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CC BY-NC-ND 4.0 · J Lab Physicians 2019; 11(04): 287-291
DOI: 10.4103/JLP.JLP_136_19
Original Article

Detection of carbapenemase-producing Pseudomonas aeruginosa by phenotypic and genotypic methods in a tertiary care hospital of East India

Nishu Verma
Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Ashok Prahraj
Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Baijayantimala Mishra
Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Bijayini Behera
Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Kavita Gupta
Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

BACKGROUND: Carbapenemase-producing Pseudomonas aeruginosa is a serious threat in hospital infection due to its multidrug resistance.

AIM: The aim of the study was to determine the frequency of carbapenem resistance in clinical isolates of Pseudomonas aeruginosa and detect the presence of carbapenemase enzymes in carbapenem-resistant P. aeruginosa (CRPA) isolates by phenotypic and genotypic methods.

MATERIAL AND METHODS: Double-disk synergy test [DDST] and combined disk synergy test [CDST]) was performed in CRPA isolates and the prevalence ofblaKPC,blaNDM-1,blaIMP,blaVIM,blaSIM,blaSPM,blaGIM, andblaOXA-48 was determined.

RESULTS: Of 559 isolates included in the study, a total of 102 isolates were resistant to carbapenem that accounted for overall 18.24% (102/559) prevalence. Of these 102 isolates, 89 (87.25%) isolates were positive by DDST and 95 (93.17%) isolates were positive by CDST. Of 102 CRPA isolates,blaVIM was detected in 30 isolates (30/102, 29.1%), followed byblaNDM-1 in 29 (29/102, 28.4%) isolates andblaSIM andblaGIM in 6 isolates each (6/102, 5.8%). A combination of two carbapenemase genes was detected in 12 isolates, with six (6/102, 5.88%) CRPA isolates harboring with bothblaVIM andblaNDM-1 genes. Four isolates were found to harbor a combination of three carbapenem-resistant genes.

CONCLUSION: A high rate of carbapenemase production was observed in P. aeruginosa. Coproducers of multiple carbapenemases are also a cause of concern. An in-depth understanding of molecular mechanisms of resistance will be helpful in optimizing patient management and hospital infection control.

Key words

Carbapenemases - genotypic methods - phenotypic methods - Pseudomonas aeruginosa


Publication History

Received: 20 August 2019

Accepted: 27 November 2019

Article published online:
07 April 2020

© 2019.

Thieme Medical and Scientific Publishers Private Ltd.
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  • References

  • 1 Centers for Disease Control and Prevention, Office of Infectious Diseases. Antibiotic Resistance Threats in the United States, 2013. Atlanta, GA: Centers for Disease Control and Prevention, Office of Infectious Diseases; 2013. Available from: http://www.cdc.gov/drugresistance/threat-report-2013. [Last accessed on 2019 Jul 24].
  • 2 Pragasam AK, Veeraraghavan B, Anandan S, Narasiman V, Sistla S, Kapil A, et al. Dominance of international high-risk clones in carbapenemase-producing Pseudomonas aeruginosa: Multicentric molecular epidemiology report from India. Indian J Med Microbiol 2018;36:344-51.
  • 3 Pragasam AK, Vijayakumar S, Bakthavatchalam YD, Kapil A, Das BK, Ray P, et al. Molecular characterisation of antimicrobial resistance in Pseudomonas aeruginosa and Acinetobacter baumannii during 2014 and 2015 collected across India. Indian J Med Microbiol 2016;34:433-41.
  • 4 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 27th ed. CLSI Document M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
  • 5 Lee K, Lim YS, Yong D, Yum JH, Chong Y. Evaluation of the hodge test and the imipenem-EDTA double-disk synergy test for differentiating metallo-beta-lactamase-producing isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol 2003;41:4623-9.
  • 6 Yong D, Lee K, Yum JH, Shin HB, Rossolini GM, Chong Y. Imipenem-EDTA disk method for differentiation of metallo-beta-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol 2002;40:3798-801.
  • 7 Ellington MJ, Kistler J, Livermore DM, Woodford N. Multiplex PCR for rapid detection of genes encoding acquired metallo-beta-lactamases. J Antimicrob Chemother 2007;59:321-2.
  • 8 Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: A molecular, biological, and epidemiological study. Lancet Infect Dis 2010;10:597-602.
  • 9 Gandra S, Joshi J, Trett A, Lamkang AS, Laxminarayan R. Scoping report on antimicrobial resistance in India. Washington, DC: Center for Disease Dynamics, Economics and Policy; 2017.
  • 10 Bajpai V, Govindaswamy A, Khurana S, Batra P, Aravinda A, Katoch O, et al. Phenotypic genotypic profile of antimicrobial resistance in Pseudomonas species in hospitalized patients. Indian J Med Res 2019;149:216-21.
  • 11 Peter S, Lacher A, Marschal M, Hölzl F, Buhl M, Autenrieth I, et al. Evaluation of phenotypic detection methods for metallo-β-lactamases (MBLs) in clinical isolates of Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis 2014;33:1133-41.
  • 12 Behera B, Mathur P, Das A, Kapil A, Sharma V. An evaluation of four different phenotypic techniques for detection of metallo-beta-lactamase producing Pseudomonas aeruginosa. Indian J Med Microbiol 2008;26:233-7.
  • 13 Kazi M, Nikam C, Shetty A, Rodrigues C. Dual-tubed multiplex-PCR for molecular characterization of carbapenemases isolated among Acinetobacter spp. and Pseudomonas spp. J Appl Microbiol 2015;118:1096-102.
  • 14 Veeraraghavan B, Pragasam AK, Bakthavatchalam YD, Anandan S, RamasubramanianV, Swaminathan S, et al. Newer ß-Lactam/ß-Lactamase inhibitor for multidrug-resistant gram-negative infections: Challenges, implications and surveillance strategy for India. Indian J Med Microbiol 2018;36:334-43.
  • 15 Ellappan K, Belgode Narasimha H, Kumar S. Coexistence of multidrug resistance mechanisms and virulence genes in carbapenem-resistant Pseudomonas aeruginosa strains from a tertiary care hospital in South India. J Glob Antimicrob Resist 2018;12:37-43.
  • 16 Mohanam L, Menon T. Coexistence of metallo-beta-lactamase-encoding genes in Pseudomonas aeruginosa Indian J Med Res 2017;146:S46-52.
  • 17 Khurana S, Mathur P, Kapil A, Valsan C, Behera B. Molecular epidemiology of beta-lactamase producing nosocomial Gram-negative pathogens from North and South Indian hospitals. J Med Microbiol 2017;66:999-1004.
  • 18 Paul D, Dhar Chanda D, Maurya AP, Mishra S, Chakravarty A, Sharma GD, et al. Co-Carriage of blaKPC-2 and blaNDM-1 in clinical isolates of Pseudomonas aeruginosa Associated with hospital infections from India. PLoS One 2015;10:e0145823.
  • 19 Paul D, Dhar D, Maurya AP, Mishra S, Sharma GD, Chakravarty A, et al. Occurrence of co-existing bla VIM-2 and blaNDM-1 in clinical isolates of Pseudomonas aeruginosa from India. Ann Clin Microbiol Antimicrob 2016;15:31.
  • 20 Li S, Jia X, Li C, Zou H, Liu H, Guo Y, et al. Carbapenem-resistant and cephalosporin-susceptible Pseudomonas aeruginosa: A notable phenotype in patients with bacteremia. Infect Drug Resist 2018;11:1225-35.