Two case reports of biliary stent infections by extensively drug-resistant Escherichia coli carrying blaNDM-5 at a tertiary-care hospital in West Bengal, India

BackgroundRising antimicrobial resistance (AMR) is an acute public health emergency impeding the clinical efficacy of surgical interventions. Biliary stent placement is one of the routine surgical procedures that rarely lead to infections that are empirically managed by broad-spectrum beta-lactams and fluoroquinolones. Critical priority pathogens, such as carbapenem-resistant Escherichia coli challenge treatment outcomes and infection prevention.Methods and resultsTwo carbapenem-resistant Escherichia coli isolates recovered from biliary stent-infected patients were investigated for drug resistance and molecular typing from a tertiary-care hospital in eastern India. The isolates were extensively drug-resistant (XDR) and remained susceptible to aminoglycosides, tigecycline, fosfomycin, or colistin. Carbapenemase blaNDM-5 was carried by both the isolates that either belonged to strain type ST361 or ST405.ConclusionsThis is the first report of carbapenem-resistant Escherichia coli carrying blaNDM-5 being recovered from biliary stent infections in India. Targeted antibiotic therapy is pivotal for the XDR infections, while molecular typing facilitates infection prevention measures by source tracking and control.