Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae: Laboratory Detection and Impact on Mortality

Abstract

In this cohort, 13% of patients with CRKp presented with ColR CRKp. The apparent polyclonal nature of the isolates suggests de novo emergence of ColR in this cohort as the primary factor driving ColR. Importantly, mortality was increased in patients with ColR isolates.

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

“…A recent study from the USA on colistin resistance in carbapenem-resistant K. pneumoniae bacteraemia reported a rate of 13% (Rojas et al, 2017). A similar study from Italy found a high rate of colistin resistance (36.1%) (Capone et al, 2013).…”

“…This is of great concern, given the limited number of antimicrobial agents available to treat such infections (Srinivas and Rivard, 2017). In a study from the USA, 13% of 246 patients with carbapenemresistant K. pneumoniae isolates were found to have colistin resistance, which was shown in that study to be associated with increased mortality (Rojas et al, 2017).…”

International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti‐infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP)

“…29,30 Finally, polymyxin resistance is increasing worldwide with several recent reports of clinical failure and resistance emergence during monotherapy. [106][107][108][109] With the recent report of mobile colistin resistance genes, 16-18, 110, 111 the presence of heteroresistance, 19 and the association between colistin resistance and increased risk of in-hospital mortality, 106 there is mounting support for strategies to optimize polymyxins therapeutically including combination therapy. 41,[111][112][113] There is a mechanism-based rationale for using polymyxins in combination with other antimicrobials that display synergy with a membrane permeabilizer (such as the polymyxins) allowing for increased concentrations of companion antibacterial agents that have intracellular targets.…”

ARGONAUT-I: Activity of Cefiderocol (S-649266), a Siderophore Cephalosporin, against Gram-Negative Bacteria, Including Carbapenem-Resistant Nonfermenters and Enterobacteriaceae with Defined Extended-Spectrum β-Lactamases and Carbapenemases

“…Reads were assembled using SPAdes software (23), annotated using NCBI's PGAP pipeline (24), and deposited in the NCBI SRA and GenBank whole-genome sequencing (WGS) repositories (BioProject accession numbers PRJNA384060 and PRJNA384065). Resistance mechanisms in isolates whose whole genomes were not sequenced were characterized by PCR amplification and sequencing of the KPC ␤-lactamase genes, if present, as previously reported (4,25). In addition, a modified carbapenemase multiplex PCR that detects bla IMP , bla NDM , bla OXA-48-like, and bla VIM was employed (26).…”