Emergence of Pan-drug resistance amongst gram negative bacteria! The First case series from India

Objective: Increasing prevalence of carbapenem resistant Gram negative bacteria is a serious clinical and public health challenge.Bacteria resistant to all available antibiotics (Pan Drug Resistance) herald the onset of post antibiotics era.We hereby report clinical profile of 13 patients with pan drug resistant gram negative isolates.Methods: Retrospective analysis of 13 patients with pan drug resistant gram negative isolates over the last 18 months was done by medical records review.Identification of the isolates and susceptibility testing was done using VITEK auto analyzer in concordance with the corresponding CLSI guidelines.Results: Out of four patients with bacteremic isolates, three patients received colistin based combination therapy.Though two of these patients had microbiologic clearance, all the three died.Out of the 9 patients with non bacteremic isolates, 4 had infection and 5 had colonization.Three (out of four) were treated with combination therapy including colistin and one patient received colistin monotherapy.All four patients had microbiological clearance.Three patients had clinical cure and were discharged.One patient later developed bacteremia and died.Conclusion: Infections, particularly blood stream with pan drug resistant organisms has a higher mortality.Urgent studies to reevaluate existing therapeutic options and research into new antibiotic molecules are the need of the hour.