COLONIZATION AND ANTIBIOTIC RESISTANCE DYNAMICS OF PATIENTS AT INTENSIVE CARE UNIT (ICU)-OUR EXPERIENCE


Mahesh Chandra Sahu, Ishwar Chandra Behera, Santosh Kumar Swain

Abstract


introduction: Multidrug resistant strains are developed day by day due to empirical therapy in intensive care unit (ICU). Both gram positive and gram negative strains are found in ICU are drug resistant bacteria. In this study, the prevalence of drug resistance bacteria in ICU were determined.

Materials and Methods: The clinical samples; ascitic fluid, blood, central line tip, ET aspiration  pleural fluid, pus from liver abscess, sputum, tracheal aspiration, urine and wound swabs were collected from ICU patients and cultured in specific medium. Subsequently antibiotic sensitivity pattern of isolated bacteria were carried out with disc diffusion methods.

Results: A total number of 794 clinical samples were cultured in specific medium and it revealed 191 of single colonies, 145 were double colonies and 87 were 3 or multy-colonies. A total of 963 bacteria were isolated among them 180 were gram positive bacteria, BYC were 135 and rest were gram negative bacteria. There was no significantly difference in growth of microorganisms with respect to clinical samples as t test revealed P= 0.87. Among the gram negative bacteria; Klebsiela pneumonia were predominant and Proteous mirabilis was lowest. Tigecycline and colistin were most effective antibiotics agonist all bacteria.

Conclusions: Urine samples of the patient’s revealed higher number of organisms where as pus from liver abscess found only one number of growths. The antibiotic stewardship programs must lead to significant decrease in all antibiotic used in the ICU setting. However, this result may be required further work to determine the fruitful necessary for success.

Key words: Antibiotics, Intensive Care Unit, Bacterial infections, Drug resistance.


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References


Dubey D, Rath S, Sahu MC, Rout S, Debata NK, Padhy RN. A report on infection dynamics of inducible clindamycin resistance of Staphylococcus aureus isolated from a teaching hospital in India. Asian Pac J Trop Biomed 2013;3(2):148-53.

Tacconelli E. Antimicrobial use: Risk driver of multidrug resistant microorganisms in healthcare settings. Curr Opin Infect Dis 2009;22(4):352-8.

Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, Burke JP, et al. Infectious diseases society of America, society for healthcare epidemiology of America: Infectious diseases society of America and the society for healthcare epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44(2):159-77.

Chang HT, Krezolek D, Johnson S, Parada JP, Evans CT, Gerding DN. Onset of symptoms and time to diagnosis of Clostridium difficile-associated disease following discharge from an acute care hospital. Infect Control Hosp Epidemiol 2007;28(8):926-31.

Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis 2008;47(6):735-43.

Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, et al. Bad bugs, no drugs: No eskape! An update from the infectious diseases society of America. Clin Infect Dis 2009;48(1):1-12.

WHO. The Evolving Threat of Antimicrobial Resistance: Options for Action. Geneva: World Health Organization; 2012.

Dash A, Sahu K, Senapati JN, Debata NK, Sahoo J, Raulo BC, et al. Surveillance of antibiotic sensitivity and resistance pattern of bacteria isolated from orthopaedic wound discharge. Int J Pharm Sci Rev Res 2016;36(1):208-11.

Lesprit P, Landelle C, Brun-Buisson C. Clinical impact of unsolicited post-prescription antibiotic review in surgical and medical wards: A randomized controlled trial. Clin Microbiol Infect 2013;19(2):E91-7.

Kollef MH, Micek ST. Antimicrobial stewardship programs: Mandatory for all ICUs. Crit Care 2012;16(6):179.

Rimawi RH, Mazer MA, Siraj DS, Gooch M, Cook PP. Impact of regular collaboration between infectious diseases and critical carepractitioners on antimicrobial utilization and patient outcome. Crit Care Med 2013;41(9):2099-107.

Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 2009;136(5):1237-48.

Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. Impact of antimicrobial stewardship in critical care: A systematic review. J Antimicrob Chemother 2011;66(6):1223-30.

DiazGranados CA. Prospective audit for antimicrobial stewardship in intensive care: Impact on resistance and clinical outcomes. Am J Infect Control 2012;40(6):526-9.

Katsios CM, Burry L, Nelson S, Jivraj T, Lapinsky SE, Wax RS, et al. An antimicrobial stewardship program improves antimicrobial treatment by culture site and the quality of antimicrobial prescribing in critically ill patients. Crit Care 2012;16(6):R216.

Elligsen M, Walker SA, Pinto R, Simor A, Mubareka S, Rachlis A, et al. Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: A controlled interrupted time series analysis. Infect Control Hosp Epidemiol 2012;33(4):354-61.

Sahu MC, Dubey D, Rath S, Debata NK, Padhy RN. Multidrug resistance of Pseudomonas aeruginosa as known from surveillance of nosocomial and community infections in an Indian teaching hospital. J Public Health 2012;20(4):413-23.

Sahu MC, Debata NK, Padhy RN. Antibacterial activity of Argemone mexicana L. against multidrug resistant Pseudomonas aeruginosa, isolated from clinical samples. Asian Pac J Trop Biomed 2012;2(2):S800-7.

Sahu MC, Patnaik R, Padhy RN. In vitro combination-efficacy of ceftriaxone and leaf extract of Combretum albidum G. Don against multidrug resistant Pseudomonas aeruginosa and host-toxicity testing with human lymphocytes from human cord blood. J Acute Med 2014;4(1):26-37.

Sahu MC, Padhy RN. In vitro antibacterial potency of Butea monosperma Lam. against 12 clinically isolated multidrug resistant bacteria. Asian Pac J Trop Dis 2013;3(3):217-26.

Sahu MC, Dubey D, Rath S, Panda T, Padhy RN. Monograph: In vitro efficacy of 30 ethnomedicinal plants used by Indian aborigines against 6 multidrug resistant Gram-positive pathogenic bacteria. Asian Pac J Trop Dis 2015;5(2):136-50.

Sahu MC, Padhy RN. Bayesian evaluation of two conventional diagnostic methods for pathogenic fungal infections. J Acute Med 2014;4(3):109-9.

Sahu MC, Debata NK, Padhy RN. In vitro efficacy of Butea monosperma Lam. Against 12 clinically isolated multidrug resistant bacteria. Asia Pac J Trop Dis 2013;3(3):217-26.

Divyashanthi CM, Adithiyakumar S, Bharathi N. Study of prevalence and antimicrobial susceptibility pattern of bacterial isolates in a tertiary care hospital. Int J Pharm Pharm Sci 2014;7(1):185-90.

Jyothi P. Antibiotic sensitivity pattern of Citrobacter spp. Isolated from patients with urinary tract infections in tertiary care hospital in south India. Int J Pharm Pharm Sci 2014;7(1):252-4.

Fluit AC, Jones ME, Schmitz FJ, Acar J, Gupta R, Verhoef J. Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Europe from the sentry antimicrobial surveillance program, 1997 and 1998. Clin Infect Dis 2000;30(3):454-60.

Pfaller MA, Jones RN, Doern GV, Kugler K. Bacterial pathogens isolated from patients with bloodstream infection: Frequencies of occurrence and antimicrobial susceptibility patterns from the sentry antimicrobial surveillance program (United States and Canada, 1997). Antimicrob Agents Chemother 1998;42(7):1762-70.

Bonten MJ, Weinstein RA. The role of colonization in the pathogenesis of nosocomial infections. Infect Control Hosp Epidemiol 1996;17(3):193-200.

Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270(24):2957-63.

Austin DJ, Anderson RM. Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models. Philos Trans R Soc Lond B Biol Sci 1999;354(1384):721-38.

Lipsitch M, Levin BR. The population dynamics of antimicrobial chemotherapy. Antimicrob Agents Chemother 1997;41:363-73.

