Phenotypic and genotypic characterization of multi-drug resistant gram-negative bacteria in admitted of tertiary care centre, Nepal.
ABSTRACT: Introduction: Increasing prevalence of multi-drug resistant bacteria is a huge risk to the global population. Infection associated with admitted patients caused by multi-drug resistant gram-negative (MDR-GNB) bacteria threatens the viability of all the progress made in medicine. In Nepa...
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| Format: | Book |
| Language: | English |
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c2021.
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| Online Access: | Visit NHRC Library |
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| Summary: | ABSTRACT: Introduction: Increasing prevalence of multi-drug resistant bacteria is a huge risk to the global population. Infection associated with admitted patients caused by multi-drug resistant gram-negative (MDR-GNB) bacteria threatens the viability of all the progress made in medicine. In Nepal too, the prevalence of these bacteria is rising thus effective mitigation plan should be formulated in real-time which will require to investigate the problem itself. This study aimed to find the prevalence of MDR-GNB associated with hospital-acquired infections and characterized them on the basis of their resistant mechanism using phenotypical and genotypic methods. Methods: This is a cross-sectional study which was conducted in Tribhuvan University Teaching Hospital, hospitalized patients with a positive growth was taken as the sample population. The study duration was 1 year and the sample was collected for six months. All the data was entered in an excel sheet and was analyzed using an appropriate statistical package. Results: Most common MDR-GNB causing infection in admitted patients were Klebsiella pneumoniae and Escherichia coli followed by Acinetobacter spp and so on. MDR-E. coli were commonly isolated from urine specimens and MDR-Klebsiella pneumoniae and MDR-Acinetobacter spp. were most commonly isolated from respiratory and blood specimens. Most of MDR- GNB were isolated from admitted patient with lower respiratory tract infections (39.3%). Nearly all MDR-GNB isolates were resistant to firstline antibiotics (≥90%). Nearly two-thirds of isolates were resistant to aminoglycosides. Around half of the isolates were also resistant to carbapenems. No isolates were found to be resistant to colistin with most of the bacteria having MIC ≤0.125. ESBL production was found with more than half of the isolates (mainly in E.coli) with most common ESBL related genes being blaCTX-M and blaSHV. MBLs were detected in 127 isolates with blaNDM being the most common type and among NDM, blaNDM-1 was the most frequently detected with one K.pneumoniae with novel-type of NDM (NDM-13). 16s rRNA methylase was detected in 111 isolates out of 223 tested with armA and rmtB being the most common variants. Conclusion: Highest percentage of MDR-GNB were isolated from the patient with HAI related to lower respiratory tract infection. Most MDR-GNB were resistant to 1st line antibiotics, resistant pattern for carbapenem and aminoglycoside was alarmingly high. No isolates were found to be resistant to polymyxin and colistin. Resistant of beta-lactams was mainly due to blaCTX-M and blaSHV type ESBL. Carbapenem-resistant was mediated by blaNDM, blaKPC with rising prevalence of blaOXA-48 and resistant of aminoglycosides was mainly due to armA. Key Words: Multi-drug resistant, Gram-negative bacteria, Hospital acquired infection, Metallo beta-lactamase, New-Delhi beta-lactamase, Klebsiella pneumoniae carbapenemase, Oxacillinase, 16s rRNA methylase |
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| Item Description: | Thesis Report. |
| Physical Description: | xviii,106p. |