Guchhait Partha, Choudhuri Nairita, Chaudhuri Bhaskar Narayan, Datta Tanni, Dawn Arup Kumar, Das Pallab, Dalui Susmriti, Das Satadal
Department of Microbiology and Molecular Biology, Peerless Hospitex Hospital and Research Centre Limited, Kolkata, India.
Department of Microbiology, Vellore Institute of Technology, Vellore, India.
J Med Microbiol. 2025 Jun;74(6). doi: 10.1099/jmm.0.002029.
Antimicrobial resistance (AMR) is an escalating global health crisis, leading to ~700,000 deaths annually. Without significant containment efforts, this number could surge to 10 million by 2050. Carbapenem-resistant organisms, particularly carbapenem-resistant (CRE), , and , present a critical challenge due to their ability to evade potent carbapenem antibiotics. This study aimed to determine the prevalence of CRE among 1,317 culture-positive patients and to assess the impact of advanced diagnostic techniques, such as RT-PCR, modified carbapenem inactivation method (mCIM), EDTA carbapenem inactivation method (eCIM) and Vitek susceptibility testing, on improving diagnostic stewardship and patient outcomes. A retrospective cross-sectional study was conducted at Peerless Hospitex Hospital and Research Centre Limited, Kolkata, from June 2023 to May 2024. CRE isolates were identified from various clinical samples and subjected to phenotypic (Vitek 2, mCIM and eCIM) and genotypic real time polymerase chain reaction (RT-PCR) testing for carbapenemase genes. Data on demographics, specimen types, bacterial isolates, comorbidities, etc. were analysed. Out of 20,129 inpatient samples sent for culture during this 1-year period, 3,124 (15.51%) had culture-proven infections. A total of 1,317 isolates were processed for carbapenem resistance (CR) detection PCR, with 354 (26.88%) identified as CRE. was the predominant isolate (60.17%), followed by (26.55%). New Delhi metallo--lactamase (MBL) (NDM) and OXA-48-like co-production (33.75%) were most commonly seen, followed by NDM gene alone (32.50%). The concordance between phenotypic susceptibility and genotypic PCR method for CRE was 85.88%. Targeted antibiotic therapy could be initiated based on PCR results, in 70.90% of cases. Synergy test guided effective combination therapy of ceftazidime-avibactam and aztreonam for MBL-producing CRE isolates. The study highlights a significant prevalence of CRE, particularly among older adults. Advanced diagnostic techniques improved diagnostic stewardship, allowing timely and accurate detection of CR. However, discrepancies between phenotypic and genotypic methods and the high cost of certain therapies are notable limitations. Enhanced infection control and early initiation of targeted therapy are crucial to combat AMR.
抗菌药物耐药性（AMR）是一场不断升级的全球健康危机，每年导致约70万人死亡。如果不采取重大遏制措施，到2050年，这一数字可能激增至1000万。耐碳青霉烯类微生物，尤其是耐碳青霉烯类肠杆菌科细菌（CRE），由于其能够逃避强效碳青霉烯类抗生素，带来了严峻挑战。本研究旨在确定1317例培养阳性患者中CRE的流行情况，并评估先进诊断技术，如逆转录聚合酶链反应（RT-PCR）、改良碳青霉烯灭活方法（mCIM）、乙二胺四乙酸碳青霉烯灭活方法（eCIM）和Vitek药敏试验，对改善诊断管理和患者预后的影响。2023年6月至2024年5月，在加尔各答的Peerless Hospitex医院及研究中心有限公司进行了一项回顾性横断面研究。从各种临床样本中鉴定出CRE分离株，并对其进行碳青霉烯酶基因的表型（Vitek 2、mCIM和eCIM）和基因型实时聚合酶链反应（RT-PCR）检测。分析了人口统计学、标本类型、细菌分离株、合并症等数据。在这1年期间送检培养的20129份住院患者样本中，3124份（15.51%）有培养证实的感染。共对1317株分离株进行了耐碳青霉烯类（CR）检测PCR，其中354株（26.88%）被鉴定为CRE。肺炎克雷伯菌是主要分离株（60.17%），其次是大肠埃希菌（26.55%）。新德里金属β-内酰胺酶（MBL）（NDM）和OXA-48样共产生（33.75%）最为常见，其次是单独的NDM基因（32.50%）。CRE的表型药敏和基因型PCR方法之间的一致性为85.88%。在70.90%的病例中，可以根据PCR结果启动针对性抗生素治疗。协同试验指导了针对产MBL的CRE分离株的头孢他啶-阿维巴坦和氨曲南的有效联合治疗。该研究突出了CRE的显著流行率，尤其是在老年人中。先进的诊断技术改善了诊断管理，能够及时准确地检测CR。然而，表型和基因型方法之间的差异以及某些治疗的高成本是明显的局限性。加强感染控制和尽早开始针对性治疗对于对抗AMR至关重要。
