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VOLUME 21 , ISSUE 5 ( May, 2017 ) > List of Articles

BRIEF COMMUNICATION

A study of 24 patients with colistin-resistant Gram-negative isolates in a tertiary care hospital in South India

Rajalakshmi Arjun, P. Senthur Nambi, D. Suresh Kumar, R. Madhumitha, V. Ramasubramanian

Keywords : Colistin resistance, combination therapy, outcome

Citation Information : Arjun R, Nambi PS, Kumar DS, Madhumitha R, Ramasubramanian V. A study of 24 patients with colistin-resistant Gram-negative isolates in a tertiary care hospital in South India. Indian J Crit Care Med 2017; 21 (5):317-321.

DOI: 10.4103/ijccm.IJCCM_454_16

License: CC BY-ND 3.0

Published Online: 01-05-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: As the use of colistin to treat carbapenem-resistant Gram-negative infections increases, colistin resistance is being increasingly reported in Indian hospitals. Materials and Methods: Retrospective chart review of clinical data from patients with colistin-resistant isolates (minimum inhibitory concentration >2 mcg/ml). Clinical profile, outcome, and antibiotics that were used for treatment were analyzed. Results: Twenty-four colistin-resistant isolates were reported over 18 months (January 2014-June 2015). A history of previous hospitalization within 3 months was present in all the patients. An invasive device was used in 22 (91.67%) patients. Urine was the most common source of the isolate, followed by blood and respiratory samples. Klebsiella pneumoniae constituted 87.5% of all isolates. Sixteen (66.6%) were considered to have true infection, whereas eight (33.3%) were considered to represent colonization. Susceptibility of these isolates to other drugs tested was tigecycline in 75%, chloramphenicol 62.5%, amikacin 29.17%, co-trimoxazole 12.5%, and fosfomycin (sensitive in all 4 isolates tested). Antibiotics that were used for treatment were combinations among the following antimicrobials-tigecycline, chloramphenicol, fosfomycin, amikacin, ciprofloxacin, co-trimoxazole, and sulbactam. Among eight patients who were considered to have colonization, there were no deaths. Bacteremic patients had a significantly higher risk of death compared to all nonbacteremic patients (P = 0.014). Conclusions: Colistin resistance among Gram-negative bacteria, especially K. pneumoniae, is emerging in Indian hospitals. At least one-third of isolates represented colonization only rather than true infection and did not require treatment. Among patients with true infection, only 25% had a satisfactory outcome and survived to discharge. Fosfomycin, tigecycline, and chloramphenicol may be options for combination therapy.


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