Carbapenem resistant Klebsiella pneumoniae isolated from bloodstream infection: Indian experience. (4th July 2017)

• Record Type: Journal Article
• Authors: Veeraraghavan, Balaji; Shankar, Chaitra; Karunasree, Susmitha; Kumari, Shantha; Ravi, Raji; Ralph, Ravikar
• Is Part Of: Pathogens and global health. Volume 111:Number 5(2017)
• Page Start: 240
• Page End: 246
• Publication Date: 2017-07-04
• Subjects: K. pneumoniae -- carbapenem resistance -- NDM -- OXA-48-like -- mortality -- bacteremia; Communicable diseases -- Periodicals; Public health -- International cooperation -- Periodicals; World health -- Periodicals; 362.1969
• DOI: 10.1080/20477724.2017.1340128
• Languages: English
• ISSNs: 2047-7724

Abstract

Abstract: Increased incidence of multidrug resistant (MDR) Gram negative infection has resulted in high rates of morbidity and mortality. Klebsiella pneumoniae is one of the commonest MDR pathogens causing bacteraemia with limited therapeutic options such as colistin and tigecycline. Present study focused on molecular characterisation of MDR K. pneumoniae from bloodstream infection and their clinical outcome . A total of 115 K. pneumoniae from January 2015 to September 2016 were included in the study which comprised of phenotypically identified ESBL and carbapenem resistant (CR) isolates. Multiplex PCR was performed for detection of resistance genes encoding β-lactam resistance. This includes bla SHV, bla TEM, bla VEB, bla PER, bla CTX-M, bla DHA, bla CIT, bla FOX, bla ACC, bla ACT, bla NDM, bla OXA48-like, bla VIM and bla KPC . Co-expression of bla SHV, bla TEM and bla CTX-M was predominant with 64% (74/115) prevalence. CTX-M-1 was the variant produced by all the isolates producing CTX-M. AmpC was uncommon, seen in 5% of the isolates (6/115). Among the carbapenemases co-expression of bla NDM and bla OXA48-like was observed in 28% (32/115) and bla NDM in 19% (22/115) and bla OXA48-like in 13% (15/115). bla KPC was absent. Overall mortality was observed to be 57% (64/113) and mortality among CR K. pneumoniae (Kp) was 68% (50/73). The antibiotics that were administered for treatment of CRKp were colistin in 90% (66/73) and tigecycline in 7% (5/73) and in 99% combined with meropenem (72/73). Prevalence of community acquired and nosocomial infections were 5% (4/73) and 95% (69/73) respectively among CRKp. Minocycline and meropenem susceptibilities were comparable and hence minocycline can be a carbapenem sparing agent. The resistance to β-lactam antibiotics is steadily increasing and are plasmid mediated, their containment in healthcare setting is a challenge.