Objective: To determine the clinical outcome and management options of gram-negative Raoultella species reported at a tertiary care pediatric Hospital in Karachi.
Study design: Descriptive study.
Place and duration of study: Pediatric and child Health department of The Aga Khan University Hospital from January 2017 to June 2020.
Methodology: A retrospective chart review was done. Data was extracted for 20 patients with culture-positive Raoultella species. Study variables included demographic features, infection site, antibiotic sensitivities, Hospital duration, clinical outcome, and management options. Data were summarised using descriptive statistics and Kaplan-Meier plots using SPSS version 22.
Results: A total of twenty-three site cultures positive with Raoultella species were isolated among 20 children with a wide array of clinical symptoms and disease severity. Predominantly the organism was isolated in blood with 12 positive cultures (60%). Eleven (55%) of the patients were females having a median age of 9.5 months. Multidrug-resistant (MDR) and extensively drug-resistant species (XDR) were isolated from eleven (47.8%) and ten (43.5%) culture sites respectively. Combination therapy of colistin or fosfomycin with carbapenem and tigecycline (triple regimen) was used in seven (35%) patients with severe sepsis. Microbiological clearance (sterility) was achieved in twelve (60%) children. Eight children (40%) died of MDR/XDR Raoultella associated sepsis.
Conclusion: Highly resistant Raoultella species were associated with high mortality among reported cases, with a limited choice of antibiotics and combination therapy. The management of Raoultella species is required with a multi-specialty approach. Furthermore, strict antimicrobial stewardship measures are required to control an outbreak of MDR and XDR infections in Pakistan.
Key words: Raoultella species, Enterobacteriaceae, Children, Multidrug-resistant, Antimicrobial resistance.