Prevalence of faecal carriage of Enterobacteriaceae with NDM-1 carbapenemase at military hospitals in Pakistan, and evaluation of two chromogenic media
Open Access
- 25 July 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of Antimicrobial Chemotherapy
- Vol. 66 (10), 2288-2294
- https://doi.org/10.1093/jac/dkr299
Abstract
To determine the prevalence and antimicrobial susceptibility of carbapenemase-producing Enterobacteriaceae among hospitalized patients and outpatients attending two military hospitals in Rawalpindi, Pakistan, and to compare the performance of two chromogenic culture media for the isolation of these organisms. Stool samples from 200 distinct patients were cultured on MacConkey agar and subsequently on two chromogenic media—Colorex KPC and a prototype chromogenic medium, ID Carba—designed for the isolation of carbapenemase-producing Enterobacteriaceae. All Gram-negative isolates growing on either chromogenic medium were investigated for carbapenemases by phenotypic and molecular methods. Producers were subjected to susceptibility testing with 40 antimicrobials by VITEK 2 or agar dilution. In total, 64 NDM-1-positive isolates of Enterobacteriaceae, belonging to seven distinct species, were recovered from 37 (18.5%) of the stool samples. No other carbapenemase types were confirmed. Nineteen positive samples were identified among 70 from inpatients (prevalence 27.1%) and there were 18 positive samples among 130 from outpatients (prevalence 13.8%). Fifty-six isolates (87.5%) harbouring the NDM-1 enzyme were recovered on ID Carba compared with 41 isolates (64.1%) on Colorex KPC (P = 0.012). Multidrug resistance was prevalent, but no pan-resistant isolates were found, with most isolates susceptible in vitro to colistin (97%), mecillinam (95%), fosfomycin (94%), tigecycline (89%) and nitrofurantoin (78%). This study shows a high prevalence of multidrug-resistant Enterobacteriaceae with the NDM-1 enzyme in Rawalpindi. The new chromogenic medium, ID Carba, was more sensitive than Colorex KPC and has potential as a screening medium for isolation of Enterobacteriaceae harbouring the NDM-1 enzyme.Keywords
This publication has 20 references indexed in Scilit:
- Early Dissemination of NDM-1- and OXA-181-Producing Enterobacteriaceae in Indian Hospitals: Report from the SENTRY Antimicrobial Surveillance Program, 2006-2007Antimicrobial Agents and Chemotherapy, 2011
- How To Detect NDM-1 ProducersJournal of Clinical Microbiology, 2011
- Extremely Drug-Resistant Citrobacter freundii Isolate Producing NDM-1 and Other Carbapenemases Identified in a Patient Returning from IndiaAntimicrobial Agents and Chemotherapy, 2011
- Evaluation of BBL CHROMagar VanRE for Detection of Vancomycin-Resistant Enterococci in Rectal Swab SpecimensJournal of Clinical Microbiology, 2010
- Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological studyThe Lancet Infectious Diseases, 2010
- Assessment of prevalence and changing epidemiology of extended-spectrum β-lactamase–producing Enterobacteriaceae fecal carriers using a chromogenic mediumDiagnostic Microbiology and Infectious Disease, 2010
- Characterization of a New Metallo-beta-Lactamase Gene, bla(NDM-1), and a Novel Erythromycin Esterase Gene Carried on a Unique Genetic Structure in Klebsiella pneumoniae Sequence Type 14 from IndiaAntimicrobial Agents and Chemotherapy, 2009
- Emergence of High Levels of Extended-Spectrum-β-Lactamase-Producing Gram-Negative Bacilli in the Asia-Pacific Region: Data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) Program, 2007Antimicrobial Agents and Chemotherapy, 2009
- Evaluation of CHROMagar KPC for Rapid Detection of Carbapenem-Resistant EnterobacteriaceaeJournal of Clinical Microbiology, 2008
- Evaluation of Methods To Identify the Klebsiella pneumoniae Carbapenemase in EnterobacteriaceaeJournal of Clinical Microbiology, 2007