Carbapenem resistant Gram-negative bacteremia in an Indian intensive care unit: A review of the clinical profile and treatment outcome of 50 patients

Porwal, Ravikant; Gopalakrishnan, Ram; Rajesh, Naga Jawahar; Ramasubramanian, V

doi:10.4103/0972-5229.144021

Cited by 37 publications

(16 citation statements)

References 5 publications

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“…This issue was addressed in our previous study where 22% of the Klebsiella spp exhibited resistance to carbapenems [2]. In recent years, [6]. Remarkably, in our experience, among the ESKAPE pathogens, the rate of carbapenem resistance is rapidly rising in Klebsiella spp.…”

mentioning

confidence: 89%

Alarming increase in carbapenemase-producing Klebsiella spp causing bloodstream infections in pediatric population in India

Pragasam

Shankar

Anandan

et al. 2017

J Infect Dev Ctries

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mentioning

confidence: 89%

Alarming increase in carbapenemase-producing Klebsiella spp causing bloodstream infections in pediatric population in India

Pragasam

Shankar

Anandan

et al. 2017

J Infect Dev Ctries

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“…[ 25 ] ESBL-producing Klebsiella accounted for highest number of culture-positive infections in both primary and secondary infections with very high mortality, Klebsiella was followed by Pseudomonas spp., Acinetobacter spp., and E. coli . [ 26 27 ] In non-ESBL culture-positive cases, major source was blood followed by ascitic fluid, sputum, urine, throat swabs, and pus. Staphylococcus accounted for highest number of cases with a high mortality rate of 17.39% (three Staphylococcus aureus cases out of which two were MRSA).…”

Section: Discussionmentioning

confidence: 99%

Epidemiological analysis of extended-spectrum beta-lactamase-producing bacterial infections in adult live donor liver transplant patients

Singh

Govil

Baveja

et al. 2018

Indian Journal of Critical Care Medicine

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Introduction:Bacterial infections are a leading cause of morbidity and mortality in patients receiving solid-organ transplants. Extended-spectrum beta-lactamases (ESBL) pathogens are the most important pathogenic bacteria infecting these patients.Aim:This study aims to evaluate for the incidence and characteristics of ESBL-positive organism, to look for the clinical outcomes in ESBL-positive infected cases, and to evaluate and draft the antibiotic policy in posttransplant patients during the first 28 days posttransplant.Materials and Methods:This is a retrospective data analysis of liver transplant recipients infected with ESBL culture-positive infections. All the culture sites such as blood, urine, and endotracheal tube aspirates were screened for the first ESBL infection they had and noted. This data were collected till day 28 posttransplant. The antibiotic susceptibility pattern and the most common organism were also noted.Results:A total of 484 patients was screened and 116 patients had ESBL-positive cultures. Out of these, 54 patients had infections and 62 patients were ESBL colonizers. The primary infection site was abdominal fluid (40.7%), with Klebsiella accounting for most of the ESBL infections. Colistin was the most sensitive antibiotic followed by tigecycline. The overall mortality was 11.4% and 31 out of 54 ESBL-infected patients died.Conclusions:Infections with ESBL-producing organism in liver transplant recipients has a high mortality and very limited therapeutic options.

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“…[ 12 ] We could find only two other combination studies from India, both small observational studies with no significant difference in the outcome between the two groups. [ 15 16 ] There are no published data from India comparing CCCT and CMT against CRGNB nonbacteremic infections. To the best of our knowledge, this is the first publication on combination therapy in nonbacteremic infections.…”

Section: Discussionsmentioning

confidence: 99%

Monotherapy versus combination therapy against nonbacteremic carbapenem-resistant gram-negative infections: a retrospective observational study

Ghafur

Devarajan

Raja

et al. 2017

Indian Journal of Critical Care Medicine

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Background:Superiority of colistin–carbapenem combination therapy (CCCT) over colistin monotherapy (CMT) against carbapenem-resistant Gram-negative bacterial (CRGNB) infections is not conclusively proven.Aim:The aim of the current study was to analyze the effectiveness of both strategies against CRGNB nonbacteremic infections.Design:This was a retrospective observational cohort study.Subjects and Methods:Case record analysis of patients who had CRGNB nonbacteremic infections identified over a period of 4 years (January 2012–December 2015) was done by medical record review at a tertiary care center in India.Statistical Analysis:P < 0.05 was considered as significant. Multivariate analysis was performed using Cox regression.Results:Out of 153 patients (pneumonia 115, urinary tract infection 17, complicated skin and soft-tissue infection 18, intra-abdominal infection 1, and meningitis 2), 92 patients received CCCT and 61 received CMT. Univariate analysis revealed higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, pneumonia as the diagnosis, and Klebsiella as the causative organism to be the risk factors for higher 28-day mortality (P = 0.036, 0.006, 0.016, respectively). Combination therapy had no significant impact on mortality (odds ratio [OR] = 0.91, 95% confidence interval [CI] = 0.327–2.535, P = 0.857). Multivariate analysis revealed that higher APACHE II score and infection due to Klebsiella were found to be independent risk factors for higher mortality (OR = 3.16 and 4.9, 95% CI = 1.34–7.4 and 2.19–11.2, P = 0.008 and 0.0001, respectively).Conclusions:In our retrospective single-center series of CRGNB nonbacteremic infections, CCCT was not superior to CMT. Multicenter large observational studies or prospective randomized clinical trials are the need of the hour.

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Carbapenem resistant Gram-negative bacteremia in an Indian intensive care unit: A review of the clinical profile and treatment outcome of 50 patients

Cited by 37 publications

References 5 publications

Alarming increase in carbapenemase-producing Klebsiella spp causing bloodstream infections in pediatric population in India

Alarming increase in carbapenemase-producing Klebsiella spp causing bloodstream infections in pediatric population in India

Epidemiological analysis of extended-spectrum beta-lactamase-producing bacterial infections in adult live donor liver transplant patients

Monotherapy versus combination therapy against nonbacteremic carbapenem-resistant gram-negative infections: a retrospective observational study

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