Molecular Characterization of Carbapenemases among Clinical Strains of Enterobacteriaceae at a Tertiary Care Hospital in Rural Uttar Pradesh

Abstract

Introduction: Emergence of Carbapenemase producing Enterobacteriaceae is one of the most important Global Health care concerns. In
recent years Carbapenemase producing Enterobacteriaceae have been implicated in numerous outbreaks. The data regarding
carbapenemase genes associated with carbapenemases production among clinical strains of Enterobacteriaceae in rural Uttar Pradesh is
very limited. Thus, in the present study we aimed to perform Phenotypic and genotypic characterization of carbapenemases among clinical
strains of Enterobacteriaceae at a tertiary care centre in rural Uttar Pradesh
Material & Methods: A total of 695 clinical strains of Enterobacteriaceae comprising of 482 Escherichia coli and 213 Klebsiella
pneumoniae were subjected to antibiotic susceptibility testing for carbapenem by Kirby Bauer disc diffusion method. Phenotypic detection
of carbapenemase activity was performed by Modified Hodge test and Molecular detection of blaNDM, blaKPC & blaVIM genes was
performed by Real Time Multiplex PCR.
Result: A total of 204 (29.35%) Enterobacteriaceae strains showed carbapenem resistance by Kirby Bauer disc diffusion method, 68.14%
(139/204) among them were Escherichia coli whereas 31.86% (65/204) were Klebsiella pneumoniae. Modified Hodge test for
carbapenemase activity was positive in 163/204 (79.90%) strains. The most prevalent gene associated with carbapenemases was found to
be blaNDM (54.90%, 112/204) followed by blaKPC (19.11%, 39/204) and blaVIM (5.88%,12/204).
Conclusion: New Delhi Metallo-β-lactamase was found to be the most prevalent carbapenemases among clinical strains of
Enterobacteriaceae in present study. The findings of present study highlight the urgent need of antimicrobial surveillance to monitor
antimicrobial patterns in rural community in Uttar Pradesh.