Multiple importations and transmission of colistin-resistantKlebsiella pneumoniaein a hospital in northern India

Abstract

Objective:Resistance to colistin, a last resort antibiotic, has emerged in India. We investigated colistin-resistant Klebsiella pneumoniae(ColR-KP) in a hospital in India to describe infections, characterize resistance of isolates, compare concordance of detection methods, and identify transmission events.Design:Retrospective observational study.Methods:Case-patients were defined as individuals from whom ColR-KP was isolated from a clinical specimen between January 2016 and October 2017. Isolates resistant to colistin by Vitek 2 were confirmed by broth microdilution (BMD). Isolates underwent colistin susceptibility testing by disk diffusion and whole-genome sequencing. Medical records were reviewed.Results:Of 846 K. pneumoniae isolates, 34 (4%) were colistin resistant. In total, 22 case-patients were identified. Most (90%) were male; their median age was 33 years. Half were transferred from another hospital; 45% died. Case-patients were admitted for a median of 14 days before detection of ColR-KP. Also, 7 case-patients (32%) received colistin before detection of ColR-KP. All isolates were resistant to carbapenems and susceptible to tigecycline. Isolates resistant to colistin by Vitek 2 were also resistant by BMD; 2 ColR-KP isolates were resistant by disk diffusion. Moreover, 8 multilocus sequence types were identified. Isolates were negative for mobile colistin resistance (mcr) genes. Based on sequencing analysis, in-hospital transmission may have occurred with 8 case-patients (38%).Conclusions:Multiple infections caused by highly resistant, mcr-negative ColR-KP with substantial mortality were identified. Disk diffusion correlated poorly with Vitek 2 and BMD for detection of ColR-KP. Sequencing indicated multiple importation and in-hospital transmission events. Enhanced detection for ColR-KP may be warranted in India.

Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study

“…28 As the network grows and receives more data, it can eventually produce representative data for comparisons and benchmarking of facility-level performance. To date, several outbreaks have been identified and contained through use of data from the surveillance network, including an outbreak of colistinresistant Klebsiella pneumoniae in network hospitals 29 and a large outbreak of bloodstream infections caused by Burkholderia cepacia. 30 There are at least seven limitations to the data generated by the surveillance network.…”

Evaluation of Specific Risk Factors and Outcomes of Colistin-Resistant Klebsiella pneumoniae Infections in a Tertiary Care Centre - An Observational Study

“…Where they have reported the incidence of ColR-KP infection at 46.4% and 33.3% respectively. However, contemporary Indian studies have reported colistin resistance in Klebsiella ranging from 4% [17], to 5.6% [8], but the relative number of cases was very less.…”

Whole-genome sequencing surveillance and machine learning for healthcare outbreak detection and investigation: A systematic review and summary

“…Overall, 35 studies (83.3%) restricted attempts to identify transmission routes to the same hospital unit during a defined period. 9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36][37][38][40][41][42][44][45][46][47] Only 7 studies (16.7%) examined other possible routes such as medical procedures or healthcare workers. [3][4][5]10,28,39,43 Several studies were notable for uncovering otherwise unidentified transmissions, which is the main goal of WGS surveillance.…”