Prevalence of antimicrobial resistance among gram-negative clinical isolates from a general hospital in Kuwait

Abstract

Background: The impact of antimicrobial resistance on public health is a major issue worldwide. The objective of this study was to determine the antimicrobial resistance patterns of clinical gram-negative bacterial (GNB) isolates originated from different samples and locations at a general hospital in Kuwait. Methods and materials: A retrospective data of antimicrobial susceptibility testing of GNB from 2017–2018 were extracted from the microbiology laboratory at a general hospital in Kuwait. The data included the patient ID, location where the samples were collected (ICU, medical, pediatric, surgical, and out-patient clinics), specimen type, bacterial isolates (Acinetobacter spp., Enterobacter spp., E. coli, K. Pneumoniae, and P. aeruginosa), and the antimicrobial resistance profile. The susceptibility testing was performed using Vitek 2 and MicroScan systems. Results: Antimicrobial resistance profiles from a total of 6135 GNB isolates were obtained. In general, high resistance percentages (>50%) towards ampicillin, aztreonam, ciprofloxacin, trimethoprim/sulfamethoxazole, and cephalosporins drugs (ceftazidime, cefpodoxime, cefotaxime, and cefuroxime) was observed across the different bacterial species. However, low resistance (<10%) was generally observed against amikacin, amoxicillin/clavulanic acid, ertapenem, fosfomycin, nitrofurantoin, meropenem, piperacillin/tazobactam, and tigecycline. The proportion of antibiotic resistant bacteria by locations varied greatly by the microorganism isolated. For instance, E. coli isolates from medical and surgical wards had higher resistance prevalence compared to the other locations; whereas P. aeruginosa isolates from pediatric ward had higher resistance prevalence to antibiotics compared to other locations. The highest overall resistance (across all bacterial isolates) was detected in urine and wound samples. For instance, in urine samples, 22% and 26.3% of E. coli and K. Pneumoniae were resistant to amoxicillin/clavulanic acid. The prevalence of resistance to at least one antibiotic was high particularly among E. coli, K. Pneumoniae, and P. aeruginosa at 78.2%, 91.0%, and 73.6%, respectively. Moreover, the prevalence of multi-drug resistance among E. coli, K. Pneumoniae, and P. aeruginosa was 50.3%, 51.3%, and 48.7%, respectively. Conclusion: Monitoring the antibiotic susceptibility data of common bacterial organisms is vital to assess the status and trends of antibiotic resistance at hospital setting, to evaluate effective intervention strategies, and to select appropriate antibiotic treatment.