Antibiotic Resistance among Gram Negative Bacilli Isolated from the ICU Admitted Patients Attending Chitwan Medical College Teaching Hospital (original) (raw)
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Harran Üniversitesi Tıp Fakültesi Dergisi, 2021
Background: Acinetobacter baumannii causes serious blood stream infections especially in immunocompromised and hospitalized patients. In this study, the distribution of antibacterial resistance among 92 A. baumannii isolates and 5 A. lwoffii isolates from blood cultures collected at Harran University Hospital (Urfa, Turkey) from 2017 to 2019 was investigated. Materials and Methods: Blood cultures were followed up in Versa-TREK (Trek Diagnostic System, USA) device; Passages were made to 5% blood agar and eosin methylene blue (EMB) agar. Passaged bacteria colonies were identified by MALDI-TOF MS (Bruker, Germany) or VITEK 2 compact system (bioMérieux, France). Sensitivities of Acinetobacter strains to meropenem, ciprofloxacin, amikacin, gentamicin, tobramycin, tigecycline and trimethoprim-sulfamethoxazole were tested by VITEK 2 compact system (bioMérieux France). The results were evaluated by VITEK 2 device based on EUCAST's guide. Results: The antibiotic resistance rates of A. baumannii strains are as follows; ciprofloxacin 92%, imipenem and meropenem 88%, gentamicin 74%, tobramycin 67%, trimethoprim-sulfamethoxazole 63%, amikacin 53%, and tigecycline 10%. The resistance ratio of A. lwoffii strains are ciprofloxacin 40%, gentamicin 40%, amikacin 40%, tobramycin 40%, trimethoprim sulfamethoxazole 20%, imipenem and meropenem 20%, and tigecycline 20%. Conclusions: Our study suggests that A. baumannii strains have high resistance ratios to available antibiotics. A. lwoffii also has an increasing resistance profile. Tigecycline is the most sensitive antibiotic, followed by amikacin and tobramycin. Conclusions: New antibiotics, rapid access to antibiotic sensitivity results and correct selection of empiric antibiotics has clinical importance.
Emergence of drug resistance of Acinetobacter at tertiary care hospital
BACKGROUND & OBJECTIVE Acinetobacter, although saprophytic, the emergence and spread of Acinetobacter in hospital environment is a major area of concern. . It has been associated with a wide variety of illnesses in hospitalized patients, especially patients in the intensive care units. These infections are often difficult to treat, because of the widespread antibiotic resistance. This study is conducted to know the prevalence and drug resistant pattern of Acinetobacter in tertiary care hospital. MATERIAL & METHODS 950 isolates of Acinetobacter were obtained from various clinical samples, and subjected to identification by different biochemical tests and antibiotic susceptibility testing by disc diffusion testing by Kirby Baurer method. RESULT Out of 950 isolates of Acinetobacter, 82% were Acinetobacter. calcoaceticus baumannii complex remained 18% were other Acinetobacter spp. Acinetobacter isolates were resistant to important groups of antibiotics tested, including amikacin (50%), gentamycin (65%), tobramycin (38%), ceftriaxone (92%), ceftazidime (80%), cefepime (88%), ampicillin-sulbactum (44%), piperacillin-tazobactum (38%),ciprofloxacin (81%) levofloxacin(82%), imipenem (10%) and trimethoprim-sulfamethoxazole (65%), meropenem (15%), polymixin B (2.2%), colistin (2%). CONCLUSION Early detection of MDR Acinetobacter and infection control practices are the best defense against these organisms. Rational use of antimicrobials is an important aspect to delay the emergence of XDR and PDR Acinetobacter spp.
