EP-004 - A SINGLE CENTRE, PROSPECTIVE STUDY TO EVALUATE THE EFFECT OF DOUBLE CARBAPENEM BASED COLISTIN THERAPY VERSUS BEST AVAILABLE THERAPY FOR THE TREATMENT OF CARBAPENEM RESISTANT ENTEROBACTERIACEAE AT A TERTIARY CARE HOSPITAL IN INDIA.

R. Somani, R. Soanker, V. Thumma, P. kanne, A. Donepudi; Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

Background:

Background: Polymyxin based combination therapies are recommended for management of Carbapenem-Resistant Enterobacteriaceae (CRE) Infections in India[1], as Polymyxin monotherapy is associated with high mortality rates. However, Double carbapenem regimen has shown success rate of 60-80% in Enterobacteriaceae isolates producing Klebsiella pneumoniae carbapenemase (KPC)[2-3]. Therefore, this study was done to compare the effect of colistin based double carbapenem regimen versus best available therapy for CRE infections.

Methods: This was a prospective, observational study in which hospitalized patients with microbiologically confirmed CRE infections were included. Patients receiving colistin with Double Carbapenem regimen (Meropenem and Ertapenem) were considered as Group A, while those receiving best available therapy (colistin in combination with second in-vitro sensitive drug) were considered as Group B. The primary endpoint was clinical cure rate analysed at day 28 by fisher exact test. Cox Regression was performed to study the factors influencing clinical outcome.

Results: Overall 46 patients were included in the study, 20 in Group A and 26 in Group B. Clinical cure was achieved in 13 (65%) of the patients in Group A and 15(57.7%) in Group B (p=0.61). The mean Sequential organ failure assessment (SOFA) score at baseline was 5.85 ±3.7 in Group A and 4.23±3.31 in Group B. Cox regression analysis demonstrated that patients with higher SOFA score at baseline had 26 % significantly less chance of clinical cure (HR:0.74, CI-0.59-0.92, p=0.008).

Conclusion: Double carbapenem based Colistin regimen can be used as definitive salvage therapy in patients with CRE infections with limited therapeutic options.

1. Indian Council of Medical Research. Guidance on Diagnosis & Management of Carbapenem Resistant Gram-negative Infections. New Delhi :ICMR;2022 https://main.icmr.nic.in/sites/default/files/upload_documents/Diagnosis_and_management_of_CROs.pdf . Accessed 15 september 2022.
2. Souli M, Karaiskos I, Masgala A, Galani L, Barmpouti E, Giamarellou H. Double-carbapenem combination as salvage therapy for untreatable infections by KPC-2-producing Klebsiella pneumoniae. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2017 Jul;36(7):1305–15.
3. Venugopalan V, Nogid B, Le TN, Rahman SM, Bias TE. Double carbapenem therapy (DCT) for bacteremia due to carbapenem-resistant Klebsiella pneumoniae (CRKP): from test tube to clinical practice. Infect Dis Lond Engl. 2017 Nov 1;49(11–12):867–70