Emergence of colistin-resistant gram-negative rods in intensive care units: A cross-sectional study from a developing country

Beenish Syed; Sadia Ishaque; Abira Imran; Osaid Muslim; Seema Khalid; Abdul Basit Siddiqui

doi:10.1177/20503121221132358

Emergence of colistin-resistant gram-negative rods in intensive care units: A cross-sectional study from a developing country

SAGE Open Med. 2022 Oct 18:10:20503121221132358. doi: 10.1177/20503121221132358. eCollection 2022.

Authors

Beenish Syed¹, Sadia Ishaque², Abira Imran³, Osaid Muslim⁴, Seema Khalid⁵, Abdul Basit Siddiqui⁶

Affiliations

¹ Sindh Infectious Diseases Hospital and Research Center, Dow University of Health Sciences, Karachi, Pakistan.
² Shaheed Mohtarma Benazir Bhutto Trauma Center, Karachi, Pakistan.
³ Department of Biostatistics, Liaquat National Hospital and Medical College, Karachi, Pakistan.
⁴ Department of Medicine, Agha Khan University Hospital, Karachi, Pakistan.
⁵ Department of Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan.
⁶ Fazaia Ruth Pfau Medical College and Hospital, Karachi, Pakistan.

Abstract

Objectives: To determine the clinical features, outcomes, and factors associated with the emergence of colistin-resistant gram-negative rods isolated from patients admitted to intensive care units.

Methods: This cross-sectional study was conducted at the intensive care units of Liaquat National Hospital, from April 2019 to February 2020. Gram-negative rods resistant to colistin with minimum inhibitory concentrations ⩾ 4 mcg/mL according to Clinical and Laboratory Standards Institute criteria as reported in cultures were included. Clinical, demographical data and treatment given were recorded and analyzed using SPSS version 25.

Results: A total of 93 patients were included; 58.1% were males. The mean age of patients was 59.48 ± 18.36 years. The most common organism isolated was Klebsiella pneumoniae (91.4%). The most common specimen was the tracheal (62.4%). Ventilator-acquired pneumonia was seen in 38.7%. The most common co-morbid disease seen in patients was diabetes (41%); 77% had a symptomatic infection and were treated with a combination of 2 or more antibiotics, most commonly meropenem plus fosfomycin. The most common susceptible antibiotics were fosfomycin (72%) and tigecycline (50.5%). Mean intensive care unit stay and total duration of hospital stay were prolonged (16.83 ± 12.93 and 23.34 ± 17.52 days, respectively). Forty-eight (62.3%) patients with symptomatic infection with colistin-resistant isolates were treated and discharged, and mortality was seen in 23 (29.9%). A significant association was found between mortality and symptomatic infection, endotracheal intubation with mechanical ventilation (p = 0.003), and a prolonged hospital stay of >20 days (p = 0.041).

Conclusion: Colistin-resistant gram-negative rods pose a significant problem especially in developing countries because of limited therapeutic options. Stringent infection control and comprehensive antimicrobial stewardship programs are needed to overcome this challenge.

Keywords: Colistin resistance; extensively drug-resistant; gram-negative rods.