Carbapenem resistance in Escherichia coli and Klebsiella pneumoniae among Indian and international patients in North India

Abstract

The aim of the study was to find out the carbapenem resistance rate and prevalence of different carbapenemase genes in <i>Klebsiella pneumoniae</i> and <i>Escherichia coli</i> from a North Indian corporate hospital that receives both Indian and international patients. A total of 528 clinical isolates of <i>E. coli</i> and <i>K. pneumoniae</i> were included in the study. All isolates that were found resistant to carbapenems by MIC testing (Vitek II Compact^®) were screened for NDM, OXA-48, VIM, and KPC genes by PCR. Sequencing of NDM gene and transmissibility by conjugation assay were checked on 22 randomly selected NDM-positive isolates. One hundred and fifty-six isolates (29.54%) were carbapenem-resistant. The rate of carbapenem resistance was significantly higher in <i>K. pneumoniae</i> as compared to <i>E. coli</i> (53.9% vs. 15.6%; <i>p</i> < 0.05). The NDM gene was found in 34.6% (54/156), OXA-48 in 31.4% (49/156), co-expression of NDM + OXA-48 in 15.3% (24/156) of the carbapenem-resistant isolates. VIM and KPC were absent in all isolates. NDM gene was significantly more prevalent in <i>E. coli</i> than <i>K. pneumoniae</i> (<i>p</i> < 0.05)<i>.</i> All the tested isolates formed transconjugants and NDM-5 was the most common variant in both species (15/22). The presence of plasmid-based NDM calls for stricter surveillance measures in our hospital settings.