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

Yıl 2014, Cilt: 4 Sayı: 03, 86 - 91, 01.09.2014

Abdul Ghafur Vidya Lakshmi Priyadarshini Kannain A. Murali Thirunarayan Ma

https://doi.org/10.5799/ahinjs.02.2014.03.0145

Cited By: 20

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Matthew Ioannis A. Bliziotis. Pan drug-resistant Gram-negative bacteria: the dawn of the post-antibiotic era? International Jour- nal of Antimicrobial Agents 2007;29:630-636.
• Valero E, Sevillano D, Calvo A, et al. Activity of new fluoroquino- lones against clinical isolates of Acinetobacter baumannii. Rev Esp Quimioter 2001;14:358-363 [in Spanish].
• Al-Sweih NA, Al-Hubail MA, Rotimi VO. Emergence of tigecycline and colistin resistance in Acenetobacter species isolated from patients in Kuwait hospitals. J Chemother 2011;23:13-16.
• Gales AC, Jones RN, Sader HS. Global assessment of the anti- microbial activity of polymyxin B against 54 731 clinical isolates of Gram negative bacilli: report from the SENTRY antimicro- bial surveillance programme (2001-2004). Clin Microbiol Infect 2006;12:315-321
• Neelam Taneja, Gagandeep Singh, Meenakshi Singh, Meera Sharma. Emergence of Tigecycline & Colistin resistant Aceneto- bacter Baumanii in patients with complicated UTI in North India. Indian J Med Res. 2011;133:681-684
• Wattal C, Goel N, Oberoi JK, et al. Surveillance of Multidrug Re- sistant Organisms in a Tertiary Care Hospital in Delhi, India. J Assoc Physicians India 2010;58:S32-S36.
• Performance standards for antimicrobial susceptibility testing; CLSI 2013.
• European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters Version 3.1, valid from 2013-02-11.
• Helen W. Boucher, George H. Talbot. Bad Bugs, No Drugs: No ESKAPE An Update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1-12.
• Matthew E. Falagas, Petros I, et al. Pan drug-resistant Klebsi- ella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii infections: Characteristics and outcome in a series of 28 patients. International Journal of Antimicrobial Agents 2008;32:450-454
• Mentzelopoulos SD, Pratikaki M, Platsouka E, et al. Prolonged use of carbapenems and colistin predisposes to ventilator-asso- ciated pneumonia by pan drug-resistant Pseudomonas aerugi- nosa. Intensive Care Med 2007;33:1524-1532.
• Antoniadou A, Kontopidou F, Poulakou G, et al. Colistin-resistant isolates of Klebsiella pneumoniae emerging in intensive care unit patients: first report of a multi clonal cluster. J Antimicrob Chemother 2007;59:786-790.
• Landman D, Bratu S, Alam M, Quale J. Citywide emergence of Pseudomonas Aeruginosa strains with reduced susceptibility to polymixin B. J Antimicrob Chemother 2005;55:954-957.
• Kontopidou F, Plachouras D, Papadomichelakis E, et al. Colo- nization and infection by colistin-resistant Gram-negative bac- teria in a cohort of critically ill patients. Clin Microbiol Infect 2011;17:E9-E11.
• Beno P, Krcmery V, Demitrovicova A. Bacteremia in cancer pa- tients caused by colistin-resistant Gram-negative bacilli after previous exposure to ciprofloxacin and/or colistin. Clin Microbiol Infect 2006;12:497-498.
• Falagas ME, Bliziotis IA, Kasiakou SK, et al. Outcome of infec- tions due to pan drug-resistant (PDR) Gram-negative bacteria. BMC Infect Dis 2005;5:24.
• Urban C, Mariano N, Rahal JJ, et al. Polymyxin B-resistant Acinetobacter baumannii clinical isolate susceptible to recom- binant BPI and cecropin P1. Anti microb Agents Chemother 2001;45:994-995.
• Tsioutis C, Kritsotakis EI, Maraki S, Gikas A. Infections by pan drug-resistant gram-negative bacteria: clinical profile, therapeu- tic management, and outcome in a series of 21 patients. Eur J Clin Microbiol Infect Dis 2010;29:301-305.
• Hsueh PR, Teng LJ, Chen CY, et al. Pan drug-resistant Acineto- bacter baumannii causing nosocomial infections in a university hospital, Taiwan. Emerg Infect Dis 2002,8:827-832.
• Kuo LC, Yu CJ, Lee LN, et al. Clinical features of pan drug-resis- tant Acinetobacter baumannii bacteremia at a university hospital in Taiwan. J Formos Med Assoc 2003;102:601-606.
• Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resis- tant, extensively drug-resistant and pan drug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-281.