Ranjan Rahul, Iyer Ranganathan N, Jangam Rekha Rao, Arora Neha
Global Hospital, Lakdi-ka Pool, Hyderabad, India.
Sankara Eye Hospital, Bangalore, India.
Indian J Med Microbiol. 2023 Jan-Feb;41:40-44. doi: 10.1016/j.ijmmb.2022.12.008. Epub 2023 Jan 13.
To determine the colistin susceptibility. To compare E-test vs broth-microdilution (BMD) method for invasive carbapenem resistant Enterobacteriaceae (CRE) infections. To study treatment options for the CRE. To analyze the clinical profile and outcome of CRE infections.
Antimicrobial susceptibility testing was performed for 100 invasive CRE isolates. Gradient diffusion and BMD methods were performed to determine colistin MICs. Essential agreement (EA), categorical agreement (CA), very major error (VME), and major error (ME) were worked out between BMD method and E-test. The clinical profile of patients was analyzed.
The majority of the patients suffered from bacteremia [47(47%)]. Klebsiella pneumoniae was the most common organism isolated overall as well as among bacteremic isolates. 9(9%) CRE isolates were colistin resistant by BMD of which six were Klebsiella pneumoniae. There was 97% CA between E-test and BMD. EA was 68%. VME was found in three out of nine colistin resistant isolates. No ME was found. Among the other antibiotics tested for CRE isolates, the highest susceptibility was seen to tigecycline [43(43%)] followed by amikacin [19 (19%)]. The most common underlying condition was post solid organ transplantation [36(36%)]. A higher survival rate was seen among non-bacteremic CRE infections (58.49%) than bacteremic CRE infections (42.6%). Four out of nine patients with colistin resistant CRE infections survived and had a satisfactory outcome.
Klebsiella pneumoniae was the most common organism causing invasive infection. Survival rates were higher in non-bacteremic CRE infections than bacteremic infections. Good CA was seen between E-test and BMD for colistin susceptibility, but the EA was poor. VME was more common than ME when E-tests were used for colistin susceptibility testing resulting in false susceptibility. Tigecycline and aminoglycosides are possible adjunct drugs for the treatment of invasive CRE infections.
确定黏菌素敏感性。比较E-test法与肉汤微量稀释法（BMD）检测耐碳青霉烯类肠杆菌科细菌（CRE）侵袭性感染的效果。研究CRE的治疗方案。分析CRE感染的临床特征及转归。
对100株侵袭性CRE分离株进行药敏试验。采用梯度扩散法和BMD法测定黏菌素的最低抑菌浓度（MIC）。计算BMD法与E-test法之间的基本一致率（EA）、分类一致率（CA）、极重大错误（VME）和重大错误（ME）。分析患者的临床特征。
大多数患者患有菌血症[47例（47%）]。肺炎克雷伯菌是总体及菌血症分离株中最常见的病原菌。通过BMD法检测，9株（9%）CRE分离株对黏菌素耐药，其中6株为肺炎克雷伯菌。E-test法与BMD法的CA为97%。EA为68%。在9株对黏菌素耐药的分离株中，有3株出现VME。未发现ME。在对CRE分离株检测的其他抗生素中，替加环素的敏感性最高[43株（43%）]，其次是阿米卡星[19株（19%）]。最常见的基础疾病是实体器官移植术后[36例（36%）]。非菌血症性CRE感染患者的生存率（58.49%）高于菌血症性CRE感染患者（42.6%）。9例对黏菌素耐药的CRE感染患者中有4例存活且转归良好。
肺炎克雷伯菌是引起侵袭性感染最常见的病原菌。非菌血症性CRE感染的生存率高于菌血症性感染。E-test法与BMD法检测黏菌素敏感性时CA良好，但EA较差。E-test法用于黏菌素敏感性检测时，VME比ME更常见，会导致假敏感。替加环素和氨基糖苷类药物可能是治疗侵袭性CRE感染的辅助用药。
