Background:Although Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) infections in immunocompromised hosts have been recognised, clinical data detailing these infections remain limited, especially from India. Antimicrobial susceptibility data on E. meningoseptica remain very limited, with no established breakpoints by Clinical and Laboratory Standards Institute (CLSI). The organism is usually multidrug resistant to antibiotics usually prescribed for treating Gram-negative bacterial infections, a serious challenge to the patient and the treating clinicians.Materials and Methods:The analysis was done in a tertiary care oncology and stem cell transplant center. Susceptibility testing and identification of E. meningoseptica was done using Vitek auto analyzer. Records of immunocompromised patients with E. meningoseptica bacteremia were analysed from January 2009 to March 2012.Results:A total of 29 E. meningoseptica bacteremia cases were documented between 2009 and 2012. Eleven patients were immunocompromised. Three were post stem cell transplant and one was post cord blood transplant. The mean age of the patients was 48.4 years. Mean Charlson’s comorbidity index was 5.7. Four had solid organ malignancies, five had hematological malignancies, and two had lymphoreticular malignancy. Eight patients had received chemotherapy. Mean Apache II score was 18. Mean Pitts score for bacteremia was 4.7. Two were neutropenic (one post SCT, one MDS post chemo) with a mean white blood cell (WBC) count of 450/mm3 . Ten had a line at the time of bacteremia. Mean duration of the line prior to bacteremia was 8 days. Eight had line-related bacteremia. Three had pneumonia with secondary bacteremia. All received combination therapy with two or more antibiotics which included cotrimoxazole, rifampicin, piperacillin–tazobactam, tigecycline, or cefepime–tazobactam. All the isolates showed in vitro resistance to ciprofloxacin. Five patients died, but a multivariate analysis was not done to calculate the attributable mortality.Conclusion:In our study, central line was the commonest risk factor for E. meningosepticum bacteremia, although a multivariate analysis was not done. There has not been much of a change in the susceptibility pattern of these organisms over 3 years, with good susceptibility to piperacillin–tazobactam and cotrimoxazole. Even though uncommon, E. meningoseptica is an important pathogen, especially in immunocompromised hosts with indwelling devices.

This is the first study from India comparing clinical features of patients with carbapenem sensitive and resistant blood stream infections. Patients with carbapenem resistant bacteremia had higher mortality compared to patients with sensitive bacteremia.

BackgroundCarbapenem resistant Enterobacteriaceae is a worldwide threat, with increasing prevalence in many countries. Restricted usage of higher end antibiotics, especially carbapenem is of great importance in tackling these super bugs. Purpose of this retrospective study was to analyse the impact of antibiotic stewardship activities on the prevalence of carbapenem resistant Enterobacteriaceae in our hospital.FindingsIn the first Quarter of 2009, average usage of carbapenem group of antibiotics was 955 vials a month while in 2010, the usage dropped to 745 vials per month. Carbapenem resistant E.coli rate dropped from 3.7% in 2009 to 1.6% in 2010 and Klebsiella rate reduced from 6% in 2009 to 3.6% in 2010.ConclusionsStrict antibiotic stewardship strategies in conjunction with good infection control practices are useful in restricting higher end antibiotic usage and reducing the prevalence of carbapenem resistant Enterobacteriaceae.

No abstract

Findings of the study make a strong argument for using BL-BLI agents and sparing carbapenem to curtail the spiraling scenario of carbapenem resistance.