Gazi Medical Journal, 2015
Objective: The aim of this study is to determine the types of specimens, distribution among clinics and antibiotic susceptibilities of 531 Acinetobacter baumannii strains isolated in our laboratory between January 2012-June 2014. Methods: Acinetobacter baumannii isolates were identified by conventional methods and API 20 NE (bioMerieux, France), antibiotic susceptibility tests were performed according to the Clinical and Laboratory Standards Institute guidelines except tigecycline evaluated according to Food and Drug Administration guidelines. Results: Strains were isolated from Anesthesiology and Reanimation Unit (36.9 %), Medical Intensive Care Unit (17.9 %), Neurological Intensive Care Unit (14.7 %), Surgical Intensive Care Unit (13.9 %), Coronary Intensive Care Unit (2.3 %), Internal Medicine Services (9.8 %) and Surgical Services (4.5 %). Specimen types were; 239 (45.0 %) tracheal aspirate, 92 (17.3 %) urine, 78 (14.7 %) blood, 55 (10.4 %) wounds, 38 (7.1 %) sputum and 29 (5.5 %) catheter. The antibiotic resistance rates were found as 99.1 % for nitrofurantoin, 98.9% for cefotaxime, 97.7 % for tetracycline, 97.4 % for piperacillin, 97.2 % for netilmicin, 94.9 % for ceftazidime, 94.7 % for cefepime, 92.8 % for piperacillin/tazobactam, 91.7 % for ampicillin/sulbactam and ciprofloxacin, 91.1 % for meropenem, 89.8 % for imipenem, 89.5 % for levofloxacin, 82.1 % for gentamicin, 81.2 % for trimethoprim/sulfamethoxazole, 79.3 % for amikacin, 69.5 % for cefoperazone-sulbactam, 25.4 % for tobramycin, 5.1 % for tigecycline and 0.8 % for colistin. Conclusion: Our strains were found as sensitive to colistin, tigecycline, tobramycin and cefoperazone/sulbactam antibiotics. Resistance to carbapenems and other antibiotics were remarkable.
Acinetobacter baumannii (Ab) is a troublesome and increasingly problematic healthcare-associated pathogen, especially in critical care unit (ICU) and cardiovascular internal medicine (CIM). This organism has a capacity for long-term survival in the hospital environment. This study aimed to investigate the drug resistance patterns of Ab strains isolated from Thongnhat Dongnai General Hospital and the relationships between Ab isolations with clinical wards and year of patients. The antibiotic susceptibility of 279 Ab isolates for aminoglycosides, fluro-quinolons, cephalosporins, carbapenems, colistin and bactrim was determined using Kirby-Bauer disk diffusion method. The minimum inhibitor concentration (MIC) of 146 Ab isolates for Meropenem was determined using E-test method according to CLSI guideline. A total 279 A. baumannii strains out of 1,976 positive isolates were collected from various specimens during study period. Among Ab-positive specimens, the most isolated specimen was sputum (26.6%, χ 2 =161.705 p<0.000), two of the most isolated clinical wards were ICU (22.19%, χ 2 =80.854, p<0.000) and Cardiovascular Internal Medicine (CIM) (27.4%, χ 2 =27.9979, p<0.000), the most isolated age group was from 76 to 99 (22.95%, χ 2 =27.9979, p<0.000). Among 279 Ab isolated, resistance from 53.16% – 63.52% to aminoglycosides, 23.6% – 68.58% to fluroquinolons, 59.61% to 97.93% to cephalosporins, 60.27% to 80.7% to carbapenem, 10.53% to 66.48% to antibiotic combinations, 0.75% to colistin and 61.71% to bactrim. Among 146 multidrug-resistant Ab, 53.42% MIC meropenem ≥ 32 μg/ml and only 18.49% strains were susceptible to Meropenem. Due to the high antimicrobial resistance to two clinical wards (ICU and CIM) and carbapenems by disk agar diffusion test and E-test; we must focus on both a wiser use of antimicrobials and the prevention of infection. Continuous monitoring of antimicrobial susceptibility and strict adherence to infection prevention guidelines are essential to eliminate major outbreaks in the future.
Pseudomonas and Acinetobacter spp. are opportunistic pathogens and primarily cause opportunistic nosocomial infections and affects severely immunocompromised patients. In this study, we observed the prevalence and resistance pattern of Pseudomonas and Acinetobacter spp. from the blood of intensive care unit (ICU) patients. Isolates of both the organisms were collected during one year period from January to December 2017. MacConkey and Blood agar were used to isolate these bacteria. Different biochemical tests (KIA, MIU, Citrate, and Oxidase tests) were carried out to identify the organisms and polymerase chain reaction (PCR) was performed to correlate and confirm the previous results. After identifying the organisms statistical analysis was done to observe the prevalence based on age and sex. Antibiogram was studied against amikacin (AK), ceftazidime (CAZ), ciprofloxacin (CIP), gentamicin (CN), imipenem (IMP), meropenem (MEM), doripenem (DOR), and netilmicin (NET). A total of 198 Pseudomonas spp. and 57 Acinetobacter spp. were isolated from blood of 312 patients. Both the bacteria were most prevalent among male patients of different ages. In antibiotic resistance experiment, Pseudomonas spp. was found to have reduced susceptibility (RS) against most of the antibiotics used especially ceftazidime (CAZ) and netilmicin (NET) and 6.76% isolates were found to be resistant against gentamicin (CN). In case of Acinetobacter spp., reduced susceptibility (RS) was observed against netilmicin (NET) and 52.63% of isolates were found to have resistance against gentamicin (CN).The presence of Pseudomonas, and Acinetobacter spp. were in notable range especially among male patients and both the bacteria showed reduced susceptibility (RS) against most of the antibiotics used and total resistance against gentamicin (CN).
