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Multiple importations and transmission of colistin-resistant Klebsiella pneumoniae in a hospital in northern India

Published online by Cambridge University Press:  18 October 2019

Purva Mathur ,
Surbhi Khurana ,
Tom J.B. de Man ,
Neha Rastogi ,
Omika Katoch ,
Balaji Veeraraghavan ,
Ayyan Raj Neeravi ,
Manigandan Venkatesan ,
Subodh Kumar  and
Sushma Sagar
...Show all authors
Purva Mathur*
Affiliation:
Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Surbhi Khurana
Affiliation:
Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Tom J.B. de Man
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Neha Rastogi
Affiliation:
Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Omika Katoch
Affiliation:
Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Balaji Veeraraghavan
Affiliation:
Christian Medical College, Vellore, India
Ayyan Raj Neeravi
Affiliation:
Christian Medical College, Vellore, India
Manigandan Venkatesan
Affiliation:
Christian Medical College, Vellore, India
Subodh Kumar
Affiliation:
Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Sushma Sagar
Affiliation:
Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Amit Gupta
Affiliation:
Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Richa Aggarwal
Affiliation:
Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Kapil Dev Soni
Affiliation:
Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Rajesh Malhotra
Affiliation:
Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
Anoop Velayudhan
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Valan Siromany
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Paul Malpiedi
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Joseph Lutgring
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, USA Emory University, Atlanta, Georgia, USA
Kayla Laserson
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Neil Gupta
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Padmini Srikantiah
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Aditya Sharma
Affiliation:
US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
*
Author for correspondence: Purva Mathur, Email: purvamathur@yahoo.co.in
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Abstract

Objective:

Resistance to colistin, a last resort antibiotic, has emerged in India. We investigated colistin-resistant Klebsiella pneumoniae(ColR-KP) in a hospital in India to describe infections, characterize resistance of isolates, compare concordance of detection methods, and identify transmission events.

Design:

Retrospective observational study.

Methods:

Case-patients were defined as individuals from whom ColR-KP was isolated from a clinical specimen between January 2016 and October 2017. Isolates resistant to colistin by Vitek 2 were confirmed by broth microdilution (BMD). Isolates underwent colistin susceptibility testing by disk diffusion and whole-genome sequencing. Medical records were reviewed.

Results:

Of 846 K. pneumoniae isolates, 34 (4%) were colistin resistant. In total, 22 case-patients were identified. Most (90%) were male; their median age was 33 years. Half were transferred from another hospital; 45% died. Case-patients were admitted for a median of 14 days before detection of ColR-KP. Also, 7 case-patients (32%) received colistin before detection of ColR-KP. All isolates were resistant to carbapenems and susceptible to tigecycline. Isolates resistant to colistin by Vitek 2 were also resistant by BMD; 2 ColR-KP isolates were resistant by disk diffusion. Moreover, 8 multilocus sequence types were identified. Isolates were negative for mobile colistin resistance (mcr) genes. Based on sequencing analysis, in-hospital transmission may have occurred with 8 case-patients (38%).

Conclusions:

Multiple infections caused by highly resistant, mcr-negative ColR-KP with substantial mortality were identified. Disk diffusion correlated poorly with Vitek 2 and BMD for detection of ColR-KP. Sequencing indicated multiple importation and in-hospital transmission events. Enhanced detection for ColR-KP may be warranted in India.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 12 , December 2019 , pp. 1387 - 1393
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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