Antimicrobial Susceptibility Pattern

I. INTRODUCTION Antimicrobial Susceptibility Pattern of Multidrug Resistant Uropathogens Urinary tract infection (UTI) is a common infection in the community and health care facility. It is easily diagnosed and easily treatable in the young and healthy patients. Over last few years UTI caused by multidrug resistant uro-pathogens is increasing worldwide. (1) Common etiological agents are Escherichia coli, Klebsiella species, Enterobacter species, Proteus species, Staphylococcus aureus, Enterococcus species, Staphylococcus saprophyticus. E. coli is the most common organism causing both community as well as

Subarna Dutta 1 , Sabah Haq 2 , Mohammad Rokibul Hasan 1 and Jalaluddin Ashraful Haq 2* Abstract Background: Melioidosis an infectious disease, caused by a Gram negative bacterium called Burkholderia pseu- domallei, is endemic in Bangladesh. This organism is sensitive to limited number of antimicrobial agents and need prolonged treatment. There is no comprehensive data on the antimicrobial susceptibility profile of B. pseudomallei isolated in Bangladesh over last several years. The present study aimed to determine the antimicrobial susceptibility pattern of B. pseudomallei isolated in a tertiary care hospital of Dhaka city from 2009 to 2015.

18. Nandita pal, Rajyasri Guhathakurta.Surgical site infection in surgery ward at a tertiary care hospital: the infection rate and the bacteriological profile. IOSR J Pharm 2012;2(5):1-5. 19. Mohammedaman Mama, Alemseged Abdissa and Tsegaye sewunet. Antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to alternative topical agents at JIMMA university specialized hospital, South –west ethiopia. Ann clin microbiol antimicrob 2014;13:1-10.

Out of the 5933 samples collected a total of 51 isolates of pseudomonas aeruginosa were collected consecutively between 26-December-2010 to 28-February-2011 from different patients. The total of 51 positive isolates consists both of pediatric as well as adult patients. The study was therefore carried out using both manual (Kirby-Bauer method) as well as automated (Vitek2 system) method to determine the Antimicrobial susceptibility pattern of pseudomonas aeruginosa isolates from in-patients and out-patients attending the microbiology section of the hospitals. The isolation rate of Pseudomonas aeruginosa was found to be 8.5% out of the total positive samples which were analyzed. In my study, notable sensitivity (100%) to P.aeruginosa was observed against Aztreonam while it was found to be different in case of a study carried out in India earlier which observed Carbepenems with 19.40% resistance. In the study colistin showed the highest (100%) sensitivity followed by Amikacin against P. aeruginosa , which is in corroboration with an earlier report published from India. Amikacin seems to be a promising therapy for Pseudomonal infection. Hence, its use should be restricted to severe nosocomial infections, in order to avoid rapid emergence of resistant strains. The sensitivity of Pseudomonas aeruginosa towards Imipenem is found to be 35.294% and towards Meropenem is 41.176%, which is different in case of the earlier study from India. An effective national and state level antibiotic policy and draft guidelines should be introduced to preserve the effectiveness of antibiotics and for

lifetime risk of developing bacterial cystitis, which develops mostly before the age of 24. 6 In contrast, men ABSTRACT Background: Urinary tract infection (UTI) is one of the common infections encountered by the clinicians. Though a good number of antimicrobial agents are available, still UTIs have become difficult to treat due to development of resistance by the uropathogens. So, regional data regarding the common uropathogens and their sensitivity pattern is required to guide the clinicians to start empirical therapy while managing UTIs. The purpose of the study was to identify different species of microorganisms, along with their antimicrobial susceptibility pattern, causing urinary tract infection in outpatient and indoor patients at RIMS, Ranchi, Jharkhand.

However, they are progressively considered pathogens Introduction: Staphylococcus is a genus of pathogenic bacteria, which asymptomatically colonizes the upper respiratory tract of the human. The incidence of invasive Staphylococcal infections and the disease burden are high among children in South Asia, including Pakistan. This study aims to determine the nasal colonization and antimicrobial susceptibility pattern of Staphylococcus species isolated from preschool children in Lahore, Pakistan. Methods: A community-based study was conducted in two camps named Shah Di Khui and Jeevan Haana in Lahore city. A total of 100 nasal samples, were collected from preschool children from lower-middle-class families during January to March 2018. Species identification was performed using the coagulase test, catalase test, and Gram staining. Also, a 370 bp fragment of the tuf gene was targetted using specific primers for the genus Staphylococcus. Antibiotic resistance pattern of the isolates was defined by an antibiotic susceptibility test using a series of antibiotic discs. Results: The results of this study indicated the presence of Staphylococcus species, mainly Staphylococcus aureus in more than 85% of the children. PCR amplification of tuf gene confirmed the identity of the S. aureus isolates from the nasal cultures. Many showed resistance to more than two broad-spectrum antibiotics. Conclusion: The prevalence of nasal colonization of S. aureus was more than 85% among preschool children. Most of the isolates were resistant to β-lactam antibiotics. J Med Microbiol Infec Dis, 2018, 6 (4): 91-98.

