Pariyar Manita, Adhikari Sanjib, Regmi Ramesh Sharma, Dhungel Binod, Banjara Megha Raj, Rijal Basista Prasad, Rijal Komal Raj, Ghimire Prakash
Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal.
Manmohan Memorial Teaching Hospital, Kathmandu, Nepal.
Microbiol Insights. 2023 Jan 24;16:11786361221150761. doi: 10.1177/11786361221150761. eCollection 2023.
Over the times, carbapenems have been the choice of drug for treating multidrug-resistant (MDR) and extended spectrum beta-lactamase (ESBL)-producing organisms. The current study aimed at determining the occurrence of metallo beta-lactamase (MBL) and AmpC beta-lactamase (ABL) in gram negative bacteria isolated from clinical samples. A cross-sectional study was conducted amongst the patients visiting Manmohan Memorial Medical College and Teaching Hospital (MMTH), Kathmandu, Nepal from August 2017 to January 2018. A total of 4351 samples including urine, pus, wound swab, endotracheal tip, catheter tip, and blood were collected from the patients and processed by standard conventional microbiological methods. Antibiotic susceptibility testing (AST) of the isolates was performed by Kirby-Bauer disk diffusion method. Double disc synergy test was performed on carbapenem resistant organisms to detect production of MBL and inhibitor-based test was used for the detection of ABL production. Of the 4351 samples, 421 bacterial isolates belonging to 16 different genera were recovered, of which 303 (71.97%) were Gram negative bacilli (GNB). (189/303) and (80/118) were the most prevalent among gram negatives and gram positives, respectively. Bacterial incidence was found significantly associated with gender, specimen type, and the department where the patients were enrolled. Colistin-sulfate and polymycin-B were the most effective drug against GNB, whereas imipenem against gram positives. Prevalence of MDR and methicillin-resistant (MRSA) was 35.15% and 60%, respectively. The prevalence of MBL and ABL-producing isolate was 11(3.6%) and 13(4.3%), respectively. (5/11) and (9/13) were the major MBL and ABL producers, respectively. MBL and ABL production was found to be significantly associated with the age of the patient and the specimen type. A regular antibiotic surveillance activity with screening for MBL and ABL-producing bacterial isolates in the hospital settings to curb the incidence and transmission of such difficult-to-treat pathogens.
长期以来，碳青霉烯类药物一直是治疗多重耐药（MDR）和产超广谱β-内酰胺酶（ESBL）微生物的首选药物。本研究旨在确定从临床样本中分离出的革兰氏阴性菌中金属β-内酰胺酶（MBL）和AmpCβ-内酰胺酶（ABL）的发生率。2017年8月至2018年1月，在尼泊尔加德满都的曼莫汉纪念医学院和教学医院（MMTH）就诊的患者中进行了一项横断面研究。从患者那里共收集了4351份样本，包括尿液、脓液、伤口拭子、气管内吸头、导管尖端和血液，并通过标准的常规微生物学方法进行处理。采用 Kirby-Bauer 纸片扩散法对分离株进行抗生素敏感性试验（AST）。对耐碳青霉烯类微生物进行双纸片协同试验以检测MBL的产生，采用基于抑制剂的试验检测ABL的产生。在4351份样本中，共分离出421株细菌，分属于16个不同的属，其中303株（71.97%）为革兰氏阴性杆菌（GNB）。大肠埃希菌（189/303）和金黄色葡萄球菌（80/118）分别是革兰氏阴性菌和革兰氏阳性菌中最常见的菌种。发现细菌发生率与性别、样本类型以及患者登记所在科室显著相关。硫酸黏菌素和多黏菌素B是针对GNB最有效的药物，而亚胺培南对革兰氏阳性菌有效。MDR和耐甲氧西林金黄色葡萄球菌（MRSA）的患病率分别为35.15%和60%。产MBL和ABL分离株的患病率分别为11株（3.6%）和13株（4.3%）。铜绿假单胞菌（5/11）和大肠埃希菌（9/13）分别是主要的MBL和ABL产生菌。发现MBL和ABL的产生与患者年龄和样本类型显著相关。应在医院环境中定期开展抗生素监测活动，筛查产MBL和ABL的细菌分离株，以遏制此类难治性病原体的发生率和传播。
