Carbapenemase and NDM-1 Production by Escherichia coli and Klebsiella pneumoniae from Patients belonging to a Rural Community in North India Hospitalized with CommunityAcquired Infections

Abstract

Carbapenem-resistant Enterobacteriaceae, especially New Delhi metallo-β-lactamase type-1-producing strains, exhibit multidrug resistance, thus posing a serious public health threat for treatment of infections caused by Gram-negative bacteria. However, most of the studies on the problem have been confined to hospitalized patients from urban population. The present study was carried out to detect carbapenemase production among Escherichia coli and Klebsiella pneumoniae Isolated from rural population hospitalized with community acquired infections. A total of 296 non-repetitive isolates of E. coli and K. pneumoniae were subjected to Modified Hodge test for carbapenemase detection, Metallo-β-lactamase detection by MIC test strip MBL and molecular detection of bla NDM gene by Polymerase Chain Reaction (PCR). Twenty three (7.8%) of the 296 isolates were detected as carbapenemase producers, of which five (21.7%) were found to harbor bla NDM genes by PCR. Gene sequencing of all the five isolates revealed bla NDM-1 genes. The present study showed the prevalence of carbapenemase-producing E. coli and K. pneumoniae in the rural community of North India and spread of NDM-1.

Urban Migrant Labourers as Potential Source for Transfer of Antimicrobial Resistance to Rural Community

“…As opposed to this pharmacy outlet-based study that may not be representative of the problem in the general community, the present study on antibiotic usage was based on survey in two distinct subpopulations from urban and rural community. Considering the overall low literacy rate in the two study subpopulations to clearly recognise medications as antibiotics and non-availability of prescriptions, the present study relied on usage of drugs in ailments suggestive of bacterial infection as correlate of antibiotic usage which showed self-medication of probable While there are few reports on the intestinal carriage rate of ESBL mediated AMR among healthy rural community in India, ranging from 15.4% to 33.8% 25,26 , there is hardly any information available on carriage rate of carbapenem and NDM-1 mediated AMR in the healthy rural community, most of the reports originating from studies on hospitalized patients from rural community 14 . Laxminarayan and Choudhary reported that non-prescription sales of carbapenems in India is among the highest in the world contributing to growing problem of carbapenem resistance 27 .…”

“…PCR for detection of bla NDM was carried out for carbapenemase producing stains using the pre-published sequences viz. forward 5'-ACCGCCTGGACCGATGACCA-3' and reverse 5'-GCCAAAGTTGGGCGCGGTTG-3', which amplified 264 bp fragment of the bla NDM gene 14 . Gene sequencing of the amplicons was done for all the bla NDM genes with amplicons purified by PCR purification kit (QIAGEN, Hidden, Germany).…”