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VOLUME 23 , ISSUE 12 ( December, 2019 ) > List of Articles

Original Article

Study of Antibiotic Sensitivity and Resistance Pattern of Bacterial Isolates in Intensive Care Unit Setup of a Tertiary Care Hospital

Sneha S Savanur, Hemamalini Gururaj

Keywords : Antibiogram, Antibiotic, Culture, Intensive care unit, Resistance, Sensitivity

Citation Information : Savanur SS, Gururaj H. Study of Antibiotic Sensitivity and Resistance Pattern of Bacterial Isolates in Intensive Care Unit Setup of a Tertiary Care Hospital. Indian J Crit Care Med 2019; 23 (12):547-555.

DOI: 10.5005/jp-journals-10071-23295

License: CC BY-NC 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective: To evaluate the antibiotic sensitivity and resistance pattern in an intensive care unit (ICU) setting of a tertiary care hospital. Materials and methods: A cross-sectional, retrospective study was conducted for a period of 1 month in October 2017 on a total of 195 patients who were admitted to ICU of tertiary care hospital. The culture and sensitivity pattern of clinical isolates from blood, urine, sputum, endotracheal tube (ET) aspirate, catheter sites, and wound swabs were analyzed. Positive cultures were segregated and their antibiotic sensitivity testing was performed under the guidelines of clinical and laboratory standard institute (CLSI). Results: Of the total 195 ICU admissions, cultures were sent for 167 cases. Of which 127 patients were culture positive and 40 cases were culture negative. Isolated bacteria were mostly gram-negative bacilli, of which Escherichia coli was (18.6%), Acinetobacter (14.5%), Klebsiella (11.6%), Pseudomonas (9.8%), and Proteus (1.74%). Among the gram-positive organisms, coagulase negative staphylococcus (CoNS) (15.6%) was most commonly isolated followed by Streptococcus (2.32%). Fungal growth was also seen in 26 (15.11%) samples. Samples that grew organisms were blood (n = 48), sputum (n = 17), urine (n = 39), ET aspirate (n = 40), pus (n = 11), catheter (n = 4), ear swab (n = 2), and stool (n = 1). Conclusion: Gram-negative bacterial infections are increasing in ICUs, leading to inappropriate selection of antibiotics. Hence, antibiotic sensitivity and resistance pattern in a hospital setup has to be studied so as to guide the treating consultant to initiate empirical antibiotics in critical cases.


