COLISTIN RESISTANCE IN CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE STRAINS


Beena Hosdurg Bhaskar, Shalini Shenoy Mulki, Sangeeta Joshi, Ranjeeta Adhikari, Bhavana Malavalli Venkatesh

Abstract


Objective: There is an increasing use of colistin consequent to increase in the infections caused by carbapenem-resistant Klebsiella pneumoniae.The present study was conducted to determine the minimum inhibitory concentration (MIC) of colistin and the resistance pattern of colistin in carbapenem-resistant K. pneumoniae (CRKP) strains in our intensive care unit (ICU).

Methods: Antibiotic susceptibility testing for other antimicrobial agents was done by Kirby-Bauer disk diffusion method. MIC of colistin was determined by agar dilution method. The results of antibiotic susceptibility testing were interpreted as per Clinical Laboratory Standard Institute guidelines 2016 and MIC of colistin were interpreted as per European Committee on Antimicrobial susceptibility testing. The carbapenem resistance was phenotypically detected by modified hodge test and imipenem/imipenem ethylenediaminetetraacetic acid disk method.

Results: Out of 518 K. pneumoniae, 329 were resistant to carbapenems, and 91 isolates showed resistance to colistin. The MIC of colistin ranged between 4 and >512 ug/ml and MIC90 was 16 ug/L and MIC50 was 4 ug/ml. A majority of the colistin-resistant isolates were found in multidisciplinary ICU (85/91).

Conclusion: The emergence of colistin-resistant strains is a major problem due to limited treatment options for infections caused by CRKP carbapenemase producing K. pneumoniae. Colistin should not be used alone, combination therapy should be preferred.


Keywords


Colistin, Carbapenemase producing Klebsiella pneumoniae, Minimum inhibitory concentration of colistin.

| PDF |

References


Perçin D, Colakoğlu S, Durmaz S, Ekincioğlu P. Comparison of ertapenem-EMB Agar with traditional methods for screening carbapenem-resistant K. pneumoniae from rectal swabs. Mikrobiyol Bul 2012;46:546-52.

Poirel L, Labarca J, Bello H, Rioseco ML, Bernabeu S, Nordmann P. Emergence of the 16S rRNA methylase RmtG in an extended-spectrum-lactamase-producing and colistin-resistant K. pneumoniae isolate in chile. Antimicrob Agents Chemother 2014;58:618-9.

Kalem F, Ergun AG, Ertuğrul O, Özçimen S, Şimşek H, Süzük S, et al. Colistin resistance in carbapenem-resistant Klebsiella pneumoniae strains. Biomed Res 2016;27(2):368-72.

Nordmann P, Naas T, Poirel L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011;17(10):1791-8.

Cannatelli A, D’Andrea MM, Giani T, Di Pilato V, Arena F, Ambretti S, et al. In vivo emergence of colistin resistance in Klebsiella pneumoniae producing KPC-type carbapenemases mediated by insertional inactivation of the PhoQ/PhoP mgrB regulator. Antimicrob Agents Chemother 2013;57(11):5521-6.

Maltezou HC. Metallo-beta-lactamases in gram-negative bacteria: Introducing the era of pan-resistance? Int J Antimicrob Agents 2009;33(5):405.e1-7.

Peirano G, Seki LM, Val Passos VL, Pinto MC, Guerra LR, Asensi MD. Carbapenem-hydrolysing beta-lactamase KPC-2 in Klebsiella pneumoniae isolated in Rio de Janeiro, Brazil. J Antimicrob Chemother 2009;63(2):265-8.

Souli M, Kontopidou FV, Papadomichelakis E, Galani I, Armaganidis A, Giamarellou H. Clinical experience of serious infections caused by Enterobacteriaceae producing VIM-1 metallo-beta-lactamase in a Greek University Hospital. Clin Infect Dis 2008;46(6):847-54.

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(33). pii:20248.

Garbati MA, Bin Abdulhak A, Baba K, Sakkijha H. Infection due to colistin-resistant Enterobacteriacae in critically-ill patients. J Infect Dev Ctries 2013;7(10):713-9.

Bogdanovich T, Adams-Haduch JM, Tian GB, Nguyen MH, Kwak EJ, Muto CA, Doi Y. Colistin-resistant, Klebsiella pneumoniae carbapenemase [KPC]-producing Klebsiella pneumoniae belonging to the international epidemic clone ST258. Clin Infect Dis 2011;53(4):373-6.

Cannatelli A, Giani T, D’Andrea MM, Di Pilato V, Arena F, Conte V, et al. MgrB inactivation is a common mechanism of colistin resistance in KPC-producing Klebsiella pneumoniae of clinical origin. Antimicrob Agents Chemother 2014;58(10):5696-703.

Kontopidou F, Plachouras D, Papadomichelakis E, Koukos G, Galani I, Poulakou G, et al. Colonization and infection by colistin-resistant gram-negative bacteria in a cohort of critically ill patients. Clin Microbiol Infect 2011;17(11):E9-11.

CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-First Informational Supplement. CLSI document M100-S21.Wayne, PA: Clinical and Laboratory Standards Institute; 2011.

Cai Y, Chai D, Wang R, Liang B, Bai N. Colistin resistance of Acinetobacter baumannii: Clinical reports, mechanisms and antimicrobial strategies. J Antimicrob Chemother 2012;67(7):1607-15.

Falagas ME, Kasiakou SK, Tsiodras S, Michalopoulos A. The use of intravenous and aerosolized polymyxins for the treatment of infections in critically ill patients: A review of the recent literature. Clin Med Res 2006;4(2):138-46.

Li J, Nation RL, Milne RW, Turnidge JD, Coulthard K. Evaluation of colistin as an agent against multi-resistant gram-negative bacteria. Int J Antimicrob Agents 2005;25(1):11-25.

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(1):E23-30.

Lucet JC, Decre D, Fichelle A, Joly-Guillou ML, Pernet M, Deblangy C. Control of a prolonged outbreak of extended-spectrum β-lactamase-producing Enterobacteriaceae in a University hospital. Clin Infect Dis 1999;29(6):1411-8.

Virk A, Steckelberg JM. Clinical aspects of antimicrobial resistance. Mayo Clin Proc 2000;75(2):200-14.

Gupta E, Mohanty S, Sood S, Dhawan B, Das BK, Kapil A. Emerging resistance to carbapenems in a tertiary care hospital in north India. Indian J Med Res 2006;124:95-8.

El-Mahdy TS, Abdelaziz MO, El-Domany RA. Prevalence and molecular characterization of extended spectrum β-lacatamases in Klebsiella pneumoniae isolates from cancer patients and others. Int J Pharm Pharm Sci 2015;7:122-7.

Bashir H, Kakru KD, Qadri SS, Bali N, Bshir S, Ione S. Carbapenem resistant Klebsiella pneumoniae in a tertiary care hospital in North India. Int J Adv Res 2014;2(1):92-102.

Dizbay M, Tunccan GO, Karasahin O, Aktas F. Emergence of carbapenem resistant Klebsiella spp. infections in a Turkish university hospital: Epidemiology and risk factors. J Infect Dev Ctries 2014;8(1):44-9.

Taneja N, Singh G, Singh M, Sahrms M. Emergence of tigecycline & colistin resistant Acinetobacter baumanii in patients with complicated urinary tract infections in North India. Indian J Med Res 2011;133(6):681-4.

Giani T, Pini B, Arena F, Conte V, Bracco S, Migliavacca R; AMCLI-CRE Survey Participants, et al. Epidemic diffusion of KPC carbapenemase-producing Klebsiella pneumoniae in Italy: Results of the first countrywide survey, 15 May to 30 June 2011. Euro Surveill 2013;18. pii:20489.

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(3):86-91.

Shah PG, Shah SR, Kamat SD, Kamat DV. Colistin-carbapenem combination therapy against carbapenem resistant gram negative bacilli infections: Clinical and in vitro synergy study. Int J Pharm Pharm Sci 2014;6:497-500.

Tumbarello M, Viale P, Viscoli C, Trecarichi EM, Tumietto F, Marchese A, et al. Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: Importance of combination therapy. Clin Infect Dis 2012;55(7):943-50.

Daikos GL, Tsaousi S, Tzouvelekis LS, Anyfantis I, Psichogiou M, Argyropoulou A, et al. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: Lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother 2014;58(4):2322-8.




About this article

Title

COLISTIN RESISTANCE IN CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE STRAINS

Keywords

Colistin, Carbapenemase producing Klebsiella pneumoniae, Minimum inhibitory concentration of colistin.

DOI

10.22159/ajpcr.2017.v10i9.18369

Date

01-09-2017

Additional Links

Manuscript Submission

Journal

Asian Journal of Pharmaceutical and Clinical Research
Vol 10 Issue 9 September 2017 Page: 70-73

Print ISSN

0974-2441

Online ISSN

2455-3891

Authors & Affiliations

Beena Hosdurg Bhaskar
Department of Microbiology, Manipal Hospital, Bengaluru, Karnataka, Inda
India

Shalini Shenoy Mulki
Department of Microbiology, Kasturba Medical College, Mangalore, Karnataka, India.
India

Sangeeta Joshi
Department of Microbiology, Manipal Hospital, Bengaluru, Karnataka, Inda
India

Ranjeeta Adhikari
Department of Microbiology, Manipal Hospital, Bengaluru, Karnataka, Inda
India

Bhavana Malavalli Venkatesh
Department of Microbiology, Manipal Hospital, Bengaluru, Karnataka, Inda
India


Article Tools


Email this article (Login required)
Email the author (Login required)

Refbacks

  • There are currently no refbacks.