Prevalence of Metallo Beta-Lactamase in Clinical Isolates of Non-Fermenters in A Tertiary Care Hospital
Prevalence of Metallo Beta-Lactamase in Clinical Isolates of Non-Fermenters in A Tertiary Care Hospital
Keywords:
Carbapenem resistance, MBL, Non-FermentersAbstract
Background & objectives: Metallo-beta-lactamase (MBL) producing Pseudomonas Spp. and Acinetobacter spp. have become a growing therapeutic concern worldwide. Therefore, an attempt has been made in this study to identify metallo beta-lactamases in carbapenem resistant isolates of non-fermenters. Methods: During July-September 2016, out of total 4869 clinical isolates, non-fermenters were 1353. All the non-fermenters were subjected to antibiotic susceptibility testing by Kirby-Bauer disc diffusion test as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Selection criteria for MBL detection among these isolates was resistance to imipenem. Imipenem resistant isolates were tested for the detection of MBL production by Imipenem-EDTA combined disc method, double-disc synergy test and minimum inhibitory concentration (MIC) of imipenem was determined by E-strip. Enhancement of inhibition zone around imipenem discs impregnated with EDTA as compared to those without EDTA confirmed MBL production. Results: Out of 1353 non-fermenter isolates from various clinical specimens, 920(68%) were Pseudomonas spp. and 433(32%) were Acinetobacter spp. They were identified by using standard microbiological techniques. Out of 920 Pseudomonas spp., Imipenem resistance was found in 208(22.61%) isolates. MBL detection test was performed on these 208 isolates & 120 (13.04%) were MBL positive. Out of 433 Acinetobacter spp., Imipenem resistance was found in 172 (39.72%) isolates. MBL detection test was performed on these 172 isolates & 133(30.71%) were MBL positive. Interpretation & conclusion: MBL-mediated imipenem resistance in Pseudomonas spp. and Acinetobacter spp. is a cause for concern in the therapy of patients. Therefore, a strict antibiotic policy should be followed to prevent further spread of MBLs. Therapeutic options for such isolates are Colistin and Polymyxin B for Pseudomonas spp. and Colistin, Polymyxin B and Tigecycline for Acinetobacter spp. [Rathod R NJIRM 2017; 8(2):149-152]
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