Deciphering the genotypic profiles of Carbapenem-resistant Enterobacterales: A study from a tertiary care hospital in Bihar, India
Abstract
Background Carbapenem-resistant Enterobacterales (CRE) present a critical challenge in healthcare, especially in low-resource settings, due to limited treatment options and high mortality rates. The global prevalence of CRE is on the rise, necessitating comprehensive understanding and strategies to combat this threat. Data on carbapenemase gene distribution among CRE from eastern India remain scarce. Objectives To characterize the distribution of carbapenemase genes among CRE isolates from a tertiary care hospital in Bihar, India, and to assess their correlation with phenotypic resistance patterns. Methods Hospital-based cross-sectional study was conducted from July 2021 to July 2023 at a tertiary healthcare centre in Bihar, India. Phenotypic methods included mCIM, eCIM, and carbapenemase inhibition assays. Genotypic analysis employed multiplex PCR to detect blaNDM, blaIMP, blaVIM, blaKPC, and blaOXA-48. PCR products were visualised by gel electrophoresis. Descriptive analyses were used to summarize genotypic and phenotypic findings. Statistical analysis was performed using SPSS v.23. Results Among the 98 isolates subjected to multiplex PCR-based carbapenemase gene profiling, Escherichia coli (61.22%) and Klebsiella pneumoniae (33/98, 33.67%) were predominant. blaNDM was the most frequently detected gene, found in 62/98 isolates (63.27%), predominantly in Escherichia coli and Klebsiella pneumoniae. Phenotypic and genotypic correlations were in complete agreement for Class A and Class B carbapenemases, but discrepancies were observed in Class D carbapenemase identification. All gene-detection rates below are expressed relative to this genotyped subset of 98 isolates. Conclusions High blaNDM prevalence in Bihar's CRE isolates necessitates urgent surveillance and strict infection control. Recommended therapies include Cefiderocol or Ceftazidime-avibactam plus Aztreonam. Continued molecular research and diagnostic enhancements remain critical.