Antimicrobial Susceptibility Patterns of Pseudomonas Aeruginosa Clinical Isolates at a Tertiary Care Hospital in Kathmandu, Nepal (original) (raw)
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Antimicrobial Resistance in P. aeruginosa - A Review
Pseudomonas aeruginosa, which is intrinsically resistant to a number of antimicrobial agents, is a leading cause of Gram negative hospital acquired infections. P. aeruginosa, in hospitalized patients, has the ability to develop multidrug resistance posing serious therapeutic problems and increases the mortality rate associated with its infection. Resistance to most antipseudomonal agents has increased by >20%, over the last five years. Many antibiotics inhibit the growth of P. aeruginosa to some extent in vitro, but only few of them show useful activity at therapeutically attainable concentrations. This review is aimed to discuss about the different groups of potential antipseudomonal agents such as antipseudomonal penicillins, cephalosporins, aminoglycosides, fluroquinolones, carbapenems, etc. and their resistance mechanisms.
Clinical microbiology, 2016
Pseudomonas aeruginosa (P. aeruginosa) has been reported as the most commonly isolated organisms in hospitals. The increasing resistance rate of P. aeruginosa to the common antimicrobial drugs has been reported worldwide. The present study aimed to investigate the incidence and antibiotic susceptibility pattern of P. aeruginosa from inpatients of two hospitals. Out of 1235 patient specimens, a total of 108 (8.7%) non-duplicated P. aeruginosa clinical isolates were identified, majority of them were from males (59.3%) and from patients above 60 years (31.5%). The most common incidence rate was from male ward (43.5%) followed by female ward (20.4%). Majority of P. aeruginosa strains were isolated from sputum specimen (38%) followed by urine specimen (14.8%). The results showed that 42.6% of the isolates were sensitive to all antibiotics while 36.1 % were found to be resistant to more than three antibiotics. The study showed that maximum antibiotic susceptibility rate of P. aeruginosa isolates was against amikacin (83.3%) followed by ciprofloxacin (75.9%). The maximum resistance rates among P. aeruginosa isolates were against Piperacillin/Tazobactum (38.5%,) followed by cefepime (32.4%). It was concluded that among P. aeruginosa isolates, amikacin was the most susceptible antimicrobial drug while piperacillin-tazobactam and cefipime were most resistant ones. Interventions and strategies to stop high resistance rate and optimizing therapy are needed.
Avicenna Journal of Clinical Microbiology and Infection, 2018
Background Pseudomonas aeruginosa, an opportunistic pathogen especially in immunocompromised patients, using its various virulence factors causes serious infections including pneumonia, urinary tract infections, bacteremia, wound infections and chronic lung infections. 1 Antibiotics are prescribed against P. aeruginosa infections but documents show the occurrence of antibiotic resistance. There are several basic resistance phenotypes in P. aeruginosa; intrinsic resistance to carbenicillin, 2 resistance to all β-lactams except cephems and carbapenems, 3 resistance to penicillins 2 and resistance to carbapenems. 4 Other resistance phenotypes are mainly controlled by extended spectrum β-lactamases (ESBLs) which are located on easily transferable plasmid or integrons and can cause any mechanisms of resistance to β-lactam antibiotics. 4 The economic and social burden of infections by drug-resistant P. aeruginosa are undeniable. 5,6 Different research reports indicate the presence of individual or classes of antibiotic resistant P. aeruginosa. 7-9 In addition, the prevalence of multidrug-resistant strain (MDR) (resistant to 3 or more drug classes) and XDR or extremely drug resistant (resistant to 6 or more drug classes) is increasing. 8,10 Another discussable issue in this regard is resistance to β-lactams due to β-lactamase production which is the major mechanism of acquired resistance to β-lactam antibiotics in P. aeruginosa. 11 Resistance to carbapenems as the most potent antibiotic against P. aeruginosa and as the mainstay for treatment of multidrug-resistant strains is a topic for researchers to concern, especially when few antibiotic options have remained and patients infected with carbapenem-resistant P. aeruginosa show multidrug resistance. 12 These reports show the crucial importance of preventive measures by specialists to stop the dissemination of resistant P. aeruginosa isolates. These findings also stress the importance of the availability of accurate information about the resistance pattern of a single drug or class of drugs to select the most effective antibiotics against P. aeruginosa infection and control the occurrence of new resistant strains. On the other
Objectives: To determine antimicrobial resistance pattern of P.aeruginosa in regional tertiary carehospitals of Saudi Arabia. Method and materials: A total of 121 clinical isolates of P.aeruginosa from eight different hospitals were studied. The clinical data of the patients was collected using a predesigned questionnaire. All isolates were identified as P.aeruginosa using standard bacteriological methods and API 20E kits. Antibiotic susceptibility testing was performed by disk diffusion method recommended by Clinical and Laboratory Standards Institute. Results: Majority of P.aeruginosa isolates were from patients suffering from respiratory tract infections (43.8%), followed by wound infections (21.5%). The overall drug resistance data of 121 P.aeruginosa strains showed low to moderate resistance to all drugs tested (4.9% to 30.6%). The highest resistance was exhibited by meropenem (30.6%) followed by ticarcillin (22.3%), imipenem (19%), and piperacillin (17.3%). Piperacillin-tazobactam showed lowest resistance (4.9%). Irrespective of site of infection, P.aeruginosa strains showed high resistance to meropenem followed by ticarcillin and imipenem. About 13.2% strains were multidrug resistant. Conclusion: This study showed low to moderate rate of drug resistance in P.aeruginosa. Resistance rate <10% to amikacin, cefepime and piperacillin-tazobactam is encouraging for the treatment of pseudomonal infection. Continuous monitoring of antimicrobial susceptibilities at each hospital is important to help in deciding the most adequate therapy for P.aeruginosa infection and to know the developing resistance pattern.
