Colistin-resistant Klebsiella pneumoniae in Surgical Polytrauma Intensive Care Unit of Level-1 Trauma Center: First Case Series from Trauma Patients in India

Brief Communication IntroductIonThe isolation of multidrug-resistant organisms is increasing day by day in the Intensive Care Unit (ICU) settings and poses a great challenge in treating these patients.Carbapenem-resistant Enterobacteriaceae are widespread across various parts of the world and particularly carbapenem-resistant Klebsiella pneumoniae are quite common.[1] Carbapenem-resistant Klebsiella constitute 92% of all carbapenem-resistant in United States.[2] Even so, carbapenemase-producing Klebsiella are considered endemic in some areas.[3] Colistimethate sodium is considered drug of choice and the only option available for treating these infections.However, now a days, there have been many isolated case reports and reports of outbreak of carbapenem and colistin-resistant Klebsiella (CRK) from various parts of the world.[4][5][6][7] The notorious CRK are emerging pathogens in Indian subcontinent also and have been reported from an oncology center in eastern India [8] and medical college in southern India.[9] These case reports of infection were in immunocompromised patients.We report 5 cases of invasive blood stream infections due to CRK in immunocompetent patients in our polytrauma ICU of Level-I trauma center in India.In April-June 2016, we had 5 cases of invasive blood stream infections due to CRK.Since incidence of CRK over last year in our hospital and ICU was 0 cases/month, this sudden increase in CRK infections was defined as an outbreak.Here, we describe the epidemioclinical profile, microbiological investigation, clinical outcome of those cases, and the various infection control practices undertaken to curb the outbreak.To the best of our knowledge, this is one of the initial reported CRK cases of blood stream infections in trauma victims.Introduction: There have been isolated case reports and reports of outbreak of colistin-resistant Klebsiella from various parts of the world but only two from India and that too from oncology centers.We report cluster of colistin-resistant Klebsiella pneumonia bloodstream infection cases from our surgical trauma Intensive Care Unit.Methodology: The study was carried out in surgical ICU of Level-I trauma center.Retrospective analysis of all the five patients with CRK was done.Demographic data, antibiotic exposure throughout the hospital stay, hospital course, and clinical outcome were analyzed.Results: Out of 5 patients, 4 were young males (mean age of 23.5 years) without comorbidities and had undergone exploratory laparotomy following blunt trauma abdomen.3 patients were chronic patients and had been on carbapenem and colistin 11-20 days before isolation whereas 2 patienst had isolation of CRK just within 7 days of admission.Out of the five patients, 3 patients survived and 2 had fatal outcome.Conclusions: CRK is an emerging and challenging pathogen in polytrauma victims .There was an outbreak of CRK in our ICU that could be contained with infection control measures.