ANTIBIOTIC RESISTANCE PATTERNS OF GRAM NEGATIVE ISOLATES IN A TERTIARY CARE HOSPITAL OF NEPAL

  • Binit Lamichhane Lumbini Medical College and Teaching Hospital Pvt. Ltd

Abstract

Abstract

Introduction: Antimicrobial resistance in the current centuries has been the cause of lack of treatment of even common diseases. Although there are various antibiotics that can be used to combat Gram negative infection, resistant strains have subsequently emerged giving rise to life threatening superbugs.

Objective: The aim of the present study is to establish the incidence of gram negative bacteria in clinical specimens and its antibiotic sensitivity pattern.

Methodology: In the present study Gram negative pathogens in clinical specimens were considered to determine prevailing antibiotic sensitivity pattern. Isolates were identified and screened for 13 different antibiotic susceptibility pattern by Kirby-Bauer disc diffusion method.

Result: A total of 1673 clinical samples were studied in 8 months. Of the total samples 531 (31.74%) were significant growth and 344 gram negative. E. coli (179/344), Pseudomonas (87/344), Proteus (31/344), Klebsiella (28/344), Salmonella (12/344) and Enterobacter (7/344) were isolated. E coli was found to be most sensitive to cephalosporins and tetracycline and most resistant to quinolones, fluroquinolones and sulphonamides. For Pseudomonas Amikacin and Ampicillin were most effective and Nalidixic acid was least effective. 114 of the isolates were found to be Multi Drug Resistant with E. coli 45.25% (81/179), Klebsiella 50% (14/28), Proteus 35.48% (11/31), Pseudomonas 2.3% (2/87), Salmonella 8.3% (1/12) and Enterobacter 71.42% (5/7).

Conclusion: Among all the tested antibiotics cephalosporins and fluroquinolones were most effective in compare to others.

 

Keywords: Gram Negative, Multi Drug Resistant, Antimicrobial Resistance

Author Biography

Binit Lamichhane, Lumbini Medical College and Teaching Hospital Pvt. Ltd
Lecturer, Department of Microbiology

References

1. Oteo J, Campos J, Baquero F. Antibiotic resistance in 1962 invasive isolates of Escherichia coli in 27 Spanish hospitals participating in the European Antimicrobial Resistance Surveillance System. J. Antimicrob. Chemother. 2002; 50: 945-952.

2. Hsu L-Y, Tan T-Y, Jureen R, Koh T-H, Krishnan P, Lin RT-P, et al. Antimicrobial drug resistance in Singapore hospitals. Emerg Infect Dis. 2007. http://www.cdc.gov/EID/content/13/12/1944.htm

3. Okonko IO, Soleye FA, Amusan TA, Ogun AA, Ogunnusi TA, Ejembi J. Incidence of Multi-Drug Resistance (MDR) Organisms in Abeokuta, Southwestern Nigeria. Global J. Pharmacol. 2009a; 3(2): 69-80.

4. Neu HC. Changing patterns of hospital infections: implications for therapy. Changing mechanisms of bacterial resistance. Am J Med. 1984; 77(1B):11-23.

5. Oteo J, Lázaro E, de Abajo FJ, Baquero F, Campos J; Spanish members of EARSS. Antimicrobial- resistant invasive Escherichia coli, Spain. Emerg Infect Dis. 2005; 11(4):546-53.
6. Mulvey MR, Bryce E, Boyd D, Ofner-Agostini M, Christianson S, Simor AE, Paton S. The Canadian Hospital Epidemiology Committee of the Canadian Nosocomial Infection Surveillance Program, Health Canada Ambler class A extended-spectrum beta-lactamaseproducing Escherichia coli and Klebsiella spp. In Canadian hospitals. Antimicrob. Agents Chemother. 2004; 48: 1204-1214.

7. Rhomberg PR, Fritsche TR, Sader HS, Jones RN. Antimicrobial susceptibility pattern comparisons among intensive care unit andgeneral ward Gram-negative isolates from meropenem yearly susceptibility test information collection program (USA). Diagn. Microbiol. Infect. Dis. 2006; 56: 57-62.

8. Chikere CB, Chikere BO, Omoni VT. Antibiogram of clinical isolates from a hospital in Nigeria. Afr. J. Biotech. 2008; 7(24): 4359-4363

9. Zhanel GG, DeCorby M, Laing N, Weshnoweski B, Vashisht R, Tailor F, Nichol KA, Wierzbowski A, Baudry PJ, Karlowsky JA, Lagace´-Wiens P, Walkty A, McCracken M, Mulvey MR, Johnson J. The Canadian Antimicrobial Resistance Alliance (CARA), Hoban DJ Antimicrobial-resistant pathogens in intensive care units in Canada: results of the Canadian National Intensive Care Unit (CANICU) study, 2005-2006. Antimicrobiol. Agents Chemother. 2008; 52: 1430-1437.

