Epidemiology of carbapenemase producing Enterobacteriaceae in a general hospital

Abstract

Objective: Detect the presence of carbapenemases producing Enterobacteriaceae (CPE) and associated epidemiologi­cal, microbiological, and clinical characteristics of patients in our hospital

Methods: During 15 months period, all non duplicate Enterobacteriaceae isolates with reduced susceptibility to car­bapenem detected by MicroScan WalkAway system and confirmed by E test were collected. These suspected isolates were further screened by modified Hodge test and carbapenemase inhibition discs to identify CPE.

Results: Out of 54 suspected Enterobacteriaceae isolates, 44 (88.5%) isolates were either extended spectrum beta-lac­tamases (ESBLs) or AmpC producers with porin loss whereas 10 isolates (18.5%) were confirmed to produce carbapen­emase representing (0.74%) of the total Enterobacteriaceae. Among these 10 isolates, 6 were OXA 48 producers and 2 isolates were class B and class A each. Six out of the 10 CPE were detected in ICU and specimen source was tracheal aspirate in 5 CPE isolates. All CPE isolates were sensitive to colistin and all but one to tigecycline. All patients had history of previous antibiotic exposure and hospital stays for more than 5 days.

Conclusion: Although CPE is not the main cause of carbapenem resistance in Enterobacteriaceae in our setting, its emergence there represents a serious infection control and therapeutic challenge. This mandates its early detection using MHT and carbapenemase inhibition tests together with strict infection control measures to limit its spread. J Mi­crobiol Infect Dis 2015;5(2): 57-62

Amina Kandeel,Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Egyp, Epidemiology of carbapenemase producing Enterobacteriaceae in a general hospital, Amina Kandeel, Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Egyp, J Microbiol Infect Dis 2015; 5(2): 57-62 doi: 10.5799/ahinjs.02.2015.02.0177

Key words: Enterobacteriaceae, carbapenemases, resistant organisms, carbapenems, epidemiology

Keywords

• Enterobacteriaceae, carbapenemases, resistant organisms, carbapenems, epidemiology

-

Öz

Amaç: Genel hastanede Karbapenemaz üreten Entereobakterlerin (KÜE) tespiti, epidemiyolojisi, mikrobiyolojisi ve hastaların klinik karakteristik özelliklerinin belirlenmesi.Yöntemler: On beş aylık dönem içinde, dublike olmayan MikroScan WalkAway sistemi ile karbapenem duyarlılığı azalmış ve E test ile doğrulanan Enterobakterler tespit edildi. Daha sonra modifiye Hodge testi ve disk inhibisyon yöntemi ile karbapenemaz üreten enterobakterler belirlendi.Bulgular: Tespit edilen 54 enterobakter izolatı içinde 44 (%88.5)’i genişletilmiş spektrumlu beta-laktamaz (GSBL) veya porin kayıplı AmpC üretiyordu. Bunun yanında 10 izolat (%18.5) karbapenemaz üretiyordu. Karbapenemaz üreten izolatlatlar tüm enterobakterler içinde %0.74 oranında idi. Bu 10 izolatın 6’sı OXA-48 üretirken 2’si grup B ve grup A idi. Bu 10 izolatın 6’sı yoğun bakım ünitesinde yatan hastalarda tespit edildi. Bu 6 izolatın 5’i trakeal aspiratta üredi. Tüm KÜE kolistine duyarlı idi, sadece 1 izolat tigesikline dirençli idi. Tüm hastalar öncesinde antibiyotik tedavisi almıştı ve 5 günden uzun süredir hastanede yatmakta idi.Sonuç: Bizim ünitemizde karbapenem direnci başlıca KÜE bağlı olmasa bile KÜE tespit edilmiş olması enfeksiyon kontrol önlemleri ve tedavi yaklaşımlarının tekrar gözden geçirilmesini gerekli kılmaktadır. Bu da erken dönemde modifiye hodge testi ve karbapenemaz inhibisyon testlerinin beraber kullanılması ile KÜE erken tesbiti ve sıkı enfeksiyon kontrol önlemlerinin uygulanması ile yayılımının önlenmesi sağlanabilir

Anahtar Kelimeler

• Enterebokterler, karbapenemazlar, dirençli organizma, karbapenemler, epidemiyoloji

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