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PREVALENCE OF DIFFERENT GENES RESPONSIBLE FOR CARBAPANEM RESISTANCE IN GRAM NEGATIVE BACILLI IN TERTIARY CARE CENTER IN SOUTH INDIA.
Abstract
Background
Carbapenem resistance in gram negative bacteria(GNB) is major concern in the management of resistant infections. The mechanism of carbapenem resistance is primarily mediated by carbapenemases. Five most common genes (NDM , KPC , VIM , OXA , IMP) are responsible for carbapenemase production. Knowledge of these genes is important as management will vary according to the type of resistant gene.
Aims
To estimate the prevalence of different genes responsible for carbapenemase production in GNB at a tertiary health care center in South India.
Methods
In this retrospective study, samples were collected over 16 months. GNB which grew on culture, showed resistance to carbapenem (meropenem mic>8) were tested by Xpert Carba-R Assay for the detection of five important genes responsible for carbapenemase production ; NDM, KPC, VIM, OXA, and IMP.
Results
Total 184 cultures were collected which suggested carbapenem resistance GNB . 12 samples were excluded as they were repeat samples. Rest 172 samples grew Klebsiella pneumonae(152), Escherichia coli(10), acinetobacter species(6), Pseudomonas(2) and Enterobacter(2). Among them , OXA 48 and NDM are most common gene with 137 (83.5%) and 97(59.1%) respectively. 70 samples(42.6%) showed presence of both , 1 (0.6%) showed presence of OXA 48, NDM, and VIM. IMP and KPC gene were not detected.
Conclusions
In view of limited options and higher cost of antibiotics, knowledge of genes responsible for carbapenem resistance is a cost effective approach. This will helps to select appropriate antibiotics, rational use of antibiotic therapy and reduce the mortality and morbidity.