Prevalence of multidrug-resistance and bla VIM and bla IMP genes among gram-negative clinical isolates in tertiary care hospital, Kathmandu, Nepal

Mehraj Ansari; Subhas Chandra Aryal; Ganesh Rai; Kul Raj Rai; Susil Pyakurel; Bina Bhandari; Anil Kumar Sah; Shiba Kumar Rai

doi:10.18502/ijm.v13i3.6392

Prevalence of multidrug-resistance and bla _VIM and bla _IMP genes among gram-negative clinical isolates in tertiary care hospital, Kathmandu, Nepal

Iran J Microbiol. 2021 Jun;13(3):303-311. doi: 10.18502/ijm.v13i3.6392.

Authors

Mehraj Ansari¹, Subhas Chandra Aryal², Ganesh Rai¹, Kul Raj Rai¹, Susil Pyakurel¹, Bina Bhandari³, Anil Kumar Sah⁴, Shiba Kumar Rai^{1

5}

Affiliations

¹ Depatment of Microbiology, Shi-Gan International College of Sciences and Technology, Kathmandu, Nepal.
² Depatment of Microbiology, Golden Gate International College, Kathmandu, Nepal.
³ Department of Microbiology, Tribhuvan University, Kathmandu, Nepal.
⁴ Department of Microbiology, Annapurna Research Centre, Kathmandu, Nepal.
⁵ Department of Microbiology, Nepal Medical College, Kathmandu, Nepal.

Abstract

Background and objectives: Carbapenems have been the choice of antibiotics for the treatment of infections caused by multidrug-resistant bacteria. The main objective of this study was to determine the prevalence of carbapenemase (bla _VIM and bla _IMP ) producing isolates among Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii.

Materials and methods: A total of 1,151 clinical samples were collected from the patients visiting Annapurna Neurological Institute and Allied Science and Annapurna Research Centre, Kathmandu, between June 2017 and January 2018. Antibiotic susceptibility testing (AST) was performed on the Enterobacteriaceae, P. aeruginosa and A. baumannii isolates using the Kirby-Bauer disk diffusion method. The modified Hodge test (MHT) was performed on the carbapenem-resistant isolates to confirm carbapenemase production. DNA was extracted and then screened for bla _VIM and bla _IMP genes by multiplex PCR.

Results: Of the total 1,151 clinical samples, 253 (22.0%) showed positive growth. Of them, 226 (89.3%) were identified as Enterobacteriaceae, P. aeruginosa, and A. baumannii. Among the 226 isolates, 106 (46.9%) were multidrug-resistant. Out of the 106, 97 (91.5%) isolates showed resistance to at least one of the carbapenem used. Among the 97 carbapenem-resistant isolates, 67 (69.1%) showed the modified Hodge test (MHT) positive results. bla _VIM and bla _IMP were detected in 40 and 38 isolates respectively using multiplex PCR assay.

Conclusion: This study determined a high prevalence of MDR and carbapenem resistance among Enterobacteriaceae, P. aeruginosa, and A. baumannii as detected by the presence of bla _VIM and bla _IMP genes. This study recommends the use of rapid and advanced diagnostic tools along with conventional phenotypic detection methods in the clinical settings for early detection and management of drug-resistant pathogens to improve treatment strategies.

Keywords: Carbapenemase; Carbapenems; Multidrug resistance; bla IMP; bla VIM.