Potential Role of Active Surveillance in the Control of a Hospital-Wide Outbreak of Carbapenem-Resistant Klebsiella pneumoniae Infection

2010 ◽  
Vol 31 (6) ◽  
pp. 620-626 ◽  
Author(s):  
Debby Ben-David ◽  
Yasmin Maor ◽  
Nathan Keller ◽  
Gili Regev-Yochay ◽  
Ilana Tal ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Active Surveillance ◽  
Medical Center ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Control Measures ◽  
Interrupted Time Series Analysis ◽  
Contact Precautions ◽  
Carbapenem Resistant ◽  
Recent Emergence

Background.The recent emergence of carbapenem resistance among Enterobacteriaceae is a major threat for hospitalized patients, and effective strategies are needed.Objective.To assess the effect of an intensified intervention, which included active surveillance, on the incidence of infection with carbapenem-resistant Klebsiella pneumoniae.Setting.Sheba Medical Center, a 1,600-bed tertiary care teaching hospital in Tel Hashomer, Israel.Design.Quasi-experimental study.Methods.The medical records of all the patients who acquired a carbapenem-resistant K. pneumoniae infection during 2006 were reviewed. An intensified intervention was initiated in May 2007. In addition to contact precautions, active surveillance was initiated in high-risk units. The incidence of clinical carbapenem-resistant K. pneumoniae infection over time was measured, and interrupted time-series analysis was performed.Results.The incidence of clinical carbapenem-resistant K. pneumoniae infection increased 6.42-fold from the first quarter of 2006 up to the initiation of the intervention. In 2006, of the 120 patients whose clinical microbiologic culture results were positive for carbapenem-resistant K. pneumoniae, 67 (56%) developed a nosocomial infection. During the intervention period, the rate of carbapenem-resistant K. pneumoniae rectal colonization was 9%. Of the 390 patients with carbapenem-resistant K. pneumoniae colonization or infection, 204 (52%) were identified by screening cultures. There were a total of 12,391 days of contact precautions, and of these, 4,713 (38%) were added as a result of active surveillance. After initiation of infection control measures, we observed a significant decrease in the incidence of carbapenem-resistant K. pneumoniae infection.Conclusions.The use of active surveillance and contact precautions, as part of a multifactorial intervention, may be an effective strategy to decrease rates of nosocomial transmission of carbapenem-resistant K. pneumoniae colonization or infection.

Institutional Control Measures to Curtail the Epidemic Spread of Carbapenem-Resistant Klebsiella pneumoniae: A 4-Year Perspective

2011 ◽  
Vol 32 (7) ◽  
pp. 673-678 ◽  
Author(s):  
Matan J. Cohen ◽  
Colin Block ◽  
Phillip D. Levin ◽  
Carmela Schwartz ◽  
Ilana Gross ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Active Surveillance ◽  
Tertiary Care ◽  
Control Measures ◽  
Change Point Analysis ◽  
Carrier Status ◽  
Epidemic Spread ◽  
Carbapenem Resistant ◽  
Tertiary Care Medical Center ◽  
The Mean

Objective.To describe the implementation of an institution-wide, multiple-step intervention to curtail the epidemic spread of carbapenem-resistant Klebsiella pneumoniae (CRKP).Design.Consecutive intervention analyses.Patients and Setting.All patients admitted to a 775-bed tertiary care medical center in Jerusalem, Israel, from 2006 through 2010.Interventions.The effects of 4 interventions were assessed: (1) a policy of isolation for patients colonized or infected with CRKP in single rooms, which was started in March 2006; (2) cohorting of CRKP patients with dedicated nursing staff and screening of patients neighboring a patient newly identified as a carrier of CRKP, which was started in March 2007; (3) weekly active surveillance of intensive care unit patients, which was started during August 2008; and (4) selective surveillance of patients admitted to the emergency department, which was started in March 2009. Interrupted regression analysis and change-point analysis were used to assess the effect of each intervention on the CRKP epidemic.Results.Patient isolation alone failed to control the spread of CRKP, with incidence increasing to a peak of 30 new cases per 1,000 hospital beds per month. Institution of patient cohorting led to a steep decline in the incidence of CRKP acquisition (P< .001). Introduction of active surveillance interventions was followed by a decrease in the incidence of CRKP-positive clinical cultures but an increase in the incidence of CRKP-positive screening cultures. The mean prevalence of CRKP positivity for the period after cohorting began showed a statistically significant change from the mean prevalence in the preceding period (P< .001).Conclusions.The cohorting of patients with dedicated staff, combined with implementation of focused active surveillance, effectively terminated the epidemic spread of CRKP. Cohorting reduced cross-infection within the hospital, and active surveillance allowed for earlier detection of carrier status. Both interventions should be considered in attempts to contain a hospital epidemic.

