Raoultella species associated sepsis in children: A case series at a tertiary hospital, Karachi

Document Type

Article

Department

Paediatrics and Child Health; Emergency Medicine

Abstract

Objective: To determine the clinical outcome and management options of gram-negative Raoultella species reported at a tertiary care pediatric Hospital in Karachi.
Study design: Descriptive study.
Place and duration of study: Pediatric and child Health department of The Aga Khan University Hospital from January 2017 to June 2020.
Methodology: A retrospective chart review was done. Data was extracted for 20 patients with culture-positive Raoultella species. Study variables included demographic features, infection site, antibiotic sensitivities, Hospital duration, clinical outcome, and management options. Data were summarised using descriptive statistics and Kaplan-Meier plots using SPSS version 22.
Results: A total of twenty-three site cultures positive with Raoultella species were isolated among 20 children with a wide array of clinical symptoms and disease severity. Predominantly the organism was isolated in blood with 12 positive cultures (60%). Eleven (55%) of the patients were females having a median age of 9.5 months. Multidrug-resistant (MDR) and extensively drug-resistant species (XDR) were isolated from eleven (47.8%) and ten (43.5%) culture sites respectively. Combination therapy of colistin or fosfomycin with carbapenem and tigecycline (triple regimen) was used in seven (35%) patients with severe sepsis. Microbiological clearance (sterility) was achieved in twelve (60%) children. Eight children (40%) died of MDR/XDR Raoultella associated sepsis.
Conclusion: Highly resistant Raoultella species were associated with high mortality among reported cases, with a limited choice of antibiotics and combination therapy. The management of Raoultella species is required with a multi-specialty approach. Furthermore, strict antimicrobial stewardship measures are required to control an outbreak of MDR and XDR infections in Pakistan.

Publication (Name of Journal)

Journal of the College of Physicians and Surgeons

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