Emerging challenges of multi-drug resistance, both intrinsic and acquired among them is of serious concern to the treating physician. 6 The study was conducted in the Department of Microbiology, RNT Medical College, Udaipur to isolate and identify the non-fermenters from various clinical samples and their antimicrobial susceptibility pattern was studied.

Antimicrobial susceptibility pattern of urinary isolates from outpatients suspected for urinary tract infection Ezenobi Nkechi Obiofu * , Ogbu Hanson Ige and Onosigho Iroro Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, University of Port Harcourt, Choba P.M.B.5323, Port Harcourt, Rivers State, Nigeria.

hospital setting is responsible for disseminating antibiotic resistant determinants. Chromosomal mutation antibiot- ics selection is also responsible for antibiotics resistance. The aim of this study was to evaluate the antimicrobial susceptibility pattern of Staphylococcus aureus at KNH from April 2014 to February 2016. Previous studies done in Kenya were targeting specific locations in the hospital and were within short periods of time. This study gives a broader picture of the susceptibility pattern of S aureus in different locations in 3 years.

In many hospitals and areas worldwide, the prevalence of MRSA poses a serious therapeutic problem. There are lim- ited choices of antimicrobial agents to treat many serious life-threatening infections caused by MRSA leading to pro- longed stay of such patients in the hospital and increased cost of care. In Trinidad and Tobago, several independent studies of MRSA prevalence though limited in many aspects have been carried out in one hospital or the other in the country. Those previous studies reported the preva- lence of MRSA from a cross section of one hospital or another in the country and this may not have reflected the true picture of the general prevalence rate of MRSA exist- ing in Trinidad & Tobago. We therefore sought to deter- mine in a more comprehensive manner the prevalence and antimicrobial susceptibility pattern of MRSA in three major regional hospitals in the country.

CONCLUSION P. aeruginosa is a leading cause of nosocomial infection. Indiscriminate use of antibiotics has led to emergenece of multidrug resistant srains. In our study, strains are more sensitive to combination drugs like piperacillin+tazobactum and cefoperazone+sulbactum and carbapenems like imipenem and meropenem. A more restricted and rational use of these drugs is necessary. A regular monitoring of antimicrobial susceptibility pattern is essential to guide the physicians in prescribing right combination of drugs and emergence of multidrug resistance strains of P. aeruginosa.

Background: Sepsis is one of the most common cause of neonatal deaths globally more so in low and middle-income countries. The key to management is high degree of clinical suspicion and prompt initiation of empirical antibiotic therapy pending investigations’ results. Knowledge of one’s own NICU flora and antimicrobial susceptibility pattern guides in choosing correct antibiotic therapy to pediatrician. If this data is standard and comparable across different sites, then it also helps in formulating regional and National treatment guidelines. Present study was therefore undertaken to study microbial flora of present NICU and analyze their antimicrobial susceptibility pattern and formulate antimicrobial policy.

CERTIFICATE This is to certify that this dissertation titled “ A STUDY ON BACTERIAL INFECTIONS AND THEIR ANTIMICROBIAL SUSCEPTIBILITY PATTERN IN DECOMPENSATED LIVER DISEASE PATIENTS IN A TERTIARY CARE HOSPITAL ’’ is a bonafide record of work done by DR.J.RAJESWARI, during the period of her Post graduate study from 2012 to 2015 under the guidance and supervision in the Institute of Microbiology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai-600003, in partial fulfillment of the requirement for M.D. MICROBIOLOGY Degree Examination of The Tamilnadu Dr. M.G.R. Medical University to be held in April 2015.

CERTIFICATE This is to certify that this dissertation titled “A STUDY ON SECONDARY BACTERIAL INFECTIONS ASSOCIATED WITH DERMATOLOGICAL LESIONS AND THEIR ANTIMICROBIAL SUSCEPTIBILITY PATTERN IN A TERTIARY CARE HOSPITAL” is a bonafide record of work done by DR. S.VINOTHA, during the period of her Post Graduate study from 2012 to 2015 under guidance and supervision in the Institute of Microbiology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai- 600003, in partial fulfillment of the requirement of M.D MICROBIOLOGY degree Examination of The Tamilnadu Dr. M.G.R Medical University to be held in April 2015.

resistance to all tested antibiotics with the exception of Tigecycline (0%) and Gentamicin (20%). Analysis of the multiple antibiotic resistance index (MARI) showed that majority (96.7%) of the isolates were resistant to 3 or more of the antimicrobial agents. No isolate was resistant to all the tested antimicrobial agents. A very high proportion of the CoNS isolates were resistant to cefoxitin, penicillin, tetracycline, amoxicillin-clavulanate, and vancomycin. In conclusion, the high proportion of isolates with MARI of 0.3 and above indicates a high level of antibiotic use or exposure in the study area. These findings revealed the need for continued surveillance for resistant phenotype to inform clinical therapy decisions.

