Colistin resistance cause for worry

KOCHI: The first case of colistin resistance in a government district hospital in the state was reported from Ernakulam General Hospital in March this year. Colistin is the last-line antibiotic drug against gram-negative bacteria that causes bloodstream and urinary tract infections.
A 63-year-old woman from Tripunithura with stage five chronic kidney disease had sought treatment at Ernakulam General Hospital.She had severe sepsis and blood culture showed presence of Klebsiella spp, a type of bacteria. Further tests confirmed the colistin resistance.
Mgr B, the gene responsible for colistin resistance was also identified.
"If there is colistin resistance, it means that you are in a post-antibiotic era as there is no effective antibiotic left. But this is not the first time colistin resistance is occurring in the state. They have been reported from private hospitals and even government medical colleges," said Dr Arvind R, head, department of infectious diseases, government medical college, Thiruvananthapuram (GMCT).
Explaining why reporting of colistin resistance should be a concern, Dr Arvind said in district hospitals, the antibiotic use is not high-end and in their ICUs they don't have patients who are in ventilators for long periods. As critical care goes up, resistance will also go up, he added.
"Colistin resistant Klebsillae has been found in meat and we are concerned that such cases may increase due to their usage as growth promoters in poultry farms. If food bacteria resistant to colistin enter the gut and mix up with genetic element of normal gut bacteria, it results in transmission of gene responsible for colistin resistance, thereby resulting in pan drug resistance," said Dr Sivaprasad P S, nodal officer, Sepsis Management project, Ernakulam General Hospital.
Incidentally, raw colistin used in animals as growth promoter doesn't cost much. But when used in human, it costs Rs 2,000 per injection. China has already banned use of colistin in animal feed.
"Once people get resistant to high-end antibiotics, we don't have next line antibiotics. So, we must stop misuse of antibiotics," said Dr K L Sarada Devi, nodal officer, state government's Antimicrobial Resistance Strategic Action Plan.