Changing trend of antimicrobial resistance among gram-negative bacilli isolated from lower respiratory tract of ICU patients: A 5-year study (original) (raw)
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A total of 58 samples of respiratory tract infection (RTI) patients were collected from intensive care unit of three Dhaka based hospitals namely National Institute of Diseases of the Chest and Hospital (NIDCH), City Hospital (CH) and Japan Bangladesh Friendship Hospital (JBFH). Out of 58 samples studied, 47 (81.03%) samples showed growth of organisms identified as Staphylococcus aureus (n=24, 51.06%), Pseudomonas aeruginosa (n=9, 19.15%), Klebsiella pneumoniae (n=7, 14.89%), Streptococcus pneumoniae (n=3, 6.38%), Escherichia coli (n=2, 4.26%), Citrobacter (n=1, 2.13%) and Shigella (n=1, 2.13%). Most of the isolates were found resistant to piperacillin/tazobactam. All the isolates of S. pneumoniae (n=3), P. aeruginosa (n=9), K. pneumoniae (n=7), E. coli (n=2), Citrobacter (n=1), and Shigella (n=1) showed 100% resistance to piperacillin. S. aureus showed 79.17% resistance to piperacillin. Most of the isolates were 100% sensitive to imipenem, whereas S. aureus was only 91.67% sensitive to it.
Clinical Infectious Diseases, 1996
We assessed the rates of antimicrobial resistance between 1990 and 1993 in intensive care units in the United States. A standardized microtiter minimal inhibitory concentration panel was used to test ~ 100 consecutive gram-negative aerobic isolates that were recovered primarily from blood, wounds, urine, and pulmonary sites in patients treated in each of 396 intensive care units in 45 states. Amikacin and imipenem were the agents most active against the 33,869 nonduplicate isolates (those recovered only once) tested. Resistance of aerobic gram-negative bacilli to third-generation cephalosporins was found to be an emerging problem. Increases in rates of resistance to ceftazidime among isolates of Klebsiella pneumoniae (from 3.6% to 14.4%; P ~ .01) and Enterobacter species (from 30.8% to 38.3%; P = .0004) were noted from 1990 to 1993; rates of resistance among Pseudomonas aeruginosa isolates remained stable. Ceftazidime-resistant bacteria were frequently resistant to aminoglycosides and ciprofioxacin. Risk factors for ceftazidime resistance included the number of beds in the hospital, the teaching status of the hospital, and specific body sites from which the isolates were recovered.
Clinical Microbiology and Infection, 1998
Objective: To determine the antimicrobial resistance patterns among aerobic Gram-negative bacilli isolated from patients in intensive care units (ICUs) in different parts of Russia. Methods: During 1995-96,lO Russian hospitals from different geographic areas were asked t o submit 100 consecutive Gram-negative isolates from patients with ICU-acquired infections. Minimal inhibitory concentrations (MICs) of 12 antimicrobials were determined by Etest and results were interpreted according t o National Committee for Clinical Laboratory Standards (NCCLS) guidelines. Results: In total, 1005 non-duplicate strains were obtained from 863 patients. The most common species were Pseudomonas aeruginosa (28.8%), Escherichia coli (21.4%), Klebsiella pneumoniae (16.7%), Proteus mirabilis (9.7%), Enterobacter spp. (8.2%) and Acinetobacter spp. (7.7%). High levels of resistance were seen t o second-and thirdgeneration cephalosporins, ureidopenicillins, p-lactam@-lactamase inhibitor combinations and gentamicin. The most active agents were imipenem (no resistance in Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter spp. and Acinetobacter spp., 7% resistance in Pseudomonas aeruginosa), amikacin (7% resistance in Pseudomonas aeruginosa and Acinetobacter spp., 4% in Enterobacter spp., 1% in Escherichia coli and Proteus mirabilis, no resistance in Klebsiella pneumoniae) and ciprofloxacin (15% resistance in Pseudomonas aeruginosa, 5% in Enterobacter spp. and Proteus mirabilis, 2% in Klebsiella pneumoniae, 1% in Escherichia coli). Conclusions: Second-and third-generation cephalosporins, ureidopenicillins, P-lactam/P-Iactamase inhibitor combinations and gentamicin cannot be considered as reliable drugs for empirical monotherapy for aerobic Gram-negative infections in ICUs in Russia.
