Antibiogram Pattern Research Articles

Molecular Detection of Antibiotic Resistance Genes Among Enterococcus faecalis Isolated From Fecal and Urine Samples of Patients With Community-Acquired Urinary Tract Infections

Background: Urinary tract infection (UTI) is one of the most common bacterial infections in outpatient settings. Enterococcus species is currently considered the second most common cause of UTI. Objectives: The aim of this study was to investigate antibiotic resistance patterns among Enterococcus faecalis strains and evaluate the association of antibiogram patterns from urine and fecal samples in community-acquired UTIs using phenotypic and molecular methods. Materials and Methods: A total of 144 urine and fecal samples were obtained from outpatients with UTI who had been referred to Labbafinejad hospital and Milad hospital from August 2014 to April 2015. For bacteriological study, samples were cultured in enterococcosel and blood agar. Antimicrobial susceptibility tests were evaluated using the disk diffusion method and the E. test according to criteria recommended by the clinical and laboratory standards institute (CLSI). PCR was performed for the detection of specific species and the antibiotic resistance genes tetM and vanA. Results: Of the 72 E. faecalis strains isolated from urine samples, 63 (87.5%) were also isolated from fecal samples. 40 (63.4%) of the isolates found in both urine and feces had similar antibiotic sensitivity patterns. 17 (26.9%) of the isolates found in both specimens were different in a class of antibiotic (related) and 8 (12.6%) isolates in more than one or two class of antibiotics (difference). The results of the disk diffusion methods were analyzed according to CLSI breakpoints. The antibiotic resistance of strains isolated from urine samples was evaluated for tetracycline (65 strains [90.3%] resistant), minocycline (64 [88.9%]), gentamicin (120 µg) (21 [29.2%]), ciprofloxacin (17 [23.6%]), levofloxacin (12 [16.7%]), and gatifloxacin (11 [15.3%]). The same evaluation was conducted for the strains isolated from fecal samples for tetracycline (48 [76.1%]), minocycline (45 [71.4%]), gentamicin (10 [15.8%]), ciprofloxacin (8 [12.6%]), and gatifloxacin (4 [6.3%]). All strains were sensitive to vancomycin, ampicillin, penicillin, nitrofurantoin, linezolid, and daptomycin. According to the PCR results as a gold standard and molecular method, 67 (93%) of the isolates from urine and 52 (82.5%) of the isolates from feces were positive for tetM genes. The vanA gene was not found in any strain. Conclusions: The simultaneous detection of E. faecalis in a patient’s gastrointestinal and urine tracts can indicate the presence of uropathogenic Enterococcus. Further study is essential to identify virulence factors involved in the colonization of these isolates in the urinary tract.

Device-associated infection rates with microbiological profile and antibiogram pattern from an adult medical-surgical ICU of a tertiary care hospital

Device-associated infection rates with microbiological profile and antibiogram pattern from an adult medical-surgical ICU of a tertiary care hospital

Device-associated infection rates with microbiological profile and antibiogram pattern from an adult medical-surgical ICU of a tertiary care hospital

Device-associated infection rates with microbiological profile and antibiogram pattern from an adult medical-surgical ICU of a tertiary care hospital

Alliance for surveillance of invasive pneumococcal disease in India – The ASIP Study: Design and methodology

Abstract Disease surveillance has been long recognized as the cornerstones for the public health decision making practices. In the regions of high childhood morbidity and mortality there is an unmet need of continued disease surveillance to identify the causes for menace. Pneumococcal surveillance in India has been heterogeneous with very few examples of attempts. Driven by the gap in the knowledge of nationwide epidemiological distribution of serotype and antibiogram pattern of Streptococcus pneumoniae in India we attempted to provide the most appropriate study design to establish Alliance for Surveillance of Invasive Pneumococci (ASIP) network in the country which we hope on further optimization will be of benefit to all surveillances in future. The various components of surveillance and the experienced gained are described, as the progress made in the establishment of sentinel network followed by strengthening the laboratory diagnostic abilities and the data management of each surveillance center participating. For the surveillance to play a role in public healthcare it is important that the local capacity of surveillance in terms of public health force must be developed along with support from global development partners. Also, an integrated approach must be explored for the parallel surveillance systems.

