Clinical study of carbapenem sensitive and resistant Gram-negative bacteremia in neutropenic and nonneutropenic patients: The first series from India

Ghafur, AK; Vidyalakshmi, PR; Kannaian, Priyadarshini; Balasubramaniam, Richard

doi:10.4103/0019-509x.175362

Cited by 10 publications

(8 citation statements)

References 3 publications

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“…In our study, the most common carbapenem resistant Gram-negative isolate was CRKP (44%) followed by CREC (26%) with more than half of all episodes due to pneumonia or CLABSI, similar to two previous Indian studies presented as abstracts in scientific meetings. [ 9 10 ] Our patients had a high APACHE II score (19.64 ± 3.8 SD) and had a mean ICU stay of 11.76 days, with a mean time of onset of bacteremia after admission of 6.4 days. These results are in concordance with previous studies implicating these organisms as causes of healthcare-associated infections.…”

Section: Discussionmentioning

confidence: 99%

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

Porwal

Gopalakrishnan

Rajesh

et al. 2014

Indian Journal of Critical Care Medicine

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Background:Growing antimicrobial resistance and limited therapeutic options to treat carbapenem-resistant bacteremia prompted us to evaluate the clinical outcomes associated with healthcare-associated bacteremia.Methods:This was a retrospective observational study of carbapenem-resistant Gram-negative bacteremia performed at a tertiary care facility in Chennai, India between May 2011 and May 2012.Results:In our study, patients had mean 11.76 days of intensive care unit (ICU) care and mean time to onset of bacteremia was 6.4 days after admission. The commonest organism was Klebsiella pneumoniae (44%). Patients with combination treatment had lower mortality (44.8%) compared with colistin monotherapy (66.6%); (P = 0.35).Conclusion:Carbapenem resistant bacteremia is a late onset infection in patients with antibiotic exposure in the ICU and carries a 30 days mortality of 60%; K. pneumoniae is the most common organism at our center. Two drug combinations appear to carry a lower mortality compared with monotherapy.

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Section: Discussionmentioning

confidence: 99%

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

Porwal

Gopalakrishnan

Rajesh

et al. 2014

Indian Journal of Critical Care Medicine

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“…Data for variables such as age, sex, underlying immunocompromising condition, comorbidities, Intensive Care Unit (ICU) stay, duration of the first isolate from admission, colistin administration within 24 h of index date of sample collection, colistin dose, duration and cumulative dose, presence of indwelling devices, and prior antibiotic exposure were looked into. [ 12 ] Charlson comorbidity index was calculated for all patients. Acute Physiology and Chronic Health Evaluation II (APACHE II) score was calculated for ICU patients.…”

Section: S Ubjects and M Ethodsmentioning

confidence: 99%

“…P < 0.05 was considered as statistically significant. [ 12 ] Multivariate analysis using Cox regression was performed, incorporating univariate variables with P < 0.05, for 28-day mortality. All categorical variables were represented by percentages.…”

Section: S Ubjects and M Ethodsmentioning

confidence: 99%

“…[ 11 ] A retrospective study of colistin monotherapy (CMT) versus CCT against CRGNB bloodstream infections from our own center revealed equivalence of both approaches, except in a subgroup of neutropenic patients with Enterobacteriaceae infections where CCT arm performed better. [ 12 ] There are no published data from India comparing CCT and CMT against CRGNB nonbacteremic infections.…”

Section: Introductionmentioning

confidence: 99%

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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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“…1,2 carbapenem resistance in Enterobacteriaceae is a growing global concern with highest rates reported from South Asia and Mediterranean countries (7-14%) Though there are plenty of publications on the in vitro characteristics of carbapenem resistant bacteria, lack of published data on clinical profile including morbidity, mortality and treatment options from Indian subcontinent; is a serious impediment, forcing clinicians to infer available data from the west, while making therapeutic decisions. 3,4,5 carbapenem-resistant K. pneumoniae (CrKP) was first reported in 1996, and is now found worldwide. 6,7,8 Multi drug resistant (CR) Klebsiella pneumoniae which constitute a major portion of carbapenem resistant Enterobacteriaceae were observed to be associated with high mortality.…”

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confidence: 99%

A Retrospective Observational Study Comparing Clinical and Microbiological Parameters of Carbapenem Sensitive and Resistant Enterobacteriaceae Infections in a Tertiary Care Centre in Kerala

Manoj¹,

Arya²,

P.S³

et al. 2020

jebmh

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BACKGROUND The alarming rise in carbapenem Resistance (CR) among Enterobacteriaceae is posing a great threat to the humanity, all over the world. This study is intended to evaluate the CR in a tertiary care centre in Kerala. METHODS It is a retrospective observational study of one year duration, analysing the culture and sensitivity reports of various body fluids from sick patients admitted in General Hospital, Ernakulam. RESULTS The study revealed 7.4% incidence of carbapenem resistance (CR) among the isolated Enterobacteriaceae. Klebsiella species showed more CR than E. coli. Uncontrolled diabetes mellitus is a major risk factor for the patients to contract entero infections. CKD and chemotherapy contribute significantly to higher mortality. CONCLUSIONS The incidence of CR in the study population is at par with the world statistics and good diabetic control along with combination therapy of colistin and meropenem, significantly reduces mortality in infections due to CR Enterobacteriaceae.

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Clinical study of carbapenem sensitive and resistant Gram-negative bacteremia in neutropenic and nonneutropenic patients: The first series from India

Abstract: 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.

Cited by 10 publications

References 3 publications

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

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

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

A Retrospective Observational Study Comparing Clinical and Microbiological Parameters of Carbapenem Sensitive and Resistant Enterobacteriaceae Infections in a Tertiary Care Centre in Kerala

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