Emergence of carbapenemase-producing urinary isolates at a tertiary care hospital in Dhaka, Bangladesh

Objectives: A growing incidence of pathogens producing carbapenemases has been observed in many countries including Bangladesh. The present study was carried out to determine the presence of carbapenemase producers among uropathogens. Materials and Methods: A total of 138 Gram-negative uropathogens were isolated and identified by conventional methods and were screened for carbapenemase production using imipenem discs. Phenotypic identification of carbapenemase production was done by the double disc synergy test, combined disc assay, and modified Hodge test. The minimum inhibitory concentration of imipenem was determined by the agar dilution method. Genes encoding blaNDM-1, blaIMP, blaVIM, blaKPC and blaOXA48/blaOXA-181 were identified by polymerase chain reaction. Results: Twenty (14.49%) imipenem resistant strains were detected among 138 Gram-negative uropathogens. The most common isolates were Escherichia coli and Klebsiella spp. Among 20 imipenem resistant strains, 16 (80%) carbapenemase producers were detected by polymerase chain reaction, 13 (65%) by double disc synergy, 15 (75%) by combined disc assay, and seven (35%) by modified Hodge test. The blaNDM-1 gene was most prevalent (55%), followed by blaOXA-48/OXA-181, blaKPC (20%), blaVIM (15%), and blaIMP (10%). More than one carbapenemase gene was present in nine (45%) of the isolates. The minimum inhibitory concentration of imipenem of the carbapenemase producers ranged from >= 128 mu g/mL to 4 mu g/mL. Overall, carbapenemase encoding genes were detected in 11.6% (16/138) of the studied Gram-negative uropathogens. All (100%) of the carbapenemase-producing organisms were resistant to all tested antibiotics apart from colistin. Conclusion: The study shows a significant rate of urinary isolates were carbapenemase producers, including a high prevalence of blaNDM-1, in Bangladesh. Copyright (C) 2016, Buddhist Compassion Relief Tzu Chi Foundation. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license.