scholarly journals Spread of Carbapenemase Producing Klebsiella pneumoniae Isolates in Our Hospital: Investigation of Molecular Typing and Clonal Relationship

2021 ◽  
Author(s):  
Reyhan Kiş ◽  
Ebru Demiray Gündüz ◽  
Ayşe Nur Sarı ◽  
Zeynep Gülay
Keyword(s):  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Carbapenem Resistance ◽  
Hospital Staff ◽  
Control Measures ◽  
Automated System ◽  
Microbiology Laboratory ◽  
Clonal Relationship ◽  
Infection Control Measures ◽  
Carbapenem Resistant

Objective: Carbapenem resistance has been reported with increasing frequency among members of Enterobacterales, especially in the last 10 years. Screening and detection of carbapenemase-producing isolates is important in terms of both directing the treatment and preventing its spread. In our study, it was aimed to determine the carbapenemase types and molecular epidemiological relationships of carbapenem resistant Klebsiella pneumoniae isolates, which were isolated sequentially from the samples sent to microbiology laboratory of our hospital. Method: A total of 32 carbapenem-resistant K. pneumoniae isolates of the samples sent to microbiology laboratory between July and September 2014, were included in the study. In addition to classical methods, identification of isolates at species level was made with BD Phoenix ID/AST automated system. Carbapenemase types (blaOXA-48, blaNDM, blaIMP, blaKPC, blaVIM and blaGES) of the isolates were investigated by PCR. The clonal relationship between the isolates was assessed with PFGE. Results: It was noted that 18 isolates were obtained from intensive care units, 9 from inpatient and 5 from outpatient departments. The blaOXA48 gene was found in all isolates while the other carbapenemase genes were not found. It was determined that strains were isolated from 32 patients in our hospital had 12 different PFGE pulsotypes, named as A-L. Among these, the most common ones were B (n=18) and closely related B1 pattern (n=2). The remaining isolates were represented by 11 different types. It was observed that the first isolate with B pulsotype was responsible for the spread of the outbreak from General Intensive Care Unit. Conclusion: It has been thought that the spread of carbapenem- resistant K. pneumoniae isolates in the hospital was probably occurred through the transfer of isolates from patients with gastrointestinal colonization to other patients through hospital staff. Therefore, the spread of the isolates in hospitals can be limited by detecting colonization with active surveillance programs and by applying contact isolation and effective infection control measures.

Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in Puerto Rico Associated with a Novel Carbapenemase Variant

2010 ◽  
Vol 31 (05) ◽  
pp. 476-484 ◽  
Author(s):  
Christopher J. Gregory ◽  
Eloisa Llata ◽  
Nicholas Stine ◽  
Carolyn Gould ◽  
Luis Manuel Santiago ◽  
...  
Keyword(s):  
Risk Factors ◽  
Puerto Rico ◽  
Klebsiella Pneumoniae ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Control Measures ◽  
Control Group ◽  
Surveillance Culture ◽  
Carbapenem Resistant

