Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 22 , ISSUE 2 ( 2018 ) > List of Articles

BRIEF COMMUNICATION

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

Amit Gupta

Keywords : Colistin-resistant Klebsiella pneumonia, polytrauma, surgical Intensive Care Unit

Citation Information : Gupta A. Colistin-resistant Klebsiella pneumoniae in Surgical Polytrauma Intensive Care Unit of Level-1 Trauma Center: First Case Series from Trauma Patients in India. Indian J Crit Care Med 2018; 22 (2):103-106.

DOI: 10.4103/ijccm.IJCCM_430_17

License: CC BY-ND 3.0

Published Online: 01-07-2013

Copyright Statement:  Copyright © 2018; The Author(s).


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 Klebsiella pneumonia 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.


PDF Share
  1. Nordmann P, Naas T, Poirel L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011;17:1791-8.
  2. Centers for Disease Control and Prevention (CDC). Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58:256-60.
  3. Kalem F, Ergun A, Ertuğrul Ö, Özçimen S, Şimşek H, Arslan U, et al. Colistin resistance in carbapenem-resistant Klebsiella pneumoniae strains. Biomed Res 2016;27:368-72.
  4. Antoniadou A, Kontopidou F, Poulakou G, Koratzanis E, Galani I, Papadomichelakis E, et al. Colistin-resistant isolates of Klebsiella pneumoniae emerging in Intensive Care Unit patients:First report of a multiclonal cluster. J Antimicrob Chemother 2007;59:786-90.
  5. Suh JY, Son JS, Chung DR, Peck KR, Ko KS, Song JH, et al. Nonclonal emergence of colistin-resistant Klebsiella pneumoniae isolates from blood samples in South Korea. Antimicrob Agents Chemother 2010;54:560-2.
  6. Zarkotou O, Pournaras S, Voulgari E, Chrysos G, Prekates A, Voutsinas D, et al. Risk factors and outcomes associated with acquisition of colistin-resistant KPC-producing Klebsiella pneumoniae: A matched case-control study. J Clin Microbiol 2010;48:2271-4.
  7. Marchaim D, Chopra T, Pogue JM, Perez F, Hujer AM, Rudin S, et al. Outbreak of colistin-resistant, Carbapenem-resistant Klebsiella pneumoniae in metropolitan Detroit, Michigan. Antimicrob Agents Chemother 2011;55:593-9.
  8. Goel G, Hmar L, Sarkar 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;35:1076-7.
  9. Pragasam AK, Shankar C, Veeraraghavan B, Biswas I, Nabarro LE, Inbanathan FY, et al. Molecular mechanisms of colistin resistance in Klebsiella pneumoniae causing bacteremia from India-A first report. Front Microbiol 2016;7:2135.
  10. Kontopidou F, Plachouras D, Papadomichelakis E, Koukos G, Galani I, Poulakou G, et al. Colonization and infection by colistin-resistant gram-negative bacteria in a cohort of critically ill patients. Clin Microbiol Infect 2011;17:E9-11.
  11. Ghafur A, Vidyalakshmi PR, Murali A, Priyadarshini K, Thirunarayan MA. Emergence of Pan-drug resistance amongst gram negative bacteria! The first case series from India. J Microbiol Infect Dis 2014;4:86-91.
  12. Mammina C, Bonura C, Di Bernardo F, Aleo A, Fasciana T, Sodano C, et al. Ongoing spread of colistin-resistant Klebsiella pneumoniae in different wards of an acute general hospital, Italy, June to December 2011. Euro Surveill 2012;17. pii: 20248.
  13. Schwaber MJ, Klarfeld-Lidji S, Navon-Venezia S, Schwartz D, Leavitt A, Carmeli Y, et al. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52:1028-33.
  14. Falagas ME, Rafailidis PI, Matthaiou DK. Resistance to polymyxins: Mechanisms, frequency and treatment options. Drug Resist Updat 2010;13:132-8.
  15. Humphries RM, Kelesidis T, Dien Bard J, Ward KW, Bhattacharya D, Lewinski MA, et al. Successful treatment of pan-resistant Klebsiella pneumoniae pneumonia and bacteraemia with a combination of high-dose tigecycline and colistin. J Med Microbiol 2010;59:1383-6.
  16. Oliva A, Mascellino MT, Cipolla A, D'Abramo A, De Rosa A, Savinelli S, et al. 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.
  17. Oliva A, D'Abramo A, D'Agostino C, Iannetta M, Mascellino MT, Gallinelli C, et al. Synergistic activity and effectiveness of a double-carbapenem regimen in pandrug-resistant Klebsiella pneumoniae bloodstream infections. J Antimicrob Chemother 2014;69:1718-20.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.