Intestinal carriage and molecular characteristics of carbapenem resistant Escherichia coli and Klebsiella pneumoniae among patients in intensive care units and outpatients in a tertiary care hospital

Abstract

Intestinal carriage of carbapenem-resistant and (CREK) plays an important role in the epidemiology of carbapenemase producers. Less is known about the carriage of CREK among the outpatients when compared to carriage among patients in Intensive Care Units. (ICU) Therefore the present study was performed to detect colonization of CREK among ICU patients and outpatients of our tertiary care hospital. Rectal swabs from ICU patients and stool specimens from outpatients were collected. Identification and antimicrobial susceptibility were performed using Vitek 2 compact system. Screening for CREK was done by two methods and confirmed for carbapenemase production by mCIM. Carbapenemase genes were detected by multiplex polymerase chain reaction.Overall 460 patients were analyzed for the intestinal carriage of CREK, 230 patients each from ICU and outpatients. 10.4% of outpatients and 26% of ICU patients found positive for CREK carriage. The target genes for carbapenemase production found in 78/86 CREK isolates. The majority of isolates 50/78 (64%) harbored beta-lactamase (bla) NDM gene followed by blaOXA-48 like in 18/78 (23%) isolates and 10/78(12%) isolates had both the genes.Detection of carbapenem-resistant genes in commensal flora of the gut is worrisome. Building proper awareness about the use of antimicrobials in the community and strict surveillance systems to monitor these resistant bacteria in humans, food-producing animals, and the environment could all help to reduce the colonization of CREK among healthy individuals. Implementation of strict infection control measures and prudent use of carbapenems can help to limit the spread of these superbugs in the hospital.