ANTIMICROBIAL RESISTANCE PATTERNS AND CARBAPENEM RESISTANCE CHARACTERIZATION AMONG ENTEROBACTERIACEAE ISOLATED FROM CLINICAL SAMPLES IN A TERTIARY CARE HOSPITAL
Main Article Content
Keywords
Enterobacteriaceae, antimicrobial resistance, carbapenem resistance, CRE, MDR, AST
Abstract
Enterobacteriaceae are leading pathogens responsible for a broad spectrum of infections ranging from urinary tract infections to septicemia. The rapid proliferation of antimicrobial resistance (AMR), especially carbapenem-resistant Enterobacteriaceae (CRE), poses a major global health threat, limiting therapeutic choices and increasing morbidity and mortality.
Aim and Objective: This study aimed to determine the antimicrobial resistance patterns of Enterobacteriaceae isolated from diverse clinical specimens and to characterize carbapenem resistance mechanisms using phenotypic and molecular tools.
Material and Methods: A cross-sectional study was conducted in the Microbiology laboratory of a tertiary care hospital. Clinical specimens including urine, pus, blood, respiratory samples, and sterile body fluids were processed using standard microbiological procedures. Enterobacteriaceae isolates were identified through biochemical tests and/or automated systems. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method as per CLSI guidelines. Carbapenem resistance was screened using meropenem and imipenem discs, followed by confirmation via Modified Hodge Test (MHT), Carba NP, mCIM/eCIM.
Results: The present study concludes that Carbapenem resistance is mainly due to production of Carbapenamases. Out of all the samples received in our laboratory,Urine (38.94%) was the most common of all.It was noted that the most common organism isolated was Escherichia coli (50.16%), whereas the most common organism isolated in urine was E.coli (54.60%) and in pus was Klebsiella (43.37%).The male: female ratio observed in present study was 1:1 with the most common age group with isolation of Enterobacteriaceae was between 41-60 years (31.48%). Out of all the samples isolated with Enterobacteriaceae members, highest were from the Department of Surgery. Klebsiella (28.23%) was found to be more carbapenem resistant than E.coli (12.23%). The antibiotics in general that were sensitive to family Enterobacteriaceae were Imipenem, Gentamicin and Nitrofurantoin.60% of the total carbapenem resistant isolates were positive for Modified Hodge test indicating the resistance owing to production of Carbapenemase.
Conclusion: The study demonstrates a high prevalence of multidrug resistance and significant carbapenem resistance among Enterobacteriaceae in the tertiary care hospital setting. The predominance of NDM and OXA-48 carbapenemases is concerning and underscores the urgent need for molecular surveillance, robust infection-control strategies, and strict antibiotic stewardship to curb resistance dissemination. The findings have major implications for empirical therapy and public health planning.
References
2. Nordmann P, Naas T, Poirel L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis. 2011;17(10):1791–8.
3. World Health Organization. Global priority list of antibiotic-resistant bacteria. Geneva: WHO; 2017.
4. Paterson DL, Bonomo RA. Extended-spectrum β-lactamases: A clinical update. Clin Microbiol Rev. 2005;18(4):657–86.
5. Shaikh S, Fatima J, Shakil S, Rizvi SMA, Kamal MA. Antibiotic resistance and Extended-Spectrum Beta-Lactamases: Types, epidemiology and treatment. Saudi J Biol Sci. 2015;22(1):90–101.
6. Gupta V, Singla N, Chander J. Prevalence of ESBL-producing Enterobacteriaceae in a tertiary care hospital in North India. J Clin Diagn Res. 2013;7(12):2602–4.
7. Mehta Y, Jaggi N, Rosenthal VD, et al. Device-associated infection rates in ICUs of India: INICC findings. J Hosp Infect. 2016;94(3):292–9.
8. Tankhiwale SS, Jalgaonkar SV, Ahamad S, Hassani U. Evaluation of ESBL and AmpC β-lactamases in Enterobacteriaceae. Indian J Med Microbiol. 2004;22(3):129–31.
9. Queenan AM, Bush K. Carbapenemases: The versatile β-lactamases. Clin Microbiol Rev. 2007;20(3):440–58.
10. CDC. Antibiotic Resistance Threats in the United States. Atlanta: Centers for Disease Control and Prevention; 2019.
11. Meletis G. Carbapenem resistance: Overview of the problem. Ther Adv Infect Dis. 2016;3(1):15–21.
12. Dortet L, Poirel L, Nordmann P. Worldwide dissemination of NDM-type metallo-β-lactamases. Antimicrob Agents Chemother. 2014;58(2):657–65.
13. Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: NDM-1. Lancet Infect Dis. 2010;10(9):597–602.
14. Johnson AP, Woodford N. Global spread of CTX-M extended-spectrum β-lactamases. Crit Care. 2013;17(2 Suppl 1):P4.
15. Wailan AM, Paterson DL. The spread and evolution of OXA-48 carbapenemases. Clin Microbiol Infect. 2014;20(9):824–30.
16. Pierce VM, Simner PJ, Lonsway DR, et al. Modified carbapenem inactivation method (mCIM) for phenotypic detection of carbapenemase. J Clin Microbiol. 2017;55(8):2321–33.
17. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. CLSI supplement M100. 33rd ed. Clinical and Laboratory Standards Institute; 2023.
18. Datta S, Wattal C, Goel N, et al. A ten-year analysis of carbapenem resistance in Enterobacteriaceae. Indian J Med Res. 2012;135:218–22.
19. Pragasam AK, Veeraraghavan B, Bakthavatchalam YD, et al. Molecular characterization of carbapenem-resistant Enterobacteriaceae in India. Indian J Med Microbiol. 2017;35(3):421–5.
20. Van Duin D, Doi Y. The global epidemiology of carbapenem-resistant Enterobacteriaceae. Virulence. 2017;8(4):460–9.
21. Wyres KL, Holt KE. Klebsiella pneumoniae as a key trafficker of clinically relevant antibiotic resistance genes. Curr Opin Microbiol. 2018;45:131–9.
22. Tamma PD, Aitken SL, Bonomo RA, et al. IDSA guidance on treatment of antimicrobial-resistant Gram-negative infections. Clin Infect Dis. 2021;72(7):1109–16.
23. Zhang Y, Wang Q, Yin Y, et al. Epidemiology of carbapenem-resistant Enterobacteriaceae infections: A systematic review. Clin Microbiol Infect. 2020;26(1):12–20.
24. Papp-Wallace KM, Endimiani A, Taracila MA, Bonomo RA. Carbapenems: Past, present, and future. Antimicrob Agents Chemother. 2011;55(11):4943–60.
25. Rossolini GM, Arena F, Pecile P, Pollini S. Update on the antibiotic resistance crisis: Bacteria versus antibiotics. Microbe Infect. 2014;16(6):407–15.
26. Prakash S. Carbapenem sensitivity profile amongst bacterial isolates from clinical specimens in Kanpur city. Indian J crit care med. 2006 Oct 1;10(4):250-53.
27. Gunjal SP, Gunjal PN, Vanaparthi N, Sudheer K. Carbapenem resistance profile amongst Escherichia coli and Klebsiella pneumoniae in a tertiary care hospital in Ahmednagar, Maharashtra. International Journal of Med.
28. Alexander VS, Oberoi A, Kumar A. Comparative activity of doripenem, imipenem and meropenem against gram negative pathogens a preliminary study. Journal of Evolution, Medical andDental Sciences. 2016 Jun 2;5(44)27
29. Patil A, Patil K, Pawar P, Maheshwari V. Isolation and survey of antibiotic sensitivity in nosocomial infections in North Maharashtra Region. Journal of the Association of Physicians of India. 2013 Jul 1;61:454-8.
30. Mulla S, Charan J, Panvala T. Antibiotic sensitivity of Enterobacteriaceae at a tertiary care center in India. Chronicles of Young Scientists. 2011 Oct 1;2(4).
31. Dahab RA, Ibrahim AM, Altayb HN. Phenotypic and genotypic detection of carbapenemase enzymes producing gram-negative bacilli isolated from patients in Khartoum State. F1000Research. 2017 Sep 7;6(1656):1656.
32. Abrar S, Ain NU, Liaqat H, Hussain S, Rasheed F, Riaz S. Distribution of bla CTX− M, bla TEM, bla SHV and bla OXA genes in Extended-spectrum-β-lactamase-producing Clinical isolates: A three-year multi-center study from Lahore, Pakistan. Antimicrobial Resistance & Infection Control. 2019 Dec;8(1):1-0.
