Antibiotic resistance profile and co-production of extended spectrum beta lactamases and AmpC in Acinetobacter spp. in a level 1 trauma center from India

Priyam Batra; Surbhi Khurana; Aishwarya Govindaswamy; Anjana Aravinda; Vijeta Bajpai; Muruganantham Ayyanar; Purva Mathur; Rajesh Malhotra

doi:10.4103/JLP.JLP_139_18

Journal of Laboratory Physicians, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · J Lab Physicians 2019; 11(02): 128-132
DOI: 10.4103/JLP.JLP_139_18

Original Article

Antibiotic resistance profile and co-production of extended spectrum beta lactamases and AmpC in Acinetobacter spp. in a level 1 trauma center from India

Priyam Batra

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Surbhi Khurana

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Aishwarya Govindaswamy

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Anjana Aravinda

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Vijeta Bajpai

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Muruganantham Ayyanar

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Purva Mathur

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Rajesh Malhotra

Department of Orthopaedics JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

› Institutsangaben

Abstract

als PDF herunterladen

Abstract

INTRODUCTION: Acinetobacter baumannii has now emerged as a significant nosocomial pathogen in health-care setting ESP in intensive care units. Rapidly growing resistance among clinical isolates suggests a need to detect resistance mechanisms in this organism. The present study was designed to compare the various phenotypic tests available with the gold standard of genotype.

METHODOLOGY: The present study was conducted to include all isolates of Acinetobacter spp. isolated over 3 years. Their resistance to various antibiotics was determined and extended spectrum beta-lactamases (ESBL) and AmpC production in the isolates showing resistance to ceftazidime/ceftriaxone/cefotaxime (CAZ/CTR/CTX) was determined. ESBL and AmpC production was confirmed using polymerase chain reaction (PCR).

RESULTS: A total of 154 strains were isolated, and all the strains were tested for ESBL and AmpC detection. Of the strains tested, 15 (9.7%), 17 (11%), 24 (15.6%), 27 (17.5%), 54 (35%), 67 (43.5%), and 72 (46.7%) strains showed ESBL production using CTX/CTX-clavulanate double-disc synergy test (DDST), CTX/CTX-clavulanate E-test, CAZ/CAZ-clavulanate DDST, CAZ/CAZ-clavulanate E-test, Piperacillin/Piperacillin-tazobactam (TZ) DDST, CTR/CTR-Sulbactum DDST, and Piperacillin/Piperacillin-TZ E-test, respectively. 20 (12.9%) and 19 (12.3%) of strains were positive for AmpC production using AmpC disc test and Boronic acid inhibition test, respectively. Genotype analysis using PCR for TEM, SHV, CTXM, PER, and VEB genes was done and 69 (51.5%) strains were positive for TEM gene.

DISCUSSION: ESBL detection in Acinetobacter spp. is difficult as standard guidelines for the same are not available unlike in enterobacteriaceae, and there are no zone diameter breakpoints for aztreonam and cefpodoxime. In comparison, piperacillin/piperacillin-TZ E-test had the best sensitivity and specificity for ESBL detection.

CONCLUSION: Standard guidelines for ESBL detection in nil fermeners like Acinetobacter spp. must be laid down for ease of detection. Use of piperacillin/piperacillin-tazobactam E-test could be used as one of the standard methods.

Key words

Acinetobacter spp. - AmpC - antibiotic resistance - extended spectrum beta-lactamases

PDF (588 kb)

