MOLECULAR DETECTION OF THE BLANDM-1 GENE AMONG CARBAPENEM-RESISTANT GRAM-NEGATIVE BACTERIAL ISOLATES FROM INTENSIVE CARE UNIT PATIENTS

Abstract

Disease prevention and management have become central priorities in modern healthcare due to the increasing burden of communicable and non-communicable diseases, aging populations, and evolving healthcare challenges. This review provides a comprehensive synthesis of current clinical and pharmaceutical approaches that support effective disease prevention, early diagnosis, and evidence-based management. It discusses contemporary preventive strategies, including lifestyle modification, public health interventions, preventive pharmacotherapy, and risk stratification, alongside advances in clinical management through evidence-based medicine, personalized care, and multidisciplinary healthcare models. The review further examines pharmaceutical innovations, including biologics, small-molecule drugs, gene and cell therapies, nanomedicine, and artificial intelligence-driven drug discovery, highlighting their roles in improving therapeutic efficacy and patient outcomes. The integration of clinical practice with pharmaceutical care, digital health technologies, telemedicine, and pharmacist-led interventions is also explored as a framework for optimizing healthcare delivery. Additionally, key challenges such as medication adherence, polypharmacy, antimicrobial resistance, healthcare disparities, regulatory concerns, and economic constraints are critically discussed. Finally, the review outlines future directions emphasizing precision medicine, pharmacogenomics, digital health, and real-world evidence to advance patient-centered and sustainable healthcare systems. Collectively, this review underscores that integrating clinical and pharmaceutical strategies is essential for improving disease prevention, enhancing therapeutic outcomes, and strengthening global healthcare systems.Background: Carbapenem-resistant Gram-negative bacteria (CR-GNB) have emerged as a significant healthcare concern, particularly in intensive care units (ICUs), owing to their limited treatment options and association with high morbidity and mortality. The New Delhi metallo-β-lactamase (BlaNDM-1) gene is one of the most important mechanisms responsible for carbapenem resistance among Gram-negative bacterial pathogens. Aim: To determine the prevalence of the BlaNDM-1 gene among carbapenem-resistant Gram-negative bacterial (CR-GNB) isolates recovered from ICU patients. Materials and Methods: This hospital-based cross-sectional observational study was conducted over 12 months in the Department of Microbiology of a tertiary care teaching hospital. A total of 911 Gram-negative bacterial isolates obtained from ICU patients were analyzed, among which 290 carbapenem-resistant isolates were included. Identification and antimicrobial susceptibility testing were performed using standard microbiological methods. Molecular detection of the BlaNDM-1 gene was carried out by polymerase chain reaction (PCR). Results: Among 290 CR-GNB isolates, Klebsiella pneumoniae was the predominant organism (126, 44.7%), followed by Acinetobacter baumannii (55, 35.3%), Escherichia coli (45, 20.5%), and Pseudomonas aeruginosa (39, 36.1%). Lower respiratory tract infections accounted for the majority of cases (54.8%), followed by urinary tract infections (17.2%) and pyogenic infections (15.2%). Overall carbapenem resistance among Gram-negative isolates was 31.8%. Resistance to meropenem, imipenem, and ertapenem exceeded 94%, while colistin demonstrated the lowest resistance rate (9.66%). The BlaNDM-1 gene was detected in 209 out of 290 CR-GNB isolates (72.0%). Highest positivity was observed in Proteus spp. (100%) and Klebsiella pneumoniae (77.0%). Major risk factors included prior antibiotic exposure (71.3%), prolonged ICU stay >7 days (65.1%), and mechanical ventilation (56.5%). Conclusion: The study demonstrates a high prevalence of NDM-mediated carbapenem resistance among ICU isolates, emphasizing the urgent need for molecular surveillance, antimicrobial stewardship programs, and strict infection control practices essential to limit the spread of these multidrug-resistant pathogens.