study on mics of tigecycline in clinical isolates of carbapenem resistant enterobacteriaceae (cre) at a tertiary care centre in north india
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2017
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Abstract
Introduction: Members of family Enterobacteriaceae are the
most common Gram-negative bacteria isolated from clinical
samples. Those Enterobacteriaceae which have acquired
resistance to all β-lactams antibiotics including the carbapenems
are considered as Carbapenem Resistant Enterobacteriaceae
(CRE). These CRE isolates are often resistant to most other
classes of antimicrobials as well, making their treatment a great
challenge. Tigecycline is one of the last resort antimicrobials
against such multidrug resistant bacteria. Decreased tigecycline
susceptibility mediated by efflux pump systems is being reported
in clinical strains of Enterobacteriaceae. Minimum Inhibitory
Concentration (MIC) data would prove useful in managing
infections by these multidrug resistant bacteria and optimizing
use of tigecycline.
Aim: To evaluate the MIC values of tigecycline against carbapenem
resistant Escherichia coli and Klebsiella pneumoniae isolates.
Materials and Methods: This prospective study was carried
out from January 2015 to December 2015 at the Department of
Microbiology, Era’s Lucknow Medical College and Hospital (ELMCH),
Lucknow, Uttar Pradesh, India. Antimicrobial susceptibility by disk
diffusion (Kirby-bauer) was done for 491 E. coli and K. pneumoniae
strains isolated from 1606 samples collected from patients
admitted in various wards and ICUs. Imipenem, meropenem and
ertapenem 10 μg disks were used for testing of sensitivity to
carbapenems. In all isolates, Tigecycline 15 µg (Hi-Media) disk
was used to screen for tigecycline resistance. In CRE isolates,
MICs of tigecycline were determined by E-test (Ezy MIC TM TG
strips, Hi Media) and interpreted using European Committee on
Antimicrobial Susceptibility Testing (EUCAST) 2016 guidelines.
Results: Out of 491 isolates tested, 186 (37.9%) were found
to be CRE showing resistance to at least one of the three
carbapenems tested and these included 99 E.coli and 87
K. pneumoniae. Sensitivity pattern of these two bacterial
isolates shows a high level of resistance to most classes of
antimicrobials. MIC testing for tigecycline was carried out in
144 CRE isolates and tigecycline resistance (MIC >2 µg/ml) was
seen in 12 (8.3%) isolates (eight K.pneumoniae and four E. coli).
Eight other isolates were found to have MIC of 2 µg/ml and thus
the overall prevalence of isolates with decreased susceptibility
was 20 (13.9%).
Conclusion: A high prevalence of carbapenem resistance coupled
with high tigecycline MICs in clinical isolates of E.coli and K.
pneumoniae highlights the judicious use of a combination of
antimicrobials. Routine in vitro sensitivity testing to evaluate the
clinical utility of tigecycline against such resistant Enterobacteriaceae
is warranted.
| Reference Key |
khare2017journalstudy
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|---|---|
| Authors | ;Vineeta Khare;Prashant Gupta;Fareya Haider;Rehana Begum |
| Journal | JAMA network open |
| Year | 2017 |
| DOI |
10.7860/JCDR/2017/24594.9629
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| URL | |
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