Nosocomial urinary tract infections caused by extended-spectrum beta-lactamase uropathogens: Prevalence, pathogens, risk factors, and strategies for infection control.

Our goal was to investigate the prevalence and antibiogram pattern of extended spectrum beta-lactamase (ESBL) production among uropathogens using isolates from urine samples collected at the Department of Urology in the Sahloul Hospital, Tunisia We also aimed to identify the risk factors for nosocomial urinary tract infections (UTIs) in patients who underwent transurethral resection of the prostate (TURP) and the measures for infection control. Laboratory records of a five-year period from January 2004 to December 2008 were submitted for retrospective analysis to determine the incidence of ESBL infections. A total of 276 isolates were collected. A case-control study involving comparisons between two groups of patients who underwent TURP was performed to determine the risk factors for ESBL infection. Group 1, designated case subjects, included 51 patients with nosocomial UTI after TURP. Group 2, designated control subjects, consisted of 58 randomly selected patients who underwent TURP without nosocomial UTI in the same period. Factors suspected to be implicated in the emergence of ESBL infection were compared between the two groups in order to identify risk factors for infection. A univariate regression analysis was performed, followed by a multivariate one. The annual prevalence of ESBL infection ranged from 1.3-2.5%. After performing univariate and multivariate regression analysis, the main risk factors for ESBL infections were identified as: use of antibiotics the year preceding the admission, duration of catheter use, and bladder washout (p=0.012, p=0.019, and p<0.001. Urologists have to perform a good hemostasis, especially in endoscopic resections, in order to avoid bladder irrigation and bladder washout and to reduce the time of bladder catheterization, which is a strong risk factor of nosocomial UTIs.

Prevalence and antimicrobial resistance pattern ofCampylobacterspecies among poultry and poultry handlers of Jammu

Campylobacter is one of the emerging zoonotic pathogens with poultry and their products serving as an important source of human infections. The present study was aimed to assess the prevalence of Campylobacter species among poultry and poultry handlers of R.S. Pura, Jammu and their antibiogram pattern. A total of 177 samples from poultry (n = 167) and poultry handlers (n = 10) were examined and 39 samples were found positive for Campylobacter species (32 C. jejuni, 6 C. coli and 1 C. lari). The prevalence of Campylobacter was 40.3, 13.2, 7.7 and 30.0% in poultry faeces, poultry meat, poultry carcass swabs and poultry handlers, respectively. Antimicrobial resistance pattern of C. jejuni and C. coli isolates was studied against nine antibiotics. Multidrug resistance among the isolates was found against ampicillin, metronidazole and cepholathin while high sensitivity was observed towards gentamicin, ciprofloxacin, furazolidone and tetracycline. The results of the present study indicate high prevalence of Campylobacter both in poultry and poultry handlers with varying in vitro sensitivity to different antibiotics. The outcome enunciates that appropriate control measures ensuring safety of poultry products and human health need to be devised.

Antibiogram of Salmonella Isolates: Time to Consider Antibiotic Salvage.

