Abstract
PREVALENCE OF K.PNEUMONIAE CARBAPENEMASE (KPC) AND METALLOBETALACTAMASE (MBL) IN URINARY ISOLATES OF KLEBSIELLA SPECIES IN A TERTIARY HEALTH CARE FACILITY IN NORTHERN INDIA

Dr. Shalley Dahiya*, Dr. Bijender Singh, Dr. Pooja Singla, Dr. Uma Chaudhary

ABSTRACT

Introduction: Klebsiella spp. is an important nosocomial pathogen of urinary tract infections. The treatment options are narrowing down because of multidrug resistance (MDR) nature of this organism due to the production of the versatile genetically mobile metallo-beta-lactamases (MBLs) and Klebsiella pneumoniae carbapenemases (KPC). Carbapenems are the mainstay of these MDR isolates but in recent times increasing resistance to carbapenems is being reported. This calls for an accurate drug susceptibility testing so that effective therapeutic interventions can be done. Objectives: To study the prevalence of carbapenem resistance and detection of KPC and MBL in urinary isolates of Klebsiella spp. in our hospital. Materials and methods: A total of 186 isolates from urine samples from various OPDs and wards of PGIMS Rohtak during the period of July 2012 to June 2013 were included in the study. All the isolates were identified according to standard Microbiological procedures and antimicrobial susceptibility testing was done by Kirby-Bauer’s disc diffusion method as per Clinical Laboratory Standard Institute (CLSI) criteria. The isolates that were resistant to Ertapenem/Imipenem were screened for MBL production by Imipenem+EDTA and KPC production by Meropenem+Boronic acid and modified Hodge test respectively. Results: Out of 186 isolates of Klebsiella spp., 28 isolates (26 K.pneumoniae, 2 K.oxytoca) were resistant to carbapenem. Ten isolates were positive for MBL production and none of the isolates was KPC producer. Conclusion: The frequent use of carbapenems has led to an increase in MDR isolates resulting in limited therapeutic options. It is therefore mandatory to detect the MBL and KPC producers by simple and cost constraint methods for planning and implementing effective infection control measures.

Keywords: Klebsiella, metallo beta lactamases, modified Hodge test, Klebsiella pneumoniae carbapenemases, multidrug resistance.


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