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Emergence of blaNDM-1 and blaVIM producing Gram-negative bacilli in ventilator-associated pneumonia at AMR

Mithlesh Kumari1, Sheetal Verma1, Vimala Venkatesh1

  • 1Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Plos One
|September 8, 2021
PubMed
Abstract

Insights

Ventilator-associated pneumonia (VAP) is a serious infection, with carbapenem-resistant Gram-negative pathogens posing a global threat. Early detection of carbapenemase genes like blaNDM and blaVIM in VAP patients is crucial for controlling their spread.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Critical Care Medicine

Background:

  • Ventilator-associated pneumonia (VAP) is a life-threatening nosocomial infection common in intensive care units.
  • The increasing prevalence of carbapenem-resistant Gram-negative pathogens presents a significant global health challenge.

Purpose of the Study:

  • To investigate the prevalence of carbapenem resistance in Gram-negative pathogens causing VAP.
  • To identify specific carbapenemase genes, such as blaNDM and blaVIM, in VAP isolates.
  • To assess the clinical associations and outcomes of VAP in the context of antimicrobial resistance.

Main Methods:

  • Endotracheal aspirates from mechanically ventilated patients (>48h) were analyzed.
  • Bacterial isolates were identified using MALDI-TOF-MS and antibiotic susceptibility testing.
  • Carbapenem-resistant isolates underwent Modified Hodge Test (MHT), mCIM, eCIM, and PCR for MBL genes (blaIMP, blaVIM, blaNDM).

Main Results:

  • VAP occurred in 48.7% of patients, with late-onset VAP being more prevalent (76.7%).
  • 58.6% of Gram-negative isolates were carbapenem-resistant, with Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae being common pathogens.
  • PCR detected blaNDM in 21.5% and blaVIM in 17.4% of isolates; 8.7% carried both genes.

Conclusions:

  • blaNDM-1 and blaVIM genes are key drivers of carbapenem resistance in VAP, indicating the public health concern of carbapenem-resistant Enterobacteriaceae (CRE).
  • Early detection of Metallo-beta-lactamase (MBL) genes in diagnostic laboratories is essential to limit the dissemination of these resistance genes.

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