Cooke EM, Ewins S, Shooter RA. Changing faecal population of Escherichia coli in hospital medical patients. Br Med J 1969;4(5683):593-5.

Datta N. Drug resistance and R factors in the bowel bacteria of London patients before and after admission to hospital. Br Med J 1969;2(5654):407-11.

Leistevuo T, Toivonen P, Osterblad M, Kuistila M, Kahra A, Lehtonen A, et al. Problem of antimicrobial resistance of fecal aerobic gram-negative bacilli in the elderly. Antimicrob Agents Chemother 1996;40(10):2399-403.

Levy SB, Marshall B, Schluederberg S, Rowse D, Davis J. High frequency of antimicrobial resistance in human fecal flora. Antimicrob Agents Chemother 1988;32(12):1801-6.

Osterblad MA, Hakanen R, Manninen T, Leistevuo R, Peltonen O, Meurman P. A between-species comparison of antimicrobial resistance in enterobacteria in fecal flora. Antimicrob Agents Chemother 2000;44(6):1479-84.

Shaw EJ, Datta N, Jones G, Marr FM, Froud WJ. Effect of stay in hospital and oral chemotherapy on the antibiotic sensitivity of bowel coliforms. J Hyg (Lond) 1973;71(3):529-34.

Sullivan A, Edlund C, Nord CE. Effect of antimicrobial agents on the ecological balance of human microflora. Lancet Infect Dis 2001;1(2):101-14.

Bonten MJ, Nathan C, Weinstein RA. Recovery of nosocomial fecal flora from frozen stool specimens and rectal swabs: Comparison of preservatives for epidemiological studies. Diagn Microbiol Infect Dis 1997;27(4):103-6.

Bruinsma N, Filius PM, van den Bogaard AE, Nys S, Degener J, Endtz HP, et al. Hospitalization, a risk factor for antibiotic-resistant Escherichia coli in the community? J Antimicrob Chemother 2003;51(4):1029-32.

Endtz HP, den Braak NV, van Belkum A, Kluytmans JA, Koeleman JG, Spanjaard L, et al. Fecal carriage of vancomycin-resistant enterococci in hospitalized patients and those living in the community in the Netherlands. J Clin Microbiol 1997;35(12):3026-31.

Taggart LR, Leung E, Muller MP, Matukas LM, Daneman N. Differential outcome of an antimicrobial stewardship audit and feedback program in two intensive care units: A controlled interrupted time series study. BMC Infect Dis 2015;15(1):4.

Phu VD, Wertheim HF, Larsson M, Nadjm B, Dinh QD, Nilsson LE, et al. Burden of hospital acquired infections and antimicrobial use in vietnamese adult intensive care units. PloS One 2016;11(1):e0147544.

Bousbia S, Papazian L, Saux P, Forel JM, Auffray JP, Martin C, et al. Serologic prevalence of amoeba-associated microorganisms in intensive care unit pneumonia patients. PLoS One 2013;8(3):e58111.

Zhang YZ, Singh S. Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us. World J Crit Care Med 2015;4(1):13-28.




About this article

Title

COLONIZATION AND ANTIBIOTIC RESISTANCE DYNAMICS OF PATIENTS AT INTENSIVE CARE UNIT (ICU)-OUR EXPERIENCE

DOI

10.22159/ajpcr.2017.v10i4.16999

Date

01-04-2017

Additional Links

Manuscript Submission

Journal

Asian Journal of Pharmaceutical and Clinical Research
Vol 10 Issue 4 April 2017 Page: 417-421

Print ISSN

0974-2441

Online ISSN

2455-3891

Statistics

98 Views | 101 Downloads

Authors & Affiliations

Mahesh Chandra Sahu
Directorate of Medical Research, Institute of Medical Science(IMS) and SUM Hospital, Siksha O Anusandhan University, K8, Kalinga Nagar, Bhubaneswar-03, Odisha, India
India

Ishwar Chandra Behera

Santosh Kumar Swain


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