Colistin Resistance Among Multi-Drug Resistant Gram-Negative Bacterial Isolates From Different Clinical Samples of ICU Patients: Prevalence and Clinical Outcomes.

INTRODUCTION: Colistin is considered to be the last resort for the management of infections caused by multi-drug resistant (MDR) gram-negative bacilli (GNB). However, in the recent past, there has been a rise in colistin resistance among MDR isolates in clinical settings with no profound data on the incidences and causes. The purpose of this study was to estimate the prevalence of colistin-resistance (CLR) in MDR isolates collected from different intensive care units (ICUs) and to determine the clinical outcomes of the patients.  Materials and methods: A prospective study was conducted in the ICU of a tertiary care hospital in Eastern Odisha, India from March 2019 to February 2020. MDR GNB isolates from different clinical samples of ICU patients, not intrinsically resistant to colistin, were included in this study. Samples collected for culture and sensitivity testing were processed as per standard guidelines in the microbiology laboratory. MDR organisms were examined for colistin susceptibility by the broth dilution method. Clinical data was collected from hospital electronic medical records and presented as percentage, number (N), and median (range). RESULTS:  The prevalence of colistin resistance MDR GNB was found to be 19.6% in the present study. Colistin resistance among the MDR isolates was found to be the highest (9.2% for Klebsiella pneumonia followed by 5% for Escherichia coli). CLR drug-resistant isolates were commonly (28.8%) isolated from samples of respiratory tract infections and the majority (54.1%) were from neurology ICU. In this study, co-morbidity was not found among 57.9% of the ICU patients and recovery was maximum i.e., 74.2%. CONCLUSION: This study found the prevalence of colistin resistance to be high (19.6%) among all MDR GNB isolates from samples of ICU patients, Klebsiella pneumonia and Escherichia coli commonly acquire colistin resistance. Patients in the neurology ICU were frequently infected with CLR MDR strains. Most of the patients who recovered were without any underlying comorbidities. Prolonged hospital stay and direct antibiotic pressure in the hospital can lead to the development of CLR variants.

Augmented balloon-assisted maturation (aBAM) for nonmaturing dialysis arteriovenous fistula.

PURPOSE: The surgically placed dialysis arteriovenous fistula (AVF) is considered by the Kidney Disease Outcomes Quality Initiative (KDOQI)and the Fistula First Breakthrough Initiative to be the ideal choice for hemodialysis access. A significant number of newly placed AVFs either slowly or never adequately mature sufficiently to provide for adequate dialysis. The balloon-assisted maturation (BAM) procedure utilizes serial angioplasty to promote and accelerate AVF maturation. We present a minimally invasive AVF maturation technique utilizing angioplasty, stent-graft, and coil embolization. METHODS: A 41-year-old white woman presented with an nonmaturing AVF with multiple venous outflow channels. An adequately functioning AVF was achieved after 2 treatments including coil embolization, angioplasty, and stent-graft placement. RESULTS: Adequate thrill and dialysis flow was achieved. Patient has done well during short-term follow-up without further intervention. CONCLUSIONS: BAM techniques can be an effective tool to help a dialysis patient achieve an adequately mature AVF. Additional vascular interventional techniques may be utilized to further improve clinical results. For the purpose of this report we call this technique "augmented balloon-assisted maturation," or aBAM.