CARBAPENEM RESISTANCE AND ANTIMICROBIAL OPTIONS IN KLEBSIELLA PNEUMONIAE ISOLATED FROM CLINICAL SPECIMENS OF ICU PATIENTS
Objective: To determine frequency of carbapenem resistance and antimicrobial options among carbapenem resistant Klebsiella pneumoniae clinical isolates in ICU patients.
Material & Methods: This cross-sectional observational study was conducted at department of microbiology AFIP Rawalpindi in collaboration with ICU departments of CMH Rawalpindi, AFBMTC Rawalpindi, AFIU Rawalpindi and ALTU Rawalpindi from 1st Jan 2018 to 30st June 2018.
Isolates of Klebsiella pneumoniae yielded from various clinical specimens of ICU patients were identified as per standard protocols. Antimicrobial sensitivity testing was performed as per CLSI guidelines (EUCAST guidelines only for tigecycline), using Modified Kirby Bauer disc diffusion method and automated VITEK-2 systems version 08.01 for breakpoint MICs of colistin, tigecycline, imipenem and meropenem. Isolates resistant to imipenem, meropenem alone or both on MICs were considered carbapenem resistant.
Results: Among 130 Klebsiella pneumoniae clinical isolates, 83 (64 %) were identified as carbapenem resistant. The most common sources of clinical specimens includes; respiratory specimens 44 (34.0 %) followed by pus 35 (27.0 %), blood 24 (18.5 %), urine 15 (11.5 %), body fluids 06 (4.6 %), tissue 04 (3.1 %) and cerebrospinal fluid 02 (1.5 %). Colistin (4 %) and tigecycline (21 %) showed least resistance, while all other classes of antimicrobials were found highly resistant.
Conclusion: Carbapenem resistance among the clinical isolates of Klebsiella pneumoniae in ICU patients was to be found very high. It indicates that carbapenems cannot be used as empirical treatment option. Combination of colistin, tigecycline and meropenem is followed by culture directed de-escalation suggested to treat these superbugs in ICU settings.
Key Words: Klebsiella pneumoniae, Carbapenem resistance, Empirical therapy, ICU settings.