Carbapenem resistant Enterobacteriaceae: Detection by modified carbapenem inactivation method (mCIM) and their association with clinical outcome at a teaching hospital in southern India.

Inamdar, Dhanashree P; Inamdar, Padmanabh; Annadani, Rachana; Basavaraju, Anuradha

doi:10.21608/mid.2024.326507.2268

Carbapenem resistant Enterobacteriaceae: Detection by modified carbapenem inactivation method (mCIM) and their association with clinical outcome at a teaching hospital in southern India.

Articles in Press

Document Type : Original Article

Authors

¹ Department of Microbiology, Mamata Medical College and Hospital, Khammam- 507002 Telangana India

² Department of General surgery, Mamata Medical College and Hospital, Khammam- 507002 Telangana India

³ Department of Community medicine, Karwar Institute of Medical Sciences, Karwar, Karnataka, India

10.21608/mid.2024.326507.2268

Abstract

Background: Carbapenemase producing-Carbapenem resistant Enterobacteriaceae (CP-CRE) have become a global threat to healthcare settings. mCIM is one of the standard method to identify them as guided by Clinical laboratory and standards institute. Objectives: To detect CP-CRE from various clinical isolates by the mCIM. To study the antibiogram of these isolates and to identify comorbidities and detect outcomes among the patients harboring them. Methods: This was a prospective observational study carried out for a period of 1 year. Detailed clinical history, demographic factors, previous exposure to antibiotics, comorbidities, and treatment given were recorded from patients with CP-CRE infections and were followed up for outcome. For a single CRE isolate, 1 tube [tryptic soy broth (TSB)] and preinoculated ATCC E. coli were needed for Carbapenemase detection. Following 4 hours of incubation, MRP discs were removed, placed on a preinoculated plate, and further incubated at 35±2oC for 18–24 hrs. Inhibition zones were measured after 22-28 hours for Carbapenemase production. Results: 90 CP-CRE isolates were detected from 87 patients’ samples. Most isolates were from urine samples (51.7%), followed by wound swabs (21.8%), and pus aspirates (11.5%). Few patients had a previous history of antibiotic exposure. Nitrofurantoin, Fosfomycin, and gentamicin sensitivity were noted in these CP-CREs. Comorbidities were present in 27.5% of patients. While most patients recovered (82.7%), death was seen in 3.4% of cases. Conclusion: mCIM could detect the Carbapenemase produced by CRE isolates with ease. A favorable outcome was seen in most patients with CP-CRE infections from sites other than bloodstream.

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