ABSTRACT
Background: The objective of the study was to find out different types of biological samples from admitted patients tested for culture and sensitivity (C&S), prevalence of different types of organisms isolated from those samples, and to analyze the resistance pattern of those isolated organisms against commonly used or tested anti-microbial agents (AMAs).Methods: Following institutional ethics committee approval and written informed consent, adult patients of both genders, receiving AMAs were enrolled from June 2014 to July 2015 and followed up daily till they were in medical intensive care unit (MICU). Demographic data, diagnosis, culture-sensitivity (antibiogram) and other investigation reports and treatment details were recorded. Descriptive statistical analysis of collected data was done.Results: Of the 514 samples (from 600 patients enrolled) sent for C&S testing, 143 were reported as sterile while from the rest 371 samples, 504 organisms were isolated; commonly isolated organisms were Pseudomonas aeruginosa (30%), Acinetobacter baumannii (23%), Klebsiella pneumoniae (16%), Providencia sp. (7.1%), Escherichia coli (5.7%), and Enterobacter sp. (4.2%). Samples were sent in 63% of enrolled patients, the commonest being broncho-alveolar lavage (48% of total). Microbial resistance was high for cephalosporins (ceftriaxone, cefepime, ceftazidime), carbapenems (meropenem, imipenem), penicillins (piperacillin), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin, netilmicin, amikacin) and cotrimoxazole. Most organisms were sensitive to colistin (100%), polymyxin B (92%) and tigecycline (69%).Conclusions: The information regarding commonly isolated organisms and their resistant pattern would aid in rational selection of AMAs and thus the present study is useful to clinicians managing MICU and the hospital infection committee to plan future policies regarding AMA use in MICU.
ABSTRACT
Background: Resistant bacteria are emerging worldwide as a threat to the favourable outcome of common infections in community and hospital settings. Extended Spectrum Beta-Lactamases (ESBLs), AmpC β lactamases and Metallo-β Lactamases (MBL) are the three important mechanism of resistance to beta lactam drugs in the bacteria. The objective of the study was to screen gram negative isolates for co-expression of extended spectrum β-lactamase, Amp C β-lactamase and Metallo β-lactamase production. Methods: In this study 50 (27 male & 23 female) adult skulls were investigated to determine the type of asterion, its distance from important bony landmarks and also the nearby venous sinuses were measured. Results: Seven hundred and six isolates from various clinical samples from Kamineni institute of medical sciences Hospital, Narketpally, were processed during the period of October 2010 to September 2012. Gram negative bacilli were identified by colony morphology, gram stain, motility, enzyme detection tests, etc. ESBL detection was carried but by two procedures like double disc synergy tests (DDST) and phenotypic confirmatory disc diffusion test (PCDDT). AmpC Beta-lactamase detection was done by AmpC Disc Test. MBL production was tested by Imipenem-EDTA combined disc test. Conclusions: Klebsiella was the commonest isolate (28.47%) followed by E coli (26.48%), Pseudomonas aeruginosa (19.54%), Enterobacter (8.92%), Acinetobacter (8.92%) and Citrobacter (7.64%). A total of 272 out of 706 gram negative isolates were ESBL producers. ESBL production was seen more in E. coli followed by Klebsiella and P. aeruginosa. A total of 73 out of 706 isolates were inducible Amp C producers. AmpC production was seen more in Acinetobacter. A total of 65 out of 706 isolates were MBL producers. MBL Production was seen more in E. coli.
ABSTRACT
The rise in super bugs causing Ventilator‑Associated Pneumonia (VAP) is a major cause of mortality and morbidity despite recent advances in management owing to the looming ‘antibiotic apocalypse’. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU) and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV) for ≥48 hrs. Endotracheal aspirates (ETA) from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP), while Nonfermenting Gram negative bacilli (NFGNB) were significantly associated with late onset VAP (LOVAP). Most of the isolates were multi drug resistant (MDR) super bugs. With limited treatment options left for this crisis situation like the pre‑antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.