Carbapenamase Producing Klebsiella Pneumoniae and Citrobacter Freundii in MICU of a Tertiary Care Hospital

Carbapenems are usually the choice of antimicrobials in infections caused by Enterobacteriaceae producing β-lactamases. Resistance to carbapenems is also been seen in ICUs which is becoming an important cause of septicemia and other infections in ICUs. Resistance to carbapenems is mostly due to production of enzyme carbapenems. The present study was carried out in MICU of a tertiary care hospital with an aim to identify any environmental source and mode of transmission over a period of six months from June 2014 to December 2014.

A total of 337 samples which included (urine, pus, blood, endotracheal aspirate) from patients admitted in ICUs were studied by culture methods. Antibiotic susceptibility Pattern was determined by Kirby Bauer's disk diffusion method. Carbapenamase detection was done by modified Hodge test and Imipenem EDTA test (DDST). Environmental samples from various sites i.e. (floor, sink, bed, ac, and monitor) from the ICU were taken and collected twice every month and processed simultaneously.

Out of 337 samples, 73 samples showed bacterial growth (21.6%) out of which Pseudomonas (36%) was the commonest organism followed by Klebsiella pneumoniae (27%) Citrobacter freundii (8%), E.coli (6.8%), Acinetobacter (6.8%), Staphylococcus aureus (3%) respectively. The similarities between antibiogram of Carbapenamase producing strains of Klebsiella pneumoniae and Citrobacter freundii isolates from patents and environmental samples of ICU's were statistically significant P value =< (0.05)

Widespread use of carbapenemase for treating patients in infected with Klebsiella pneumoniae and Citrobacter freundii has contributed to emergence of carbapenemase resistant Enterobacteriaceae strains and also extensively colonized the environment of ICU. Transmission can be stopped by maintaining sterility of ICU and strict infection control measures.