Official Journal of the Association of Medical Microbiology and Infectious Disease Canada, 2016
BACKGROUND: Using different indicators and definitions, the present study aimed to describe population antimicrobial use, as well as prevalence and incidence of clinically relevant antimicrobial resistances found in respiratory cultures performed in intensive care unit (ICU) patients. Results obtained with the various methodologies were then compared. METHODS: The present retrospective cohort study included all patients admitted to nine ICUs between April 2006 and March 2010. Prevalence and incidence of clinically relevant resistances in respiratory cultures were described and population antimicrobial use was measured using 10 different indicators based on dosage, duration of treatment, or exposure to antimicrobials. RESULTS: Indicators had variable sensitivity to detect time trends and differences among ICU types. However, the highest prevalence and incidence rates in respiratory isolates were in Staphylococcus aureus resistance to oxacillin (0.52% of ICU admissions and 6.57 acquis...
Revista da Sociedade Brasileira de Medicina Tropical, 2013
Introduction: Antimicrobial resistance is an increasing threat in hospitalized patients, and inappropriate empirical antimicrobial therapy is known to adversely affect outcomes in ventilator-associated pneumonia (VAP). The aim of this study was to evaluate antimicrobial usage, incidence, etiology, and antimicrobial resistance trends for prominent nosocomial pathogens causing ventilatorassociated pneumonia in a clinical-surgical intensive care unit (ICU). Methods: Gram-negative bacilli and Staphylococcus aureus causing VAP, as well as their antimicrobial resistance patterns and data on consumption (defined daily dose [DDD] per 1,000 patient days) of glycopeptides, extended-spectrum cephalosporins, and carbapenems in the unit were evaluated in two different periods (A and B). Results: Antimicrobial use was high, mainly of broad-spectrum cephalosporins, with a significant increase in the consumption of glycopeptides (p < 0.0001) and carbapenems (p < 0.007) in period B. For Acinetobacter baumannii and members of the Enterobacteriaceae family, 5.27-and 3.06-fold increases in VAPs, respectively, were noted, and a significant increase in resistance rates was found for imipenem-resistant A. baumannii (p = 0.003) and third-generation cephalosporinsresistant Enterobacteriaceae (p = 0.01) isolates in this same period. Conclusions: Our results suggest that there is a link between antibiotics usage at institutional levels and resistant bacteria. The use of carbapenems was related to the high rate of resistance in A. baumannii and therefore a high consumption of imipenem/meropenem could play a major role in selective pressure exerted by antibiotics in A. baumannii strains.
Pharmaceutical Sciences Asia
Antimicrobial resistance (AMR) has become a concerning health issue worldwide, and this resistance leads to poor treatment outcomes and high mortality, especially, AMR of NP in ICU. To determine the reality of AMR and find the factors related to AMR of NP in the ICU. We performed a cross-sectional study in the ICU Department from July 2015 to July 2019. We calculated the incidence of the degree of multidrug-resistant strains and the percentages of factors related to AMR. Data management and analysis were performed by SPSS version 22.0. Of the initial observation of 281 patients, all participants had NP due to gram-negative bacteria; 91 (32.4%) were early-onset and 190 (67.6%) were lately-onset NP. Out of all pathogens examined, above 80% were resistant to quinolone, carbapenem, and cephalosporin. Moreover, multiple drug resistance in bacteria was about 87.5%. Furthermore, bacteria, changed antibiotics have been significantly associated with the multi-resistance of bacteria. Besides, the increase in antibiotic use, especially ciprofloxacin and imipenem, is also related to antibiotic resistance. These results show that the resistance to quinolones, carbapenem, and cephalosporin is high in the ICU, with rates exceeding 80%. Furthermore, the bacteria, change of antibiotics, and the increasing use of antibiotics have been significantly associated with multiple antibiotic resistance.
Journal of Hospital Infection, 2005
We studied the changes in antibiotic resistance of the most common Gram-negative bacteria isolated in the intensive care units at our hospital in 2000 and 2002. Bacterial identification was performed by use of the VITEK 60 analyser, and antibiotic susceptibilities were tested by the VITEK 60 analyser and the disk diffusion agar method. The bacteria isolated most frequently were Pseudomonas aeruginosa (132 strains in 2000 and 106 in 2002), Acinetobacter calcoaceticus (98 and 109 strains, respectively) and Klebsiella pneumoniae (53 and 83 strains, respectively). Acinetobacters presented the highest percentage resistance, with significant increases in resistance to imipenem (15% in 2000 and 67% in 2002) and piperacillin/tazobactam (41% and 72%, respectively). P. aeruginosa presented a significant increase in resistance to all antibiotics, except ceftazidime. A large increase was observed in the resistance of K. pneumoniae to amikacin (from 10% to 50%), ceftazidime (from 80% to 90%) and tobramycin (from 80% to 90%). No imipenem-resistant strains of K. pneumoniae were found.