Universal Journal of Pharmaceutical Research, 2018
Objective: Pseudomonas aeruginosa is clinically significant and opportunistic pathogen that causes infections in hospitalized patients. Antibiotic resistance is a major concern in clinical practice. The ongoing emergence of resistant strains that cause nosocomial infections contributes substantially to the morbidity and mortality of hospitalized patients. Objective of present study was to estimate the prevalence of Pseudomonas aeruginosa and the antimicrobial resistance patterns of P. aeruginosa isolates from hospitalized patients. Methods: The study was performed at microbiology department of a local hospital in Sana'a, Yemen. All the patients' samples of hospital departments from January, 2017 to December, 2017 were included. A Total of 2079 samples were collected during the study period. Among them, 193 strains of Pseudomonas spp. were isolated. One hundred ninety three isolates of P. aeruginosa were isolated from different clinical specimens and fully characterized by standard bacteriological procedures. Antimicrobial susceptibility pattern of each isolates was carried out by the Kirby-Bauer disk diffusion method as per CLSI guidelines. Majority of P. aeruginosa were isolated from Sputum, followed by urine specimens. Results: The isolate pathogen showed the highest sensitive to Meropenem (85.5%), followed by Amikacin (80.5%), Imipenem (80.0%), and Piperacillin/tazobactam (77.2). The highest frequency of resistance (96.2%) was observed with amoxicillin /clavulinic Acid followed by cefuroxime 94.6%, ampicillin/ sulbactam 94.5%, Co-Trimoxzole 80.5%, and norfloxacin 54%. Conclusion: The result confirmed the occurrence of drug resistance strains of P. aeruginosa. Meropenem, imipenem, and amikacin, were found to be the most effective antimicrobial drugs. It therefore calls for a very judicious, appropriate treatment regimens selection by the physicians to limit the further spread of antimicrobial resistance P. aeruginosa.
Emergence of Multidrug Resistant Pseudomonas Aeruginosa in a Tertiary Care Center
https://www.ijhsr.org/IJHSR\_Vol.8\_Issue.8\_Aug2018/IJHSR\_Abstract.08.html, 2018
The worldwide emergence of multi-drug resistant bacterial strains in hospitals and community continues to be a problem of due scientific concern, especially infections caused by Pseudomonas species. This study was carried out to determine the multidrug resistant pattern of P. aeruginosa, among the clinical isolates at a tertiary care hospital in Kanpur. Methods: Total 50 P. aeruginosa were isolated from different clinical samples of a tertiary care hospital during Jun 2016 to Dec 2016. Bacterial isolates were identified by standard microbiological tests and antimicrobial resistance pattern were determined by CLSI guidelines. Results: Among 50 P. Aeruginosa, (70%) strains were isolated from pus followed by sputum (10%), bronchial washing (20%). Most of the organism was isolated from advance age and in male patients. Out of 50 P. Aeruginosa isolates, 20 (40%) were resistant to piperacillin tazobactam, tobramycin and levofloxacin, 30 (60 %) were resistant to ceftazidime, cefepime and meropenem, 10 (20%) were resistant to imipenem and amikacin, 25 (50%) were resistant to ciprofloxacin. Conclusion: There has been rapid emergence of MDR P. aeruginosa in recent times which is an important concern for clinicians who treat these infections. Therefore restriction of 'selected antibiotic usage' and infection control policies must be undertaken to combat the rapid emergence of MDR P. aeruginosa. P. aeruginosa showed highest resistance to piperacillin tazobactam, tobramycin and levofloxacin and minimum resistance to imipenem and amikacin.
Antimicrobial susceptibility of imipenem-resistant Pseudomonas aeruginosa
Journal of Antimicrobial Chemotherapy, 2002
Sir, In a recent leading article by Giamarellou, 1 the prescribing guidelines for Pseudomonas aeruginosa infections were discussed. It was stated that the anti-pseudomonal drugs available for the clinician include the aminoglycosides, ureidopenicillins, ceftazidime, the carbapenems and ciprofloxacin. Given the propensity for this organism to become drug resistant, a worrying question for the clinician arises: what alternatives exist if one of these major anti-pseudomonal drugs fails?