10. Prabhu K, Bhat S, Rao S. Bacteriologic Profile and Antibiogram of Blood Culture Isolates in a Pediatric Care Unit. J Lab Physicians. 2010; 2(2): 85-88.

11. Cheesbrough M. District Laboratory Practice in Tropical countries. Cambridge University Press, London. 2000; 2: 151-154, 180-265.


12. Forbes AB, Sahm FD, Weissfelt SA. Bailey and Scott’s diagnostic Microbiology. 12th edition. Mosby publication. 2007.

13. Greenwood D, Slack RCB , Peutherer JF. Medical Microbiology. 14th edition. ELBS: 1997; 781-9.

14. Antibiogram of clinical isolates from a Healthcare Infection Control Practices Advisory Committee (HICPAC). Central for Disease Control and Prevention (CDC). Management of Multidrug-Resistant Organisms in Healthcare Settings; 2006. Available from http://www.cdc.gov/hicpac/pdf/MDRO/MDROGuideline2006.pdf

15. Panta K, Ghimire P, Rai SK, Mukhiya RK, Singh RN, Rai G. Antibiogram typing of gram negative isolates in different clinical samples of a tertiary hospital. Asian J Pharm Clin Res. 2013; 6 (1):153-156


16. Shrestha S, Chaudhari R, Karmacharya S, Kattel HP, Mishra SK, Dahal RK, Bam N, Banjade N, Rijal BP, Sherchand JB, Ohara H , Koirala J and Pokhrel BM. Prevalence of nosocomial lower respiratory tract infections caused by Multi- drug resistance pathogens. J Inst Med. 2011; 33 (2).

17. Baral P, Neupane S, Marasini BP, Ghimire KR, Lekhak B, Shrestha B. High prevalence of multidrug resistance in bacterial uropathogens from Kathmandu, Nepal. 2012; BMC Res Notes. 2012;5 (38).

18. Fridkin SK. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med. 2001; 29: 64-8.

19. Hassanzadeh P, Motamedifar M and Hadi N. Prevalent bacterial infections in intensive care units of Shiraz University of medical sciences teaching hospitals, Shiraz, Iran. Jpn. J. Infect. Dis. 2009; 62: 249-53.

20. Kollef MH, Silver P, Murphy DM and Trovillion E.The effect of late-onset ventilator-associated pneumonia in determining patient mortality. Chest. 1995; 108: 1655-62.

21. Mohammadi-mehr M, Feizabadi MM. Antimicrobial resistance pattern of Gram-negative bacilli isolated from patients at ICUs of Army hospitals in Iran. Iran J Microbial. 2011; (1):26-30.

22. F Günserena, Mamıkoğlua L, Öztürkb S, Yücesoy M , Biberoğluc K , Yuluğc N, Doğanayd M, Kocagöze S , Ünale S, Çetinf S, Çalanguf S , Köksalg I, Leblebicioğluh H and Günaydınh M A surveillance study of antimicrobial resistance of Gram-negative bacteria isolated from intensive care units in eight hospitals in Turkey. J. Antimicrob. Chemother. (1999) 43 (3): 373-378.

23. Ghosh A, Karmakar PS, Pal J, Chakraborty N, Debnath NB, Mukherjee JD. Bacterial incidence and antibiotic sensitivity pattern in moderate and severe infections in hospitalised patients. J Indian Med Assoc. 2009; 107(1): 21-2, 24-5

24. Zhanel GG, DeCorby M, Laing N, Weshnoweski B, Vashisht R, Tailor F, Nichol KA, Wierzbowski A, Baudry PJ, Karlowsky JA, Lagacé-Wiens P, Walkty A, McCracken M, Mulvey MR, Johnson J; Canadian Antimicrobial Resistance Alliance (CARA), Hoban DJ. Antimicrobial-resistant pathogens in intensive care units in Canada: results of the Canadian National Intensive Care Unit (CAN-ICU) study, 2005-2006. Antimicrob Agents Chemother. 2008; 52(4):1430-7

25. Sader HS, Jones RN, Gales AC, et al. Antimicrobial susceptibility patterns for pathogens isolated from patients in Latin American medical centers with a diagnosis of pneumonia: analysis of results from the SENTRY Antimicrobial Surveillance Program (1997): SENTRY Latin America Study Group. Diagn Microbiol Infect Dis. 1998; 32:289–301