Enteric fever is a major problem especially in developing countries. Timely and appropriate treatment plays a very important role in reducing the mortality. Fluoroquinolones and cephalosporins are the treatment options for enteric fever. Recent studies have shown that it is time to reconsider the use of earlier antibiotics. The study was aimed to know whether salvage is possible and to avoid treatment failures following fluoroquinolone usage. A one year retrospective data of Salmonella species isolated from 319 blood samples from our hospital and other diagnostic centers were studied. Demographic data, organism isolated and their changing pattern of antibiogram were analysed. Out of 319 Salmonella isolates, 52.4% (167) was Salmonella typhi (S. typhi) and 47.6% (152) Salmonella paratyphi A (S. paratyphi A), with a male preponderance. Most of the salmonellae were isolated in the months of June and July, with the majority being in the 1-10 and 21-30 years age groups. Both species were highly susceptible to chloramphenicol (95.2% and 100%) followed by third generation cephalosporins (97% and 98%), cotrimoxazole (95.8% and 98.6%) and ampicillin (94.6% and 93.4%) respectively. Highest resistance was seen for nalidixic acid (90.4% and100%) among both S. typhi and S. paratyphi A isolates followed by ciprofloxacin (62.2% and 54.6%) respectively. MDR to first line drugs was observed in a small proportion of S. typhi (1.7%) only. The frequency of isolation of S. typhi and S. paratyphi A are in equal proportion and enteric fever is more prevalent in younger age group. It is ideal to adopt bivalent vaccination in Universal immunization schedule. The isolates show sensitivity to first line drugs, paving the way for salvage of the earlier drugs. Cephalosporins still remain the treatment of choice in MDR salmonella isolates.

Speciation of Enterococcal Isolates in a Tertiary Care Hospital and Molecular Characterisation of Vancomycin Resistant Enterococci (VRE)

Background: Enterococci are gram positive cocci which reside as commensal microbial flora in gastrointestinal tract, vagina, biliary tract and male urethra. E.faecalis is the predominant species followed by E.faecium. Resistance against glycopeptides and aminoglycosides are being increasingly demonstrated and that is conferred upon largely by van A gene. Aims: To isolate and speciate Enterococci from various clinical samples, antibiogram pattern determination, followed by genotyping of vancomycin resistant Enterococci. Settings and Design: Prospective study. Materials and Methods: 200 Enterococcal isolates were collected and processed for speciation based on battery of phenotypic characteristics. Antibiotic sensitivity testing was performed as per CLSI guidelines 2014 for glycopeptide and aminoglycoside antibiotics. Enterococci which were resistant to vancomycin were subjected to polymerase chain reaction for van A gene detection. Statistical analysis used: Nil. Results: Of the 200 isolates 5 were resistant to vancomycin and teicoplanin (2.5%), 30 were resistant to high level gentamicin (15%). van A gene was detected in 3 of the 5 vancomycin resistant isolates. E.faecium was observed to be more resistant to the antimicrobials. Conclusions: If the vancomycin resistance in Enterococci gets dispersed throughout the world, it may pose a challenge in the treatment of Gram positive infections and may lead to treatment failure. Further treatment options may not be available. Hence these infections have to be prevented and the sequence of development of resistance to higher drugs has to be controlled by active surveillance and prevention. Key-words: E.faecalis, E.faecium, High-level Gentamicin resistance, Vancomycin-resistance, Van A gene Key Messages: Implementation of vigorous surveillance and provision of timely data

Fate of airborne coagulase-negative staphylococci

Hospital indoor air can be a source for transmitting nosocomial infections in resource limited settings. This study was undertaken over two months period (February – March 2010) in Chennai, India, to 1) characterise bacteria isolated from indoor air of healthcare facility; and 2) establish whether environmental and clinical isolates are similar by molecular typing methods. Daily visits were made to microbiology laboratory to determine clustering of cases of nosocomial infections. Patients with illnesses related to respiratory tract and skin and soft tissues were included. Clinical strains (from laboratory) with similar antibiogram patterns were systematically stocked. Indoor air samples were collected from such locations by exposed plate method for 30 minutes. Growth was identified by standard microbiological procedures. Phenotypically similar strains were further subjected to genotyping by polymerase chain reaction and pulsed field gel electrophoresis (PFGE) to confirm similarity. Coagulase-negative Staphylococci (CNS) were only isolated from both environmental and clinical samples during the study period. Totally, 15 clinical and six environmental strains of CNS were isolated over two months. One airborne and one clinical strain, isolated subsequently from a patient in the same location, had similar phenotypic (biochemical and antibiogram) characteristics. Isolates were identified as Staphylococcus haemolyticus using API STAPH system (bioMe´rieux), and confirmed to be methicillin resistant CNS using appropriate primers. When subjected to typing by PFGE, they were found to be similar (F=0.51). This is the first study documenting the similarity of CNS of environmental and clinical origin, thus establishing the possibility of air as a source for transmitting nosocomial infections.

