Jatin Kumar Majhi 1 , Asit Kumar Mishra 2 , Arati Behera 3
BACKGROUND A retrospective study was performed in a nursery of a tertiary care hospital in Jamshedpur, India, between March 2016 and July 2016. There was an outbreak of carbapenem+colistin resistant Klebsiella during that period. We identified all blood culture results that had yielded a growth of carbapenem+colistin resistant Klebsiella pneumoniae during the study period. Only the blood cultures showing growth of Klebsiella pneumoniae were included under study. Medical records of these babies were reviewed for demographic and clinical data. MATERIALS AND METHODS Clinical parameters analysed included severity of illness and various factor affecting outcome. The records of 60 patients with bacteraemia caused by Klebsiella pneumonia were identified and analysed. The mean age of patients was 3 days and 32 (53%) were male. RESULTS The mean duration of hospital stay was 12 days. The mean time for onset of bacteraemia was 2.4 days after admission. The most common co-morbid condition was prematurity (31.6%) followed by birth asphyxia (HIE) (20%). All patients received IV tigecycline with a dose of 1.2 mg per kg with 1:10 dilution of normal saline over 15 minutes of IV infusion twice daily. Mean duration of antibiotics was 7.8 days. Minor drug reactions like generalised rash, vomiting and diarrhoea were documented. Serious adverse reaction of tigecycline therapy like ARF was reported in 3 babies. The overall survival at 30 days was 76.6% in our study with lowest survival rate of 50% was for babies undergoing surgery followed by preterm babies <32 weeks with survival rate of 63.3%, while survival rates for HIE and RDS babies were 84.4%, 66.6%, respectively. We also found that patients treated with combination therapy had lower mortality (64.28%) compared with tigecycline monotherapy (35.71%), although this was statistically not significant. CONCLUSION Carbapenem+colistin resistant K. pneumoniae is a serious healthcare-associated infection in critically ill-patients in NICU with co-morbidities and prior antibiotic exposure; K. pneumoniae was the most common organism at our center. Thirty day survival rate was only 76.6% and even lower for premature <32 weeks. Klebsiella pneumonia was highly sensitive to only tigecycline and was the cornerstone of therapy, but its safety in newborn may need to be studied to optimise the outcome; neonatal hepatitis and ARF was seen in 15% of patients only and was reversible in most of the cases. Combinations of other antibiotics with tigecycline may result in a lower mortality compared with monotherapy; however, this needs to be explored by randomised-controlled studies.
