We are handling increasing number of patients infected with carbapenamase producing enterobacteriaceae (CRE) (Escherichia coli / Klebsiella pneumonia) resistant to all antimicrobials barring colistin. These patients are identified with microbiological evidence of the pathogen in blood cultures. Many of these patients are also with acute kidney injury. We are currently administering double dose carbapenem (preferably meropenem) combined with colistin & rifampicin.
We do have 40-60% recovery and the remaining patients fail to respond to the above combination therapy. As per the Centers for Disease Control Guidelines, we do perform cultures on rectal swab and invariably all these patients are found to be colonized within their gut with CRE. We do enforce prompt contact precautions and a dedicated 1:1 patient to nurse ratio throughout their care in the intensive care units. How are the…
