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. 2023 Jan 3;22(1):1.
doi: 10.1186/s12941-022-00549-9.

Trends in carbapenem resistance in Pre-COVID and COVID times in a tertiary care hospital in North India

Nirupama Chatterjee  1 , Pushpa K Nirwan #  1 , Shruti Srivastava #  1 , Ruchi Rati  2 , Lalit Sharma  2 , Priyanka Sharma  1 , Priyambada Dwivedi  1 , Namita Jaggi  3
Affiliations

Trends in carbapenem resistance in Pre-COVID and COVID times in a tertiary care hospital in North India

Nirupama Chatterjee et al. Ann Clin Microbiol Antimicrob. .

Abstract

Background: Carbapenem resistance is endemic in the Indian sub-continent. In this study, carbapenem resistance rates and the prevalence of different carbapenemases were determined in Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa during two periods; Pre-COVID (August to October 2019) and COVID (January to February 2021) in a north-Indian tertiary care hospital.

Methods: Details of patient demographics and clinical condition was collated from the Hospital Information System and detection of carbapenemases NDM, OXA-48, VIM, IMP and KPC was done by Polymerase chain reaction (PCR) in 152 and 138 non-consecutive carbapenem resistant isolates during the two study periods respectively. Conjugation assay and sequencing of NDM and OXA-48 gene was done on a few selected isolates.

Results: As compared to Pre-COVID period, co-morbidities and the mortality rates were higher in patients harbouring carbapenem resistant organisms during the COVID period. The overall carbapenem resistance rate for all the four organisms increased from 23 to 41% between the two periods of study; with Pseudomonas aeruginosa and Klebsiella pneumoniae showing significant increase (p < 0.05). OXA-48, NDM and co-expression of NDM and OXA-48 were the most common genotypes detected. NDM-5 and OXA-232 were most common variants of NDM and OXA-48 family respectively during both the study periods.

Conclusion: Higher rate of carbapenem resistance in COVID times could be attributed to increase in number of patients with co-morbidities. However, genetic elements of carbapenem resistance largely remained the same in the two time periods.

Keywords: COVID; Carbapenem resistance; India; NDM; OXA-48 family.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Carbapenem resistance rates in Pre-COVID and COVID times. A Flow chart showing the distribution of organisms of the four species: E. coli, K. pneumoniae, A. baumannii and P. aeruginosa during Pre-COVID and COVID times and their resistance rates. B Carbapenem resistance rates in the four gram negative species under study: E. coli, K. pneumoniae, A. baumannii and P. aeruginosa during Pre-COVID and COVID times. #indicates significant difference (p < 0.05) in resistance rates between the two phases of study (independent t-test). C Distribution of all the isolates (Sensitive and Resistant) of E. coli, K. pneumoniae, A. baumannii and P. aeruginosa in different sample types during Pre-COVID and COVID times. Note: Respiratory samples include bronchoalveolar lavage and Tracheal aspirate. D: Distribution of only resistant isolates of E. coli, K. pneumoniae, A. baumannii and P. aeruginosa in different sample types during Pre-COVID and COVID times. EC: E. coli, KP: K. pneumoniae, AB: A. baumannii, PA: P. aeruginosa, Pre-COVID: August to October 2020; COVID: January to February 2021
Fig. 2
Fig. 2
Frequency and distribution of various carbapenemases in the isolates. A Frequency of the common carbapenemases in the total number of resistant isolates during the two phases of the study. B Organism wise distribution of the common carbapenemases during the two phases of the study. EC: E. coli, KP: K. pneumoniae, AB: A. baumannii, PA: P. aeruginosa, Pre-COVID: August to October 2020; COVID: January to February 2021
Fig. 3
Fig. 3
Plasmid profile of NDM carrying isolates by EcoR1 digestion. Gel picture of EcoR1 restriction digestion pattern of NDM carrying plasmids from the second phase (January to February 2021) of the study. Bands marked by arrows of the same colour indicate similar digestion pattern
See this image and copyright information in PMC

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