Prevalence of E. coli in broiler chickens in winter and summer seasons by application of PCR with its antibiogram pattern

Prevalence of E. coli in broiler chickens in winter and summer seasons by application of PCR with its antibiogram pattern

Prevalence of E.Coli in broiler chickens in winter and summer seasons by application of PCR with its antibiogram pattern

A total of 205 chicken samples from apparently healthy broiler chickens (35 and 30), diseased broilerchickens (35 and 30) and freshly dead ones (35 and 40) were collected in winter (from December toFebruary) and summer (from June to August) seasons, respectively from Menofyiea government. Theresults showed that the incidence of E.coli in apparently healthy broiler chickens was 15.7%, diseasedbroiler chickens 37.1% and in freshly dead ones 55% in winter season while in summer season was15.8% in apparently healthy, 17.5% in diseased broiler chickens and 18.7% in freshly dead one. Theserogroups of E.coli that obtained by serological identification were O128, O78, O111, O124, O55, O142, O114,O2 and O1. The results of antibiotic sensitivity test for isolated E.coli showed that the isolated E.coliwere highly sensitive for norfloxacin (60%), gentamycin(50%) , neomycin (50%) , streptomycin(50%)and chloramphenicol (50%). moderately sensitive for doxcyclin (10%) and erythromycin(40%) andhighly resistant for amoxacillin /clavulinic acid (0%). The results of multiplex PCR showed that eae A(intimin or E.coli attaching and effacing) gene detected in O128,O55, O1and O2, OmpA (outer membraneprotein ) gene detected in all E.coli serogroups that isolated , stx1 gene not detected in all E. colisergroups that isolated ,but stx2 gene detected in O114 and O128.

Prevalence and epidemiology of Salmonella enterica serovar Gallinarum from poultry in some parts of Haryana, India.

Aim:The present study was investigated to ascertain the epidemiological status of fowl typhoid (FT) in broilers in some parts of Haryana during January 2011 to December 2013.Materials and Methods:To elucidate the epidemiological status of FT in broiler chickens for the 3 years (2011-2013) and to study the prevalence of various Salmonella serovars in poultry on the basis of culture characteristics, biochemical features, serotyping, and their antibiogram profile from some parts of Haryana (India).Results:A total of 309 outbreaks of FT were recorded in chickens during this period. Overall percent morbidity, mortality, case-fatality rate (CFR) in broiler chicks due to FT during this period was 9.45, 6.77, and 71.55. The yearly observations were divided into quarters A (January-March), B (April-June), C (July-September) and D (October-December). Maximum number of outbreaks - 106 (34.3%) was recorded in quarter D followed by quarters B - 84 (27.3%), C - 64 (20.7%), and A - 55 (17.7%). Salmonella isolates (253) were recovered from disease outbreaks in broilers from different parts of Haryana. Typical morphology and colony characters on MacConkeys Lactose Agar and Brilliant Green agar, biochemical reactions, serotyping along with antibiogram profiles were able to group these isolates into 3 groups namely Salmonella Gallinarum (183), Salmonella Enteritidis (41) and Salmonella Typhimurium (29). The antibiogram pattern of 183 isolates of S. Gallinarum revealed that most of the isolates were sensitive to gentamicin (76%) followed by amikacin (72%), kanamycin (71%).Conclusion:FT is prevalent in commercial broiler flocks in different parts of Haryana and is responsible for considerably high morbidity and mortality in affected flocks. Isolation of S. Gallinarum (9, 12:183) from FT cases suggest it to be the primary pathogen, however, isolation of S. Typhimurium and S. Enteritidis from these cases is a major concern. The detection of S. Enteritidis and S. Typhimurium from FT cases assumes significance from public health point of view.

