Frequency of colistin and fosfomycin resistance in carbapenem-resistant Enterobacteriaceae from a tertiary care hospital in Karachi (original) (raw)
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Colistin Sparing Strategies to Overcome Resistance: Can We Save Future
SSR Institute of International Journal of Life Sciences, 2024
Background: Colistin is the last resort drug to treat multidrug-resistant organisms. The most common isolate obtained in the healthcare is Klebsiella sp., which is usually resistant to carbapenems owing to carbapenem-resistant genes. This study was undertaken to analyze the resistance trend of Klebsiella sp. and its sensitivity to beta-lactams, beta-lactams inhibitor combinations, carbapenems, and aminoglycoside. Emphasis was laid on finding the possibilities of colistin salvage strategies and placement of ceftazidime-avibactam in the antibiotic policy. Methods: Data from India and clinical samples isolating Klebsiella species were included. Genes included in the study were AMP C, TEM, CTXM1, KPC, OXA, NDM, and SHV. Antibiotics included in the study were amikacin, gentamicin, ceftriaxone, cefepime, ceftazidime, ciprofloxacin, amoxiclavulanic acid, ampicillin-sulbactam, pipercillin tazobactam, ceftazidime avibactam, Imipenem, meropenem, tigecycline, colistin, minocycline, aztreonam. Results: Among 10524 isolates from India (2004-2021), 7910 were Gram negatives. 1996 (25.23%) isolates of Klebsiella species were identified. 65.76% were males. Antibiotic Sensitivity pattern was analyzed. Carbapenem resistance was found in 49.04%. Among Carbapenem-resistant isolates, the NDM gene was detected in 51.14%, and 93.67% were sensitive to ceftazidime avibactum in the remaining 48.86% isolates. Genes were analyzed. A 2x2 chi-squire test revealed that the OXA gene was connected with carbapenem resistance towards Klebsiella isolates (OR: 103 (44.8-236.8), p=0.001). Moreover, the effect of the OXA gene on ceftazidime avibactam resistance was found to be null (p>0.05). Conclusion: This study concludes that ceftazidime-avibactam is a good alternative among NDM-negative carbapenem-resistant isolates and can be a treatment option. Routine testing of ceftazidime avibactam with aztreonam in ICU isolates is to be done. This study emphasizes detecting resistant genes in all critical cases to avoid accidental use of antibiotics, which is one of the leading causes of antibiotic resistance. Colistin antibiotics should be reserved for isolates where all the drug combinations fail.
Microbiology Research, 2016
Due to the increasing prevalence of infections caused by resistant bacteria and especially multiple drug resistance <em>Enterobacteriaceae</em>, availability of alternative effective antibiotics is restricted. The goal of this study was to investigate the susceptibility profile of multiple drug resistance and extensively drug resistance <em>Enterobacteriaceae</em> isolated from various clinical samples to fosfomycin. A total of 303 non-duplicate <em>Enterobacteriaceae</em> isolates were collected. Identification and susceptibility testing were done according to standard microbiological procedures and the Kirby-Bauer test, respectively. Of all isolates, 272 (89.8%) and 26 (8.6%) were detected as multiple drug resistance and extensively drug resistance strains, respectively. The most effective antibiotic (98%) was fosfomycin, when compared with other antibiotics against multiple drug resistance and extensively drug resistance <em>Enterobacteri...
Fosfomycin Susceptibility in Carbapenem-Resistant Enterobacteriaceae from Germany
Journal of Clinical Microbiology, 2014
Due to the increase in multidrug-resistant Enterobacteriaceae, the interest in older antimicrobial agents, like fosfomycin, has increased. In this study, we used agar dilution for testing susceptibilities to fosfomycin in a collection of 107 carbapenem-nonsusceptible Enterobacteriaceae isolates, of which 80 produced various types of carbapenemases, including KPC, VIM, NDM, and OXA-48. Overall, 78% of the strains had fosfomycin MICs of ≤ 32 mg/liter and were thus considered to be susceptible according to the current EUCAST breakpoint. The MIC50 and MIC90 were 8 mg/liter and 512 mg/liter, respectively. Escherichia coli strains had significantly lower fosfomycin MICs than the Klebsiella pneumoniae and Enterobacter cloacae strains. Furthermore, comparisons of the susceptibility testing methods, like Etest and disk diffusion, were performed against agar dilution as the reference method. Essential agreement between Etest and agar dilution was 78.9%, and categorical agreement between the two methods was 92.5%, with 20% very major errors and 2.6% major errors. Disk diffusion was studied with 50-μg and 200-μg fosfomycin disks, but no inhibition zone breakpoint that reduced very major and major errors to an acceptable level was found. Etest and disk diffusion showed poor agreement with fosfomycin agar dilution.
Risk factors for infection with colistin-resistant gram-negative microorganisms: a multicenter study
Annals of Saudi medicine
Knowing risk factors for colistin resistance is important since colistin is the only remaining choice for the treatment of infections caused by multi-drug resistant microorganisms. Evaluate risk factors associated with infection by colistin-resistant microorganisms. Retrospective study. Tertiary healthcare centers. An e-mail including the title and purpose of the study was sent to 1500 infec.tious disease specialists via a scientific and social web portal named "infeksiyon dunyasi (infection world)". Demographic and clinical data was requested from respondents. Colistin-resistance. Eighteen infectious disease specialists from twelve tertiary care centers responded to the invitation data was collected on 165 patients, 56 cases (39.9%) and 109 (66.0%) age- and sex-matched controls. The colistin-resistant microorganisms isolated from cases were 29 Acinetobacter baumannii (51.8%), 18 Pseudomonas aeruginosa (32.1%) and 9 Klebsiella spp. Colistin, carbapenem, and quinolone use i...