Epidemiology of carbapenem-resistant Enterobacteriaceae colonization in ICU: a pilot study from a tertiary care hospital in Western Rajasthan, India

Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) is a serious global public health threat. Antibiotic overuse, improper sanitation and unhygienic practices lead to large scale carriage and rapid spread.Methods: This is a prospective hospital based study planned for a period of 3 months including all patients admitted to 14 bedded Trauma ICU of a tertiary care hospital in Rajasthan. Rectal swabs were collected from admitted patients and carriage of carbapenem resistant Enterobacteriaceae looked for as per CDC guidelines. Screening of the Enterobacteriaceae colonies for carbapenemase production was done by Modified Hodge test. Carbapenem-resistant isolates were also tested for Metallo beta lactamase production by phenotypic disc confirmatory test.Results: A total of 73 patients were screened and 27 CRE isolates were obtained, carriage rate being 37%. A high level of resistance was seen to aminoglycosides, fluoroquinolones and cephalosporins. 100% sensitivity was however seen to Colistin, Tigecycline and Fosfomycin. 5 out of 27 strains showed a positive MHT test. Metallo beta lactamase (MBL) production was seen in 21/25 strains as tested by meropenem and Meropenem-EDTA discs.Conclusions: The current pilot study finds out the prevalence of CRE carriage among critically ill patients and stresses upon strong need for stringent infection control measures.

Molecular Characterization of New Delhi Metallo-ß-Lactamases-Producing Bacteria in the Gastrointestinal Tract of Intensive Care Unit Patients

“…Patients colonized with CRO showed increased mortality than patients not colonized with CRO (53.7%, p = 0.027). Several studies corroborate our study, showing a mortality rate ranging from 30%-75% [5,21].…”

“…The most common isolate in this study was E. coli , but carbapenemase production was maximally seen in Klebsiella pneumoniae (70.6%), followed by Pseudomonas aeruginosa (60%) and E. coli (34.6%). Our study, like other similar studies, reported K. pneumoniae the commonest carbapenemase-producing organism [ 5 , 9 , 13 - 15 ]. However, some studies reported organisms other than K. pneumoniae as a common carbapenemase producer [ 3 , 10 , 16 , 17 ].…”

“…Many studies have shown that the use of invasive devices, three or more classes of antibiotics, hospitalization during the previous six months, comorbidities, and hospital stay for ≥48 h were significantly associated with the development of CRO carriage [ 5 , 9 , 11 , 12 ]. While the use of multiple antibiotics causes selection pressure, invasive devices, and comorbid conditions lead to prolonged hospitalization resulting in the gastrointestinal carriage of CRO [ 11 , 12 ].…”

“…These conditions are often found in ICU settings. The prevalence of carbapenem resistance is reported from 5.9% to 59% in various studies in India [ 4 , 5 ]. Carbapenemases belong to all four classes of ß-lactamases, A, B, C, and D. Class B metallo-ß-lactamases include NDM, VIM, and IMP family enzymes and hydrolyzing most of the ß-lactams including carbapenems.…”

Detection of Klebsiella pneumoniae Carbapenemase (KPC) Producing Enterobacteriaceae Isolates from Various Clinical Samples in a Rural Health Setup

“…Two different studies from Western Rajasthan reported 31.7% and 37% CRE respectively 11,12 . Whereas, the present study showed 14.9% CRE, this is lesser than the other two studies.…”