DebBarma Pramurtajyoti, Kokkayil Prathyusha, Sarfraz Asim, Pati Binod Kumar, Thakuria Bhaskar
Department of Microbiology, All India Institute of Medical Sciences, Patna, Patna, India.
Sci Rep. 2025 Aug 26;15(1):31477. doi: 10.1038/s41598-025-04460-z.
Carbapenem-resistant Enterobacterales (CRE) infections pose a global health threat due to limited treatment options. This study aimed to determine the prevalence, phenotypic characteristics, and distribution of CRE classes in Bihar, India. A cross-sectional study was conducted from July 2021 to July 2023. CRE detection involved modified carbapenem inactivation and EDTA-modified carbapenem inactivation methods, coupled with carbapenemase inhibition tests (Combined disc tests) to classify them into various phenotypes. Antibiotic susceptibility patterns and phenotypic class distribution were determined. Statistical analysis was performed using SPSS v.23. Among 3421 Enterobacterales isolates, 32.97% exhibited carbapenem resistance. Inpatients showed higher resistance (47.74%) compared to outpatients (14.48%). Resistance was prominent in respiratory (68.09%) and pus samples (56.99%). Most CRE were Escherichia coli (31.3% in pus, 22.4% in urine). Resistance to third-generation cephalosporins, BL-BLI combinations, and Aztreonam was high. Colistin resistance was observed in one isolate. Class B carbapenemases were predominant (70% in E. coli, 55% in Klebsiella pneumoniae). Co-expression of Class A and Class B carbapenemases was observed in 23% of E. coli and 36.2% of K. pneumoniae isolates. This study reveals a high prevalence of CRE in Bihar, India, with concerning antimicrobial resistance patterns. Class B carbapenemases predominate, warranting the development of effective interventions, including screening, isolation, hand hygiene, and antibiotic stewardship, to combat CRE's spread. Standardized phenotypic tests can guide therapy and infection control, especially in resource-limited settings. Research and development of new antibiotics are urgently needed to address this growing public health concern.
耐碳青霉烯类肠杆菌科细菌（CRE）感染因治疗选择有限而对全球健康构成威胁。本研究旨在确定印度比哈尔邦CRE的流行率、表型特征及类别分布。于2021年7月至2023年7月进行了一项横断面研究。CRE检测采用改良碳青霉烯灭活法和EDTA改良碳青霉烯灭活法，并结合碳青霉烯酶抑制试验（联合纸片试验）将其分为不同表型。确定了抗生素敏感性模式和表型类别分布。使用SPSS v.23进行统计分析。在3421株肠杆菌科细菌分离株中，32.97%表现出对碳青霉烯类耐药。住院患者的耐药率（47.74%）高于门诊患者（14.48%）。呼吸道样本（68.09%）和脓液样本（56.99%）中的耐药情况较为突出。大多数CRE为大肠埃希菌（脓液中占31.3%，尿液中占22.4%）。对第三代头孢菌素、β-内酰胺类-β-内酰胺酶抑制剂合剂及氨曲南的耐药率较高。在一株分离株中观察到对黏菌素耐药。B类碳青霉烯酶占主导（大肠埃希菌中占70%，肺炎克雷伯菌中占55%）。在23%的大肠埃希菌分离株和36.2%的肺炎克雷伯菌分离株中观察到A类和B类碳青霉烯酶的共表达。本研究揭示了印度比哈尔邦CRE的高流行率以及令人担忧的抗菌药物耐药模式。B类碳青霉烯酶占主导地位，因此有必要制定有效的干预措施，包括筛查、隔离、手卫生及抗生素管理，以对抗CRE的传播。标准化的表型试验可指导治疗和感染控制，尤其是在资源有限的环境中。迫切需要研发新抗生素来应对这一日益严重的公共卫生问题。
