Pan drug resistance organism having OXA-48 drug resistance pattern in ICU of Nepal

 

A patient was admitted in ICU with the diagnosis of septic shock. His multiple samples were sent to the laboratory for multiple times. Klebsiella pneumonia was isolated in his sputum sample which was sensitive to Meropenem and Colistin. So patient was started with Meropenem and Colistin but the infection was still not cleared. His repeat pan culture were sent to our laboratory. In his urine sample, Providencia rettegeri was isolated which was resistant to all drug including Meropenem. To identify the resistant pattern of the organism, we checked for ESBL, MBL, KPC, AMPc and Co-producer phenotypically which was negative.

As we had recently done a journal club on phenotypic detection of Oxa-48 published in ASM. So we implied it on our isolate. Coincidentally, the organism had oxa-48 drug resistance pattern. As the organism was pan-drug resistant, we all were helpless and were oblige to wait and watch that when he will die. The patient died on his 30th day of ICU admission due to lack of antimicrobial choice.

Antibiotic resistance and emergence of super bugs is a great problem of the whole world and in case of poor country like Nepal it’s a huge burden. We are entering in the stage of post-antibiotic era, super bugs and multidrug resistance organism is frequently detected in our laboratory.  If proper steps is not taken by the physician, government and international organization to implement rational use of antibiotics and provide proper facilities for prompt detection of drug resistance pattern then sooner we will reach the stage where we will be helpless to save a single patient from simple infection.

 

10

Non Lactose Fermenting colony of Providencia rettegeri on CLED Media

 

 

 

8

Biochemical Test of Providencia

 

9

PPA test positive for Providencia

 

2

Modified Hodge Test positive for test organism (Providencia)

 

 

 

Modified Hodge Test by Dr. Ranjit

Modified Hodge Test positive for test organism (Providencia)

 

3

Modified Hodge Test positive for test organism (Providencia)

 

 

dr. Ranjit

Detection of OXA-48 by blank disk diffusion method2 E –EDTA-0.1M 10μl (292μg of EDTA), P-Phenyl BoronicAcid-10μL (containing 600μg of PBA)

 

Dr. Ranjit

Detection of OXA-48 by blank disk diffusion method2 E –EDTA-0.1M 10μl (292μg of EDTA), P-Phenyl BoronicAcid-10μL (containing 600μg of PBA)

 

 

Dr. Ranjit sah

Detection of OXA-48 by using antibiotic containing disk which is intrinsically resistant to Providencia instead of Blank Disk.                             E –EDTA-0.1M 10μl (292μg of EDTA), P-Phenyl BoronicAcid-10μL (containing 600μg of PBA)

 

Dr. Ranjit Sah

Detection of OXA-48 by using antibiotic containing disk which is intrinsically resistant to Providencia instead of Blank Disk.               E –EDTA-0.1M 10μl (292μg of EDTA), P-Phenyl BoronicAcid-10μL (containing 600μg of PBA)

 

 

Thanks to ASM for the publication of such article, Dr. Shusila for helping me to establish the drug resistance pattern for the first time in Nepal and a big thanks to the faculty and In-charge of ICU ( Dr. Subash Acharya and Dr. Gentle Sunder Shrestha) for proper response to our report, isolation of the patient and fumigation of the isolation room after death of the patient.

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