Literature review highlights the facts that there is increased incidence of drug resistance cases like the methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant Staphylococcus aureus (VRSA) or extended spectrum beta lactamases (ESBL). The reported incidence of such cases in Japan, Korea and China is about 60%. In Europe it is 35% 6, 7 . While in Pakistan it is 36.1%. Hence, the management of simple infections is becoming challenging for the health care professionals globally 8 . Falagas ME etal in 2010 described that besides treatment for urinary tract infection, this drug can be used for the management of systemic infections as well 9 . As mentioned in the results of current study, a wide spectrum of susceptibility was observed for fosfomycin for various isolates in different specimens. It was assessed from the current study results that, 76.06% (n=143) gram negative organisms, and 68.42% (n=13) gram positive organisms. This is in favor of two studies conducted by Falagas ME etal in 2008 & 2010. He narrated that fosfomycin harbors good efficacy against various gram positive cocci like the Staphylococcus aureus and Enterococcus faecalis. While for gram negative organisms like

Aim: The present study was to analysis of the uropathogenic bacteria in patients were attended RMMC Hospital and their antibiotic resistance pattern, in vitro detection of haemolysis virulent factor of uropathogenic. Material and Methods: All urine samples were tested by the standard microbiological procedure. Kirby-Bauer method used for the Antibiotic Susceptibility Test according to the CLSI guidelines. Commercially available antibiotics were used. Blood Agar used for the detection of haemolysis.

Zone, Post Box No.: 138, Ethiopia, Eastern Africa. Email: rvinodhini71@gmail.com Received: 16 December 2013, Revised and Accepted: 12 January 2014 ABSTRACT Objective: The ESBL producing organisms has been steadily increasing over the past years. The detection and treatment of these ESBL organisms are extremely limited. In the present study, to determine the Extended Spectrum Beta Lactamases producing organism which were isolated from various samples of Multispeciality hospital in Salem, India. Methods: A total of 278 gram negative isolates were received from various samples were used to detect the ESBL production by using double disk approximation test and Phenotypic confirmatory test with combination disc. The susceptibility of ESBL producers were analysed by antibiotic susceptibility test by using 4 commercially available beta-lactamase inhibitors combinations (Piperacillin/ tazobactam, Ampicillin/Sulbactam, Ticarcillin/Clavulanic acid and Amoxycillin/Clavulanic acid). Results: A total of 351 samples were received, from that 53 Escherichia coli, 73 Klebsiella spp, 37 Pseudomonas aeruginosa, 58 Salmonella spp, 31 Enterobacter spp and 26 Proteus spp were isolated and tested; from the 278 isolates 151 were found to be ESBL producers. From the 151 ESBL producers, P/T exhibited best activity against 134(88.74%) followed by A/C 128(84.76%) and A/S 126(83.44%). T/C 108(71.52%) shown the poor activity against all the organisms compare to other combination antibiotics. P/T exhibited significantly greater inhibitory activity against Klebsiella spp (96.15%), E. coli (92.68%), P. aeruginosa (90.47%), whereas, A/C exhibited considerable antimicrobial activity against Klebsiella spp (92.30%) and P. aeruginosa (90.47%). The A/S exhibited greater inhibitory activity against P. aeruginosa (90.38%) and Klebsiella spp (90.38%). P/T, A/C and A/S exhibited better activity against rest of the organisms. All the four agents show good activity against Proteus spp. Conclusion: These data suggest that Amoxycillin/Clavulanic acid and Ampicillin/Sulbactam combination antibiotics showed maximum inhibitory activity against ESBL producers. So, it can be used for the treatment of ESBL infection.

Conclusion The emergence and spread of resistance to various antibiotics in E.coli which cause UTI is an example of ongoing global problem of antimicrobial resistance. Ultimately control depend on a multidisciplinary and worldwide approach to the problem, including reduced and judicious use of antimicrobial agents in humans as well as in animals. The alarming reports of community acquired UTI caused by Fluoroquinolone resistant E.coli strains in some parts of the world suggests that we will see an evolution of resistance to these agents just as reported in literature with Sulfonamides, Ampicillin etc., unless we take a much more aggressive approach to the control of antimicrobial resistance. After Amikacin, Nitrofurantoin is highly active against E. coli followed by others. seven days therapy may be required to achieve reasonable cure rates with this drug. Thus nitrofurantoin can be considered as first line empirical treatment for uncomplicated UTI. 20, 21,

also states resistance from as high as 63%, Gupta et al to 76.9% Ali et al. 28,32 The isolated strain of K. pneumoniae also exhibited considerable susceptibility to aminoglycosides like amikacin (57% high sensitivity 43% intermediate sensitivity making a total of 100%) and gentamycin (85.7%). The finding were consistent were previous study reporting 88% and 78% isolates to be sensitive to amikacin and gentamycin respectively. 33 Even then reports of Klebsiella pneumoniae resistant to aminoglycosides were reported earlier. 34 Resistance to aminoglycosides is frequently due to the acquisition of modifying enzymes that vary in their substrate ranges, such as acetyl transferases, phosphorylases and adenylyl transferases. Klebsiella pneumoniae that produced 16S rRNA methylases 113 were reported in 2003. 35 These enzymes in Klebsiella pneumoniae were found to confer