Binish Arif Sultan, Seema Irfan, Erum Khan.
Detection of metallo-beta lactamases (IMP, VIM, NDM) and KPC carbapenemases in Carbapenem Resistant Enterobacteriaceae: Report from Clinical Laboratory Aga Khan University Karachi, Pakistan..
Infect Dis J Jan ;22(3):584-7.

Background: Carbapenem resistance in enterobacteriaceae due to New Delhi metallobetalactamase (NDM-1) has recently been reported as a major global health problem with potential spread from Indian subcontinent. The purpose of this study was to assess presence of different carbapenemases: metallobetalactamases(NDM-1, IMP-1, and VIM-1) and KPC (Klebsiella pneumoniae carbapenemases) enzymes among the carbapenem resistant enterobacteriaceae (CRE) isolated from different centers of Pakistan. Methods: 114 carbapenem resistant enterobacteriaceae (CRE) isolated from different clinical samples were prospectively collected from June 2009 to July 2010. MICs for meropenem were determined by E-test. Presence of gene for metallobetalactamase (NDM-1, IMP-1, VIM-1) and KPC enzymes were detected using PCR. Results: 114 CRE isolates yielded from clinical samples were included in the study. Among the bacterial pathogens 63.11% were Klebsiella pneumoniae (n=72) followed by E.coli 31.5% (n=36).MIC of meropenem tested by E-test strip on isolates positive for NDM-1 detected 33 isolates to be highly resistant, with MIC (>32µgm/ml). Gene for NDM-1 enzymes was detected in 93.8% (n=107) of clinical isolates. None of the clinical isolates were found positive for blaIMP, blaVIM and genes for KPC enzymes. Conclusion: NDM-1 was found to be the commonest underlying gene among carbapenem resistant Enterobacteriaceae in this study. Its very high prevalence suggests that NDM-1 may be the most common enzyme responsible for carbapenem resistance among Enterobacteriaceae in Pakistan.

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