Colistin-resistant in Surgical Polytrauma Intensive Care Unit of Level-1 Trauma Center: First Case Series from Trauma Patients in India

Overview

Journal Indian J Crit Care Med

Specialty Critical Care

Date 2018 Mar 14

PMID 29531451

Citations 6

Authors

Richa Aggarwal

Neha Rastogi

Purva Mathur

Kapil Dev Soni

Subodh Kumar

Amit Gupta

Sushma Sagar

Affiliations

Soon will be listed here.

Abstract

Introduction: There have been isolated case reports and reports of outbreak of colistin-resistant Klebsiella from various parts of the world but only two from India and that too from oncology centers. We report cluster of colistin-resistant bloodstream infection cases from our surgical trauma Intensive Care Unit.

Methodology: The study was carried out in surgical ICU of Level-I trauma center. Retrospective analysis of all the five patients with CRK was done. Demographic data, antibiotic exposure throughout the hospital stay, hospital course, and clinical outcome were analyzed.

Results: Out of 5 patients, 4 were young males (mean age of 23.5 years) without comorbidities and had undergone exploratory laparotomy following blunt trauma abdomen. 3 patients were chronic patients and had been on carbapenem and colistin 11-20 days before isolation whereas 2 patienst had isolation of CRK just within 7 days of admission. Out of the five patients, 3 patients survived and 2 had fatal outcome.

Conclusions: CRK is an emerging and challenging pathogen in polytrauma victims. There was an outbreak of CRK in our ICU that could be contained with infection control measures.

Citing Articles

Study of Colistin Resistant Gram Negative Organism in Hospitalized Patients: A Retrospective Study.

Diwane D, Rajhans P, Jog S, Dalvi M Indian J Crit Care Med. 2024; 28(3):286-289.

PMID: 38477004 PMC: 10926024. DOI: 10.5005/jp-journals-10071-24658.

The Global and Regional Prevalence of Hospital-Acquired Carbapenem-Resistant Infection: A Systematic Review and Meta-analysis.

Lin X, Li C, Zhang S, Yang X, Jiang M Open Forum Infect Dis. 2024; 11(2):ofad649.

PMID: 38312215 PMC: 10836986. DOI: 10.1093/ofid/ofad649.

Comparative Evaluation of Broth Microdilution With Disc Diffusion and VITEK 2 for Susceptibility Testing of Colistin on Multidrug-Resistant Gram-Negative Bacteria.

Anita , Kumari R, Saurabh K, Kumar S, Kumari N Cureus. 2024; 15(12):e50894.

PMID: 38259409 PMC: 10803103. DOI: 10.7759/cureus.50894.

Colistin exposure enhances expression of eptB in colistin-resistant Escherichia coli co-harboring mcr-1.

Elizabeth R, Baishya S, Kalita B, Wangkheimayum J, Choudhury M, Dhar Chanda D Sci Rep. 2022; 12(1):1348.

PMID: 35079093 PMC: 8789769. DOI: 10.1038/s41598-022-05435-0.

Colistin Resistance Among Multiple Sequence Types of Is Associated With Diverse Resistance Mechanisms: A Report From India.

Azam M, Gaind R, Yadav G, Sharma A, Upmanyu K, Jain M Front Microbiol. 2021; 12:609840.

PMID: 33692764 PMC: 7937630. DOI: 10.3389/fmicb.2021.609840.

