Spread of resistant gram negatives in a Sri Lankan intensive care unit

Abstract

BackgroundInfections with multi drug resistant (MDR) organisms are a major problem in intensive care units (ICUs). Proper infection control procedures are mandatory to combat the spread of resistant organisms within ICUs. Well stablished surveillance programmes will enhance the adherence of the staff to infection control protocols. The study was conducted to assess the feasibility of using basic molecular typing methods and routine hospital data for laboratory surveillance of resistance organisms in resource limited settings.MethodsA retrospective study was conducted using consecutive Gram negative isolates obtained from an ICU over a six month period. Antibiotic sensitivity patterns and random amplified polymorphic DNA (RAPD) based typing was performed on the given isolates.ResultsOf the seventy isolates included in the study, seven were E.coli. All E.coli were MDRs and Extended Spectrum β lactamse (ESBL) producers carrying bla CTX-M. Fourteen isolates were K.pneumoniae, and all were MDRs and ESBL producers. All K.pneumoniae harboured bla SHV while 13 harboured bla CTX-M. The MDR rate among P.aeruginosa was 13% (n=15) while all acinetobacters (n=30) were MDRs. Predominant clusters were identified within all four types of Gram negatives using RAPD and the ICU stay of patients overlapped temporally.ConclusionWe propose that simple surveillance methods like RAPD based typing and basic hospital data can be used to convince hospital staff to adhere to infection control protocols more effectively, in low and middle income countries.

Molecular epidemiology of carbapenem resistant Enterobacteriaceae in Sri Lanka: First report of KPC-producing Klebsiella pneumoniae

“…These observations may at least partly be associated with the frequent usage of carbapenems and ventilator equipment in ICU settings. Similarly, high rate of respiratory CRE (38.1%; 2/7 E.coli and 6/14 K. pneumoniae) has been reported in the ICUs of a tertiary care hospital in the Central Province of Sri Lanka ( 30). Additionally, in the present study, an alarmingly high prevalence of CRE (83.3%) was found among the blood culture Enterobacteriaceae isolates of ICU origin.…”

“…Intensive care units (ICUs) are known reservoirs for multi-drug resistant bacteria in healthcare settings due to the presence of high antibiotic pressure and higher propensity for cross-contamination ( 30,31). Considering the antibiotic resistance in the cohort of Enterobacteriaceae isolated from the clinical samples of the ICUs, we found that high overall prevalence of CRE (38.7%; 12/31), which was significantly higher than the prevalence of ESBL-PE (22.6%; 7/31) detected in the same group.…”

“…Enterobacteriaceae is a diverse family of Gram negative rods which includes diverse spectrum of human pathogens with K. pneumoniae being the most frequent CRE species found globally ( 8,22). Earlier studies have reported the presence of carbapenem resistant K. pneumoniae, E. coli, and E. cloacae in Sri Lanka ( 18,19,30). In addition to the previously documented Enterobacteriaceae species in the country, carbapenem resistance was also recognized in C. freundii, P. rettgeri, and E. aerogens in our study (Figure 2).…”

Is systematic fecal carriage screening of extended-spectrum beta-lactamase-producing Enterobacteriaceae still useful in intensive care unit: a systematic review

“…Therefore, it should be kept in mind that the studies reported here assessed a non-outbreak situation in western countries. A study assessing the ESBL-E respiratory colonization in Sri Lanka suggested a higher cross-transmission rate but no data are provided about the imported or acquired status of ESBL-E colonization [48]. Further studies are needed to assess the rate of cross-transmission and the efficacy of hygiene procedures in non-western countries which have a higher prevalence of ESBL-E [2, 16].…”

7-Hydroxycoumarin Attenuates Colistin-Induced Kidney Injury in Mice Through the Decreased Level of Histone Deacetylase 1 and the Activation of Nrf2 Signaling Pathway

“…In the past 20 years, there has been a pronounced increase in the emergence of multiple resistance of Gram-negative bacterial infections, especially multiresistant Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa (Lachiewicz et al, 2017;Tissera et al, 2017). Due to the slow developmental process of new antibiotics, colistin has been considered as the last-line therapy for the treatment of multiresistant Gram-negative bacterial infections (Li et al, 2006).…”