Annals of Clinical Microbiology and Antimicrobials
Background: Multidrug-resistant (MDR) Acinetobacter baumannii infections are considered as emerging nosocomial infections particularly in patients hospitalized in intensive care units (ICUs). Therefore, reliable detection of MDR strains is crucial for management of treatment but also for epidemiological data collections. The purpose of this study was to compare antimicrobial resistance and the clonal distribution of MDR clinical and environmental A. baumannii isolates obtained from the ICUs of 10 different hospitals from five geographical regions of Turkey in the context of the demographic and clinical characteristics of the patients. Methods: A multicenter-prospective study was conducted in 10 medical centers of Turkey over a 6 month period. A total of 164 clinical and 12 environmental MDR A. baumannii isolates were included in the study. Antimicrobial susceptibility testing was performed for amikacin (AN), ampicillin-sulbactam (SAM), ceftazidime (CAZ), ciprofloxacin (CIP), imipenem (IMP) and colistin (COL) by microdilution method and by antibiotic gradient test for tigecycline (TIG). Pulsed-field gel electrophoresis (PFGE) was performed to determine the clonal relationship between the isolates. The detection of the resistance genes, bla OXA-23 , bla OXA-24 , bla OXA-51, bla OXA-58, bla IMP, bla NDM , bla KPC , bla OXA-48 and bla PER-1 was carried out using the PCR method. Results: The mortality rate of the 164 patients was 58.5%. The risk factors for mortality included diabetes mellitus, liv1er failure, the use of chemotherapy and previous use of quinolones. Antimicrobial resistance rates for AN, SAM, CAZ, CIP, IMP, COL and TIG were 91.8%, 99.4%, 99.4%, 100%, 99.4%, 1.2% and 1.7% respectively. Colistin showed the highest susceptibility rate. Four isolates did not grow on the culture and were excluded from the analyses. Of 172 isolates, 166 (96.5%) carried bla OXA-23 , 5 (2.9%) bla OXA-58 and one isolate (0.6%) was positive for both genes. The frequency of bla PER-1 was found to be 2.9%. None of the isolates had bla IMP , bla KPC , bla NDM and bla OXA-48 genes. PFGE analysis showed 88 pulsotypes. Fifteen isolates were clonally unrelated. One hundred fifty-seven (91.2%) of the isolates were involved in 14 different clusters.
Extent of antimicrobial resistance in Acinetobacter species in a Tertiary Care Teaching Hospital
IP Innovative Publication Pvt. Ltd., 2018
Acinetobacter, gram negative coccobacillus, has become a frequent pathogen in hospitals and other health care settings. Acinetobacter species cause a wide variety of illness in debilitated and hospitalized patients especially in intensive care units (ICU). Carbapenems constitute the backbone of treatment of complicated Acinetobacter infections. However, resistance to Carbapenem is established and observed globally, leading to limited therapeutic options. The study was designed to understand the extent of resistance in Acinetobacter species in our hospital which is located in an island separated from mainland India. Isolates showing resistance to either Imipenem (IMP) and/or Meropenem by disc diffusion method was considered as Carbapenamase producing and further subjected to identification by phenotypic methods. Of the 160 isolates, 111 were resistant to either Imipenem and/or Meropenem. The susceptibility patterns of antibiotics tested suggests high resistance to 3rd/4th generation Cephalosporins (CTR 93.7%, CAZ 88.29%, CPM 85.59%) and least resistance to Colistin and Polymyxin B. MHT alone was positive in 66.98% isolates suggesting production of OXA type class D ?-lactamase and DDST alone was positive in 7.55% isolates suggesting production of Metallo-?-lactamase /Group B ?-lactamase. The present study adds to the literature available in respect to increasing instances of Carbapenem resistance and their presumptively mechanism of resistance. Keywords: Antimicrobial, Resistance, Carbapenem, Acinetobacter
