Saseedharan Sanjith, Sahu Manisa, Pathrose Edwin Joseph, Shivdas Sarita
Head, Department of Critical Care, S.L. Raheja Hospital (A Fortis Associate) , Mumbai, Maharashtra, India .
Head, Department of Microbiology, S.L. Raheja Hospital (A Fortis Associate) , Mumbai, Maharashtra, India .
J Clin Diagn Res. 2016 Sep;10(9):DC01-DC05. doi: 10.7860/JCDR/2016/17638.8400. Epub 2016 Sep 1.
Carbapenem-resistant (CRE) are drug-resistant Gram-negative bacteria that are present in the community as well as in hospitals. Their infection and colonisation puts critically ill patients at high risk due to the drug-resistant nature of the strains and possible spreading of these organisms, even in a hospital environment.
To examine the presence and types of species in patients admitted directly from the community.
The present study was a one-month pilot conducted in the ICU of a tertiary care hospital in Mumbai, India in 2015. Faecal samples of patients admitted from the community directly to the ICU were analysed using tests like MHT (Modified Hodge) and EDTA for the presence of IMP (action on Imipenem) and KPC ( Test Pneumoniae Carbapenemase) producing strains of . Polymerase Chain Reaction (PCR) was performed to look for , , 1, , and KPC genes. Antibiotic Sensitivity Test was carried out as per CLSI guidelines.
The results showed an alarming level of faecal carriage rates in adult ICU patients. was the most common carbapenem-resistant isolate, closely followed by . PCR results revealed nine strains were positive for (KPC) gene, from which 7 were and one each of and was observed. Antibiotic Sensitivity Test results showed that the isolates had maximum sensitivity to Colistin (100%) and Tigecycline (95%).
These levels indicate that in the absence of CRE screenings, proper isolation of carrier patients is not possible, leading to possible spreading of these resistant bacteria strains in ICUs. A longer period of study is required to obtain more substantial data to validate the results of this pilot.
耐碳青霉烯类肠杆菌科细菌（CRE）是存在于社区及医院中的耐药革兰氏阴性菌。由于这些菌株的耐药性以及这些微生物可能的传播，即使在医院环境中，其感染和定植也会使重症患者面临高风险。
检查直接来自社区的患者中CRE的存在情况及种类。
本研究于2015年在印度孟买一家三级护理医院的重症监护病房进行了为期一个月的试点研究。对直接从社区入住重症监护病房的患者的粪便样本进行分析，使用改良 Hodge试验（MHT）和乙二胺四乙酸（EDTA）检测产IMP（对亚胺培南的作用）和KPC（肺炎克雷伯菌碳青霉烯酶检测）的CRE菌株。进行聚合酶链反应（PCR）以寻找NDM、VIM、OXA-48、IMP和KPC基因。按照美国临床和实验室标准协会（CLSI）指南进行抗生素敏感性试验。
结果显示成人重症监护病房患者的粪便携带率达到令人担忧的水平。肺炎克雷伯菌是最常见的耐碳青霉烯类分离株，其次是大肠埃希菌。PCR结果显示有9株KPC基因呈阳性，其中7株为肺炎克雷伯菌，大肠埃希菌和阴沟肠杆菌各1株。抗生素敏感性试验结果表明，分离株对黏菌素（100%）和替加环素（95%）的敏感性最高。
这些水平表明，在没有进行CRE筛查的情况下，无法对携带患者进行适当隔离，从而导致这些耐药菌株可能在重症监护病房中传播。需要更长时间的研究以获得更充分的数据来验证本试点研究的结果。
