Antibiotic resistance and detection of plasmid mediated colistin resistance mcr-1 gene among Escherichia coli and Klebsiella pneumoniae isolated from clinical samples

Abstract Background The prevalence of antimicrobial resistance (AMR) among Gram-negative bacteria is alarmingly high. Reintroduction colistin as last resort treatment in the infections caused by drug-resistant has led to emergence and spread resistance. This study was designed determine drug-resistance beta-lactamase-producing strains Escherichia coli Klebsiella pneumoniae, isolated from clinical specimens received at a tertiary care centre Kathmandu, Nepal during period March August, 2019. Methods A total 3216 different samples were processed Microbiology laboratory Kathmandu Model Hospital. isolates ( E. K. pneumoniae ) for susceptibility test (AST) using modified Kirby-Bauer disc diffusion method. Drug-resistant further screened extended-spectrum beta-lactamase (ESBL), metallo-beta-lactamase (MBL), carbapenemase (KPC) production tests. All suspected enzyme producers phenotypic confirmatory Colistin determined minimum inhibitory concentration (MIC) agar dilution resistant plasmid-mediated mcr-1 gene conventional polymerase chain reaction (PCR). Results Among processed, 16.4% (529/3216) had bacterial growth. 583 recovered 529 samples. isolates, 78.0% (455/583) bacteria. most predominant isolate Gram-negatives (66.4%; 302/455) 9% (41/455). In AST, colistin, polymyxin B tigecycline effective antibiotics. overall multidrug-resistance (MDR) both 58.0% (199/343). ESBL testing, 41.1% (n = 141) confirmed ESBL-producers. ESBL-producing 43% (130/302) whereas that K . 26.8% (11/41). Similarly, 12.5% (43/343) 10.9% (33/302) 24.3% (10/41) carbapenem. 43 carbapenem 30.2% (13/43) 60.5% (26/43) KPC MBL-producers respectively. KPC-producers 33.3% (11/33) 20% (2/10) 63.6% (21/33) 50% (5/10) MBL-producers. MIC assay, 2.2% (4/179) 10% (2/20) (MIC ≥ 4 µg/ml). Overall, 3.1% (6/199) acquisition 16.6% (3/18) isolates. Conclusion High our indicative deteriorating situation AMR. Moreover, significant enzymes reinforces their roles drug Resistance (colistin) isolation indicate urgency infection management. Therefore, extensive surveillance, formulation implementation policies, augmentation diagnostic facilities incorporation antibiotic stewardship programs can be some remedies cope with this global crisis.