International Journal of Medical Laboratory Research, 2019
Antimicrobial resistance (AMR) is a major issue especially in patients admitted in Intensive care units. Irrational overuse and misuse of antibacterial drugs has made the pathogens resistant to them. In eastern countries, infections in ICU are caused mainly by Gram negative pathogens, which are MDR. Hence, this study was conducted to study the gram negative pathogens causing ICU infections in our centre and their drug resistance pattern. Material and Methods: It was a prospective study done for four months (Dec 2015-March 2016) in different ICU of the tertiary care hospital. All patients admitted for more than 48 hours in ICU and having symptoms of infections were included in the study. The relevant sample was collected and preceded as per Standard microbiological procedure and Antimicrobial susceptibility test was done by Kirby Bauer's disc diffusion method as per CLSI guidelines. Results: During the study period, 327 patients were admitted in ICUs, of which 173 were admitted for more than 2 days. A total of 1013 samples were received from ICU, only 245 samples showed significant bacterial growth. Majority of the isolates were Gram negative pathogens accounting for 209 (73.8%) of the 283 total pathogens isolated. Respiratory infection and Urinary tract infections, were the commonest infections accounting for around 25% each. Klebsiella species and Acinetobacter species were the commonest Gram negative pathogen isolated. Klebsiella species and Escherichia coli were resistant to most of the commonly used drugs like aminoglycosides, 3 rd Generation cephalsporins (3GC) and β lactam-β lactamase Inhibitor (BL-BLI) combination, with only resort being carbapenems. But, in case of Acinetobacter species, 92% of the isolates were resistant to carbapenems. Conclusion: The infections in patients admitted in ICU are predominantly caused by MDR Gram negative bacteria. The commonly administered antibacterial drugs in ICU like aminoglycosides, 3GC and BL-BLI are not effective in combating these pathogens. It's high time to implement antibiotic stewardship programme to combat this menace of drug resistance.
Antibiotic Resistance Among Gram Negative Bacilli Causing Ventilator – Associated Pneumonia
2011
OBJECTIVE: To determine the microbial pattern and antimicrobial resistance among Gram- negative bacteria (GNB) recovered from patients with ventilator- associated pneumonia (VAP). MATERIALS & METHODS: An observational case control study was conducted in medical intensive care unit (MICU), having 15 beds, from January 2010 to December 2010. All the patients who remained ventilated for > 48 hours were prospectively followed for the occurrence of VAP. Deep tracheal aspirate were obtained for culture and Gram-stain and antibiotic resistance rate among Gram negative bacilli was documented. RESULTS: Ventilator associated pneumonia was identified in 54 (42.8%) patients. Gram negative bacilli were isolated from 77% specimens. Acinetobacter spp. (34%) followed by Pseudomonas aeruginosa (18%) were the most frequently isolated pathogens. All Acinetobacter spp. were resistant to ceftazidime (100%), amikacin (91%), ciprofloxacin 88% and to imipenem 86%. Isolates of Pseudomonas aeruginosa wer...
Asian Journal of Medical Sciences, 2019
Background: Lower respiratory tract infections are one of the most common infections among the patients in Intensive Care Units (ICUs). Admission in ICUs and use of life supporting devices increase the risk of infection with multidrug resistant pathogens. Aims and Objectives: This study was aimed to determine the prevalence and antibiograms ofthe bacterial pathogens causing lower respiratory tract infectionsamong patients of ICUs. Materials and Methods: A total of 184 specimens from patients admitted in ICUswith lower respiratory tract infections were included in this study. Isolation, identification and antibiotic susceptibility testing of the isolates was performed by standard microbiological techniques. Carbapenamase detection was performed by modified Hodge test method.Detection of metallo beta lactamase (MBL) was tested by imipenem and imipenem/EDTA disc. Detection of Klebsiellapneumoniaecarbapenamase (KPC) was performed by imipenem and imipenem/phenyl boronic acid. Results: Ou...