References

Zarkotou O, Pournaras S, Voulgari E, Chrysos G, Prekates A, Voutsinas D . Risk factors and outcomes associated with acquisition of colistin-resistant KPC-producing Klebsiella pneumoniae: a matched case-control study. J Clin Microbiol. 2010; 48(6):2271-4. PMC: 2884508. DOI: 10.1128/JCM.02301-09. View

Schwaber M, Klarfeld-Lidji S, Navon-Venezia S, Schwartz D, Leavitt A, Carmeli Y . Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother. 2007; 52(3):1028-33. PMC: 2258527. DOI: 10.1128/AAC.01020-07. View

. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep. 2009; 58(10):256-60. View

Antoniadou A, Kontopidou F, Poulakou G, Koratzanis E, Galani I, Papadomichelakis E . Colistin-resistant isolates of Klebsiella pneumoniae emerging in intensive care unit patients: first report of a multiclonal cluster. J Antimicrob Chemother. 2007; 59(4):786-90. DOI: 10.1093/jac/dkl562. View

Kontopidou F, Plachouras D, Papadomichelakis E, Koukos G, Galani I, Poulakou G . Colonization and infection by colistin-resistant Gram-negative bacteria in a cohort of critically ill patients. Clin Microbiol Infect. 2011; 17(11):E9-E11. DOI: 10.1111/j.1469-0691.2011.03649.x. View

Goel G, Hmar L, De M, Bhattacharya S, Chandy M . Colistin-resistant Klebsiella pneumoniae: report of a cluster of 24 cases from a new oncology center in eastern India. Infect Control Hosp Epidemiol. 2014; 35(8):1076-7. DOI: 10.1086/677170. View

Oliva A, Mascellino M, Cipolla A, DAbramo A, De Rosa A, Savinelli S . Therapeutic strategy for pandrug-resistant Klebsiella pneumoniae severe infections: short-course treatment with colistin increases the in vivo and in vitro activity of double carbapenem regimen. Int J Infect Dis. 2015; 33:132-4. DOI: 10.1016/j.ijid.2015.01.011. View

Marchaim D, Chopra T, Pogue J, Perez F, Hujer A, Rudin S . Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in metropolitan Detroit, Michigan. Antimicrob Agents Chemother. 2010; 55(2):593-9. PMC: 3028794. DOI: 10.1128/AAC.01020-10. View

Suh J, Son J, Chung D, Peck K, Ko K, Song J . Nonclonal emergence of colistin-resistant Klebsiella pneumoniae isolates from blood samples in South Korea. Antimicrob Agents Chemother. 2009; 54(1):560-2. PMC: 2798536. DOI: 10.1128/AAC.00762-09. View

10.

Pragasam A, Shankar C, Veeraraghavan B, Biswas I, Nabarro L, Inbanathan F . Molecular Mechanisms of Colistin Resistance in Causing Bacteremia from India-A First Report. Front Microbiol. 2017; 7:2135. PMC: 5220082. DOI: 10.3389/fmicb.2016.02135. View

11.

Nordmann P, Naas T, Poirel L . Global spread of Carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis. 2011; 17(10):1791-8. PMC: 3310682. DOI: 10.3201/eid1710.110655. View

12.

Falagas M, Rafailidis P, Matthaiou D . Resistance to polymyxins: Mechanisms, frequency and treatment options. Drug Resist Updat. 2010; 13(4-5):132-8. DOI: 10.1016/j.drup.2010.05.002. View

13.

Mammina C, Bonura C, Di Bernardo F, Aleo A, Fasciana T, Sodano C . Ongoing spread of colistin-resistant Klebsiella pneumoniae in different wards of an acute general hospital, Italy, June to December 2011. Euro Surveill. 2012; 17(33). View

14.

Oliva A, DAbramo A, DAgostino C, Iannetta M, Mascellino M, Gallinelli C . Synergistic activity and effectiveness of a double-carbapenem regimen in pandrug-resistant Klebsiella pneumoniae bloodstream infections. J Antimicrob Chemother. 2014; 69(6):1718-20. DOI: 10.1093/jac/dku027. View

15.

Humphries R, Kelesidis T, Bard J, Ward K, Bhattacharya D, Lewinski M . Successful treatment of pan-resistant Klebsiella pneumoniae pneumonia and bacteraemia with a combination of high-dose tigecycline and colistin. J Med Microbiol. 2010; 59(Pt 11):1383-1386. PMC: 8482875. DOI: 10.1099/jmm.0.023010-0. View