Background.Carbapenem-resistantKlebsiella pneumoniae(CRKP) is resistant to almost all antimicrobial agents, and CRKP infections are associated with substantial morbidity and mortality.Objective.To describe an outbreak of CRKP in Puerto Rico, determine risk factors for CRKP acquisition, and detail the successful measures taken to control the outbreak.Design.Two case-control studies.Setting.A 328-bed tertiary care teaching hospital.Patients.Twenty-six CRKP case patients identified during the outbreak period of February through September 2008, 26 randomly selected uninfected control patients, and 26 randomly selected control patients with carbapenem-susceptibleK. pneumoniae(CSKP) hospitalized during the same period.Methods.We performed active case finding, including retrospective review of the hospital's microbiology database and prospective perirectal surveillance culture sampling in high-risk units. Case patients were compared with each control group while controlling for time at risk. We sequenced theblaKPCgene with polymerase chain reaction for 7 outbreak isolates and subtyped these isolates with pulsed-field gel electrophoresis.Results.In matched, multivariable analysis, the presence of wounds (hazard ratio, 19.0 [95% confidence interval {CI}, 2.5-142.0]) was associated with CRKP compared with noK. pneumoniae.Transfer between units (adjusted odds ratio [OR], 7.5 [95% CI, 1.8-31.1]), surgery (adjusted OR, 4.0 [95% CI, 1.0-15.7]), and wounds (adjusted OR, 4.9 [95% CI, 1.1-21.8]) were independent risk factors for CRKP compared to CSKP. A novelK. pneumoniaecarbapenemase variant (KPC-8) was present in 5 isolates. Implementation of active surveillance for CRKP colonization and cohorting of CRKP patients rapidly controlled the outbreak.Conclusions.Enhanced surveillance for CRKP colonization and intensified infection control measures that include limiting the physical distribution of patients can reduce CRKP transmission during an outbreak.

scholarly journals Comparative analysis of Clinial Carbapenem- Resistant (CR), Hypermucoviscous (HM) and CR-HM Klebsiella pneumoniae isolates in China

2020 ◽  
Author(s):  
Jun-Ying Zhu ◽  
Guang-Yu Wang ◽  
Qing Wei ◽  
Zhen Shen ◽  
Qiong Li ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Virulence Genes ◽  
Carbapenem Resistance ◽  
Resistance Rate ◽  
Molecular Characteristics ◽  
Carbapenem Resistant ◽  
Recent Emergence ◽  
String Test

Abstract Background: Although carbapenem-resistant Klebsiella pneumoniae (CRKP) and hypermucoviscous K. pneumoniae (HMKP) were largely non-overlapping, the recent emergence of CR-HMKP has raised great alarm in the world. We compared the molecular characteristics of CRKP, HMKP and CR-HMKP isolates.Results: 220 cases of K. pneumoniae isolates was collected and identified between Jan 2015 and Dec 2016 from Renji Hospital. Carbapenem resistance test and string test were performed to screen CRKP, HMKP and CR-HMKP isolates. All the CRKP, HMKP and CR-HMKP isolates were investigated for capsular genotyping, virulence genes and resistance genes by PCR and DNA sequencing. Multilocus sequence typing (MLST) was used to characterize isolates sequence types (STs). Serum killing assay and mouse lethality assay were respectively performed to confirm the virulence of the isolates in vitro and in vivo. Of 220 K. pneumoniae，71 HMKP, 84 CRKP and 8 CR-HMKP were identified. Resistance rate to carbapenems was significantly higher in CRKP than HMKP and CR-HMKP. For MLST and serotyping, ST23 (26.8%)，K1 (33.8%) and K2 (23.9%) serotypes were the most common in HMKP isolates while ST11 (84.5%, 100%) and K-nontypable (91.6%, 100%) were the predominant types in CRKP and CR-HMKP isolates. The existence of virulence genes rmpA, magA and iutA was significantly higher in HMKP while the prevalence of resistance gene blaKPC-2 was higher in CRKP and CR-HMKP. Virulence test in vivo and in vitro both showed the lower virulence of CRKP and CR-HMKP compared to HMKP.Conclusions: In spite of low virulence, the emergence of CR-HMKP indicates a confluence of hypermucoviscous phenotype and carbapenem resistance. Furthermore, the similar molecular characteristics between CRKP and CR-HMKP suggested that CR-HMKP might evolve from CRKP.

scholarly journals Rapid Increase in Prevalence of Carbapenem-ResistantEnterobacteriaceae(CRE) and Emergence of Colistin Resistance Genemcr-1in CRE in a Hospital in Henan, China