Referenzen

References
1 Baumann P. Isolation of Acinetobacter from soil and water. J Bacteriol 1968;96:39-42.
2 Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: Emergence of a successful pathogen. Clin Microbiol Rev 2008;21:538-82.
3 Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 2006;42:692-9.
4 Dijkshoorn L, Nemec A, Seifert H. An increasing threat in hospitals: Multidrug-resistant Acinetobacter baumannii. Nat Rev Microbiol 2007;5:939-51.
5 Maragakis LL, Perl TM. Acinetobacter baumannii: Epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008;46:1254-63.
6 Falagas ME, Bliziotis IA, Siempos II. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: A systematic review of matched cohort and case control studies. Crit Care 2006;10:R48.
7 Falagas ME, Karveli EA. The changing global epidemiology of Acinetobacter baumannii infections: A development with major public health implications. Clin Microbiol Infect 2007;13:117-9.
8 Hsueh PR, Teng LJ, Chen CY, Chen WH, Yu CJ, Ho SW, et al. Pandrug-resistant Acinetobacter baumannii causing nosocomial infections in a university hospital, Taiwan. Emerg Infect Dis 2002;8:827-32.
9 Sara A, Aroma M, Sheeba O, Kaur MP. Acinetobacter infections in a tertiary level intensive care unit in northern India: Epidemiology, clinical profiles and outcomes. J Infect Public Health 2012;5:145-52.
10 Sivaranjani V, Umadevi S, Srirangaraj S, Kali A, Seeth KS. Multi-drug resistant Acinetobacter species from various clinical samples in a tertiary care hospital from South India. Australas Med J 2013;6:697-700.
11 Esterly J, Richardson CL, Eltoukhy NS, Qi C, Scheetz MH. Genetic mechanisms of antimicrobial resistance of Acinetobacter baumannii. Ann Pharmacother 2011;45:218-28.
12 Singla P, Sikka R, Deeep A, Gagneja D, Chaudhary U. Co-production of ESBL and AmpC β-lactamases in clinical isolates of A. baumannii and A. lwoffii in a teaching tertiary care hospital. J Clin Diagn Res 2014;8:DC16-9.
13 Litake GM, Ghole VS, Niphadkar KB, Joshi SG. Phenotypic ESBL detection in Acinetobacter baumannii: A real challenge. Am J Infect Dis 2015;11:48.53.
14 Black JA, Moland ES, Thomson KS. AmpC disk test for detection of plasmid-mediated AmpC β-lactamases in Enterobacteriaceae lacking chromosomal AmpC β-lactamases. J Clin Microbiol 2005;43:3110-3.
15 Jacoby GA. AmpC β-lactamases. Clin Microbiol Rev 2009;22:161-82.
16 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.
17 Kallman O, Lundberg C, Wretlind B, Ortqvist A. Gram negative bacteria from patients seeking medical advice in Stockholm after the tsunami catastrophe. Scand J Infect Dis 2006;38:448-50.
18 Unal S., Rodriguez JA. Activity of meropenem and comparators against Pseudomonas aeruginosa and Acinetobacter spp. Isolated in the MYSTIC program, 2002-2004. Diagn Microbiol Infect Dis 2005;53:265-71.
19 Trottier V, Segura PG, Namias N, King D, Pizano LR, Schulman CI. Outcomes of Acinetobacter baumannii infection in critically ill burned patients. J Burn Care Res 2007;28:248-54.
20 Gales AC, Jones RN, Sader HS. Global assessment of the antimicrobial activity of polymyxin B against 54,731 clinical isolates of gram-negative bacilli: Report from the SENTRY antimicrobial surveillance programme (2001-2004). Clin Microbiol Infect 2006;12:315-21.
21 Henwood CJ, Gatward T, Warner M, James D, Stockdale MW, Spence RP, et al. Antibiotic resistance among clinical isolates of Acinetobacter in the UK, and in vitro evaluation of tigecycline (GAR-936). J Antimicrob Chemother 2002;49:479-87.
22 Beno P, Krcmery V, Demitrovicova A. Bacteraemia in cancer patients caused by colistin-resistant gram-negative bacilli after previous exposure to ciprofloxacin and/or colistin. Clin Microbiol Infect 2006;12:497-8.
23 Clinical Laboratory Standards Institute. Performance Standards of Antimicrobial Susceptibility Testing; 26th International Supplement CLSI Document M100-S25. Vol. 31. Clinical Laboratory Standards Institute; 2016.
24 Sinha M, Srinivasa H, Macaden R. Antibiotic resistance profile and amp; extended spectrum beta-lactamase (ESBL) production in Acinetobacter species. Indian J Med Res 2007;126:63-7.
25 Mohamudha Parveen R, Harish BN, Parija SC. Ampc beta lactamases among gram negative clinical isolates from a tertiary hospital, South India. Braz J Microbiol 2010;41:596-602.
26 Safari M, Mozaffari Nejad AS, Bahador A, Jafari R, Alikhani MY. Prevalence of ESBL and MBL encoding genes in Acinetobacter baumannii strains isolated from patients of intensive care units (ICU). Saudi J Biol Sci 2015;22:424-9.
27 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.