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.Tabled 1Results:OrganismNumber of isolatesPercentage (%) ResistanceMeropenemImipenemColistinEscherichia coli97518.6618.660.67Klebsiella sp.25345.3343.6612.67Pseudomonas sp.20163.666018 Open table in a new tab Conclusion: Colistin resistance was 18%, 12.67% and 0.67% for Pseudomonas aeruginosa, Klebsiella sp. and Escherichia coli respectively. Carbapenem resistance was 63.66%, 45.33% and 18.66% for Pseudomonas aeruginosa, Klebsiella sp. and Escherichia coli respectively. Colistin resistance was highest for Pseudomonas aeruginosa followed by Klebsiella sp. among the gram negative bacteria from urinary tract infection. Resistance of colistin against Pseudomonas aeruginosa is increasing which is alarming and it is the right time to use colistin judiciously. Isolation of Pseudomonas aeruginosa may be colonization and should be differentiate from true infection before starting treatment. In place of colistin, carbapenems should be the choice of treatment for multi drug resistant gram negative bacteria if sensitive.