Alarming emergence, molecular characterization, and outcome of NDM-1 in patients infected with multidrug-resistant Gram-negative bacilli in a tertiary care hospital.

INTRODUCTION

This study was conducted to assess the prevalence of metallo-beta-lactamases (MBLs) in general and NDM-1 in particular. It also aimed at evaluating clinical characteristics and outcome in patients infected with MBLs.

MATERIALS AND METHODS

A total of 116 carbapenem-resistant Gram-negative bacilli (CRGNB) were evaluated in the study. These CRGNB were tested for MBL production both phenotypically for MBLs and genotypically for NDM-1 gene by polymerase chain reaction (PCR). Representative stains of NDM-1 isolates were further sequenced by Triyat Scientific Co., (Nagpur, India).

RESULTS

Among 116 CRGNB species 28 (24.13%) was the most common pathogen. Phenotypically, MHT, imipenem-EDTA (IPM-EDTA) double-disk synergy test and IPM-EDTA combined disk synergy test (CDST) detected MBL production in 105 (90.51%), 96 (81.03%), and 87 (75%) CRGNB, respectively. However, NDM-1 genes were detected in 66 (56.89%) isolates. The prevalence of NDM-1 gene was highest among 26 (100%). Considering PCR as gold standard, it was observed that IMP-EDTA CDST was most specific (78.38%) while MHT was most sensitive (97.47%). Results of NDM-1 gene by PCR were further confirmed by sequencing (Triyat genomics, Nagpur). All the 11 representative strains were confirmed to be an NDM-1 gene. The presence of MBLs in our group of patients (non-Intensive Care Unit patients) is a cause for concern. However, on tracing their outcome, it was interesting to note that while the duration of stay lengthened in a large number of patients 112 (96.5%), mortality was relatively low 5 (4.31%).

CONCLUSION

The results of this study provide insight into the prevalence of MBLs, including NDM-1, in a tertiary care hospital. Antibiotic stewardship implemented in all seriousness may to a great extent stave off the impending pan-drug resistance. The surprising outcome of our patients suggests either that the bacteria trade off virulence for drug resistance or the relatively robust immune response of non ICU patients fights back.