Occurrence and characterization of carbapenem‐resistant Gram‐negative bacilli: A collaborative study of antibiotic‐resistant bacteria between Indonesia and Japan

Abstract

Objectives To explore the occurrence and characterization of carbapenemase‐producing pathogens among carbapenem‐resistant Gram‐negative bacilli isolated from hospitalized patients with urinary tract infection in Indonesia. Methods This was a study promoted by the Japanese–Indonesian collaborative research program in the Japan Initiative for Global Research Network on Infectious Diseases. Bacterial pathogens were prospectively isolated from urine specimens of hospitalized urinary tract infection patients at Dr. Soetomo Hospital (Surabaya, Indonesia). All Gram‐negative bacteria resistant to third‐generation cephalosporin or carbapenem were included in this study. Carbapenemase genes were investigated for phenotype and genotype. Results In total, 1082 Gram‐negative bacilli were isolated, of which 116 strains were resistant to imipenem or meropenem (carbapenem‐resistant Gram‐negative bacilli), and 22 strains were carbapenemase‐producing Gram‐negative bacilli. Carbapenemase‐producing Gram‐negative bacilli consisted of Acinetobacter baumannii (n = 4), Pseudomonas aeruginosa (n = 4), Klebsiella pneumoniae (n = 5), Providencia rettgeri (n = 4) and five others. The carbapenemase‐producing Gram‐negative bacilli included NDM‐1 (n = 18, 81.8%, in Enterobacteriaceae and Acinetobacter spp.) and IMP‐7 (n = 4, 18.2%, all in P. aeruginosa). Among carbapenem‐resistant Gram‐negative bacilli, all four P. aeruginosa were sensitive to colistin, and all six Acinetobacter spp. were sensitive to minocycline, colistin and tigecycline. Of those patients harboring carbapenemase‐producing Gram‐negative bacilli, 12 (54.5%) were seriously ill at the time of admission, with longer hospital stays and three deaths (13.6% mortality rate). Conclusions Urinary tract infection‐causing carbapenem‐resistant Gram‐negative bacilli are widely disseminated in Indonesia. The NDM‐1 phenotype seems to be dominant, and it can be treated with colistin and tigecycline in most cases. Most patients harboring carbapenemase‐producing Gram‐negative bacilli are seriously ill, have a bad prognosis, with a longer hospital stay and a significant mortality rate.

Differential effects of chromosome and plasmid blaCTX‐M‐15 genes on antibiotic susceptibilities in extended‐spectrum beta‐lactamase‐producing Escherichia coli isolates from patients with urinary tract infection

“…7 Specimens were determined as positive for ESBL using the double-disk synergy test. [7][8][9] The antimicrobial agents used were AMP, CFZ, CTX, CRO, CAZ, SAM, TZP, IPM, MEM, GEN, AMK, TOB, LVX, CIP, CHL, SXT, TET and FOF. E. coli ATCC 25922 was used for quality control.…”

High plasmid variability, and the presence of IncFIB, IncQ, IncA/C, IncHI1B, and IncL/M in clinical isolates of Klebsiella pneumoniae with bla KPC and bla NDM from patients at a public hospital in Brazil.

“…Klebsiella pneumoniae is clinically important because it is involved in a variety of healthcare-association infections (HAI) such as in the urinary and respiratory tracts, wounds, endocarditis, and sepsis 1,2,3 . Intestinal colonization is one of the main factors favoring infection by K. pneumoniae, as colonized carriers can serve as important reservoirs for the spread of bacteria in the hospital environment.…”

Antimicrobial susceptibility and molecular species identification of clinical carbapenem-resistant bacteria

“…These bacteria can be found in various sources, including blood, sputum, urine, and others. The current study in Indonesia found that in 2015-2016, from total of 1082 clinical bacteria in the hospital, 10.7% were carbapenem-resistant (Kuntaman et al 2018). A study in Aceh showed that from 212 methicillin-resistant Staphylococcus haemolyticus, 99.1% of them were resistant to carbapenem (Suhartono et al 2019).…”