Carbaspenems Resistant Enterobacteriaceae surveillance in Maharat Nakhonratchasima Hospital

Nittaya Singpoltan

Abstract


There are increased reports in resistance of Enterobacteriaceae family to carbapenems and the third-generation cephalosporins, the antibiotics which have high efficacy for treatment of patients who were infected. The most common mechanism of antibiotic resistance by Enterobacteriaceae is production of          ß-lactamase. Enterobacteriaceae resistance was found in Maharat Nakhonratchasima hospital, however there is no information regarding prevalence and genotypes of the carbapenemase enzyme. The present study aimed to investigate the prevalence of carbapenemase genes in Enterobacteriaceae strains exhibiting decreased susceptibility to carbapenems and to determine their antimicrobial susceptibility patterns. A total of 2,945 isolates were collected from patients in Maharat Nakhonratchasima Hospital between January and December 2012. There were 112 isolates from K. pneumonia (62), Enterobacter cloacae (22), E. coli (16), Citrobacter spp. (9), Enterobacter spp. (2) and K. ozaenae (1), which were positive for carbapenemase gene in this study.  Therefore, the prevalence rate of carbapenemase gene was 3.8%.  Multiplex-polymerase chain technique revealed the existing of New Delhi metallo-ß-lactamase gene (52 isolates), Imipenem metalloproteinase (5 isolates), oxacillinase (3 isolates), New Delhi metallo-ß-lactamase and Imipenem  metalloproteinase (1 isolate), New Delhi metallo-ß-lactamase and oxacillinase (1 isolate) and other genes (54 isolates). The strains harboring carbapenemase genes were resistance to most antimicrobial agents tested, while aminoglycosides were mostly affected as shown by less than 50% drug susceptibility. These resistant determinants were found across departments of the hospital. Therefore, epidemiological survey of the carbapenemase may have impact on surveillance and control of microbial resistance to carbapenems.


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