Incidence of Metallo beta-lactamases producing Non-fementers in a tertiary care Hospital

  • Dr Anjali Swam, Badhuli S, Desai P, Shastri J
Keywords: MBL, imipenem-EDTA, E test

Abstract

Introduction: In recent years, resistance to carbapenems due to metallobetalactamse production is increasing. The genes (IMP and VIM) responsible for metallo beta-lactamase (MBL) production may be
chromosomally or plasmid mediated and hence poses a threat of spread of resistance by gene transfer among the Gram-negative bacteria. Therefore early identification and treatment of infections with MBL
producers becomes essential.
Screening of MBL is not done as routine in our laboratory. The present study was therefore undertaken to know the incidence of MBL producing bacteria in our set up.
Aims: To study incidence of metallo-beta-lactamase (MBL) producers among nonfermenters.
Material and Methods: 315 P. aeruginosa and 170 Acinetobacter species were isolated from blood and pus samples and evaluated for carbapenem resistance and MBL production by imipenem-EDTA disc
method. The inhibition zone with imipenem-EDTA disc were <14 mm for MBL-negative isolates and >17 mm for MBL-positive isolates. MBL production was confirmed by E test strip containing imipenem (4-
256 μg/ml) and imipenem(1- 64 μg/ml) plus EDTA.100/10 μg).
Results: Of 315 isolates of P. aeruginosa and170 isolates of Acinetobacter, of the total 315 P. aeruginosa 265 were isolated from pus and 50 from blood cultures and out of the total 170 of Acinetobacter spp120
from pus and 50 from blood cultures were isolated. Piperacillin/tazobactam and Imipenem were the most effective antibiotics for NFGNB.
Out of the 50 Imipenem resistant isolates tested, 9 (18%) were found to be MBL producers.
Conclusions: Identification of MBL production is mandatory for making appropriate choice of antibiotics. This enables to relook into the antibiotic policy, create awareness and strengthen infection control to
prevent the further spread of MBL producers.

References

1. Walsh T, Bolmstorm A, Qwarnstorm A & Gales A. Evaluation of a new E test for detecting metallo B lavtamases in routine clinical testing. J Clin Microbiol.2002; 40 (8): 2755-2759
2. Steinberg JP, Rio DC. Other Gram negative and Gram variable bacilli. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of Infectious diseases, 6th ed. vol. 2 Philadelphia, USA: Elsevier Publication; 2005. p. 2751-2768.
3. Gales AC, Jones RN, Forward KR, Linares J, Sader HS, Verhoef J, Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: Geographic patterns, Epidemiological features, and trends in the SENTRY antimicrobial surveillance program (1997-1999). Clin Infect Dis,2001,32: 104-13
4. Goossens H, Susceptibility of multi-drugresistant Pseudomonas aeruginosa in intensive care units: results from the European MYSTIC study group. Clin Microbiol Infec., 2003, 9 : 980-983,
5. Butt T, Usman M, Ahmed RN, Saif I. Emergence of Metallo- β-lactamase producing Pseudomonas aeruginosa in Pakistan. J Pak Med Assoc. 2005;55:302– 4. [PubMed]
6. Bennett PM. Integrons and gene cassettes; A genetic construction kit for bacteria. Antimicrob Agents Chemother 1999; 43 : 1-4.
7. Bush K. Metallo [beta]-lactamase: a class apart. Clin Infect Dis 1998; 27 Suppl 1): S48-53.
8. Lee K, Lim Y.S, Yong D. Evaluation of the Hodge test and Imipemen- EDTA double disk synergy test for differentiating metallo- beta- lactamase producing Pseudomnasspp and Acinobacter spp. J ClinMicrobiol. 2003; 41 (10): 4623-4629.
9. Migliavacca R, Docquire JD, Mμgnaioli C, Amicosante G, Daturi R, Lee K, et al. Simple Microdilution test for detection of metallo-[beta]- 1actamase production in Pseudomonas aerμginosa. J ClinMicrobiol 2002; 40 : 4388-90.
10. Animicrobial susceptibility testing in Color Atlas and Textbook of Diagnostic Microbiology. Koneman E, Allen S, Janda W, Schreckenberge P, Winn W Lippincott. Williams. 5th edition , 1997: 785-856.
11. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial disk tests; Approved Standards, 10 th ed. CLSI Document M02- A10. Wayne PA 2009.
12. Yano H, Kμga A, Okamota R, Kitasato H, Kobayashi T, Inon M. Plasmid coded metailo beta lactamase (imp 6) conferring resistance to carbapenems, especially meropenam. Antimicrob Agents Chemother
2001; 45 : 1343-8.
13. Navneeth BV, Sridaran D, Sahay D, Belwadi MR. A preliminary study on metallobetalactamse producing Pseudomonas aeruginosa in hospitalized patients. Indian J Med Res 2002; 116 : 264-7.
14. Endimiani A, Luzzaro F, Pini B, Amicosante G, Rossolini GM, Toniolo AQ. Pseudomonas aeruginosa bloodstream infections: risk factors and treatment outcome related to expression of the PER-1 extended- spectrum beta-lactamase. BMC Infect Dis2006; 6 : 52; available from www.biomedcentral.com/1471- 2334/6/52.
15. Walsh, T. R., A. Bolmström, A. Qwärnström, and Å. Gales. 2002. Evaluation of a new Etest for detecting metallo-β-lactamases in routine clinical testing. J. Clin. Microbiol. 40:2755-2759.
16. Hodiwala (Bhesania) A, Dhoke R, Urhekar AD, Incidence of metallo-beta-lactamase producing pseudomonas, acinetobacter & enterobacterial isolates in hospitalised patients. Int J Pharm Bio Sci,
2013, 3(1):79- 83
17. Livermore DM, Woodford N, Carbapenemse: A problem in waiting? Curr Opin Microbiol, 2000, 3 : 489-495.
Published
2019-09-26
How to Cite
Dr Anjali Swam, Badhuli S, Desai P, Shastri J. (2019). Incidence of Metallo beta-lactamases producing Non-fementers in a tertiary care Hospital. The Indian Practitioner, 67(4), 219-223. Retrieved from https://articles.theindianpractitioner.com/index.php/tip/article/view/842