Citation Information :
Gopalakrishnan R, 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.
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.
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.
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.
Bialvaei AZ, Samadi Kafil H. Colistin, mechanisms and prevalence of resistance. Curr Med Res Opin 2015;31:707-21.
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.
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.
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.
Falagas ME, Bliziotis IA. Pandrug-resistant Gram-negative bacteria: The dawn of the post-antibiotic era? Int J Antimicrob Agents 2007;29:630-6.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Sood S. Chloramphenicol-A potent armament against Multi-Drug Resistant (MDR) gram negative bacilli? J Clin Diagn Res 2016;10:DC01-3.
Mathur P, Behera B, Chaturvedi D, Misra MC. Chloramphenicol: Is old really gold? J Assoc Physicians India 2010;58:584.
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.
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.
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.
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.
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.