Thursday, January 19, 2017

Report of a Klebsiella pneumoniae strain resistant to 26 antibiotics

Ever since MCR-1 has started making its news as an antibiotic resistance gene of interest, a lot of reports have been published around the world looking into colistin resistance. It should be noted that MCR-1 is not the only mode of colistin resistance. Here is a recent report on one such example.

In a recent publication of CDC MMWR, a Klebsiella pneumoniae isolate is described that is resistant to 26 antibiotics (This includes aminoglycosides, polymyxins, tigecycline and Colistin). The strain was also NDM positive. This case was reported from Nevada, of a woman who died in September from an incurable infection. The isolate was negative for MCR-1. Quoting from the article

The patient was a female Washoe County resident in her 70s who arrived in the United States in early August 2016 after an extended visit to India. She was admitted to the acute care hospital on August 18 with a primary diagnosis of systemic inflammatory response syndrome, likely resulting from an infected right hip seroma. The patient developed septic shock and died in early September. During the 2 years preceding this U.S. hospitalisation, the patient had multiple hospitalisations in India related to a right femur fracture and subsequent osteomyelitis of the right femur and hip; the most recent hospitalisation in India had been in June 2016.

This article raises the red flag of how serious the issue of pan-drug resistance has now become. Basically, at least in this case, there was nothing in the antibiotic panel that could have been used for treatment. Technically speaking it is a total drug resistant Klebsiella pneumoniae species. It is still called pan-drug resistance since The isolate had a relatively low fosfomycin resistance and was intermediately resistant to tigecycline.

The article mentions the possibility that this strain was acquired from India but cannot confirm the same due to several reasons. Colistin resistance in Klebsiella has been described earlier in India in 2014. However, it is absurd from the side of media to blame that colistin resistance comes from countries like India. Colistin resistance has been reported as early as 2009 in US.

Alexander Kallen, a medical officer at the CDC comments, “It was tested against everything that’s available in the United States and was not effective. I think it’s concerning. We have relied for so long on just newer and newer antibiotics. But obviously the bugs can often [develop resistance] faster than we can make new ones.”

References

A Nevada woman dies of a superbug resistant to every available antibiotic in the US. 

Chen L, Todd R, Kiehlbauch J, Walters M, Kallen A. Notes from the Field: Pan-Resistant New Delhi Metallo-Beta-Lactamase-Producing Klebsiella pneumoniae — Washoe County, Nevada, 2016. MMWR. 2017;66(1):33. 

Goel G, Hmar L, Sarkar De M, Bhattacharya S, Chandy M. Colistin-Resistant Klebsiella pneumoniae: Report of a Cluster of 24 Cases from a New Oncology Center in Eastern India. Infection Control. 2014; 35 (08):1076-1077. 

Marchaim D, Chopra T, Pogue J, Perez F, Hujer A, Rudin S et al. Outbreak of Colistin-Resistant, Carbapenem-Resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan. Antimicrobial Agents and Chemotherapy. 2010;55(2):593-599.

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