A high prevalence of multi-drug resistant Gram-negative bacilli in a Nepali tertiary care hospital and associated widespread distribution of Extended-Spectrum Beta-Lactamase (ESBL) and carbapenemase-encoding genes

Annals of Clinical Microbiology and Antimicrobials

Stephen Baker¹  Sameer Mani Dixit²  Guy Thwaites³  Raphael M. Zellweger⁴  Nhukesh Maharjan⁵  Sabina Dongol⁵  Buddha Basnyat⁶  Abhilasha Karkey⁶  Sulochana Manandhar⁶  Krishna G. Prajapati⁷ 

[1] Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Department of Medicine, University of Cambridge, Cambridge, UK;Center for Molecular Dynamics Nepal, Kathmandu, Nepal;Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK;Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;International Vaccine Institute, Seoul, South Korea;Patan Academy of Health Sciences, Oxford University Clinical Research Unit, Kathmandu, Nepal;Patan Academy of Health Sciences, Oxford University Clinical Research Unit, Kathmandu, Nepal;Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK;Patan Academy of Health Sciences, Patan Hospital, Kathmandu, Nepal;

关键词: Multi-drug resistance;    Antimicrobial resistance;    Nepal;    ESBL;    Gram-negative bacilli;    Carbapenemase;    ESKAPE;   

DOI  :  10.1186/s12941-020-00390-y

来源: Springer

【 摘 要 】

BackgroundMulti-drug resistance (MDR) and extensive-drug resistance (XDR) associated with extended-spectrum beta-lactamases (ESBLs) and carbapenemases in Gram-negative bacteria are global public health concerns. Data on circulating antimicrobial resistance (AMR) genes in Gram-negative bacteria and their correlation with MDR and ESBL phenotypes from Nepal is scarce.MethodsA retrospective study was performed investigating the distribution of ESBL and carbapenemase genes and their potential association with ESBL and MDR phenotypes in E. coli, Klebsiella spp., Enterobacter spp. and Acinetobacter spp. isolated in a major tertiary hospital in Kathmandu, Nepal, between 2012 and 2018.ResultsDuring this period, the hospital isolated 719 E. coli, 532 Klebsiella spp., 520 Enterobacter spp. and 382 Acinetobacter spp.; 1955/2153 (90.1%) of isolates were MDR and half (1080/2153) were ESBL producers. Upon PCR amplification, blaTEM (1281/1771; 72%), blaCTXM-1 (930/1771; 53%) and blaCTXM-8 (419/1771; 24%) were the most prevalent ESBL genes in the enteric bacilli. BlaOXA and blaOXA-51 were the most common blaOXA family genes in the enteric bacilli (918/1771; 25%) and Acinetobacter spp. (218/382; 57%) respectively. Sixteen percent (342/2153) of all isolates and 20% (357/1771) of enteric bacilli harboured blaNDM-1 and blaKPC carbapenemase genes respectively. Of enteric bacilli, Enterobacter spp. was the most frequently positive for blaKPC gene (201/337; 60%). The presence of each blaCTX-M and blaOXA were significantly associated with non-susceptibility to third generation cephalosporins (OR 14.7, p < 0.001 and OR 2.3, p < 0.05, respectively).The presence of each blaTEM, blaCTXM and blaOXA family genes were significantly associated with ESBL positivity (OR 2.96, p < 0.001; OR 14.2, p < 0.001 and OR 1.3, p < 0.05 respectively) and being MDR (OR 1.96, p < 0.001; OR 5.9, p < 0.001 and OR 2.3, p < 0.001 respectively).ConclusionsThis study documents an alarming level of AMR with high prevalence of MDR ESBL- and carbapenemase-positive ESKAPE microorganisms in our clinical setting. These data suggest a scenario where the clinical management of infected patients is increasingly difficult and requires the use of last-resort antimicrobials, which in turn is likely to intensify the magnitude of global AMR crisis.

【 授权许可】

CC BY