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Category: Volume 07 Issue 09 September 2019
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Title: Phenotype and Genotype Prevalence of Carbapenemase genes in bacterial isolates from lower respiratory tract specimens in a tertiary care centre in central Kerala

Authors: Sheeba K Thomas, Shoba Kurian Pulikottil, Kiran N, Leah Thomas, Molly Antony

 DOI: https://dx.doi.org/10.18535/jmscr/v7i9.94

Abstract

  

Background: Carbapenem-resistant Enterobacteriaceae (CRE) represent a global public health threat. Emergence of carbapenems-resistant organisms represents a serious challenge for antimicrobial therapy. Among the widely recognized types of Carbapenemases, New Delhi β-lactamase (NDM) and Klebsiella pneumoniae carbapenemase (KPC) are the most important enzymes.

Objective: The aim of this research is to determine the genotypic prevelance of NDM and KPC genes among Gram negative organisms with high-level Carbapenem resistance from respiratory tract specimens at Government Medical College Kottayam using RT-PCR .

Method: A total of 1216 respiratory tract specimens including sputum, bronchoalveolar lavage and tracheal aspirate were collected during June 2017 to November 2017. The susceptibility of all isolates to Meropenem was selected by disc diffusion method according to Clinical Laboratory Standards Institute guidelines. Isolates with intermediate susceptibility to Meropenem and Meropenem resistant isolates were further selected for genotyping. The presence of genes coding for Carbapenemases such as  blaNDM-1 and blaKPC   was detected by polymerase chain reaction.

Results: Out of 290 isolates, 40 isolates are resistant to Carbapenems phenotypically. 14% (31/220) were Klebsiella pneumonia and 12.8% (9/70) were Escherichia coli. Genotypic study shows 3 out of the 40 isolates possessed NDM gene and all three were Klebsiella pneumoniae. No KPC gene was located in all 40 isolates. Escherichia coli did not posess both NDM or KPC genes.

Conclusion: Carbapenem resistance is due to injudicious use of higher antibiotics, therefore to prevent this, periodic surveillance of sputum cultures, antibiotic resistance pattern and regular updates on antibiotic policy guidelines is the best strategy.

Keywords: Carbapenem-resistant Enterobacteriaceae (CRE), Carbapenemase- producing Enterobacteriaceae (CPE),  Klebsiella pneumonia, Escherichia coli, New Delhi β-lactamase (NDM), Klebsiella pneumoniae carbapenemase (KPC).

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Corresponding Author

Sheeba K Thomas

Assistant Professor, Department of Microbiology, Government Medical College, Kottayam, Kerala, India