searched various databases for relevant publication on carbapenemase-producing isolates in Nepal.
 Various classes of carbapenemases had been reported in Nepal. Most frequent was the New Delhi Metallo beta lactamase with many variants where NDM-1 was most prevalent. Similarly, Oxacillinase and Klebsiella pneumoniae carbapenemase producers were also prevalent in Nepal. While other carbapenemases like VIM, IPM, and DIM also detected. The isolates producing carbapenemases were extremely drug-resistant as they also co-produced various other carbapenemases, beta-lactamases, 16S rRNA methylase. Most isolates were resistant to many members of carbapenem, cephalosporin, quinolone, penicillin, aminoglycoside group of antibiotics. Such isolates had very few treatment options as only last line drugs like colistin, fosfomycin, and tigecycline was effective against most of these isolates. Carbapenemase production by almost all major human pathogens including E. coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter. Citrobacter, Proteus, Providencia is a matter of concern because some of these enzymes are located on plasmids and pose rapid dissemination among various gram-negative pathogens. Timely surveillance for carbapenemase producers throughout the nation, their proper treatment, and proper hospital hygiene to prevent nosocomial infections by carbapenemase producers, controlled use of carbapenems, educating health care workers, students and the general public about the adverse effects of antimicrobial resistance is imminent.

Genotypic and Phenotypic Characterization of Novel Sequence Types of Carbapenem-Resistant Acinetobacter baumannii, With Heterogeneous Resistance Determinants and Targeted Variations in Efflux Operons

“…Carbapenem resistance is a severe problem affecting Africa’s health-care system, where the occurrences have surged from <1 to 60% among Gram-negative bacteria ( Anane et al, 2020 ). In a recent study carried out in Nepal’s tertiary care hospital, of the 177 A. baumannii studied, nearly 91% of them exhibited carbapenem resistance ( Devkota et al, 2020 ). Grisold et al (2021) recently reported that among the 114 A. baumannii isolates characterized, 97.4 and 98.2% were resistant to imipenem and meropenem, whereas 88.6% exhibited multidrug resistance.…”

Multi-drug Resistance, β-Lactamases Production, and Coexistence of blaNDM-1 and mcr-1 in Escherichia coli Clinical Isolates From a Referral Hospital in Kathmandu, Nepal

“…Similarly, clinical E. coli isolates from Nepal have been reported to contain NDM-1 as well as several NDM variants. 11 , 19 , 20 If a plasmid encoding the bla NDM-1 gene is acquired by the colistin-resistant organism, bacterial infections may become incurable. 20 …”

“… 11 , 19 , 20 If a plasmid encoding the bla NDM-1 gene is acquired by the colistin-resistant organism, bacterial infections may become incurable. 20 …”

“…Similarly, clinical E. coli isolates from Nepal have been reported to contain NDM-1 as well as several NDM variants. 11,19,20 If a plasmid encoding the bla NDM-1 gene is acquired by the colistin-resistant organism, bacterial infections may become incurable. 20 This study will help to investigate the prevalent colistinresistant E. coli (ColREco) and CREco and their capacity to produce antagonistic enzymes against antibiotics in Nepal because there hasn't been much research on these topics.…”

“…11,19,20 If a plasmid encoding the bla NDM-1 gene is acquired by the colistin-resistant organism, bacterial infections may become incurable. 20 This study will help to investigate the prevalent colistinresistant E. coli (ColREco) and CREco and their capacity to produce antagonistic enzymes against antibiotics in Nepal because there hasn't been much research on these topics. Furthermore, research on the coexistence of the mcr-1 and bla NDM-1 genes may be crucial for molecular epidemiology.…”