Emergence of Colistin Resistance among Gram Negative Bacteria in Urinary Tract Infections from Super Specialty Hospital of North India

Abstract

Background: Use of colistin is increasing due to the increasing prevalence of multi drug resistant gram negative bacteria (GNB). Increasing prevalence of carbapenem resistant GNB is a serious clinical and public health challenge because the treatment options are limited to colistin, Tigecycline etc. Colistin resistance is being increasingly reported in Indian hospitals. Bacteria resistant to all available antibiotics (Pan Drug Resistance) are also increasing and left no treatment option. Resistance to colistin is a major threat that limits therapeutic choices for treating carbapenem-resistant Pseudomonas aeruginosa and Klebsiella sp. infections. We hereby report the prevalence of colistin resistance among gram negative bacteria from urinary tract infection.Methods & Materials: This study was performed from January 2016 to December 2016 in Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India. A total of 1429 out of 2273 positive urinary isolates of Escherichia coli (975), Pseudomonas aeruginosa (201) and Klebsiella sp. (253) were included in this study. Identification and sensitivity was conducted by Vitek 2 compact automated system. Susceptibility of antimicrobials were interpreted according to the Clinical Laboratory Standards Institute (CLSI 2016) guidelines.

Prevalence of Colistin-Resistant, Carbapenem-Hydrolyzing Proteobacteria in Hospital Water Bodies and Out-Falls of West Bengal, India

“…So far, the spread of carbapenem-resistant Enterobacteriaceae and New Delhi Metallo-β lactamase-1 (NDM-1) in hospital wastewater out-falls has been explicitly probed only in New Delhi [19,20]. Colistin resistance is increasingly being reported by tertiary care hospitals in India; however, there are no reports on the prevalence rates in hospital wastewater [21].…”

A comparative study among different methods of detection of colistin resistant gram negative bacilli in a tertiary care hospital

“…Other studies [7,9,10,22,24,25] also stated that colistin resistant Klebsiella pneumoniae as an emerging pathogen which was seen in the present study as well. On the contrary, Pawar et al [8] reported Pseudomonas aeruginosa as most common colistin resistant isolate followed by Acinetobacter baumannii whereas Jain S [11] reported Pseudomonas aeruginosa and Klebsiella pneumoniae as major organism with colistin resistance.…”

“…The highest resistance was reported from Asia followed by Europe, America and Africa [3]. In India reports of colistin resistance among GNB are also emerging at an alarming rate especially colistin resistant Klebsiella pneumonia and Pseudomonas aeruginosa [8][9][10][11][12]. Due to emergence of MDR GNB colistin has been re-introduced as a therapeutic drug which can be used in both human and veterinary medicine [13,14].…”

<p>How Phages Overcome the Challenges of Drug Resistant Bacteria in Clinical Infections</p>

“…1,2 Several antibacterial resistance profiles have been detected recently including the multidrug-resistant (MDR), extensively drugresistant (XDR) and pan drug-resistant (PDR) phenotypes. [3][4][5][6] Accordingly, the human health and efficiency of commonly used antibiotics are threatened seriously by MDR and XDR bacteria. Studies showed that at least 25,000 patients die each year in the European hospitals from an infection due to MDR bacteria.…”

“…[1][2][3][4][5][6] Furthermore, the mortality rate for patients infected by XDR organisms is reported to be over 50 percent, which has led to increased healthcare costs. 1,2,[4][5][6] The impacts of resistant infections to healthcare costs are estimated at about $ 20 billion yearly and they also result in 8 million additional hospital days in the United States. [7][8][9] Furthermore, over 30 percent of pharmaceutical budgets of hospitals in the United States is spent on antibiotics.…”