33. Thomas N, Sarwat T. Prevalence of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital. Int. J. Curr. Microbiol. App. Sci. 2019;8(11):1418-24.
34. Kalra DK, Singh SP, Sahni AK, Grover N, Kumar M, Kalra D. Utility of phenotypic methods in detection of metallo-beta-lactamases in gram-negative bacteria. Journal of Marine Medical Society. 2020 Jan 1;22(1):18.
35. Thomas N, Sarwat T. Prevalence of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital. Int. J. Curr. Microbiol. App. Sci. 2019;8(11):1418-24.
36. Datta S, Dey R, Dey JB, Ghosh S. A comparative study of modified Hodge test and Carba NP test for detecting carbapenemase production in Gram-negative bacteria. Medical Journal of Dr. DY Patil University. 2017 Jul 1;10(4):365.
37. Gupta V, Ye G, Olesky M, Lawrence K, Murray J, Yu K. Trends in resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States 2013–2017. BMC infectious diseases. 2019 Dec;19(
38. Nair PK, Vaz MS. Prevalence of carbapenem resistant Enterobacteriaceae from a tertiary care hospital in Mumbai, India. Journal of Microbiology and Infectious Diseases. 2013 Dec 1;3(04):207-10.
39. Oduyebo OO, Falayi OM, Oshun P, Ettu AO. Phenotypic determination of carbapenemase producing enterobacteriaceae isolates from clinical specimens at a tertiary hospital in Lagos, Nigeria. Nigerian Postgraduate Medical Journal. 2015 Oct 1;22(4):223.
40. Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, Chaudhary U, Doumith M, Giske CG, Irfan S, Krishnan P. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. The Lancet infectious diseases. 2010 Sep 1;10(9):597-602.
41. Hodiwala A, Dhoke R, Urhekar AD. Incidence of metallo-betalactamase producing pseudomonas, acinetobacter & enterobacterial isolates in hospitalised patients. Int J Pharamcy Biol Sci. 2013;3(1):79-83.
42. Datta P, Thakur A, Mishra B, Gupta V. Prevalence of clinical strains resistant to various beta-lactams in a tertiary care hospital in India. Japanese journal of infectious diseases. 2004 Aug 1;57(4):146-9.
43. Pawar SK, Mohite ST, Shinde RV, Patil SR, Karande GS. Carbapenem–resistant Enterobacteriaceae: Prevalence and bacteriological profile in a tertiary teaching hospital from rural western India. Indian J Microbiol Res. 2018 Sep 15;5(3):342-7.
44. Ramana KV, Rao R, Sharada CV, Kareem MA, Reddy LR, Mani MR. Modified Hodge test: a useful and the low-cost phenotypic method for detection of carbapenemase producers in Enterobacteriaceae members. Journal of natural science, biology, and medicine. 2013 Jul;4(2):346.
45. Wattal C, Goel N, Oberoi JK, Raveendran R, Datta S, Prasad KJ. Surveillance of multidrug resistant organisms in tertiary care hospital in Delhi, India. J Assoc Physicians India. 2010 Dec 1;58(Suppl):32-6.
46. Hrabák J, Walková R, Študentová V, Chudáčková E, Bergerová T. Carbapenemase activity detection by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Journal of clinical microbiology. 2011 Sep 1;49(9):3222-7.
47. Joyanta Karmakar et al. Molecular Characterization and Antimicrobial Resistance Patterns of Multidrug-Resistant Gram-Negative Bacilli Isolated from ICU Patients in A Tertiary Centre. European Journal of Cardiovascular medicine. Research Article | Volume 15 Issue 10 (October, 2025) | Pages 441 - 446
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Dr. Surbhi Nayyar
Assistant Professor1*, Department of Microbiology, GGSMCH, Faridkot ,Punjab, India.
Dr. Vanita Ashok Kulkarni
Professor & Head (Retd.)2, Department of Microbiology, GMC Miraj, Maharashtra, India.
Dr. Supriya Arun Gaikwad
Assistant Professor3, Department of Microbiology, GMC Parbani, Maharashtra, India.
Dr. Tarun Gupta
Assistant Professor4, Department of Paediatric Surgery, GGSMCH, Faridkot ,Punjab, India
Dr. Komal Kailashchandra Biyani
Assistant Professor5, Department of Microbiology, D.Y. Patil Medical College, Pune, Maharashtra, India
