STUDY ON ANTIMICROBIAL RESISTANCE PATTERN IN A TERTIARY CARE HOSPITAL – AN OBSERVATIONAL RETROSPECTIVE STUDY

Objective: The aim of the study was to monitor the magnitude and trends in antimicrobial resistance through surveillance programs and bacteriological diagnostic methods. Methods: The study research has performed a retrospective observational study for period of 6 months (Dec 2019–June 2020) to determine the antimicrobial susceptibility pattern on cultures of various specimens at Vivekanandha Medical Care Hospital. The resultant data were computed in Microsoft Excel. Analyses were expressed as the total number, frequencies, and percentage. Results: A total of 110 culture and sensitivity reports were collected from microbiology departments. Among the culture report, 84% accounted for gram-negative and 16% for Gram-positive organisms. Out of eight specimens, 15 different bacteria were identified and the most common bacteria were Klebsiella pneumonia (25%), E. coli (14%), Staphylococcus aureus (13%), and Pseudomonas aeruginosa (12%). Conclusion: The interferences from the present study can help in bridging the gap in future educations, training, and adequate decision-making.


INTRODUCTION
Antibiotics are essential medicines that combat bacterial infections with the aid of disrupting the method essential for bacterial cell growth and proliferation. They represent one of mankind's crucial medical inventions saving millions of lives throughout the years. The first broad-spectrum antibiotic introduced into the world, Penicillin was discovered by Alexander Fleming in 1928. Penicillin has saved and is still saving millions of lives worldwide playing a major role in treating bacterial diseases and in the creation of today's pharmaceutical industry [1,2]. On receiving the Nobel Prize on 1945, December 11, Alexander Fleming has warned regarding the abuses of penicillin one may impose on themselves and on others when they are not used appropriately, and with this thoughtless behavior comes the consequence. Adding to the statement, "The time may come when penicillin can be bought by anyone in the shops." The genetic ability of resistant microbe to exhibit inhibitory action on antibiotics by resistance genes gives rise to the phenomena called antimicrobial resistance (AMR) [3]. AMR is a severe health issue concern with the extreme impact on the global health sector and economy. They are the subsequent results of evolution through natural selection or we can say antibiotic action. A large part of resistant pathogenic organisms in a micro-biosphere is pushed due to human activities, consisting of indiscriminate use and misuse of antibiotics in humans, veterinary medication, and agriculture [4,5]. At the same time, when high concentrations of antibiotics used therapeutically can create an environment for resistant mutants challenging minor and primary infectious.
Many patients are given a non-specific broad-spectrum medicament for an actual or suspected infection which is often not necessary to the given condition. Subsequently, determining the resistance patterns inside the geographical area will assist in choosing and use of the effectiveness of antibiotics.

METHODS
The current research performed an observational retrospective study for 6 months (December 2019-June 2020) to determine the antimicrobial susceptibility pattern on cultures of various specimens collected over 2 years. Data on the identified micro-organisms and their antimicrobial susceptibility pattern were obtained from the Clinical Microbiology Laboratory of Vivekanandha Medical Care teaching Hospital (VMCH). The data regarding culture and sensitivity (C/S) were isolated from the different specimens such as pus, blood, wound swab, conjunctival, tracheal, pleural fluid, sputum, and urine and were analyzed including out-patients (OP) and in-patients (IP). To eliminate bias in the collection of research data, the C/S reports were filtered to retain only the first isolate of the patient. The report was computed in Microsoft Excel and was expressed as proportions and percentages. The research protocol was approved by the Institutional Ethical Committee, with the approval number SVCP/IEC/JAN/2020/02.

RESULTS
The total 110 culture and sensitivity reports had shown (46.2%) significant growth of pathogenic organisms exhibiting resistance to either single or multiple antibiotics.

Distribution of bacteria as per Gram-stain
Among the culture reports collected, 84% were Gram-negative organisms and 16% accounted for Gram-positive organisms as depicted in Fig. 1.
As shown in Fig. 2, Klebsiella pneumoniae (n=17) and Escherichia coli (n=15) were the most frequent bacteria isolated from the urine culture, Staphylococcus aureus (n=10) and Streptococcus pneumoniae (n=6) were found from pus and Pseudomonas aeruginosa (n=5) from sputum culture. Staphylococcus aureus (n=3) was the most seen organism in the blood samples.

DISCUSSION
The research aimed to study the identified organisms and to understand their antibiotic susceptibility pattern as per the culture and sensitivity  As per the finding, the maximum clinical isolates obtained were from urine specimens (45) followed by pus (23), sputum (17), and tracheal (9). The result was comparable with the reports of Alnamnakani et al. [15].   [9,15,19,20,[25][26][27][28]. These reports support the current findings that these organisms are known etiologies for both community and nosocomial associated infections.
The previous other studies conducted in Ethiopia and overseas had also conducted C/S reports on Pseudomonas sp. [33][34][35][36].

CONCLUSION
The study was able to observe and provide an epidemiological variation in resistance and sensitivity pattern by comparing the previous reports. To decrease the rising antibiotic resistance, rational use of antibiotics is essential according to the antibiotic resistance pattern of that particular institution. For this concern, a regular epidemiological study needs to be conducted on C/S isolates to guide the clinicians in the selection of the appropriate empirical therapy and switching over to the best therapeutic choice based on the data. In addition, study data can be used as a baseline for future analysis to establish prescribing guidelines, determining new therapies, and improve the focus of education and campaigns in reducing AMR.

CONFLICTS OF INTERESTS
Nil.

AUTHORS FUNDING
Nil.