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A Study for detection of Carbapenem resistant Enterobacteriaceae (CRE) with focus on isolation of metalio- betalactamase (MBL) strains from Intensive Care Unit of rural based hospital.
India (MSAI) - Parul Institute of Medical Sciences & Research, Vadodara, Gujrat
Dr Anant Marathe
Dr Anant Marathe
Type of Research Project
- Clinical Project with Laboratory work
What is the background of the project?
Carbapenemase-producing (CP) CRE harbouring plasmid- encoded resistance genes that easily spread to different species emerged in the mid-1990s. Additional carbapenemases that have been associated with epidemics in Enterobacteriaceae include the Verona integron-encoded metallo-ß-lactamase(VIM), New Delhi metallo-b-lactamase (NDM),Imipenemase (IMP) metallo-b-lactamase, and Oxacillinase-48-type (OXA-48) enzymes. In a 2013 US Centers for Disease Control and Prevention (CDC) report, carbapenem-resistant Enterobacteriaceae (CRE) were listed as one of the three most urgent antimicrobial resistant threats.With limited therapeutic options and substantial mortality associated with infections caused by carbapenem resistant Enterobacteriaceae (CRE) prevention is of the utmost importance. We are interested in determining the incidence of NDM carrying strains of aerobic bacterial pathogens in our ICU. This will help in better understanding of resistance pattern of the pathogens. The strains that do not possess NDM can be treated with some antibiotic like Minocyclin. This study will have positive therapeutic impact”
What is the aim of the project?
Isolation of CRE from various specimens received in Microbiology laboratory from ICU patients Detection of MBL among CRE isolated.
What techniques and methods are used?
Since we are working on detection of MBL in the CRE. We use specimens from ICU, they will be inoculated on different culture medias. AST –Antibiotic Susceptibility Test. MIC – Minimum Inhibitory Concentration MBL – Metallo Beta lactamase. Isolation and identification will be done on automated system (Vitek 2) as well as by manual methods. AST will be performed by MIC on Vitek 2. Carbapenam resistance strains detected by automated system will be further confirmed using E test for the presence of MBL. Data will be analysed using Microsoft excel and a software named Statistical Package for Social Sciences. In vitek 2 there is inbuilt software which will analyse data. Statistical analysis will be done on the total number of strains of different pathogens and the percentage of them showing Carbapenem resistance. Statistical analysis will be done on the different specimens and the type of bacterial isolates from them.
What is the role of the student?
- The tasks will be done under supervision
What are the tasks expected to be accomplished by the student?
The students will collect specimen and history of the patient Student will also monitor the process of collection and transport of the specimen from ICU to the Micrbiology lab. The history of the patient is available in the ICU record book at our Hospital. Processing of specimen and inoculation of specimen on various culture media will also be done by the students The specimen will be inoculated on Blood agar, Nutrient agar, MacConkey’s agar and chocholate agar incubated at 37C in incubator. The students will in be given hands on on overnight incubation after which they will be carrying forward processing of isolated organism for identification and after overnight incubation the isolated colonies will be further processed for Identification of species and the antibiotic susceptibility test by taking few isolated colonies and adding them to sterile buffer saline to make 0.5 MacFerland turbidity and will be loaded in to the automated system VITEK II. Processing of isolated specimen will be done by the students . The specimens like Blood, sputum, urine or other body fluids ect.The antibiotics testing is followed according to the CLSI guidelines. The VITEKII has specified panel of antibiotic based on the isolate The detection of CRE based on processed specimen will also be looked into by the students .The pattern of CRE is based on the software available in the VITEK II which gives an idea as to what kind of mechanism is involved in Carbapenem resistance. Further , the students will also go ahead by perfeorming detection of MBL based on various testsl.Detection of MBL(Metallo beta lactamase) will be done by E test. Which is agar diffusion test with different gradients of Antibiotic concentration with and without EDTA to detect presence of Metallo beta lactamase. Finally the students will be performing compilation of data for analysis at the end of the study period and formulating a detailed report for future publication.
Will there be any theoretical teaching provided (preliminary readings, lectures, courses, seminars etc)
Student will be provided with some preliminary study material. After acquiring basic knowledge, tutor will take lecture on the research topic to clear any doubts. Lectures – 2 hours and as and when requested by student by tutor ( Dr Anant Marathe)
What is expected from the student at the end of the research exchange? What will be the general outcome of the student?
- The student will prepare a scientific report - The student’s name will be mentioned in a future publication
What skills are required of the student? Is there any special knowledge or a certain level of studies needed?
Student should have basic knowledge of pre clinical subjects especially microbiology. Student should also have basic knowledge of microorganisms.
Are there any legal limitations in the student’s involvement
Type of students accepted
This project accepts: - Medical students - Pre-Medical students from the American-British system
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