Carbapenems are relatively expensive, second or third line antibiotics which are used in infections caused by antibiotic resistant bacteria. However, results from the Resistance Map project conducted by the Center for Disease Dynamics, Economics and Policy (CDDEP) has shown that the use of carbapenems is on the rise in India, mainly driven by rampant prescribing in healthcare settings accompanied by ready, over-the-counter availability without prescriptions or with invalid prescriptions. Given this rise in the consumption of carbapenems, it is logical to hypothesise that the number of carbapenem resistant bacterial infections should be on the rise. In fact, in the developed world, Carbapenem Resistant Enterobacteriaceae have become a major source of concern. In India, although the proportion of samples reported to bear Carbapenem Resistant Escherichia coli has remained relatively stable over the past decade or so, there has been a distressing rise in the proportion of Carbapenem Resistant Klebsiella. Given this scenario, an interesting study has come out in a recent issue of the CDC’s Emerging Infectious Diseases journal that talks about carbapenem resistance in a bacterial genus which has not been in the resistance discourse – Vibrio.
In a study conducted by the National Institute of Cholera and Enteric Diseases (NICED), Kolkata, the diarrheal stool samples of patients admitted to an infectious diseases hospital, has found:
“Carbapenems have been used for many years to treat severe nosocomial Enterobacteriaceae infections. The spread of resistance to these drugs among other bacterial families is an emerging problem worldwide, mostly caused by New Delhi metallo-β-lactamase (NDM-1). We screened for the prevalence of NDM-1–expressing enteric pathogens from hospitalized patients with acute diarrhea in Kolkata, India, and identified 27 Vibrio fluvialis–harboring blaNDM-1 (NDM-VF) strains. These isolates were also resistant to all the tested antimicrobial drugs except doxycycline. The large plasmid of V. fluvialis harboring blaNDM-1 could be easily transferred to other enteric pathogens. Genes flanking the blaNDM-1 were found to be identical to the reported sequence from an Escherichia coli isolate. Analyses showed that the V. fluvialis possessing the NDM-VF region belonged to different clones. The pathogenicity of V. fluvialis to humans and its ubiquitous presence in the environment call for constant monitoring of this species for emerging antimicrobial drug resistance. “
Vibrio fluvialis is a pathogenic bacteria, which may also be found as a commensal from environmental samples. This raises the risk for antibiotic resistant infections to occur at the community level. The data on which the current study is published is based on results from surveillance of diarrheal infections at the Infectious Diseases hospital, Kolkata.
Choudhury G, Pazhani GP, Sarkar A, Rajendran K, Mukhopadhyay AK, Bhattacharya MK, et al. Carbapenem resistance in clonally distinct clinical strains of Vibrio fluvialis isolated from diarrheal samples. Emerg Infect Dis. 2016 Oct 24. http://dx.doi.org/10.3201/eid2210.151612