Phenotypic and Genotypic Detection of Carbapenem Resistant Organism Causing Nosocomial Infection in Patients Attending Tertiary Care Hospital

Abstract

Aims: Nosocomial infections are the leading cause of mortality. ESKAPE organisms are the primary causes of nosocomial infection as these organisms are more or less carbapenem resistant. This study aimed to isolate and identify the etiological agents responsible for causing nosocomial infection and determine the carbapenemase producing organism by phenotypic and genotypic detection. Study Design: The study design is cross-sectional study. Place and Duration of Study: The study was conducted in the Department of Microbiology, at Index Medical College, Indore, two years and six months duration. Methodology: Total of 246 samples was collected from the patients who develop symptoms after 48- 72 hrs of hospitalization. Samples were processed for identification of etiological agents. Gram negative organisms were selected and further identified for carbapenemase enzyme. Screening was done by Kirby Bauer disc diffusion test and further confirmed by Modified Hodge test, Combined Disc test, Double Disc Synergy Diffusion test and Carbapenem Inactivation method. Genotypic detection was done by using multiplex polymerase chain reaction for KPC, NDM and OXA-48 gene. Results: Out of 107-gram-negative organisms, 19 (17.75%) were carbapenem resistant. Among 19 carbapenem resistant GNR, 13% MHT, 15% CCDT, 17% DDST and 17% mCIM were positive. The sensitivity and specificity of MHT, CCDT, DDST, mCIM were 74%/100, 84%/100,95%/100 and 95%/100respectively. The genotypic detection shows highest percentage of blaNDM 74% which is followed by bla OXA-48 31% and blaKPC 26%. Conclusion: Hospitals have become the hotspot for various microorganism causing nosocomial infections and are getting carbapenem resistance due to irrational use of antibiotics. Antimicrobial stewardship is one of the effective measures that minimize the resistance. Proper universal precaution can also minimize, spread of resistance in organism. If the last resort drug gets resistant, then it could be challenging for the clinician to treat their patients. Hospitals should have regular HAI meeting and release of antibiogram to know the pattern of these notorious organisms invading infection.