Abstract
This study was conducted in response to the rising incidence of drug resistance observed in the intensive care unit (ICU) of King Fahad Medical City. A retrospective observational study was conducted in the ICU of King Fahad Medical City between October 2003 and April 2012. Data were collected using a structured data sheet. Nine episodes of infection with colistin-resistant Enterobacteriacae were recorded in seven patients. Five were females with an average age of 59.75 years. All patients had multiple co-morbidities; five had diabetes mellitus. In five of the episodes, Klebsiella pneumoniae was responsible, Serratia marcescens was reported in two, while Enterobacter aerogenes and Providencia stuartii were responsible for one episode of infection each. Prior colistin use was documented in all but one patient. Colistin resistance was defined by a minimum inhibitory concentration (MIC) of > 4 µg/mL according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoint for Enterobacteriacae. Various antibiotics were used to treat the patients, with mortality reported in two. Infection due to colistin-resistant Enterobacteriacae is a rising challenge in Saudi Arabia; colistin use is thought to be associated with these infections. This calls for a stricter antimicrobial stewardship program and improved infection control measures to curb the rising trend of antibiotic resistance.
Highlights
This study was conducted in response to the rising incidence of drug resistance observed in the intensive care unit (ICU) of King Fahad Medical City
Among the factors thought to be associated with infection with colistin-resistant Enterobacteriacae were prolonged ICU stay, mechanical ventilation, invasive procedures such as central venous catheter (CVC) line insertion, percutaneous endoscopic gastrostomy (PEG) tube, peripherally-inserted central catheter (PICC) line, indwelling Foley’s catheter (IFC), esophago-gastro-duodenoscopy (EGD), cystoscopy, bronchoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and biliary stent insertion
We present, to the best of our knowledge, the first case series among critically ill patients from Saudi Arabia that focuses on clinical information and outcome of infection due to colistin-resistant Enterobacteriacae
Summary
This study was conducted in response to the rising incidence of drug resistance observed in the intensive care unit (ICU) of King Fahad Medical City. Gram-negative, non-spore-forming, facultative anaerobes that ferment glucose and other sugars, reduce nitrate to nitrite, and produce catalase but (with the exception of Pleisomonas) do not produce oxidase These bacteria have caused significant challenges to infectious disease (ID) physicians and their patients throughout the world by their resistance to currently available antibiotics. There are a growing number of reports on infections caused by Gram-negative bacteria (GNB), for which no adequate therapeutic options exist, with attendant morbidity and mortality [1,2,3] This return to the pre-antibiotic era has become a reality in Saudi Arabia [4], where antimicrobials from all classes are prescribed, and the antimicrobial stewardship program is still in its infancy. Overuse of colistin has recently led to the emergence of resistance to this life-saving agent [6]
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