Antibiotic resistance profile and co-production of extended spectrum beta lactamases and AmpC in Acinetobacter spp. in a level 1 trauma center from India

Priyam Batra; Surbhi Khurana; Aishwarya Govindaswamy; Anjana Aravinda; Vijeta Bajpai; Muruganantham Ayyanar; Purva Mathur; Rajesh Malhotra

doi:10.4103/JLP.JLP_139_18

Journal of Laboratory Physicians, Table of Contents

CC BY-NC-ND 4.0 · J Lab Physicians 2019; 11(02): 128-132
DOI: 10.4103/JLP.JLP_139_18

Original Article

Antibiotic resistance profile and co-production of extended spectrum beta lactamases and AmpC in Acinetobacter spp. in a level 1 trauma center from India

Authors

Priyam Batra

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Surbhi Khurana

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Aishwarya Govindaswamy

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Anjana Aravinda

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Vijeta Bajpai

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Muruganantham Ayyanar

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Purva Mathur

Department of Lab Medicine and JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Rajesh Malhotra

Department of Orthopaedics JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

Abstract

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Abstract

INTRODUCTION: Acinetobacter baumannii has now emerged as a significant nosocomial pathogen in health-care setting ESP in intensive care units. Rapidly growing resistance among clinical isolates suggests a need to detect resistance mechanisms in this organism. The present study was designed to compare the various phenotypic tests available with the gold standard of genotype.

METHODOLOGY: The present study was conducted to include all isolates of Acinetobacter spp. isolated over 3 years. Their resistance to various antibiotics was determined and extended spectrum beta-lactamases (ESBL) and AmpC production in the isolates showing resistance to ceftazidime/ceftriaxone/cefotaxime (CAZ/CTR/CTX) was determined. ESBL and AmpC production was confirmed using polymerase chain reaction (PCR).

RESULTS: A total of 154 strains were isolated, and all the strains were tested for ESBL and AmpC detection. Of the strains tested, 15 (9.7%), 17 (11%), 24 (15.6%), 27 (17.5%), 54 (35%), 67 (43.5%), and 72 (46.7%) strains showed ESBL production using CTX/CTX-clavulanate double-disc synergy test (DDST), CTX/CTX-clavulanate E-test, CAZ/CAZ-clavulanate DDST, CAZ/CAZ-clavulanate E-test, Piperacillin/Piperacillin-tazobactam (TZ) DDST, CTR/CTR-Sulbactum DDST, and Piperacillin/Piperacillin-TZ E-test, respectively. 20 (12.9%) and 19 (12.3%) of strains were positive for AmpC production using AmpC disc test and Boronic acid inhibition test, respectively. Genotype analysis using PCR for TEM, SHV, CTXM, PER, and VEB genes was done and 69 (51.5%) strains were positive for TEM gene.

DISCUSSION: ESBL detection in Acinetobacter spp. is difficult as standard guidelines for the same are not available unlike in enterobacteriaceae, and there are no zone diameter breakpoints for aztreonam and cefpodoxime. In comparison, piperacillin/piperacillin-TZ E-test had the best sensitivity and specificity for ESBL detection.

CONCLUSION: Standard guidelines for ESBL detection in nil fermeners like Acinetobacter spp. must be laid down for ease of detection. Use of piperacillin/piperacillin-tazobactam E-test could be used as one of the standard methods.

Key words

Acinetobacter spp. - AmpC - antibiotic resistance - extended spectrum beta-lactamases

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