2018 ◽  
Vol 56 (4) ◽  
Author(s):  
Yi Li ◽  
Qiao-ling Sun ◽  
Yingbo Shen ◽  
Yangjunna Zhang ◽  
Jun-wen Yang ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Carbapenem Resistance ◽  
Clinical Samples ◽  
New Delhi ◽  
Colistin Resistance ◽  
Large Hospital ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Recent Emergence ◽  
Almost All

ABSTRACTThe global spread of carbapenem-resistantEnterobacteriaceae(CRE) is one of the most severe threats to human health in a clinical setting. The recent emergence of plasmid-mediated colistin resistance genemcr-1among CRE strains greatly compromises the use of colistin as a last resort for the treatment of infections caused by CRE. This study aimed to understand the current epidemiological trends and characteristics of CRE from a large hospital in Henan, the most populous province in China. From 2014 to 2016, a total of 7,249Enterobacteriaceaeisolates were collected from clinical samples, among which 18.1% (1,311/7,249) were carbapenem resistant. Carbapenem-resistantKlebsiella pneumoniaeand carbapenem-resistantEscherichia coliwere the two most common CRE species, withKlebsiella pneumoniaecarbapenemases (KPC) and New Delhi metallo-β-lactamases (NDM), respectively, responsible for the carbapenem resistance of the two species. Notably, >57.0% (n= 589) of theK. pneumoniaeisolates from the intensive care unit were carbapenem resistant. Furthermore,blaNDM-5andmcr-1were found to coexist in oneE. coliisolate, which exhibited resistance to almost all tested antibiotics. Overall, we observed a significant increase in the prevalence of CRE isolates during the study period and suggest that carbapenems may no longer be considered to be an effective treatment for infections caused byK. pneumoniaein the studied hospital.

scholarly journals Active surveillance for carbapenemase-producing Klebsiella pneumoniae and correlation with infection in subjects attending an Italian tertiary-care hospital: a 7-year retrospective study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042290
Author(s):  
Adriana Calderaro ◽  
Mirko Buttrini ◽  
Monica Martinelli ◽  
Sara Montecchini ◽  
Silvia Covan ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Active Surveillance ◽  
Rectal Swab ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Contact Precautions ◽  
Rectal Swabs ◽  
Potential Reservoir ◽  
Risk Patients

ObjectivesThe distribution of carbapenemase-producing Klebsiella pneumoniae (CPKP) phenotypes and genotypes in samples collected during 2011–2018 was evaluated. The association between patients with CPKP-positive rectal swab and those with CPKP infection, as well as the overall analysis of CPKP-infected patients, was performed.SettingThe study was performed in a tertiary-care hospital located in Northern Italy.ParticipantsTwo groups were considered: 22 939 ‘at-risk’ patients submitted to active surveillance for CPKP detection in rectal swabs/stools and 1094 CPKP-infected patients in which CPKP was detected in samples other than rectal swabs.ResultsCPKP-positive rectal swabs were detected in 5% (1150/22 939). A CPKP infection was revealed in 3.1% (719/22 939) of patients: 582 with CPKP-positive rectal swab (50.6% of the 1150 CPKP-positive rectal swabs) and 137 with CPKP-negative rectal swab. The 49.4% (568/1150) of the patients with CPKP-positive rectal swab were carriers. The overall frequency of CPKP-positive patients (carriers and infected) was almost constant from 2012 to 2016 (excluding the 2015 peak) and then increased in 2017–2018. blaKPC was predominant followed by blaVIM. No difference was observed in the frequency of CPKP-positive rectal swab patients among the different material groups. Among the targeted carbapenemase genes, blaVIM was more significantly detected from urine than from other samples.ConclusionsThe high prevalence of carriers without evidence of infection, representing a potential reservoir of CPKP, suggests to maintain the guard about this problem, emphasising the importance of active surveillance for timely detection and separation of carriers, activation of contact precautions and antibiotic treatment guidance on suspicion of infection.

scholarly journals Draft Genome Sequences of Three Hypervirulent Carbapenem-ResistantKlebsiella pneumoniaeIsolates from Bacteremia

