Resistant Gram-Negative Bacilli (Red Plague) from ICU in Sohag University Hospital

Abstract

Background: Gram-negative bacteria; such as Escherichia, Klebsiella, Enterobacter, proteus, Pseudomonas and Acinetobacter, are common human pathogens. Now, it is difficult to treat these infections by most of the available antibiotics due to emergence of multidrug resistant Gram-negative bacilli or Red Plague. Objectives: This work aims to identify the rate of resistant gram negative bacteria in Sohag University hospital. Methodology: The present study was done in Sohag University Hospital, a tertiary care teaching hospital in Upper Egypt, more than 1000 bed capacity. Clinical specimens from the ICU patients were collected aseptically and transferred immediately to the microbiology laboratory for culture and sensitivity during the period from September 2016 to March 2017. Identification and antimicrobial sensitivity of the isolated Gram-negative bacilli were done by Vitek 2 automated system. Susceptibility was confirmed using the disc diffusion (modified Kirby Bauer) method using antimicrobial susceptibility testing discs supplied by (Oxoid, UK). The results were interpreted according to CLSI guidelines. Results: Out of 226 isolates from the different clinical specimens; 118 (52.2%) isolates were Gram-negative bacilli. Escherichia coli was the most common isolated among these Gram-negative bacilli (53 out of 118 isolates, 44.9%) and was the most common cause of urinary tract infection in ICU, 84% (42 isolates out of 50 urine samples). Klebsiella pneumoniae was the commonest cause of pneumonia in ICU (28 out of 34 respiratory isolates, 82.3%). Pseudomonas spp.; (17 isolates, 14.4%; Pseudomonas aeruginosa 15 isolates and Pseudomonas stutzeri 2 isolates) also isolated. Acinetobacter baumonni complex (6 isolates, 5.1%), Serratia liquefaciens (2 isolates, 1.7%) and Stenotrophomonas maltophilia (2 isolates, 1.7%) were the least common in ICU. Nearly all the MDR Gram-negative bacilli isolated in this study were sensitive to Tigecycline. Conclusion: This study highlights high rates of multidrug resistant gram negative bacilli. Almost all the isolates were sensitive to Tigecycline. Therefore; antibiotic stewardship, rigorous adherence to infection control guidelines, prevention of antibiotic misuse and continuous surveillance system should be followed to decrease emergence of new resistant strains. ohag University, Upper Egypt