Antibiogram Pattern of Shigella flexneri: Effect of BioField Treatment

Antibiogram Pattern of Shigella flexneri: Effect of BioField Treatment

Prevalence of E.Coli in diseased chickens with its antibiogram pattern

Prevalence of E.coli among poultry farms was investigated in these studies, which cover differentprovinces in Egypt through examination of 400 chicken samples using standard methods for isolationand identification of E.coli. The result showed presence of E.coli among imported chicks in rate 44%and from local broiler chickens about 75%. The incidence of E.coli in on day old living diseased chickswas(58.3), while the incidence of E.coli from local broiler chickens was (71%) from living diseasedchickens and about (83%) from freshly dead chickens These serotype of E.coli were O63, O103, O125,O158, O44. Antibiogram pattern test indicated the highest rate of resistant against tetracycline groupwhere about 80% followed by the2 β-Lactam antibiotic (73.3%), erythromycin about 63.3% of testedisolate were resistant, florfenicol about 53.3% were resistant , gentamycin was about 46.6% wereresistance , finally ciprofloxacin about 40% of tested isolate were resistant by using disc diffusionmethod

Nasal carriage of S. aureus among the students of Kasturba Medical College, Mangalore: Prevalence and antibiogram pattern

Nasal carriage of S. aureus among the students of Kasturba Medical College, Mangalore: Prevalence and antibiogram pattern

Antibiotics Before Removal of Percutaneously Inserted Central Venous Catheters Reduces Clinical Sepsis in Premature Infants.

Evaluate the incidence of postcatheter removal clinical sepsis when antibiotics were infused prior to the removal of percutaneously inserted central venous catheters (PICCs). A retrospective chart review of premature neonates (n = 196) weighing ≤1250 g at birth with 218 PICC line removals in the presence or absence of antibiotics at a tertiary level neonatal intensive care unit (NICU) between January 1, 2010, and May 31, 2012. Charts were reviewed looking for the presence of clinical sepsis defined as a sepsis workup including white blood cell count, differential, C-reactive protein, blood and/or cerebral spinal fluid (CSF), and urine cultures along with at least 48 hours of antibiotic therapy given within 72 hours after removal of a PICC line. Antibiotics were considered present at line removal if given within 12 hours before catheter removal either electively or at completion of a planned course. When antibiotics were given within 12 hours before PICC line removal, only 2% of the line removal episodes (1/48) resulted in a neonate developing clinical sepsis versus 13% (21/165) when no antibiotics were given prior to removal (p = 0.03, Fisher's exact test). Despite the increased use of elective antibiotics with line removal, there was no increase in total antibiotic usage due to the overall decrease in episodes of clinical sepsis or changes in antibiogram susceptibility patterns. There was an 11% absolute decrease and a 6-fold relative decrease in postcatheter removal clinical sepsis events in premature neonates who received antibiotics prior to PICC line removal.

Meticillin-resistant Staphylococcus aureus (MRSA) antibiogram: How inaccurate have our estimates been?

The objective of this study was to determine the accuracy of antimicrobial resistance patterns reported by the Australian Group on Antimicrobial Resistance (AGAR) established using surveys of just the first 100 Staphylococcus aureus isolates from each participating hospital. Patterns of resistance of a survey sample of S. aureus isolates collected prospectively from five Queensland hospitals participating in the AGAR biennial national survey, using the first 100 isolates diagnosed from each test year, were tested. Meticillin-resistant S. aureus (MRSA) antibiograms for five antimicrobials commonly used to treat outpatients established from a sample have underestimated the true level of resistance by 13-21 percentage points. Conversely, inpatient antibiograms have significantly overestimated the resistance level. Random selection of 100 isolates from all isolates did not provide valid resistance patterns for outpatients or inpatients. Nearly 50% of resistance demonstrated in all inpatient isolates and about 45% of resistance in all outpatient isolates was due to AUS-2/3-like, EMRSA-15-like and MRSA unclassified. In conclusion, testing S. aureus, and in particular MRSA, for resistance levels to commonly prescribed antimicrobials is under/over-estimated in Australia because of a faulty annual sampling method that failed to consider the effect of endemic phenotypes (AUS-2/3-like and EMRSA-15-like). MRSA represents one-third of all S. aureus AGAR isolates. Endemic phenotypes bias the antibiogram patterns when small consecutive sampling (first 100 samples) is used and this bias remains even when samples are selected at random. A minimum sample of 6 months of isolates must be used to accurately establish a national antibiogram.

