Journal of Laboratory Physicians
Home About us Ahead of print Current issue Back issues Subscribe Instructions Contact Login 
Wide layoutNarrow layoutPrint this page  Email this page Bookmark this page Small font size Default font size Increase font size 
 


 
   Table of Contents     
LETTER TO EDITOR
Year : 2013  |  Volume : 5  |  Issue : 2  |  Page : 142  

Prevalence of metallo-β-lactamase producing Pseudomonas aeruginosa in intensive care unit: A report from tertiary care hospital from western India


Department of Microbiology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India

Date of Web Publication15-Oct-2013

Correspondence Address:
Vrishali Avinash Muley
Department of Microbiology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2727.119868

Rights and Permissions

How to cite this article:
Muley VA, Ghadage DP, Bhore AV. Prevalence of metallo-β-lactamase producing Pseudomonas aeruginosa in intensive care unit: A report from tertiary care hospital from western India. J Lab Physicians 2013;5:142

How to cite this URL:
Muley VA, Ghadage DP, Bhore AV. Prevalence of metallo-β-lactamase producing Pseudomonas aeruginosa in intensive care unit: A report from tertiary care hospital from western India. J Lab Physicians [serial online] 2013 [cited 2019 Sep 21];5:142. Available from: http://www.jlponline.org/text.asp?2013/5/2/142/119868

Sir,

Pseudomonas aeruginosa is an important nosocomial pathogen in the health-care settings. Increasing resistance to carbapenems mediated by metallo-β-lactamase (MBL) and other mechanisms is a cause for concern because they adversely affect clinical outcomes and add to treatment costs.[1] This study was undertaken to determine the prevalence of MBL production in carbapenem-resistant isolates and to study the factors influencing the clinical outcomes of infections.

A total of 140 consecutive P. aeruginosa isolates obtained from hospitalized patients were subjected to susceptibility testing to antipseudomonal drugs by disc diffusion and minimum inhibitory concentration (MIC) of imipenem was determined.

MBL detection was done by zone enhancement with ethylene diamine tetraacetic acid (EDTA) impregnated imipenem and ceftazidime discs [2] and minimum of four-fold reduction in MIC of the isolates with imipenem-(EDTA) combination. [3]

A total of 35% (49 out of 140) of the P. aeruginosa isolates tested were found resistant to imipenem by disc diffusion method. Twenty resistant isolates showed a significant enhancement in zone size with the EDTA impregnated discs as well as a four-fold reduction in MIC with imipenem EDTA. Thus, 40.8% isolates of imipenem resistant P. aeruginosa were found to be MBL producers. Overall prevalence of MBL production was 14.2% among all the P. aeruginosa isolates.

Multiple risk factors such as a hospital stay >8 days, catheterization, intravenous line and previous antibiotic use were present in all MBL-positive isolates. All these were also the major risk factors for imipenem resistance.

All the MBL positive isolates were resistant to all the antibiotics tested except aztreonam. Emergence of MBL producing P. aeruginosa in intensive care units is alarming and reflects excessive use of carbapenems. There is an urgent requirement of strict statuary guidelines implanting intervention for limiting inappropriate uses of antibiotics. Ignorance of rational antibiotics prescribing principles, lack of awareness of the problem of the alarming rise in the multi-resistance and pharmaceutical promotion are possible combining factors leading to unnecessary antimicrobial usage. Inadequate infection control is further compounding the problem.

The early detection of MBL producing P. aeruginosa will help in appropriate antimicrobial therapy and avoid the development and dissemination of these multidrug resistance strains. All isolates of P. aeruginosa resistant to imipenem should be screened for MBL production. Disk potentiation test should be introduced in every clinical microbiology laboratory in order to aid infection control.

 
   References Top

1.Varaiya A, Kulkarni M, Bhalekar P, Dogra J. Incidence of metallo-beta-lactamase-producing Pseudomonas aeruginosa in diabetes and cancer patients. Indian J Pathol Microbiol 2008;51:200-3.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Yong D, Lee K, Yum JH, Shin HB, Rossolini GM, Chong Y. Imipenem-EDTA disk method for differentiation of metallo-beta-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol 2002;40:3798-801.  Back to cited text no. 2
    
3.Migliavacca R, Docquier JD, Mugnaioli C, Amicosante G, Daturi R, Lee K, et al. Simple microdilution test for detection of metallo-beta-lactamase production in Pseudomonas aeruginosa. J Clin Microbiol 2002;40:4388-90.  Back to cited text no. 3
    




 

Top
 
 
  Search
 
  
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References

 Article Access Statistics
    Viewed1082    
    Printed45    
    Emailed0    
    PDF Downloaded117    
    Comments [Add]    

Recommend this journal