Pranjal Pankaj
BACKGROUND
Gram-negative infections are the most common cause of morbidity and mortality among critically-ill immunosuppressed patients especially in CKD. The increasing emergence of multidrug resistance among these patients is an important point of concern in today’s practice. In recent times, there has been increasingly reported incidence of resistance to carbapenems also, which leave the intensivists with very few options of antibiotics. With no new antibiotics in pipeline, increasing incidence of resistance to carbapenems is an important threat to all.
The aim of the study is to study the pattern of gram-negative infections in patients of chronic kidney disease and pattern of carbapenem resistance among the isolated organisms with the impact of multidrug resistance on clinical outcome of patients.
MATERIALS AND METHODS
A total of 50 patients were included in study that were known case of chronic kidney disease presenting with evidence of infection. Urine culture, blood culture and sputum culture reports of these patients were included in the study. All the culture and sensitivity reports were obtained from Department of Microbiology of our institute.
Inclusion Criteria- Known case of chronic kidney disease with evidence of infection.
Exclusion Criteria- Patients with associated comorbidities leading to immune suppression like malignancy AIDS, etc. and culture-negative patients.
RESULTS
The commonest organism isolated in cultures was Klebsiella (40%). Acinetobacter was isolated in 24% cases. E. coli was isolated in another 24% cases. Proteus and pseudomonas was isolated in 6% patients each. No resistance to any carbapenems was found in 24% patients. 36% patients were found to be resistant to all carbapenems. Another major group of 40% patients were found sensitive to all carbapenems except meropenem. If meropenem is excluded, then sensitivity to carbapenems rise to 64%. The group resistant to all carbapenems have the highest mortality. Isolates resistant to meropenem are responsive to other carbapenems like imipenem.
CONCLUSION
Increasing incidence of gram-negative infections and increasing resistance to all the conventional antibiotics pose a major threat to all the healthcare providers. The multidrug-resistant organisms including those resistant to carbapenems have been found to have increased mortality despite appropriate antibiotic therapy. Resistance to meropenem is reportedly higher than all other carbapenems even in community-acquired infections. Rational use of antibiotics and targeted therapy is warranted.
