Original Article

Rapid identification of carbapenemases by CarbAcineto NP test and the rate of beta-lactamases among Acinetobacter baumannii from a teaching hospital

Abstract

Background and Objectives: Acinetobacter baumannii has emerged as a major organism accounting for hospital acquired infections particularly in intensive care units. Due to production of different kinds of beta lactamases these bacteria have developed drug resistance rendering the treatment of such infections very difficult and expensive. Rapid identification of A. baumannii producing such beta-lactamases is the need of the hour in reducing morbidity and mortality associated with A. baumannii infections.
Materials and Methods: A. baumannii was isolated from clinical samples like endotracheal aspirates, sputum, urine, exudates using standard culture techniques. Identification and drug sensitivity was done using Vitek 2 system. All the isolates were subjected to detection of ESBLs using phenotypic confirmatory test, plasmid mediated AmpC beta- lactamase by AmpC disc test, Carbapenemase production by CarbAcineto NP Test and Modified hodge method.
Results: 149 A. baumannii isolates were analysed for antimicrobial susceptibility and various beta-lactamase production. Results were evaluated for statistical significance using Chi-Square and P value. 81.8% of isolates were from male patients with majority of them above 50 years of age. 88.5% of samples were from ventilator associated pneumonia patients. 83.8% of isolates were sensitive to tigecycline. Only 10% to 12% of isolates were sensitive to carbapenems. 23.4% of isolates were ESBL producers and 46.9% of them were AmpC producers. Modified Hodge test method identified 63.7% of A. baumannii as carbapenemase producers where as CarbAcineto NP test identified 63% and exibiting 94.74% sensitivity, 93.22% specificity when compared to Modified Hodge test.
Conclusion: Multidrug resistant Acinetobacter spp. is on the rise. Present study showed that high percentage of drug resistance in A. baumannii could be due to production of ESBLs, AmpC and carbapenemases. Among all beta lactamases carbapenemase producers are more and quickly raising in A. baumannii. Rapid, cost effective assay which can be adopted in all clinical laboratories is critical to prevent their further transmission particularly in hospital environment.

