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  Table of Contents  
CORRESPONDENCE
Year : 2014  |  Volume : 32  |  Issue : 4  |  Page : 455-456
 

High prevalence of New Delhi metallo-β-lactamase in Acinetobacter calcoaceticus-A. baumannii complex at two tertiary care centres in north India


1 Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
2 Department of Microbiology, Government Medical College and Hospital, Chandigarh, Punjab, India

Date of Submission11-Jul-2013
Date of Acceptance15-Feb-2014
Date of Web Publication4-Oct-2014

Correspondence Address:
P Ray
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.142231

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How to cite this article:
Gautam V, Mewara A, Raj A, Gupta V, Singla N, Ray P. High prevalence of New Delhi metallo-β-lactamase in Acinetobacter calcoaceticus-A. baumannii complex at two tertiary care centres in north India . Indian J Med Microbiol 2014;32:455-6

How to cite this URL:
Gautam V, Mewara A, Raj A, Gupta V, Singla N, Ray P. High prevalence of New Delhi metallo-β-lactamase in Acinetobacter calcoaceticus-A. baumannii complex at two tertiary care centres in north India . Indian J Med Microbiol [serial online] 2014 [cited 2019 Sep 23];32:455-6. Available from: http://www.ijmm.org/text.asp?2014/32/4/455/142231


Dear Editor,

New Delhi metallo-β-lactamase (NDM) mediated carbapenem resistance has rapidly disseminated across the globe. [1] We evaluated presence of NDM in Acinetobacter calcoaceticus-A. baumannii complex (Acinetobacter CBC) at two tertiary care centres, Postgraduate Institute of Medical Education and Research (PGIMER) and Government Medical College and Hospital (GMCH), Chandigarh, in north India. The study was approved by the institutional ethics committee of PGIMER. One hundred and seventeen (117) consecutive clinical isolates of Acinetobacter CBC, 99 (84.6%) from respiratory and 18 (15.4%) from blood specimens, with reduced susceptibility to imipenem (10 μg) and/or meropenem (10 μg) by Kirby-Bauer disc diffusion method, were evaluated for presence of carbapenemases by modified Hodge test (MHT). [2] Positive (Klebsiella pneumoniae ATCC BAA-1705) and negative (K. pneumoniae ATCC BAA-1706) controls were put with each test. The isolates were subjected to polymerase chain reaction (PCR) for blaNDM gene and blaNDM-1 variant. [3],[4] In all reactions, blaNDMand blaNDM-1 positive K. pneumoniae was used as positive control and PCR grade water as negative control. Twelve representative NDM positive isolates from medical  intensive care unit (ICU) (n = 3), neurosurgery ICU (n = 2), respiratory ICU (n = 1), cardio-throracic vascular surgery ICU (n = 1), emergency medical wards and out-patient departments (OPDs) (n = 5) of PGIMER were subjected to repetitive extragenic palindromic (REP)-PCR typing. [5]

Of the 117 isolates, 66.1% (77/117) were from ICUs, 14.7% (17/117) from general wards and 19.3% (23/117) from emergency OPDs and wards. Among these isolates, 31% (36/117) were positive by MHT, and on PCR, 27% (32/117) were positive for NDM gene and 6.8% (8/117) for NDM-1. Among ICU isolates 25% (19/77) were positive for NDM, whereas 12.5% (2/17) isolates from wards and 52.4% (12/23) isolates from emergency OPDs and wards were positive for NDM. Two distinct banding patterns were obtained by REP-PCR [Figure 1]. The first profile was obtained from three patient isolates from three different ICUs. All three had different resistotypes and one was NDM-1 positive. The second profile was obtained from nine patient isolates from three different ICUs, and emergency wards and OPDs. These nine isolates had two resistotypes and two were NDM-1 positive.
Figure 1: REP-PCR typing of NDM positive Acinetobacter CBC isolates showing presence of two distinct patterns among the circulating strains. Distribution of isolates: Lanes 1,2,3 - medical ICU; Lanes 4, 5 - neurosurgery ICU; Lane 6, respiratory ICU; Lane 7 - cardio-throracic vascular surgery ICU; Lanes 8, 9, 10, 11, 12 - emergency medical wards and OPDs. Lane 13 - no DNA control; M1 - 50 bp DNA ladder; M2 - 1 kb ladder

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We observed a hospital-wide distribution of NDM positive isolates. A higher percentage of isolates carrying NDM in emergency wards and OPDs (52.5%) than in ICUs (25%) was noted, however, this finding cannot be statistically substantiated as there were more number of isolates from ICUs (66.1%) than emergency OPDs and wards (19.3%), and also as the number of isolates was small. NDM-1 was found in only 6.8% of these isolates suggesting a possibility of genetic variation in these isolates of Acinetobacter CBC. Two distinct REP-PCR profiles were obtained, which differed in location of the patients, resistotypes, as well as NDM-1 positivity of the isolates, suggesting presence of different lineages of NDM positive MDR Acinetobacter CBC strains.

There is an immense public health importance of antibiotic resistance, which transcends national borders. [1] The clock is ticking and the time is not too far when there will be no drug available to treat serious infections, lest we enhance our infection control practices and implement the use of strong antibiotic policies urgently.


 ~ Acknowledgement Top


The authors are thankful to Dr Camilla Rodrigues, Department of Microbiology, Research Laboratories, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, for providing us blaNDMand blaNDM-1 positive K. pneumoniae strain.

 
 ~ References Top

1.Johnson AP, Woodford N. Global spread of antibiotic resistance: The example of New Delhi metallo-β-lactamase (NDM)-mediated carbapenem resistance. J Med Microbiol 2013;62:499-513.  Back to cited text no. 1
    
2.Carvalhaes CG, Picao RC, Nicoletti AG, Xavier DE, Gales AC. Cloverleaf test (modified Hodge test) for detecting carbapenemase production in Klebsiella pneumoniae: Be aware of false positive results. J Antimicrob Chemother 2010;65:249-51.  Back to cited text no. 2
    
3.Deshpande P, Rodrigues C, Shetty A, Kapadia F, Hedge A, Soman R. New Delhi Metallo-beta lactamase (NDM-1) in Enterobacteriaceae: Treatment options with carbapenems compromised. J Assoc Physicians India 2010;58:147-9.  Back to cited text no. 3
    
4.Kaase M, Nordmann P, Wichelhaus TA, Gatermann SG, Bonnin RA, Poirel L. NDM-2 carbapenemase in Acinetobacter baumannii from Egypt. J Antimicrob Chemother 2011;66:1260-2.  Back to cited text no. 4
    
5.Misbah S, AbuBakar S, Hassan H, Hanifah YA, Yusof MY. Antibiotic susceptibility and REP-PCR fingerprints of Acinetobacter spp. isolated from a hospital ten years apart. J Hosp Infect 2004;58:254-61.  Back to cited text no. 5
    


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