Thapa Pratigya, Bhandari Dinesh, Shrestha Dhiraj, Parajuli Hiramani, Chaudhary Prakash, Amatya Jyoti, Amatya Ritu
Department of Microbiology, Trichandra Multiple College, Ghantaghar, Kathmandu, Nepal.
Public Health Research Laboratory, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
BMC Res Notes. 2017 Jul 25;10(1):322. doi: 10.1186/s13104-017-2640-7.
A rising threat of the rapid spread of acquired metallo-beta-lactamases (MBLs) among major Gram-negative pathogens is a matter of public health concern worldwide. Hence, for a low income nation like Nepal, surveillance data on MBL producing clinical isolates via a cost effective technique is necessary to prevent their dissemination as well as formulation and regulation of antimicrobial stewardship policy.
The prospective study was conducted at Nepal Medical College, Kathmandu from May to October, 2014 to assess the prevalence of MBL production among ceftazidime-resistant Gram-negative rods (GNRs) isolates. The samples were processed according to standard microbiological procedure following the Manual of clinical Microbiology. Isolated GNRs were subjected to susceptibility testing against the selected panel of antibiotics by Kirby- Bauer disc diffusion method and interpretation made in conformity with the Clinical and Laboratory Standards Institute (CLSI) guidelines. Ceftazidime-resistant isolates were subjected to the detection of MBL production by imipenem-EDTA combined disc (CD) method.
Among the Gram-negative isolates, 5.80% (21/362) were found to be MBL positive with Acinetobacter spp. showing the highest prevalence i.e. 85.71% (18/21), followed by P. aeruginosa i.e. 14.29% (3/21). None of the other cefazidime resistant gram negative bacteria tested were found to be positive for MBL production with all the positive isolates determined to be Multidrug resistant (MDR) strains.
This study demonstrated a higher rate of resistance among P. aeruginosa and Acinetobacter spp. to a wide variety of antibiotic categories with an additional burden of MBL production within them, warranting a need for strict surveillance and rapid detection of MBL production among the GNRs.
获得性金属β-内酰胺酶（MBLs）在主要革兰氏阴性病原体中迅速传播的威胁日益增加，这是一个全球公共卫生关注的问题。因此，对于像尼泊尔这样的低收入国家，通过具有成本效益的技术获取关于产MBL临床分离株的监测数据，对于防止其传播以及制定和规范抗菌药物管理政策是必要的。
2014年5月至10月在加德满都的尼泊尔医学院进行了一项前瞻性研究，以评估耐头孢他啶革兰氏阴性杆菌（GNRs）分离株中产MBL的流行情况。样本按照《临床微生物学手册》中的标准微生物学程序进行处理。分离出的GNRs通过 Kirby-Bauer 纸片扩散法对选定的一组抗生素进行药敏试验，并按照临床和实验室标准协会（CLSI）指南进行解读。对耐头孢他啶的分离株通过亚胺培南-EDTA 联合纸片（CD）法检测MBL的产生。
在革兰氏阴性分离株中，5.80%（21/362）被发现MBL呈阳性，其中不动杆菌属的患病率最高，即85.71%（18/21），其次是铜绿假单胞菌，为14.29%（3/21）。测试的其他耐头孢唑林革兰氏阴性菌均未发现MBL产生呈阳性，所有阳性分离株均被确定为多重耐药（MDR）菌株。
本研究表明铜绿假单胞菌和不动杆菌属对多种抗生素类别的耐药率较高，且其中存在MBL产生的额外负担，因此有必要对GNRs中的MBL产生进行严格监测和快速检测。