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  1. World Health Organisation (WHO), WAAW: World Antibiotic Awareness Week, 2018, available from: https://www.who.int/campaigns/world-antibiotic-awareness-week/world-antibiotic-awareness-week-2018.
  2. Travasso C. India draws a red line under antibiotic misuse. BMJ 2016;352:i1202. DOI: 10.1136/bmj.i1202.
  3. World Health Organization (WHO). Antimicrobial resistance: draft global action plan on antimicrobial resistance, 2015, available from: http://www.wpro.who.int/entity/drug_resistance/resources/global_action_plan_eng.pdf.
  4. Ganguly NK, Arora NK, Chandy SJ, Fairoze MN, Gill JP, Gupta U, et al. Rationalizing antibiotic use to limit antibiotic resistance in India. Indian J Med Res 2011;134:281–294.
  5. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370(13):1198–1208. DOI: 10.1056/NEJMoa1306801.
  6. Prabaker K, Weinstein RA. Trends in antimicrobial resistance in intensive care units in the United States. Curr Opin Crit Care 2011;17(5):472–479. DOI: 10.1097/MCC.0b013e32834a4b03.
  7. de Kraker ME, Davey PG, Grundmann H, BURDEN study group. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLoS Med 2011;8(10):e1001104. DOI: 10.1371/journal.pmed.1001104.
  8. Sader HS, Flamm RK, Jones RN. Tigecycline activity tested against antimicrobial resistant surveillance subsets of clinical bacteria collected worldwide (2011). Diagn Microbiol Infect Dis 2013;76(2): 217–221. DOI: 10.1016/j.diagmicrobio.2013.02.009.
  9. Bouchillon SK, Badal RE, Hoban DJ, Hawser SP. Antimicrobial susceptibility of inpatient urinary tract isolates of gram-negative bacilli in the United States: results from the study for monitoring antimicrobial resistance trends (SMART) program: 2009-2011. Clin Ther 2013;35(6):872–877. DOI: 10.1016/j.clinthera.2013.03.022.
  10. Paterson DL, Ko WC, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, et al. Antibiotic therapy for Klebsiellapneumoniae bacteremia: implications of production of extended-spectrum beta-lactamases. Clin Infect Dis 2004;39(1):31–37. DOI: 10.1086/420816.
  11. Trouillet JL, Chester J, Vuagnat A, Joly-Guillou ML, Combaux D, Dombret MC, et al. Ventilator associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998;157(2):531–539. DOI: 10.1164/ajrccm.157.2.9705064.
  12. Tiwari HK, Sapkota D, Das AK, Sen MR. Assesment of different tests to detect methicillin resistant Staphylococcus aureus. Southeast Asian J Trop Med Public Health 2009;40(4):801–806.
  13. Radji M, Fauziah S, Aribinuko N. Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmavati Hospital, Indonesia. Asian Pac J Trop Biomed 2011;1(1):39–42. DOI: 10.1016/S2221-1691(11)60065-8.
  14. Chakraverti TK, Tripathi PC. Pattern of antibiotic susceptibility of common isolates in ICU of a tertiary care hospital: 2 years study. Int J Clin Biomed Res 2015;1(2):79–86.
  15. Lautenbach E, Synnestvedt M, Weiner MG, Bilker WB, Vo L, Schein J, et al. Imipenem resistance in Pseudomonas aeruginosa: emergence, epidemiology, and impact on clinical and economic outcomes. Infect Control Hosp Epidemiol 2010;31(1):47–53. DOI: 10.1086/649021.
  16. Lautenbach E, Polk RE. Resistant gram-negative bacilli: a neglected healthcare crisis? Am J Health Syst Pharm 2007;64(23 suppl 14): S3–S21; quiz S22–S24. DOI: 10.2146/ajhp070477.
  17. Dellit TH, Owens RC, McGowan Jr JE, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44(2):159–177. DOI: 10.1086/510393.
  18. Vanitha Rani N, Gopal K, Venkata Narendra M, Vishwakanth D, Nagesh VRD, Yogita M, et al. A retrospective study on blood stream infections and antibiotic susceptibility patterns in a tertiary care teaching hospital. Int J Pharm Pharm Sci 2012;4(1):543–548.
  19. Javeed I, Rubeena Hafeezamd M, Anwar S. Antibiotic susceptibility pattern of bacterial isolates from patients admitted to a tertiary care hospital in Lahore. Biomedica 2011;27(18):19–23.
  20. Jain A, Agarwal A, Verma RK, Awasthi S, Sing KP. Intravenous device associated blood stream staphylococcal infection in paediatric patients. Indian J Med Res 2011;134:193–199. DOI: 10.4103/0971-5916.92642.
  21. Rajeevan S, Ahmad SM, Jasmin PT. Study of prevalence and antimicrobial susceptibility pattern in blood isolates from a tertiary care hospital in North Kerala, India. Int J Curr Microbiol Appl Sci 2014;3(4):655–662.
  22. Shrestha S, Shrestha NC, Dongol Singh S, Shrestha RPB, Kayestha S, Shrestha M, et al. Bacterial isolates and its antibiotic susceptibility pattern in NICU. Kathmandu Univ Med J (KUMJ) 2013;11(41):66–70. DOI: 10.3126/kumj.v11i1.11030.
  23. Bajaj JK, Karyakarte RP, Kulkarni JD, Deshmukh AB. Changing aetiology of urinary tract infections and emergence of drug resistance as a major problem. J Commun Dis 1999;31(3):181–184.
  24. Sheth KV, Patel TK, Malek S, Tripathi CR. Antibiotic sensitivity pattern of bacterial isolates from the ICU of a tertiary care hospital in India. Trop J Pharm Res 2012;11(6):991–999.
  25. Beck-Sagué C, Jarvis WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. National Nosocomial Infections Surveillance System. J Infect Dis 1993;167(5):1247–1251. DOI: 10.1093/infdis/167.5.1247.
  26. Storefront SP, Medoff G, Fraser VJ, Powderly WG, Duncan WC. Candiduria: retrospective review in hospitalised patients. Infect Dis Clin Pract 1994;3:23–29. DOI: 10.1097/00019048-199401000-00004.
  27. Schönebeck J, Ånséhn S. The occurrence of yeast-like fungi in the urine under normal conditions and in various types of urinary tract pathology. Scand J Urol Nephrol 1972;6(2):123–128. DOI: 10.3109/00365597209133624.
  28. Agarwal R, Gupta D, Raif P, Aggarwal AN, Jindal SK. Epidemiology, risk factors and outcome of nosocomial infection in respiratory intensive care unit in North India. J Infect 2006;53(2):98–105. DOI: 10.1016/j.jinf.2005.10.021.
  29. Prashanth K, Badrinath S. Nosocomial infections due to Acinetobacter species: clinical findings, risk and prognostic factors. Indian J Med Microbiol 2006;24(1):39–44. DOI: 10.4103/0255-0857.19893.
  30. Ghanshani R, Gupta R, Gupta BS, Kalra S, Khedar RS, Sood S, et al. Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India. Lung India 2015;32(5):441–448. DOI: 10.4103/0970-2113.164155.
  31. Hsu L-Y, Tan T-Y, Jureen R, Koh T-H, Krishnan P, Tzer-Pin Lin R, et al. Antimicrobial drug resistance in Singapore hospitals. Emerg Infect Dis 2007;13(12):1944–1947. DOI: 10.3201/eid1312.070299.
  32. Mangaiarkkarasi A, Meher Ali R, Gopal R. Bacteriological profile of gram negative organisms and drug sensitivity pattern of escherichia coli in hospital specimens. Int J Recent Sci Res 2013;4(5):572–575.
  33. Oteo J, Campos J, Baquero F. Antibiotic resistant in 1962 invasive isolates of Escherichia coli in 27 Spanish hospitals participating in the participating in the European antimicrobial resistance surveillance system. J Antimicrob Chemother 2002;50(6):945–952. DOI: 10.1093/jac/dkf255.
  34. Mohanasundaram KM. The antimicrobial resistance pattern in the clinical isolates of Pseudomonas aeruginosa in a tertiary care hospital. J Clin Diagn Res 2011;5(3):491–494.
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