Act Fast as Time Is Less: High Faecal Carriage of Carbapenem-Resistant Enterobacteriaceae in Critical Care Patients

Abstract

Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) are drug-resistant Gram-negative bacteria that are present in the community as well as in hospitals. Their infection and colonisation puts critically ill patients at high risk due to the drug-resistant nature of the strains and possible spreading of these organisms, even in a hospital environment.

Aim: To examine the presence and types of Enterobacteriaceae species in patients admitted directly from the community.

Materials and methods: The present study was a one-month pilot conducted in the ICU of a tertiary care hospital in Mumbai, India in 2015. Faecal samples of patients admitted from the community directly to the ICU were analysed using tests like MHT (Modified Hodge) and EDTA for the presence of IMP (action on Imipenem) and KPC (Klebsiella Test Pneumoniae Carbapenemase) producing strains of Enterobacteriaceae. Polymerase Chain Reaction (PCR) was performed to look for VIM, IMP, NDM1, OXA, and KPC genes. Antibiotic Sensitivity Test was carried out as per CLSI guidelines.

Results: The results showed an alarming level of faecal carriage rates in adult ICU patients. Klebsiella pneumonia was the most common carbapenem-resistant isolate, closely followed by Escherichia coli. PCR results revealed nine strains were positive for bla(KPC) gene, from which 7 were Klebsiella pneumoniae and one each of Escherichia coli and Klebsiella oxytoca was observed. Antibiotic Sensitivity Test results showed that the isolates had maximum sensitivity to Colistin (100%) and Tigecycline (95%).

Conclusion: These levels indicate that in the absence of CRE screenings, proper isolation of carrier patients is not possible, leading to possible spreading of these resistant bacteria strains in ICUs. A longer period of study is required to obtain more substantial data to validate the results of this pilot.

Keywords: EDTA; KPC; MHT; PCR.

[Table/Fig-1]:

CRE Isolates on KPC Agar (a) Klebsiella oxytoca, (b) Enterobacter aerogenes, (c) Escherichia coli and (d) Klebsiella pneumonia.

[Table/Fig-4]:

Positive modified hodge test.

[Table/Fig-6]:

Gel Electrophoresis Pictures of Resistant Genes [“L” is DNA ladder of 100 base pairs] a) KPC gene: 490 bps; b) VIM gene: 390 bps; c) IMP gene: 188 bps and d) NDM gene: 621 bps.