Title: Detection of Carbapenem resistance by Carbapenemin activation method in tertiary care centre in central Kerala
Authors: Dr Sheeba K Thomas, Dr Leah Thomas, Dr Shoba Kurian Pulikottil, Dr Ratheesh Kumar
DOI: https://dx.doi.org/10.18535/jmscr/v9i10.22
Abstract
Background: Most laboratories do not presently conduct testing for the presence of ESBL, Amp C and Carbepenemases and the justification is that these resistance genes are already well dispersed. This study reveals that if this is totally neglected, there will not be a sense of direction regarding antibiotic susceptibility and resistance patterns pertaining to the concerned scenario and consequently, the injudicious use of higher antibiotics may continue, eventually affecting patient care.
Objective: To determine the phenotype prevalence of Carbapenem resistant organisms in lower respiratory tract specimens at tertiary care centre in central Kerala usingCarbapenem inactivation method.
Method: 1101 respiratory tract specimens including sputum, bronchoalveolar lavage and tracheal aspirate were received from October 2020 to March 2021.Following routine antibiotic susceptibility of all isolates to standard antibiotics by disc diffusion method according to Clinical Laboratory Standards Institute guidelines and phenotypic screening for ESBL, Amp C and Carbapenemase with the resistant isolates, Carbapenem inactivation method of testing for Carbapenemase was performed.
Results: Out of 301 isolates, 49 isolates were resistant to Carbapenemson routine antibiotic susceptibility testing and phenotypic screening. Among 49 isolates, 36 isolates were identified as Klebsiella pneumonia, 7 as Escherichia coli, 4 as Acinetobacter species and 2 as Pseudomonas aeruginosa. The Enterobactericeae namely Klebsiella pneumonia and E coli isolates were subjected to Carbapenem inactivation method for Carbapenemase testing and among these,4 isolates(13.88%) were positive for the presence of Metallo-Beta-lactamase and only one isolate possessed Serine carbapenemase.
Conclusion: In the present scenario in which antibiotic resistance testing is carried out only in very limited centres and genotype testing reveals very few number of positive isolates, it will be prudent and wiser to conduct Carbapenem inactivation method of Carbapenemase testing as this will be provide an awareness regarding the actual Carbapenem resistance patterns prevalent in the concerned centre.
Keywords: Carbapenem-resistant Enterobacteriaceae (CRE), Carbapenemase- producing Enterobacteriaceae (CPE), Klebsiella pneumonia, Escherichia coli, Metallo-beta-lactamase, Serine carbapenemase.
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