2016 ◽  
Vol 4 (6) ◽  
Author(s):  
Chaitra Shankar ◽  
Laura E. B. Nabarro ◽  
Naveen Kumar Devanga Ragupathi ◽  
Dhiviya Prabaa Muthuirulandi Sethuvel ◽  
Jones Lionel Kumar Daniel ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
South India ◽  
Care Center ◽  
Tertiary Care ◽  
Draft Genome ◽  
Carbapenem Resistance ◽  
Tertiary Care Center ◽  
Genome Sequences ◽  
Carbapenem Resistant

HypervirulentKlebsiella pneumoniaestrains have been increasingly reported worldwide, and there is emergence of carbapenem resistance among them. Here, we report the genome sequences of three carbapenem-resistant hypervirulentK. pneumoniaeisolates isolated from bacteremic patients at a tertiary-care center in South India.

scholarly journals Molecular epidemiology of carbapenem-resistant Enterobacterales in Thailand, 2016–2018

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Wantana Paveenkittiporn ◽  
Meghan Lyman ◽  
Caitlin Biedron ◽  
Nora Chea ◽  
Charatdao Bunthi ◽  
...  
Keyword(s):  
Infection Control ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
The United States ◽  
Control Measures ◽  
Case Report Form ◽  
Specimen Type ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Cp Gene

Abstract Background Carbapenem-resistant Enterobacterales (CRE) is a global threat. Enterobacterales develops carbapenem resistance through several mechanisms, including the production of carbapenemases. We aim to describe the prevalence of Carbapenem-resistant Enterobacterales (CRE) with and without carbapenemase production and distribution of carbapenemase-producing (CP) genes in Thailand using 2016–2018 data from a national antimicrobial resistance surveillance system developed by the Thailand National Institute of Health (NIH). Methods CRE was defined as any Enterobacterales resistant to ertapenem, imipenem, or meropenem. Starting in 2016, 25 tertiary care hospitals from the five regions of Thailand submitted the first CRE isolate from each specimen type and patient admission to Thailand NIH, accompanied by a case report form with patient information. NIH performed confirmatory identification and antimicrobial susceptibility testing and performed multiplex polymerase chain reaction testing to detect CP-genes. Using 2016–2018 data, we calculated proportions of CP-CRE, stratified by specimen type, organism, and CP-gene using SAS 9.4. Results Overall, 4,296 presumed CRE isolates were submitted to Thailand NIH; 3,946 (93%) were confirmed CRE. Urine (n = 1622, 41%) and sputum (n = 1380, 35%) were the most common specimen types, while blood only accounted for 323 (8%) CRE isolates. The most common organism was Klebsiella pneumoniae (n = 2660, 72%), followed by Escherichia coli (n = 799, 22%). The proportion of CP-CRE was high for all organism types (range: 85–98%). Of all CRE isolates, 2909 (80%) had one CP-gene and 629 (17%) had > 1 CP-gene. New Delhi metallo-beta-lactamase (NDM) was the most common CP-gene, present in 2392 (65%) CRE isolates. K. pneumoniae carbapenemase (KPC) and Verona integron-encoded metallo-β-lactamase (VIM) genes were not detected among any isolates. Conclusion CP genes were found in a high proportion (97%) of CRE isolates from hospitals across Thailand. The prevalence of NDM and OXA-48-like genes in Thailand is consistent with pattern seen in Southeast Asia, but different from that in the United States and other regions. As carbapenemase testing is not routinely performed in Thailand, hospital staff should consider treating all patients with CRE with enhanced infection control measures; in line with CDC recommendation for enhanced infection control measures for CP-CRE because of their high propensity to spread.

