1417. Clinical Features and Outcomes of raoultella terrigena Infections. A Single-Center Experience from Karachi, Pakistan

Abstract

Background Raoultella terrigena (formerly Klebsiella terrigena) is an environmental gram-negative rod, occasionally causing infections in humans, especially in elderly, immunosuppressed patients. Moreover, this organism tends to be multi-drug resistant, limiting treatment options. Evidence on clinical presentation and outcomes of this infection is limited; we conducted a cross-sectional study to get a better insight into these infections. Methods We conducted a cross-sectional study on all adult patients with clinical specimen positive for Raoultella terrigena at a 700-bedded tertiary care hospital in Karachi, Pakistan, between January 2013 to December 2018. Results A total of 58 patients with R. terrigena were identified. The median age was 61.5 years, and the male to female ratio was (60.9% vs. 39.1%). The most common site of infection was respiratory tract 28.3%, followed by urinary tract infections 26%, and central line-associated infections 15.2%. In 12 patients 22.6%, R. terrigena was a colonizer. Amongst infected cases, 23.6% were in shock, and of which 18.1% required vasopressors. 29.2% had respiratory failure requiring non-invasive ventilation in 13.9%, and mechanical ventilation in 15.3%. The previous history of multidrug-resistant organisms was present in 67.4% cases and the history of prior antibiotics use within the last six months was present in 78.3%. 91.3% of isolates were resistant to piperacillin-tazobactam and meropenem, 65.2% were resistant to colistimethate. However, tigecycline susceptibility maintained in 30.4% checked in n=31, 67.4% and fosfomycin sensitivity in 15.2% cases, checked in n=29, 63% cases. Eight patients lost to follow up. Majority of patients were treated with combination therapy n=31, 81.6% and meropenem plus colistemethate was the most commonly used combination n=11, 44%. The overall mortality rate was 44.7%. Among all recorded co-morbid conditions, chronic kidney disease was strongly associated with mortality (p= .029), as also the use of vasopressors (p= .005).Persons who had high (greater or equal to three) Charlson comorbidity index had high mortality (p=0.002). Conclusion R.terrigena is a highly drug-resistant organism with high mortality rate, and causes hospital-acquired respiratory tract infections in majority of patients. Disclosures All Authors: No reported disclosures

Raoultellaterrigena: Current state of knowledge, after two recently identified clinical cases in Eastern Europe

“…Raoultella terrigena infection showed high mortality (44.4%), 4 patients from 9 separately reported clinical cases with presented outcome information have died (Table 3). Similar mortality levels (44.7%) have been reported in Pakistan during 2013‐2018 years 22 . In our case, 1 of our study patient had pregnancy, eclampsia, and long‐term smoking anamnesis; in case 2, the patient had decompensation of type 1 diabetes, so we may say both patients were immunocompromised 23 …”

“…And 8 cases were reported in Pakistan as bacteriemia 32 . 58 cases of R. terrigena in another hospital in Pakistan were reported during 2013‐2018 years, 12 patients of which were colonized without clinical symptoms 22 . There were isolated 2 strains of R. terrigena from the gallbladders in patients with gallstones after cholecystectomy, 33 but without connection between stone formation or inflammation and isolated pathogens.…”

Isolation and Identification of Multidrug-Resistant Raoultella terrigena as a Causative Agent of Urinary Tract Infection in Pregnant Women in the South of Libya

“…The occurrence of Raoultella terrigena infections is known to be a very rare, however some studies have reported the isolation of R. terrigena from several clinical sites, such as urinary tract (Wang, et al, 2016;Mal, et al, 2019;Ahmed, et al, 2020;Lekhniuk, et al, 2021). Until the date of this study, just about 363 cases of R. terrigena infections have been published in the world, while according to our knowledge there is no reported cases either in Libya or Arabic countries (Lekhniuk, et al, 2021).…”

“…The first documented case of R. terrigena as a human pathogen was confirmed in 2007 in a patient with a post-liver transplant and endocarditis (Goegele et al, 2007). This bacterium has been isolated from other different clinical sites such as subungual abscess, bronchial secretion, blood and urine (Wang, et al, 2016;Mal, et al, 2019;Ahmed, et al,. 2020;Lekhniuk, et al, 2021).…”

“…Occasionally, with a low prevalent rate of infection, the members of this genus have been recognized as a human opportunistic pathogen and have the capability of causing diseases (Drancourt, et al, 2001;Chun, et al, 2014). R. terrigena has been reported to harbour several virulence factors that have been found in Klebsiella pneumonia, however very few cases of infections by this species have been reported (Podschun and Ullmann, 2000;Ahmed, et al, 2020;Lekhniuk, et al, 2021).…”