26. Meyer KS, Urban C, Eagan JA, et al. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med. 1993; 119:353–358


27. Monnet DL, Biddle JW, Edwards JR, et al. Evidence of inter hospital transmission of extended-spectrum b–lactam resistant Klebsiella pneumoniae in the United States, 1986 to 1993. Infect Control Hosp Epidemiol. 1997; 18:492–498

28. Jones RN, Pfaller MA. Bacterial resistance: a worldwide problem. Diagn Microbiol Infect Dis. 1998; 31:379–388

29. Jones RN. Contemporary antimicrobial susceptibility patterns of bacterial pathogens commonly associated with febrile patients with neutropenia. Clin Infect Dis. 1999; 29:495–502


30. Jones RN.Resistance Patterns Among Nosocomial Pathogens - Trends Over the Past Few Years. CHEST 2001; 119:397S–404S

31. Shrestha S, Amatya R, Dutta R. Prevalence of extended spectrum beta lactamase (ESBL) production in gram negative isolates from pyogenic infection in tertiary care hospital of eastern Nepal. Nepal Med Coll J. 2011; 13(3):186-9.

32. Khanal S, Joshi DR, Bhatta DR, Devkota U, Pokhrel BM β-Lactamase-Producing Multidrug-Resistant Bacterial Pathogens from Tracheal Aspirates of Intensive Care Unit Patients at National Institute of Neurological and Allied Sciences, Nepal. ISRN Microbiology. 2013; Article ID 847569

33. Colodner R, Samra Z, Keller N, Sprecher H, Block C, Peled N, Lazarovitch T, Bardenstein R, Schwartz-Harari O, and Carmeli Y. First national surveillance of susceptibility of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. to antimicrobials in Israel. Diagn. Microbiol. Infect. Dis. 2007; 57:201-205.

34. Schwaber MJ, Navon-Venezia S, Schwartz D, and Carmeli Y. High levels of antimicrobial coresistance among extended-spectrum-β-lactamase-producing Enterobacteriaceae. Antimicrob. Agents Chemother. 2005; 49:2137-2139.

35. Ghosh A, Karmakar PS, Pal J, Chakraborty N, Debnath NB, Mukherjee JD. Bacterial incidence and antibiotic sensitivity pattern in moderate and severe infections in hospitalised patients. J Indian Med Assoc. 2009; 107(1):21-2, 24-5

36. Jones RN. Impact of changing pathogens and antimicrobial susceptibility patterns in the treatment of serious infections in hospitalized patients. Am J Med. 1996; 24;100(6A):3S-12S

37. Talbot GH, Bradley J, Edwards JE, Gilbert D., Scheld M, and Bartlett JG. Bad bugs need drugs: an update on the development pipeline from the Antimicrobial Availability Task Force of the Infectious Diseases Society of America. Clin. Infect. Dis. 2006; 42:657-668.

38. Falagas ME, Bliziotis IA, Kasiakou SK, Samonis G, Athanassopoulou P, and Michalopoulos A. Outcome of infections due to pandrug-resistant (PDR) gram-negative bacteria. BMC Infect. Dis. 2005; 5:24.

39. Coelho J, Woodford N, Turton J, and Livermore DM. Multiresistant Acinetobacter in the UK: how big a threat? J. Hosp. Infect. 2004; 58:167-169.

40. Paterson DL, and Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin. Microbiol. Rev.2005; 18:657-686.

41. Walsh TR, Toleman MA, Poirel L, and Nordmann P. Metallo-beta-lactamases: the quiet before the storm? Clin. Microbiol. Rev. 2005;18: 306-325.

42. Paterson DL. Resistance in gram-negative bacteria: Enterobacteriaceae. Am. J. Med. 2006; 119:S20-S28.
43. Subha A, Ananthan S. Extended spectrum beta lactamase (ESBL) mediated resistance to third generation cephalosporins among Klebsiella pneumoniae in Chennai. Indian J Med Microbiol. 2002; 20(2): 92-5
Statistics
527 Views | 558 Downloads
How to Cite
Lamichhane, B. “ANTIBIOTIC RESISTANCE PATTERNS OF GRAM NEGATIVE ISOLATES IN A TERTIARY CARE HOSPITAL OF NEPAL”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 7, no. 3, July 2014, pp. 30-33, https://innovareacademics.in/journals/index.php/ajpcr/article/view/1112.
Section
Original Article(s)