Infection and Drug Resistance (Dec 2020)

Distribution of NDM1 Carbapenemase-Producing Proteeae Strains on High-Risk Hospital Wards

  • Rus M,
  • Licker M,
  • Musuroi C,
  • Seclaman E,
  • Muntean D,
  • Cirlea N,
  • Tamas A,
  • Vulpie S,
  • Horhat FG,
  • Baditoiu L

Journal volume & issue
Vol. Volume 13
pp. 4751 – 4761

Abstract

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Maria Rus,1,2 Monica Licker,1– 3 Corina Musuroi,2 Edward Seclaman,4 Delia Muntean,1– 3 Natalia Cirlea,2 Alina Tamas,2 Silvana Vulpie,2 Florin George Horhat,1,3 Luminita Baditoiu3,5 1Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2“Pius Brinzeu” County Clinical Emergency Hospital, Timisoara, Romania; 3Multidisciplinary Research Center on Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 4Department of Biochemistry, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania; 5Department of Epidemiology, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, RomaniaCorrespondence: Monica LickerDepartment of Microbiology, “Victor Babes” University of Medicine and Pharmacy, 2 E. Murgu, Timisoara 300041, RomaniaTel +40 0256-707513Email [email protected] MusuroiPius Brinzeu” County Clinical Emergency Hospital, No. 156 L.Rebreanu, Timisoara 300723, RomaniaTel +40745050232Email [email protected]: Carbapenem-resistant Proteeae (CRP) is a group of multidrug-resistant (MDR) microorganisms that raise special treatment problems due to their intrinsic resistance to colistin. In this study, our aim is to provide a phenotypic and molecular characterization of the carbapenemases secreted by CRP strains isolated from inpatients from an intensive care unit (ICU) and surgical wards, as well as the identification of the risk factors involved in their acquisition.Methods: An observational, cross-sectional study was performed which included all Proteeae strains isolated in samples from inpatients on high-risk wards of the largest university hospital in Western Romania, from July 2017 to April 2019. Meropenem-resistant strains (N=65) with MIC ≥ 16 μg/mL were subjected to a singleplex PCR assay for the detection of blaNDM, blaVIM and blaCTX-M genes. The analysis of risk factors was performed by logistic regression.Results: Out of 8317 samples that were processed, 400 Proteeae strains were isolated: 64% belonging to the genus Proteus, 26.75% to the genus Providencia and 9.25% to the genus Morganella. Most CRP strains (N=56) were of MBL type, and 55 had the blaNDM gene as the prevalent gene substrate. P. stuartii was the main species that provided the circulating MDR strains. Most CRP strains came from patients admitted to ICU, being isolated mainly from bronchial aspirates and blood cultures. Multivariate analysis revealed 3 independent risk factors – mechanical ventilation> 96h (HR: 40.51 [13.65– 120.25], p < 0.001), tracheostomy (HR: 2.65 [1.14– 6.17], p = 0.024) and prolonged antibiotic therapy (HR: 1.01 [1.00– 1.02], p = 0.03).Conclusion: There is a significant increase in the incidence of CR P. stuartii strains, the MBL-blaNDM type being predominant. These strains presented various other resistance mechanisms, being often extremely difficult to treat and led to an excess of lethality of 27.16%.Keywords: carbapenem-resistant Proteeae, intensive care unit, P. stuartii

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