title: Risk factors for fecal carriage of carbapenemase producing Enterobacteriaceae among intensive care unit patients from a tertiary care center in India.
abstract: Resistance amongst the commensal flora is a serious threat because a very highly populated ecosystem like the gut, may at a later stage, be a source of extra intestinal infections, resistant strains may spread to other host or transfer genetic resistance element to other members of micro-biota including pathogens. This study was carried out to assess fecal colonization by carbapenemase producing Enterobacteriaceae (CPE) and associated risk factors among 100 patients admitted to intensive care unit (ICU). The phenotypic and molecular characterizations of CPE were also included.
  
  
  
  Colonization with CPE was observed in 6.6 % (8/122) controls. Among ICU patients, fecal carriage of CPE was significantly higher on day 4 (D4) (22 %) as compared to day 1 (D1) (11 %) (p value 0.002). The carbapenemase genes detected included OXA- 48, 181, KPC and NDM-1 with NDM-1 being the predominant carbapenemase in both ICU D1 and D4. Among the 50 CPE isolates, 8 (16 %) were susceptible to meropenem and imipenem (Minimum inhibitory concentration; MIC ≤ 1 mg/L) and all were susceptible to colistin (MIC range 0.125 - 1 mg/L) and tigecycline (MIC range 0.06- 1.5 mg/L). The risk factors associated with CPE carriage were duration of ICU stay, use of ventilator and aminoglycosides.
  
  
  
  Prior colonization with CPE could result in their influx and spread in ICU, challenging infection control measures. Exposure to ICU further increases risk of colonization with diverse carbapenemase-producing Enterobacteriaceae. Gut colonization with these strains may be a source of endogenous infection and horizontal transfer of these genes in future.
authors.affiliation: Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
authors.forename: Gajanand
authors.initials: G
authors.lastname: Mittal
authors.affiliation: Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India. rgaind5@hotmail.com.
authors.forename: Rajni
authors.initials: R
authors.lastname: Gaind
authors.affiliation: Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Kumar
authors.affiliation: Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Kaushik
authors.affiliation: Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
authors.forename: Kunj Bihari
authors.initials: KB
authors.lastname: Gupta
authors.affiliation: Department of Anaesthesia, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Verma
authors.affiliation: Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
authors.forename: Monorama
authors.initials: M
authors.lastname: Deb
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000096:biosynthesis* / Q000235:genetics; D004269:DNA, Bacterial / Q000235:genetics; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology / Q000635:transmission; D005243:Feces / Q000737:chemistry* / Q000382:microbiology*; D000069196:Gastrointestinal Microbiome; D006801:Humans; D007194:India; D017053:Infection Control; D007362:Intensive Care Units; D008826:Microbial Sensitivity Tests; D012307:Risk Factors; D062606:Tertiary Care Centers; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial; D001618:beta-Lactamases; C063912:carbapenemase
keywords: AmpC; Carbapenem resistant Enterobacteriaceae; Carbapenemase producing Enterobacteriaceae; ESBL; Gut colonization; Intensive care unit; Risk factor