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Abstract

INCIDENCE AND DETECTION OF METALLO-BETA-LACTAMASE PRODUCING P.MIRABILIS IN A TERTIARY CARE HOSPITAL AT CENTRAL INDIA

Atul Khajuria* and Ashok Kumar Praharaj

ABSTRACT

Objective: To examine the distribution, emergence and spread of genes encoding beta-lactamase resistance in P.mirabilis recovered from hospitalized patients in a tertiary care hospital. Methods: A prospective study was conducted in an 1800 bedded tertiary care centre in Pune, India from October 2013 to October 2017. A total of 115 isolates were recovered from clinical specimens of hospitalized patients admitted to the Medical and Surgical intensive care units (one isolate per patient). Polymerase chain reaction (PCR) assays and sequencing was used to determine the presence of beta-lactamase encoding genes and conjugation experiments were performed to
determine the transferability. Isolate relatedness were determined by REP PCR, ERIC PCR and RAPD. Results: A total of 115 P.mirabilis isolates were recovered, largest proportion of specimens were from SSTIs 39.1%, followed by 29.6% in UTIs, 14.8% in IAIs 9.6% in BSIs, and 6.9% in RTIs, respectively. Among 115 tested isolates, 64.3% isolates showed MIC >4µg/ml against imipenem and meropenem. Of the total number of samples, males contributed 71.3% while females contributed 28.7%. Of the total samples, highest 26.9% were from Medicine ward followed by 24.3% in ICU Medical, 21.7% in ICU Surgery, 14% in surgery ward 7.9% in Urology and 5.2% in orthopedics. Majority of Carbapenem resistant P.mirabilis 40.5% were from SSTIs, followed by 27% in UTIs, 16.2% in IAIs, 12.2% in BSIs, and 4.1% in RTIs, respectively. MHT was positive in 31.3%, DDST in 48.7%, CDST in 49.6%, and MBL (IP/IPI) E-test in 53% isolates. 100% P.mirabilis isolates retained susceptible to colistin. Conjugation experiments indicated that blaNDM-1, blaVIM, blaOXA-48, blaSHV-5, blaSHV-11, blaSHV-12, blaSHV-28, blaCTX-M-15, blaCTX-M-14 were transferable via plasmid. Conclusion: This study highlights prevalence of blaVIM, blaOXA-48 and blaNDM-1, producing P.mirabilis along with other β-lactamases genes carried on a single or multiple plasmids that serve as a driving force for the horizontal spread of carbapenem resistance. Running title- Metallo-beta-lactamase resistance in P.mirabilis.

Keywords: blaNDM-1, blaVIM, blaSHV-5, blaSHV-12, blaSHV-28, blaCTX-M-15, blaCTX-M-14, REP PCR, ERIC PCR and RAPD.


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