Multi-Drug Resistant Acinetobacter: Detection of blaNDM-1 genotype and biofilm formation at a tertiary care hospital in Eastern Nepal

Abstract Background: Acinetobacter species is an important hospital acquired pathogen. Rapid development of resistance to multiple drug and ability to form biofilm make these bacteria more adaptable to survive in health care facilities, thus posing a challenge for its effective management. This study was aimed to characterize clinical isolates of Acinetobacter spp, study their antimicrobial susceptibility pattern and ability to form biofilm. Resistant Acinetobacter was further analyzed for the detection of extended spectrum β-lactamases (ESBLs), metallo β-lactamases (MBLs) production and presence of blaNDM-1 (New Delhi metallo-beta-lactamase-1) gene.Results: A total of 324 Acinetobacter species isolated from various clinical specimens submitted to Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, were studied Antibiotic susceptibility testing, detection of ESBL and MBL production, and biofilm formation was performed by standard microbiological methods. PCR was done to determine the presence of blaNDM-1 gene.Predominant Acinetobacter species isolated was A calcoaceticus-baumannii Complex (Acb complex) 167 (51.5%). 13 (4.0%) were ESBL producers, 61.9% (70/113) were MBL, 10.6% (12/113) were carbapenemase producers. About 40% were Multi-drug resistant (MDR). Among MDR, producers of ESBL, MBL and carbapenemase were 1.6%, 57% and 9.6%, respectively. Thirty seven percent isolates formed biofilm. A significant proportion of biofilm producers were MDR (p<0.001). Majority was resistant to cefotaxime (73.8%) and cefepime (74.4%). blaNDM1 gene was present in 33 isolates. Conclusions: Resistant Acinetobacter formed a substantial proportion in our hospital with presence of blaNDM-1 gene in significant numbers. A matter of great concern is association of Multi-drug resistant phenotype with biofilm formation. This situation warrants a stringent surveillance and adherence to Infection prevention and control practice.