1. Kaur A, Singh S. Prevalence of extended spectrum betalactamase (ESBL) and metallobetalactamase (MBL) producing Pseudomonas aeruginosa and Acinetobacter baumannii isolated from various clinical samples . J Pathog 2018;2018: 6845985.
2. Abdar MH, Taheri-Kalani M, Taheri K, Emadi B, Hasanzadeh A, Sedighi A, et al. Prevalence of extended-spectrum beta-lactamase genes in Acinetobacter baumannii strains isolated from nosocomial infections in Tehran, Iran. GMS Hyg Infect Control 2019;14: Doc02.
3. Zarabadi-Pour M, Peymani A, Habibollah-Pourzereshki N, Sarookhani MR, Karami AA, Javadi A. Detection of extended-spectrum β-Lactamases among Acinetobacter baumannii isolated from hospitals of Qazvin, Iran. Ethiop J Health Sci 2021;31:229-236.
4. Liu Y, Liu X. Detection of AmpC β-lactamases in Acinetobacter baumannii in the Xuzhou region and analysis of drug resistance. Exp Ther Med 2015;10:933-936.
5. Kyriakidis I, Vasileiou E, Pana ZD, Tragiannidis A. Acinetobacter baumannii antibiotic resistance mechanisms. Pathogens 2021;10:373.
6. Gladstone P, Rajendran P, Brahmadathan KN. Incidence of carbapenem resistant nonfermenting gram negative bacilli from patients with respiratory infections in the intensive care units. Indian J Med Microbiol 2005;23:189-191.
7. Hodiwala A, Dhoke R, Urhekar AD. Incidence of metallo-betalactamase producing pseudomonas, acinetobacter & enterobacterial isolates in hospitalised patients. Int J Pharma Bio Sci 2013;3:79-83.
8. Rehman U, Dolma KG, Singh TS. Comparative analysis of various phenotypic methods for the detection of beta-lactamase in Acinetobacter baumannii isolates from a referral hospital in Sikkim, India. IJBAMR 2017;6:226-233.
9. Abouelfetouh A, Torky AS, Aboulmagd E. Phenotypic and genotypic characterization of carbapenem-resistant Acinetobacter baumannii isolates from Egypt. Antimicrob Resist Infect Control 2019;8:185.
10. Lee K, Yong D, Jeong SH, Chong Y. Multidrug-resistant Acinetobacter spp.: increasingly problematic nosocomial pathogens. Yonsei Med J 2011;52:879-891.
11. Richet HM, Mohammed J, McDonald LC, Jarvis WR. Building communication networks: international network for the study and prevention of emerging antimicrobial resistance. Emerg Infect Dis 2001;7:319-322.
12. Lowe M, Ehlers MM, Ismail F, Peirano G, Becker PJ, Pitout JDD, et al. Acinetobacter baumannii: epidemiological and beta-lactamase data from two tertiary academic hospitals in Tshwane, South Africa. Front Microbiol 2018;9:1280.
13. Van TD, Dinh QD, Vu PD, Nguyen TV, Pham CV, Dao TT, et al. Antibiotic susceptibility and molecular epidemiology of Acinetobacter calcoaceticus–baumannii complex strains isolated from a referral hospital in northern Vietnam. J Glob Antimicrob Resist 2014;2:318-321.
14. Soudeiha MH, Dahdouh E, Daoud Z, Sarkis DK. Phenotypic and genotypic detection of β-lactamases in Acinetobacter spp. isolates recovered from Lebanese patients over a 1-year period. J Glob Antimicrob Resist 2018;12:107-112.
15. Batra P, Khurana S, Govindaswamy A, Aravinda A, Bajpai V, Ayyanar M, et al. Antibiotic resistance profile and co-production of extended spectrum beta lactamases and AmpC in Acinetobacter spp. in a level 1 trauma center from India. J Lab Physicians 2019;11:128-132.
16. Khan MFK, Rashid SS, Ramli ANM, Ishmael UC, Maziz MNH. Detection of ESBL and MBL in Acinetobacter spp. and their plasmid profile analysis. Jordan J Biol Sci 2019;12:373-378.
17. Abd El-Baky RM, Farhan SM, Ibrahim RA, Mahran KM, Hetta HF. Antimicrobial resistance pattern and molecular epidemiology of ESBL and MBL producing Acinetobacter baumannii isolated from hospitals in Minia, Egypt. Alexandria J Med 2020;56:4-13.
18. Yadav SK, Bhujel R, Hamal P, Mishra SK, Sharma S, Sherchand JB. Burden of multidrug-resistant Acinetobacter baumannii infection in hospitalized patients in a tertiary care hospital of Nepal. Infect Drug Resist 2020;13:725-732.
19. Hans R, Bisht D, Agarwal R, Irfan M. Phenotypic detection of MBL, Ampc beta-lactamase and carbapenemases in multi drug resistant isolates of Acinetobacter baumannii. Int J Med Res Heal Sci 2015;4:311-316.
20. Moulana Z, Babazadeh A, Eslamdost Z, Shokri M, Ebrahimpour S. Phenotypic and genotypic detection of metallo-beta-lactamases in Carbapenem resistant Acinetobacter baumannii. Caspian J Intern Med 2020;11:171-176.
21. Jiang L, Liang Y, Yao W, Ai J, Wang X, Zhao Z. Molecular epidemiology and genetic characterisation of carbapenem-resistant Acinetobacter baumannii isolates from Guangdong province, South China. J Glob Antimicrob Resist 2019;17:84-89.
22. Lee YT, Huang TW, Liu IF, Kuo SC, Yang YS, Lin PY, et al. The prediction values of carbapenemase detection methods and carbapenem susceptibility testing for clinical outcomes of patients with Acinetobacter bacteremia under carbapenem treatment. J Microbiol Immunol Infect 2022; 55: 257-265.
23. Labeeb AZ, Elbrolosy AM. Comparative study for detection of carbapenemase producers among non-fermenting gram negative uropathogens with special reference to risk factors and fosfomycin susceptibility. J Clin Diagn Res 2019; 13:DC14-DC21.
Files
IssueVol 14 No 2 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v14i2.9184
Keywords
AmpC; Beta-lactamase; Carbapenemase; Extended spectrum beta lactamase
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Rao M, Urs T, Chitharagi V, Shivappa S, Mahale R, Gowda R, Shree K. Rapid identification of carbapenemases by CarbAcineto NP test and the rate of beta-lactamases among Acinetobacter baumannii from a teaching hospital. Iran J Microbiol. 2022;14(2):174-180.