Changing trend of antimicrobial resistance among gram-negative bacilli isolated from lower respiratory tract of ICU patients: A 5-year study
Uma Chaudhary, Ritu Aggarwal, Deep Gagneja
Gram-negative bacilli, intensive care unit, resistance trend
Citation Information :
Chaudhary U, Aggarwal R, Gagneja D. Changing trend of antimicrobial resistance among gram-negative bacilli isolated from lower respiratory tract of ICU patients: A 5-year study. Indian J Crit Care Med 2011; 15 (3):164-167.
Background: Lower respiratory tract infections (LRTIs) are the most frequent infections among patients in intensive care units (ICUs). Aim: To track the resistance rate among the causative agents causing LRTI in the ICU patients. Design and Settings: This is a retrospective study done in a tertiary care hospital. Materials and Methods: Transtracheal or bronchial aspirates from 2776 patients admitted to the ICU were cultured and identified, and antibiotic sensitivity was performed by standard methods. Results: Of 2776 specimens, 1233 (44.41%) isolates were recovered, of which 1123 (91.07%) were gram-negative bacilli (GNB) and 110 (8.92%) were gram-positive organisms. From 2004 to 2009, Pseudomonas aeruginosa remained the most common pathogen. In phase I, high level of resistance (79-98%) was observed against all GNB. During phase II increasing trend in resistance to cephalosporins and declining trend in resistance to aminoglycosides against most GNB were observed. Multidrug resistance (resistance to three or more than three drugs) was observed in 83% of total isolates. Conclusions: Gram-negative organisms are the predominant pathogens causing LRTI in ICU. The increasing trend of resistance to cephalosporins and carbapenems in gram-negative organisms is very disturbing. Judicious use of antimicrobial agents is essential to prevent the emergence of multidrug-resistant bacteria in the ICU.
Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. JAMA 1995;274:639-44.
Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867-903.
Verbist L. Epidemiology and sensitivity of 8625 ICU hematology/oncology bacterial isolates in Europe. Scand J Infect Dis 1993;91:14-24.
Navaneeth BV, Belwadi MR. Antibiotic resistance among gram-negative bacteria of lower respiratory tract secretion in hospitalized patients. Indian J Chest Dis Allied Sci 2002;44:173-6.
Gonlugur U, Bakici MZ, Akkurt I, Efeoglu T. Antibiotic susceptibility patterns among respiratory isolates of Gram negative bacilli in Turkish University Hospital. BMC Microbiol 2004;4:32-4.
Mukhopadhyay C, Bhargava A, Ayyagari A. Role of mechanical ventilation and development of multidrug resistant organisms in hospital acquired pneumonia. Indian J Med Res 2003;118:229-35.
Jafari NJ, Ranjbar R, Haghi-Ashtiani MT, Abedini M, Izadi M. The study of prevalence and antimicrobial susceptibility of tracheal bacterial strains isolated from pediatric patients. Pak J Biol Sci 2009;12:455-8.
Forbes BA, Sahm DF, Weissfeld AS, editors. Bacterial identification flow charts and schemes: A Guide to Part III. In: Bailey and Scott′s diagnostic microbiology. 12th ed. Missouri: Mosby Elsevier; 2007. p. 251-3.
Clinical and Laboratory Standard Institute. Performance standards for antimicrobial susceptibility: Sixteenth informational supplement. Wayne, PA, USA: CLSI: 2006. M100-S16.
Lockhart SR, Abramson MA, Beekmann SE, Gallagher G, Riedel S, Diekema DJ, et al. Antimicrobial resistance among gram-negative bacilli causing infections in intensive care unit patients in the United States between 1993 and 2004. J Clin Microbiol 2007;45:3352-9.
Kumari HB, Nagarathna S, Chandramuki A. Antimicrobial resistance pattern among aerobic gram negative bacilli of lower respiratory tract specimens of intensive care unit patients in a neurocentre. Indian J Chest Dis Allied Sci 2007;49:19-22.
Shehabi AA, Baadran I. Microbial infection and antibiotic resistance patterns among Jordanian intensive care patients. East Mediterr Health J 1996;2:515-20.