title: Does the presence ofKlebsiella pneumoniaecarbapenemase and New Delhi metallo-β-lactamase-1 genes in pathogens lead to fatal outcome?
abstract: BACKGROUND
  Infections due to multidrug-resistant (MDR) pathogens are a medical challenge. There is considerable apprehension among clinicians regarding pathogens reported as carrying New Delhi metallo-β-lactamase-1 (NDM) and Klebsiella pneumoniae carbapenemase (KPC) genes from their patients. In the face of extremely high rates of antimicrobial resistance, it is essential to gauge the clinical significance of isolation of pathogens carrying these genes from clinical samples. This study compares the outcome of patients infected with pathogens carrying NDM/KPC genes versus those without these genes.
  
  
  METHODS
  The study was conducted over a 1-year period at a Level-1 trauma centre. Hospital-acquired infections were diagnosed on the basis of CDC's criteria. The correlation of isolation of a multi-resistant pathogen carrying KPC or NDM genes with the clinical outcome was ascertained.
  
  
  RESULTS
  A total of 276 consecutive patients admitted to the Intensive Care Units/wards of the JPNA Trauma Centre were included in this study. Of the 371 isolates recovered from these patients, 116 were from patients who had a fatal outcome. The difference in prevalence of blaNDMand blaKPCwas not significant in any genera of Gram-negative pathogens isolated from patients who survived versus those who had a fatal outcome.
  
  
  CONCLUSIONS
  Isolation of MDR pathogens carrying NDM/KPC genes from clinical samples is not always a harbinger of a fatal outcome. Efforts should be made to prevent cross-transmission of these pathogens.
authors.affiliation: Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.
authors.forename: P
authors.initials: P
authors.lastname: Mathur
authors.affiliation: Department of Surgery, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Sagar
authors.affiliation: Department of Surgery, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Orthopedica, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.
authors.forename: V
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.
authors.forename: D
authors.initials: D
authors.lastname: Gupta
authors.affiliation: Department of Forensic Medicine, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Lalwani
authors.affiliation: Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.
authors.forename: R
authors.initials: R
authors.lastname: Rani
authors.affiliation: Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All Institute of Medical Sciences, New Delhi, India.
authors.forename: A
authors.initials: A
authors.lastname: Muruganantham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D002648:Child; D016638:Critical Illness; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology* / Q000401:mortality*; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1; C063912:carbapenemase