Carbapenem resistant Klebsiella pneumoniae isolated from bloodstream infection: Indian experience

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, bla, bla, bla, bla, bla, bla, bla, bla, bla, bla, bla, bla and bla. Co-expression of bla, bla and bla 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 and bla was observed in 28% (32/115) and bla in 19% (22/115) and bla in 13% (15/115). bla 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.

Prevalence and 30-day all-cause mortality of carbapenem-and colistin-resistant bacteraemia caused by Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae: Description of a decade-long trend

“…As expected, most cases of carbapenemresistant bacteraemia (87%) in this study were healthcare-acquired. This is consistent with the results of several studies from different parts of the world, which have attributed most of the carbapenemresistant blood isolates to healthcare (Chen et al, 2018;Hattemer et al, 2013;Veeraraghavan et al, 2017).…”

Various combinations of Carbapenemase production in community-acquired clinical isolates in Nepal

“…An Indian study reported 5% community-acquired K. pneumoniae bloodstream infection as carbapenem-resistant (Veeraraghavan et al) [9]. Our case of community-acquired pneumonia, along with bacteremia, also showed carbapenem resistance, which signifies the increasing carbapenem resistance in the community.…”

“…The organism can have more than one type of carbapenemase-producing gene. Indian study reported CRKp from blood isolates (n = 115) producing blaNDM in 19% and blaOXA48-like in 13% and a combination of both in 28% (Veeraraghavan et al) [9]. A similar study of 30 isolates of Carbapenem-resistant Acinetobacter baumannii reported that all 30 isolates (100%) were positive for blaOXA-51 like gene, blaIMP-1, and blaVIM-1 genes (Niranjan et al) [10].…”

First Indian report on genome-wide comparison of multidrug-resistant Escherichia coli from blood stream infections

“…The bla NDM positive isolates belonging to ST410 and ST405 harboured only the bla NDM-5 variant, whereas ST167 and ST131 isolates had bla NDM-4 and bla NDM-1 respectively, in addition to bla NDM-5 . Interestingly only two isolates out of 60 MDR E. coli had bla NDM-1 , while it is still common among other species of MDR clinical pathogens in India [18]. From Hong Kong, a previous report identified bla NDM-1 as common among E. coli though the sample size was lesser [19], whereas in central China, bla NDM-1 and bla NDM-5 occurrence in E. coli has been reported in equal numbers [20].…”