Clinical and molecular characteristics of NDM-1 harboring Multi-Drug Resistant Gram Negative Bacteria at Carilion Medical Center
Methods: A retrospective study was conducted on a small number of banked specimens (n=15) of MDR-GNB collected at CMC in 2011-2012. We isolated plasmids of these organisms using Qiagen kits as per the manufacturer’s protocol, characterized plasmid profile and performed screening with NDM-1 gene specific primers by using polymerase chain reaction (PCR). Retrospective chart analysis was performed and demographic, clinical and outcome data were collected.
Results: Among 15 MDR-GNB specimens, 10 were Pseudomonas aeruginosa, 1 Enterobacter cloacae, 1 Burkholderia cepacia, 1 Proteus mirablis, 1 Achromobacter xylosoxidans, 1 Kleibsiella pneumonia. Nine of 15 organisms were resistant or intermediate to Amikacin and 13/15 were resistant to C. These plasmids were larger in size (>23kbp in size) and multiple (2-3) in 5/15 bacteria. NDM-1 gene specific primer PCR with 813 kbp band was positive in 8 of 15 MDR-GNB. Chart analysis was available for 14 patients (pts) only (7 NDM-1 +ve and 7 NDM-1 -ve). Mean age of NDM-1 +ve pts was 65.4 yrs and NDM-1 -ve pts was 60.8 yrs. Six of 7 NDM-1 +ve and 3/7 NDM-1 -ve pts were admitted from a healthcare facility. Information regarding foreign travel or contact with foreign pts was unavailable. Five of 7 NDM-1 +ve pts were admitted with acute respiratory failure and 4/7 patients died; 2/7 NDM-1 -ve pts died.
Conclusion: C resistant GNB remain a threat to pts in healthcare settings. NDM-1 gene-present pts have 2.33 times higher relative risk of death than non NDM-1 carrying pts in our study. Resistance to A and C should arouse suspicion to the presence of NDM-1 gene with need for early detection and intervention.
C. Schleupner, None
R. Kohli, None
A. Baffoe, None
E. Purwantini, None
B. Mukhopadhyay, None
J. Rao, None
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