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


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

R. Madhumitha, V. Ramasubramanian

Keywords : Colistin resistance, combination therapy, outcome

Citation Information : 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: 01-05-2018

Copyright Statement:  Copyright © 2017; The Author(s).


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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  1. Li J, Nation RL, Turnidge JD, Milne RW, Coulthard K, Rayner CR, et al. Colistin: The re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections. Lancet Infect Dis 2006;6:589-601.
  2. 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.
  3. Bialvaei AZ, Samadi Kafil H. Colistin, mechanisms and prevalence of resistance. Curr Med Res Opin 2015;31:707-21.
  4. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-81.
  5. Liu YY, Wang Y, Walsh TR, Yi LX, Zhang R, Spencer J, et al. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: A microbiological and molecular biological study. Lancet Infect Dis 2016;16:161-8.
  6. Valero E, Sevillano D, Calvo A, García R, Leturia A, Gómez-Lus ML. Activity of new fluoroquinolones against clinical isolates of Acinetobacter baumannii. Rev Esp Quimioter 2001;14:358-63.
  7. Falagas ME, Bliziotis IA. Pandrug-resistant Gram-negative bacteria: The dawn of the post-antibiotic era? Int J Antimicrob Agents 2007;29:630-6.
  8. Gales AC, Jones RN, Sader HS. Global assessment of the antimicrobial activity of polymyxin B against 54 731 clinical isolates of Gram-negative bacilli: Report from the SENTRY antimicrobial surveillance programme (2001-2004). Clin Microbiol Infect 2006;12:315-21.
  9. Al-Sweih NA, Al-Hubail MA, Rotimi VO. Emergence of tigecycline and colistin resistance in Acinetobacter species isolated from patients in Kuwait hospitals. J Chemother 2011;23:13-6.
  10. Taneja N, Singh G, Singh M, Sharma M. Emergence of tigecycline and colistin resistant Acinetobacter baumanii in patients with complicated urinary tract infections in north India. Indian J Med Res 2011;133:681-4.
  11. Qureshi ZA, Hittle LE, O′Hara JA, Rivera JI, Syed A, Shields RK, et al. Colistin-resistant Acinetobacter baumannii: Beyond carbapenem resistance. Clin Infect Dis 2015;60:1295-303.
  12. Chiu SK, Wu TL, Chuang YC, Lin JC, Fung CP, Lu PL, et al. National surveillance study on carbapenem non-susceptible Klebsiella pneumoniae in Taiwan: The emergence and rapid dissemination of KPC-2 carbapenemase. PLoS One 2013;8:e69428.
  13. 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.
  14. 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.
  15. Ramesh N, Gothandam KM, Prasanth M, Ramkumar S, Karthikeyan S, Bozdogan B, et al. Colistin susceptibility of gram-negative clinical isolates from Tamil Nadu, India. Asian Biomed 2016;10:35-9.
  16. 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.
  17. Monaco M, Giani T, Raffone M, Arena F, Garcia-Fernandez A, Pollini S, et al. 2014. Colistin resistance superimposed to endemic carbapenem-resistant Klebsiella pneumoniae: A rapidly evolving problem in Italy, November 2013 to April 2014. Euro Surveill 2014;19:pii:20939.
  18. Bogdanovich T, Adams-Haduch JM, Tian GB, Nguyen MH, Kwak EJ, Muto CA, et al. Colistin-resistant, Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae belonging to the international epidemic clone ST258. Clin Infect Dis 2011;53:373-6.
  19. 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.
  20. Heudorf U, Farber D, Mischler D, Schade M, Zinn C, Nillius D, et al. Multidrug-Resistant Organisms (MDRO) in rehabilitation clinics in the Rhine-Main-district, Germany, 2014: Prevalence and risk factors. Rehabilitation (Stuttg) 2015;54:339-45.
  21. Chen S, Hu F, Zhang X, Xu X, Liu Y, Zhu D, et al. Independent emergence of colistin-resistant Enterobacteriaceae clinical isolates without colistin treatment. J Clin Microbiol 2011;49:4022-3.
  22. Sood S. Chloramphenicol-A potent armament against Multi-Drug Resistant (MDR) gram negative bacilli? J Clin Diagn Res 2016;10:DC01-3.
  23. Mathur P, Behera B, Chaturvedi D, Misra MC. Chloramphenicol: Is old really gold? J Assoc Physicians India 2010;58:584.
  24. Civljak R, Giannella M, Di Bella S, Petrosillo N. Could chloramphenicol be used against ESKAPE pathogens? A review of in vitro data in the literature from the 21 st century. Expert Rev Anti Infect Ther 2014;12:249-64.
  25. Tsioutis C, Kritsotakis EI, Maraki S, Gikas A. Infections by pandrug-resistant gram-negative bacteria: Clinical profile, therapeutic management, and outcome in a series of 21 patients. Eur J Clin Microbiol Infect Dis 2010;29:301-5.
  26. Humphries RM, Kelesidis T, Dien Bard J, Ward KW, Bhattacharya D, Lewinski MA. 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.
  27. Falagas ME, Kastoris AC, Kapaskelis AM, Karageorgopoulos DE. Fosfomycin for the treatment of multidrug-resistant, including extended-spectrum beta-lactamase producing, Enterobacteriaceae infections: A systematic review. Lancet Infect Dis 2010;10:43-50.
  28. Capone A, Giannella M, Fortini D, Giordano A, Meledandri M, Ballardini M, et al. High rate of colistin resistance among patients with carbapenem-resistant Klebsiella pneumoniae infection accounts for an excess of mortality. Clin Microbiol Infect 2013;19:E23-30.
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