Infections with resistant strain are one of the leading causes of morbidity and mortality in hospitalized patients especially the critically ill patients in intensive care unit (ICU). The present study was conducted to know the changing pattern of antibiotic resistance of the common isolates from blood, urine, respiratory secretions and pus/ wound swab of patients admitted in ICU at Holy Family Red Crescent Medical College hospital over a two years period from January 2012 to December 2013. A total of 1282 samples were analyzed. Out of which 301 (23.5%) samples were positive for growth of organisms. The predominant isolates were E.coli (28%), Klebsiella (27%), Acinetobacter (17.3%), Pseudomonas (9.6%), Staphylococcus aureus (5.3%) & candida (6%). Majority isolates were resistant to Cephalosporin and Amoxycillin, (>70-90%). Carbapenem were still highly active against E.coli. However, Klebsiella, Pseudomonas and Acinetobacter were showing alarming resistance (55-60%) towards those drugs. Aminoglycosides resistance has also increased for Pseudomonas and Klebsiella. The percentage of Cloxacillin resistant for staphylococcus was near about 40%. The most active drug against Pseudomonas was piperacillin/Tazobactam. The positive result from this study was that organisms showed decreased resistance towards Tetracycline, Cotrimoxazole and Ciprofloxacin. The sensitivity of Nitrofurantoin for urinary isolates was good. Regular surveillance of antibiotic susceptibility pattern & judicious use of antibiotics is very important for reducing the infection rate and antimicrobial resistance.
The Pan African medical journal, 2019
Introduction: infection due to multidrug-resistant microorganisms is a growing threat in healthcare settings. Acinetobacter species specifically A. baumannii is increasingly becoming resistant to most antimicrobial agents recommended for treatment. This study aimed to determine the antimicrobial susceptibility pattern of Acinetobacter species isolated from patients in Kenyatta National Hospital. Methods: we conducted a retrospective study based on VITEK 2 (BioMérieux) electronic records capturing identification and antimicrobial susceptibility of Acinetobacter isolates from patient samples analyzed between 2013 and 2015 at Kenyatta National Hospital microbiology laboratory. Generated data wer e analyzed using WHONET and SPSS. Results: a total of 590 Acinetobacter isolates were analyzed. 85% of the isolates tested were multi-drug resistant (MDR). Among the 590 isolates, 273 (46%) were from tracheal aspirates and 285 (48%) from the critical care unit. A. baumannii was the most frequently isolated species with high susceptibility to amikacin (77%) and poor susceptibility to ciprofloxacin (69-76%), tobramycin (37%) and meropenem (27%). Both A. lwoffii and A. haemolyticus had high susceptibility to amikacin (80-100%) and meropenem (75-100%). Conclusion: A. baumannii is resistant to commonly administered antibiotics. There is need for continuous antimicrobial resistance surveillance especially in health care facilities and strengthening of antibiotic stewardship programmes which will contribute to enhancement of infection control policies.
Medical Laboratory Journal, 2018
Background and Objectives: Acinetobacter baumannii is an opportunistic pathogen that affects different groups of people, especially intensive care unit (ICU) patients. The prevalence of infections caused by this bacterium is very high. Today, prevalence of infections caused by multidrug-resistant (MDR) and extreme-drug resistant (XDR) strains is increasing. This study aimed to determine the antibiotic susceptibility pattern of A. baumannii isolates from ICU patients. Methods: This cross-sectional study was conducted from October 2014 to March 2015 on patients admitted to ICU of Imam Khomeini hospital in Tehran, Iran. Clinical samples of various sources were collected from patients. Isolates were detected and identified via microbiological and biochemical tests as well as PCR amplification of the blaOxa51 gene. Then, susceptibility testing was performed using the Kirby-Bauer disk diffusion test. Statistical analysis was performed with SPSS (version 22, Chicago, IL, USA) using Chi-square and Fisher's exact tests. Results: Of the total of 62 clinical samples, 24 (39%) were respiratory samples and only three (6%) were cerebrospinal fluid samples. Most MDR and XDR strains were isolated from respiratory samples. The highest resistance rate was against ceftriaxone, ticarcillin and erythromycin (100%), while the lowest resistance rate was against to minocycline (20%). Conclusion: Owing to detection of high multi-drug resistance isolates in the present study, and importance of multi-drug resistance in A. baumannii, the identification of multi-drug resistance genes and their reporting to health care/treatment centers is important. Thus, it is recommended to perform susceptibility testing to help determine the most effective antibiotic(s) for the treatment of infections in ICU patients.