Multidrug resistant NDM-1 metallo-beta-lactamase producing Klebsiella pneumoniae sepsis outbreak in a neonatal intensive care unit in a tertiary care center at central India.
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Date
2014-01
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Abstract
Objective: The objective of the following study is to detect genes encoding
carbapenem resistance in Klebsiella pneumoniae sepsis outbreak in a neonatal
intensive care unit (NICU). Materials and Methods: Antibiotic sensitivity
test was performed by standard Kirby Bauer disc diffusion technique and
minimum inhibitory concentrations of antibiotics was determined by VITEK-2.
Polymerase chain reaction (PCR) assays and sequencing was used to determine
the presence of beta-lactamase encoding genes. Conjugation experiments
were performed to determine the transferability of beta-lactamase. Isolate
relatedness were determined by repetitive-element PCR (REP), enterobacterial
repetitive intergenic consensus (ERIC) PCR and random amplifi ed polymorphic
deoxyribonucleic acid (RAPD). Results: All the isolates were completely
resistant to the second and third generation cephalosporins tested as well as
carbapenems. Susceptibility profi ling of the isolates indicated that 100% retained
susceptibility to tigecycline and colistin. Conjugation experiments indicated
that blaNDM-1 was transferable and likely through a plasmid-mediated event. All
the isolates showed the presence of blaNDM-1 with co association of blaCTX-M-15.
REP-PCR, ERIC-PCR and RAPD revealed a single clonal type circulating in
NICU environment. Conclusion: Co-production of NDM-1 with CTX-M-15 in K.
pneumoniae isolates was detected for the fi rst time in our NICU. Transmission of
plasmid carrying these resistant genes to other members of Enterobacteriaceae
will increase the incidence of multidrug resistance. Early detection of these genes
will help in prevention and adequate infection control by limiting the spread of
these organisms.
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Keywords
blaNDM-1, Klebsiella pneumonia outbreak, multidrug resistance, neonatal intensive care unit
Citation
Khajuria Atul, Praharaj Ashok Kumar, Kumar Mahadevan, Grover Naveen, Aggarwal Amit. Multidrug resistant NDM-1 metallo-beta-lactamase producing Klebsiella pneumoniae sepsis outbreak in a neonatal intensive care unit in a tertiary care center at central India. Indian Journal of Pathology & Microbiology. 2014 Jan-Mar 57 (1): 65-68.