Emergence of Pan drug resistance amongst gram negative bacteria! The First case series from India

Abstract

Abdul Ghafur, Vidya Lakshmi, Priyadarshini Kannain, Thirunarayan MA Emergence of Pan-drug resistance amongst gram negative bacteria! The First case series from India Ghafur A, Vidyalakshmi PR, A Murali, Priyadarshini K, Thirunarayan MA Department of Infectious Diseases, Apollo Speciality Hospitals, Chennai, India Background: Increasing prevalence of carbapenem resistant Gram negative bacteria is a serious clinical and public health challenge. Bacteria resistant to all available antibiotics (Pan Drug Resistance) herald the onset of post antibiotics era. We hereby report clinical profile of 13 patients with pan drug resistant gram negative isolates. Methods: Retrospective analysis of 13 patients with pan drug resistant gram negative isolates over the last 18 months was done by medical records review. Identification of the isolates and susceptibility testing was done using VITEK auto analyzer in concordance with the corresponding CLSI guidelines. Results: Out of four patients with bacteraemic isolates, three patients received colistin based combination therapy. Though two of these patients had microbiologic clearance, all the three died. Out of the 9 patients with non bacteraemic isolates, 4 had infection and 5 had colonization. Three (out of four) were treated with combination therapy including colistin and one patient received colistin monotherapy. All four patients had microbiological clearance. Three patients had clinical cure and were discharged. One patient later developed bacteraemia and died. Conclusion: Infections, particularly blood stream with pan drug resistant organisms has a higher mortality. Urgent studies to reevaluate existing therapeutic options and research into new antibiotic molecules are the need of the hour.

Keywords

• Pan drug resistance, gram negative bacterial infections, colistin

Emergence of Pan drug resistance amongst gram negative bacteria! The First case series from India

Öz

Amaç: Karbapenem dirençli Gram negatif bakterilerin sıklığının artması halk sağlığı ve klinik yaklaşım açısından ciddi bir problemdir. Mevcut bütün antibiyotiklere dirençli (tam dirençli) bakteriler antibiyotik sonrası dönemin başladığının habercisidir. Burada tam dirençli gram negatif suşlarla enfekte 13 hastanın profilini sunmaktayız. Yöntemler: son 18 ay içerisinde takip edilen tam dirençli gram negatif izolatlarla enfekte olan 13 hastanın kayıtları retrospektif olarak incelendi. Bakterilerin izolasyonu ve duyarlılıkları CLSI rehberine uygun olarak VITEK otomatik analiz cihazı ile yapıldı. Bulgular: Bakteriyemili hastalardan üçü kolistin içeren kombinasyon tedavisi aldı. Bu hastalardan ikisinde bakteri kandan temizlenmesine rağmen üçü de öldü. Bakteriyemi olmayan dokuz hastadan dördü enfeksiyon beşi ise kolonizasyon olarak kabul edildi. Bu dört hastadan üçü kolistin içeren kombinasyonla ve biri de tek başına kolistin ile tedavi edildi. Bu dört hastada mikrobiyolojik olarak temizlenme sağlandı. Üç hasta klinik olarak iyileşti ve taburcu edildi. Bir hastada daha sonra bekteriyemi gelişti ve öldü. Sonuç: Özellikle tam dirençli bakterilerle olan kan dolaşımı enfeksiyonları yüksek mortaliteye sahiptir. Şu anda mevcut tedavilerin yeniden gözden geçirecek çalışmalara ve yeni antibiyotik moleküllerini araştırmaya acil olarak ihtiyaç vardır

Anahtar Kelimeler

• Tam direnç, gram negatif bakteri enfeksiyonları, kolistin

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