Prevalence of faecal carriage of Enterobacteriaceae with NDM-1 carbapenemase at military hospitals in Pakistan, and evaluation of two chromogenic media
Prevalence of faecal carriage of Enterobacteriaceae with NDM-1 carbapenemase at military hospitals in Pakistan, and evaluation of two chromogenic media
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DOI：
10.1093/jac/dkr299
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发表时间：
2011-10-01
影响因子：
5.2
通讯作者：
Raza, Muhammad W.
中科院分区：
文献类型：
--
作者：
Perry, John D.;Naqvi, Sakeenah Hussain;Raza, Muhammad W.
目的：确定巴基斯坦拉瓦尔品第两所军事医院住院患者和门诊患者中产碳青霉烯酶肠杆菌科细菌的流行率和抗菌药物敏感性，并比较两种显色培养基分离这些微生物的性能。方法：将 200 名不同患者的粪便样本在麦康凯琼脂上培养，随后在两种培养基上培养。 显色培养基 - Colorex KPC 和原型显色培养基 ID Carba - 设计用于分离产生碳青霉烯酶的肠杆菌科细菌。通过表型和分子方法研究在任一显色培养基上生长的所有革兰氏阴性分离株的碳青霉烯酶。生产者通过 VITEK 2 或琼脂稀释液对 40 种抗菌药物进行了药敏测试。结果：从 37 个（18.5%）粪便样本中总共回收了 64 个 NDM-1 阳性肠杆菌科菌株，属于 7 个不同的物种。没有确认其他碳青霉烯酶类型。 70 例住院患者中有 19 例呈阳性（患病率 27.1%），130 例门诊患者中有 18 例呈阳性（患病率 13.8%）。 ID Carba 上回收了 56 个含有 NDM-1 酶的分离株 (87.5%)，而 Colorex KPC 上回收了 41 个分离株 (64.1%) (P=0.012)。多重耐药现象普遍存在，但未发现泛耐药菌株，大多数菌株在体外对粘菌素（97%）、美西林（95%）、磷霉素（94%）、替加环素（89%）和呋喃妥因（78%）敏感。结论：本研究表明多重耐药菌株的患病率很高 拉瓦尔品第具有 NDM-1 酶的肠杆菌科。新的显色培养基 ID Carba 比 Colorex KPC 更敏感，并且有潜力作为分离含有 NDM-1 酶的肠杆菌科细菌的筛选培养基。
Objectives: To determine the prevalence and antimicrobial susceptibility of carbapenemase-producing Enterobacteriaceae among hospitalized patients and outpatients attending two military hospitals in Rawalpindi, Pakistan, and to compare the performance of two chromogenic culture media for the isolation of these organisms.Methods: Stool samples from 200 distinct patients were cultured on MacConkey agar and subsequently on two chromogenic media-Colorex KPC and a prototype chromogenic medium, ID Carba-designed for the isolation of carbapenemase-producing Enterobacteriaceae. All Gram-negative isolates growing on either chromogenic medium were investigated for carbapenemases by phenotypic and molecular methods. Producers were subjected to susceptibility testing with 40 antimicrobials by VITEK 2 or agar dilution.Results: In total, 64 NDM-1-positive isolates of Enterobacteriaceae, belonging to seven distinct species, were recovered from 37 (18.5%) of the stool samples. No other carbapenemase types were confirmed. Nineteen positive samples were identified among 70 from inpatients (prevalence 27.1%) and there were 18 positive samples among 130 from outpatients (prevalence 13.8%). Fifty-six isolates (87.5%) harbouring the NDM-1 enzyme were recovered on ID Carba compared with 41 isolates (64.1%) on Colorex KPC (P=0.012). Multidrug resistance was prevalent, but no pan-resistant isolates were found, with most isolates susceptible in vitro to colistin (97%), mecillinam (95%), fosfomycin (94%), tigecycline (89%) and nitrofurantoin (78%).Conclusions: This study shows a high prevalence of multidrug-resistant Enterobacteriaceae with the NDM-1 enzyme in Rawalpindi. The new chromogenic medium, ID Carba, was more sensitive than Colorex KPC and has potential as a screening medium for isolation of Enterobacteriaceae harbouring the NDM-1 enzyme.