title: Act Fast as Time Is Less: High Faecal Carriage of Carbapenem-ResistantEnterobacteriaceaein Critical Care Patients.
abstract: BACKGROUND
  Carbapenem-resistantEnterobacteriaceae(CRE) are drug-resistant Gram-negative bacteria that are present in the community as well as in hospitals. Their infection and colonisation puts critically ill patients at high risk due to the drug-resistant nature of the strains and possible spreading of these organisms, even in a hospital environment.
  
  
  OBJECTIVE
  To examine the presence and types ofEnterobacteriaceaespecies in patients admitted directly from the community.
  
  
  METHODS
  The present study was a one-month pilot conducted in the ICU of a tertiary care hospital in Mumbai, India in 2015. Faecal samples of patients admitted from the community directly to the ICU were analysed using tests like MHT (Modified Hodge) and EDTA for the presence of IMP (action on Imipenem) and KPC (KlebsiellaTest Pneumoniae Carbapenemase) producing strains ofEnterobacteriaceae. Polymerase Chain Reaction (PCR) was performed to look forVIM,IMP,NDM1,OXA, and KPC genes. Antibiotic Sensitivity Test was carried out as per CLSI guidelines.
  
  
  RESULTS
  The results showed an alarming level of faecal carriage rates in adult ICU patients.Klebsiella pneumoniawas the most common carbapenem-resistant isolate, closely followed byEscherichia coli. PCR results revealed nine strains were positive forbla(KPC) gene, from which 7 wereKlebsiella pneumoniaeand one each ofEscherichia coliandKlebsiella oxytocawas observed. Antibiotic Sensitivity Test results showed that the isolates had maximum sensitivity to Colistin (100%) and Tigecycline (95%).
  
  
  CONCLUSIONS
  These levels indicate that in the absence of CRE screenings, proper isolation of carrier patients is not possible, leading to possible spreading of these resistant bacteria strains in ICUs. A longer period of study is required to obtain more substantial data to validate the results of this pilot.
authors: Head, Department of Critical Care, S.L. Raheja Hospital (A Fortis Associate) , Mumbai, Maharashtra, India .
authors: Sanjith
authors: S
authors: Saseedharan
authors: Head, Department of Microbiology, S.L. Raheja Hospital (A Fortis Associate) , Mumbai, Maharashtra, India .
authors: Manisa
authors: M
authors: Sahu
authors: ICU Registrar, Critical Care Department, S.L. Raheja Hospital (A Fortis Associate) , Mumbai, Maharashtra, India .
authors: Edwin Joseph
authors: EJ
authors: Pathrose
authors: Research Scholar in Critical Microbiology, Department of Microbiology, S.L. Raheja Hospital (A Fortis Associate) , Mumbai, Maharashtra, India .
authors: Sarita
authors: S
authors: Shivdas
keywords: EDTA; KPC; MHT; PCR