Infection, epidemiology and microbiology, 2020
Aims: Recently, overuse and misuse of antibiotics have led to the development of multidrugresistant bacteria and infectious diseases caused by these organisms, increasing morbidity and mortality rate in patients. Pseudomonas aeruginosa as a common Gram-negative pathogen is predominantly responsible for hospital-acquired infections. In this study, the prevalence of multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) P. aeruginosa strains isolated from clinical specimens of patients admitted to a teaching hospital in Gorgan, Iran, was determined. Materials & Methods: Clinical samples of blood, urine, burn wound, eye, and secretions (pleural fluid, tracheal or bronchial aspirates and sputum) were collected from all hospitalized patients during a three-month period from April to June 2019. Using conventional biochemical methods, P. aeruginosa strains were identified, and the antibiotic resistance pattern was determined by Kirby-Bauer disc diffusion method. Findings: A total of 40 (25.4%) P. aeruginosa strains were isolated from 377 clinical specimens. Most of the P. aeruginosa strains were isolated from wound (35%) and urine (30%) samples. Most of the P. aeruginosa positive samples were recovered from intensive care unit (32.5%) and burn ward (30%). The highest susceptibility was shown to fosfomycin (100%), and the lowest susceptibility was observed to ceftazidime (87.5%), followed by aztreonam (60%). Based on the results, 52.5 and 20% of the isolates were MDR and XDR, respectively. All of the MDR isolates exhibited susceptibility to colistin. No PDR phenotype was observed. Conclusion: Continuous monitoring of drug resistant strains among clinical isolates of P. aeruginosa must be done to adopt effective strategies to decrease the threat of antimicrobial resistance.
Asian Journal of Pharmaceutical and Clinical Research, 2021
Objective: One of the most common bacteria known to cause nosocomial infection and found to be multidrug-resistant is Pseudomonas aeruginosa. The objective of the study was to know the prevalence of the P. aeruginosa isolates with varied clinical conditions and specimens and to assess the antimicrobial susceptibility patterns of P. aeruginosa as well as its magnitude of multidrug resistance (MDR). Methods: A total of 229 biochemically tested and confirmed isolates of P. aeruginosa from various clinical samples were studied. Antibiotic susceptibility testing was determined by Kirby-Bauer disc diffusion method. Results: Out of the 229 isolates of P. aeruginosa, majority (60.70%) were from pus sample. Resistance to amikacin and tobramycin was 23.6% and 20.1%, ciprofloxacin was 33.2%. Resistance to ceftazidime, cefoperazone and cefepime were 21.8%, 45.9%, and 25.7%. Imipenem and meropenem showed 26.2% and 20.5% resistance, respectively. Resistance to piperacillin was 18.3% while piperacillin-tazobactam was only 13.5%. The MDR was observed in 33.7% of the isolates. Conclusion: There is increased resistance to cephalosporins as compared to aminoglycosides, carbapenems and beta lactamase inhibitor. To restrict the inappropriate use of antimicrobial agents, the development of MDR, needs to be continuously monitored and documented.
Indian Journal of Pharmacology, 2008
A total of one hundred and forty two swab samples (92 clinical and 50 from hospital environment) were collected for the detection of Pseudomonas aeruginosa. Out of the total samples, 29 isolates of P. aeruginosa were isolated and recorded an overall prevalence rate of 20.42% (29/242) of which 18 (19.56%) were from wounds and burns swabs of patients, and 11 (22%) were from hospital environment. The highest rate of P. aeruginosa (60%) identified from hospital environmental specimens were from door handles followed by ward sinks (57.15%) and the least (10.53%) from patients' beds and table tops. According to gender and age group, the study showed the highest rate of P. aeruginosa in the male (55.6%), and in young patients (38.9%) between the ages of 5 and 25 years compared to the elderly; while the lowest rate 27.8% were from those age 45 years and above. Results showed that all isolates from patients and hospital environment were resistant to ticarcillin and ceftazidime (100%). Also, P. aeruginosa from patients demonstrated high resistance to cefepime, ofloxacin, gentamycin, tobramycin, ciprofloxacin, lomefloxacin, norfloxacin, levofloxacin and amikacin in the following order respectively :88.8, 77.7, 61.1, 50.0, 44.4, 44.4, 38.8, 38.8 and 33.3%; whereas showed low resistance (16.6 and 11.1%) to each of ticarcillin/clavulanate and meropenem, and only 5.5% to imepenem. Generally, this study pointed that P. aeruginosa isolates from hospital environment were more resistant to particular antibiotics than that of clinical isolates. It was also revealed that P. aeruginosa have high sensitivity to imepenem, meropenem and ticarcillin /clavulanate and these should be considered in the treatment of this bacterium.