Nordmann et al screened 27 NDM-1

Nordmann screened 27 NDM-1 positive isolates and reported that the MIC of these isolates vary from 0.5 – >32 μg/ml, 1.5 – 231 >32 μg/ml and 1.5 – >32 μg/ml for ertapenem, meropenem and imipenem respectively. However, only one isolate

i.e. P Providencia NSC 683864 cost rettgeri A showed MIC of 0.5 μg/ml for ertapenem [25]. In present study with 2 step broth enrichment method using meropenem disc only one strain of Enterobacter sp was positive by MHT and PCR confirmed presence of kpc-2 gene. MIC of other 28 suspected CRE isolates were ≤ 0.5 μg/ml for all carbapenems. Two isolates were positive for ESBL and AmpC, having MIC of 0.5 μg/ml for ertapenem but were negative for carbapenem genes. In the present study widespread resistance to Ampicillin and 3rd generation cephalosporin (3GC) was observed but carbapenem resistance was rare. This can be explained by indiscriminate use of 3GC in human and animals due to availability of oral

formulations and over the counter unrestricted access. Ampicillin and 3GC are used as an empirical therapy in India for the management of neonatal sepsis and other heath related complications like UTI, meningitis, bacterial sepsis (6, 1). The high prevalence of resistance to these drugs as indicated in our study raises the selleck question regarding the efficacy of these antibiotics as an empirical therapy. Carbapenems on the other hand are used sparingly as they are available as parentral

formulation for which a patient have to visit the health care facility and in addition there is no reports of their use in animals from India. It is noteworthy that the presence of kpc-2 gene in antibiotic naive neonates may be an alarming IMP dehydrogenase finding as carbapenem resistance genes are on plasmids and have a potential for rapid dissemination in future. Commensal flora can colonize the human gut without causing any symptoms, but most of the infections are endogenous and come from patient’s own gut flora [26]. The present study estimate of β-lactam resistance may be biased due to following reasons. Babies were supplemented with probiotics which have beneficial effect on gut by producing organic acids, bacteriocins, peptides and in turn decreasing pH of gut leading to inhibition of colonization of Enterobacteriaceae[27]. In addition, only the subdominant population was screened for ESBL carriage resulting in an under estimate of ESBL in the community. However, this data could not be an over-estimate as there are no reports of presence of ESBL genes in probiotic bacteria or transfer of antibiotic resistant genes from gram positive (Probiotic) bacteria to gram negative bacteria. Conclusions Our data strongly suggest there is a tremendous load of ESBL and/or AmpC in the community in absence of any direct selection pressure indicating that these genes are widely distributed in the environment.

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