From the Guidelines
In India, the epidemiology, prevalence, and geographical distribution of carbapenemase-producing organisms, including KPC, OXA-48, NDM, VIM, and IMP, show distinct patterns, with NDM being the most prevalent, accounting for approximately 50-60% of carbapenem resistance, as reported in recent studies 1. The distribution of these carbapenemases varies across different regions in India, with NDM being more common in northern and eastern regions, particularly in Delhi, Haryana, and West Bengal, while OXA-48-like enzymes are more prevalent in southern states like Tamil Nadu and Karnataka 1. KPC remains relatively uncommon in India, mostly isolated in tertiary care centers in metropolitan areas, with a prevalence of less than 5% 1. VIM and IMP metallo-beta-lactamases are detected at low rates, ranging from 2-8%, with VIM being more common in western India and IMP being sporadically reported nationwide 1. These carbapenemases primarily affect Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii, and their high prevalence is concerning due to their ability to confer resistance to nearly all beta-lactam antibiotics, severely limiting treatment options and contributing to India's growing antimicrobial resistance crisis 1. Some key points to consider include:
- The importance of rapid testing to identify specific carbapenemase families, such as KPC, NDM, VIM, and OXA-48-like, to guide treatment strategies 1.
- The use of novel beta-lactam agents, such as ceftazidime/avibactam and meropenem/vaborbactam, as first-line treatment options for infections caused by KPC-producing CRE 1.
- The consideration of local epidemiology and the emergence of resistance to ceftazidime/avibactam in KPC-producing isolates when selecting treatment options 1. Overall, the management of infections caused by carbapenemase-producing organisms in India requires a comprehensive approach, including rapid testing, appropriate treatment strategies, and infection control measures to mitigate the spread of these resistant organisms 1.
From the Research
Epidemiology of Carbapenemase-Producing Bacteria in India
- The global emergence of carbapenemase-producing bacteria is a contemporary public health concern, with carbapenemase enzymes such as KPC, VIM, IMP, NDM, and OXA-48 being reported in different bacteria within the Enterobacterales order of bacteria 2.
- Carbapenemase-producing Enterobacteriaceae (CPE) are a significant concern in India, with a high prevalence of NDM, OXA-48, and other carbapenemases being reported 3, 4.
Prevalence of Specific Carbapenemases in India
- NDM-1 is a prevalent carbapenemase in India, with studies reporting its presence in various Enterobacteriaceae species 4, 5.
- OXA-48 is also commonly reported in India, with one study finding it in 49 out of 95 Enterobacteriaceae isolates 4.
- VIM and IMP carbapenemases have also been reported in India, although at lower frequencies than NDM and OXA-48 4, 5.
- KPC carbapenemase has been reported in India, although its prevalence is lower than that of NDM and OXA-48 6, 5.
Geographical Distribution of Carbapenemase-Producing Bacteria in India
- There is limited data available on the geographical distribution of carbapenemase-producing bacteria in India, although studies suggest that they are widespread across the country 3, 4.
- The use of rapid diagnostic assays such as real-time PCR and melt-curve analysis can help identify carbapenemase-producing bacteria and track their spread in India 6, 5.
Detection and Identification of Carbapenemase-Producing Bacteria
- Rapid diagnostic assays such as the RESIST-4 O.K.N.V. multiplex lateral flow assay and real-time PCR with melt-curve analysis can be used to detect and identify carbapenemase-producing bacteria in India 6, 5.
- These assays can help identify the specific type of carbapenemase present, which is essential for guiding treatment and infection control measures 3, 6.