A Randomized, Double-Blind, Placebo-Controlled Trial of Selective Digestive Decontamination Using Oral Gentamicin and Oral Polymyxin E for Eradication of Carbapenem-Resistant Klebsiella pneumoniae Carriage

2012 ◽  
Vol 33 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Lisa Saidel-Odes ◽  
Hana Polachek ◽  
Nehama Peled ◽  
Klaris Riesenberg ◽  
Francisc Schlaeffer ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Controlled Trial ◽  
Tertiary Care ◽  
Selective Digestive Decontamination ◽  
Control Measures ◽  
University Hospital ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Carbapenem Resistant ◽  
Polymyxin E

Objective.To assess the effectiveness of selective digestive decontamination (SDD) for eradicating carbapenem-resistant Klebsiella pneumoniae (CRKP) oropharyngeal and gastrointestinal carriage.Design.A randomized, double-blind, placebo-controlled trial with 7 weeks of follow-up per patient.Setting.A 1,000-bed tertiary-care university hospital.Patients.Adults with CRKP-positive rectal swab cultures.Methods.Patients were blindly randomized (1:1) over a 20-month period. The SDD arm received oral gentamicin and polymyxin E gel (0.5 g 4 times per day) and oral solutions of gentamicin (80 mg 4 times per day) and polymyxin E (1 × 106 units 4 times per day for 7 days). The placebo arm received oral placebo gel 4 times per day and 2 placebo oral solutions 4 times per day for 7 days. Strict contact precautions were applied. Samples obtained from the throat, groin, and urine were also cultured.Results.Forty patients (mean age ± standard deviation, 71 ± 16 years; 65% male) were included. At screening, greater than or equal to 30% of oropharyngeal, greater than or equal to 60% of skin, and greater than or equal to 35% of urine cultures yielded CRKP isolates. All throat cultures became negative in the SDD arm after 3 days (P< .0001). The percentages of rectal cultures that were positive for CRKP were significandy reduced at 2 weeks. At that time, 16.1% of rectal cultures in the placebo arm and 61.1% in the SDD arm were negative (odds ratio, 0.13; 95% confidence interval, 0.02–0.74; P<.0016). A difference between the percentages in the 2 arms was still maintained at 6 weeks (33.3% vs 58.5%). Groin colonization prevalence did not change in either arm, and the prevalence of urine colonization increased in the placebo arm.Conclusions.This SDD regimen could be a suitable decolonization therapy for selected patients colonized with CRKP, such as transplant recipients or immunocompromised patients pending chemotherapy and patients who require major intestinal or oropharyngeal surgery. Moreover, in outbreaks caused by CRKP infections that are uncontrolled by routine infection control measures, SDD could provide additional infection containment.Infect Control Hosp Epidemiol 2012;33(1):14-19

scholarly journals Metallo - β - Lactamase Producers among Carbapenem Resistant Gram-Negative Isolates from Clinical Samples in a Tertiary Care Hospital

2021 ◽  
Vol 10 (9) ◽  
pp. 105-113
Author(s):  
M. Shabnum P. Sreenivasulu Reddy
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Control Measures ◽  
Clinical Samples ◽  
Care Hospital ◽  
Klebsiella Species ◽  
Strict Adherence ◽  
Gram Negative ◽  
Carbapenem Resistant

Gram – Negative Bacilli (GNB) are important cause of UTI, Blood stream infections, hospital acquired pneumonias. With the Carbapenems becoming the drug of choice in treating Multidrug resistant Organisms (MDRO) due to their safety and efficacy, there is rise in Carbapenem Resistant organisms which is becoming a threat to health care setup. Early diagnosis of Metallo – β – lactamase (MBL) producers by routine laboratory methods makes it the need of the hour to prevent spread of resistant strains. To detect MBL producers among Carbapenem resistant GNB. GNB were isolated from 2576 various clinical samples received by Department of Microbiology between December 2020 to March 2021. MBL production among Carbapenem resistant GNB was tested by Combined Disc Diffusion Assay using Imipenem disc and Imipenem + EDTA disc. Results: 899 GNB were isolated among 2576 samples with E. coli (35.05%) followed by Klebsiella species (28.58%) and Pseudomonas aeruginosa (14.90%). 180 isolates (20.02%) were Carbapenem Resistant GNB of which 55 isolates (30.55%) were MBL producers with Klebsiella species (29.01%) being highest MBL producer followed by Pseudomonas aeruginosa (27.27%). Rapid dissemination of MBL producers is worrisome making routine detection of MBL strains important. Regular surveillance, strict adherence to infection control measures and implementation of proper antibiotic policy is crucial to minimize the increasing Carbapenem resistance.

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