Frequency of Extended-Spectrum Beta-Lactamase (ESBLs) –Multidrug Resistance Produced by Pseudomonas aeruginosa Isolated from Clinical Specimens in Khorramabad City, Iran

Background: Pseudomonas aeruginosa is one of the most important pathogenic bacteria causing hospital infections, which has intrinsic resistance to many antibiotics. One of the reasons for the emergence of drug resistance in P. aeruginosa isolates is the production of ESBLs (extendedspectrum beta-lactamase) enzymes. Resistance rate is increasing due to the production of these enzymes in P. aeruginosa. The goal of this study was to determine the prevalence of ESBL senzymes in P. aeruginosa isolates from different samples of patients in Khorramabad city by CDT (combined disk test) phenotypic method. Methods: This study was an investigation on 70 P. aeruginosa samples isolated from patients in Original Research Article Azizi et al.; BMRJ, 5(6): 490-495, 2015; Article no.BMRJ.2015.052 491 medical centers of Khorramabad city during one year (2013). The bacteria were identified by routine biochemical tests. Antibiotic sensitivity of the isolates was evaluated by double disk diffusion method. Phenotypic investigation of ESBLs production among the tested isolates using cefotaxime and ceftazidime disks alone and in combination with clavulanic acid (combined disk test) was performed. Results: Results of combined disk test showed that, out of 70 isolated pseudomonas, 100% of the samples had multi-drug resistance. Maximum resistance to cefixime (79.1%) and minimum resistance to meropenem (25%) were observed. Out of 70 isolates, 25 (35.7%) were phenotypic beta-lactamase-producing enzymes. That highest percentage was related to wounds, equal to 12 (17%). Conclusion: Considering the increasing prevalence of P. aeruginosa strains which produce extended-spectrum beta-lactamase, it is recommended to use an appropriate treatment protocol based on determining antibiogram pattern of strains. This means that all isolated before treating with antibiotics were examined by antibiotic susceptibility test. Also antibiotics should be used according to CLSI (Clinical and Laboratory Standards Institute). This issue is of serious concern for applying infection-control criteria with the purpose of preventing spread of this microbe.

Antibiotic Susceptibility and Molecular Identification of Antibiotic Resistance Genes of Staphylococci Isolated from Bovine Mastitis in Algeria

The study aimed to investigate the phenotypic and genotypic identification of in vitro antimicrobial susceptibility of 21 Staphylococci (10 Staphylococcus aureus and 11 Coagulase Negative Staphylococci) isolated from bovine mastitis to 12 antimicrobial drugs frequently using in veterinary medicine in Algeria. Isolates of staphylococci from bovine mastitis were tested for antibiotics with disc-diffusion method according to the National Committee for Clinical Laboratory Standards guidelines in the Mueller-Hinton agar, and resistant genes mecA, blaZ, aac-aph, ermA, ermC, tetK and tetM were detected by PCR. Staphylococci isolates showed high resistance to penicillin (95.23%), oxacillin (80.95%), clindamycine (80.95%), and erythromycin (76.19%) but, no resistance in all these strains was detected for gentamicin. Among 21 isolates of Staphylococci, 20 were found to be methicillin and multidrug resistant. Multidrug resistant strains exhibited several antibiogram patterns (antibiotic I to XIII). The distribution of antibiotic-resistant genes was mecA (100%) and tetM (100) followed by blaZ (42.85%). In the present study, the significant determination was the high prevalence of methicillin-resistant Staphylococci, which were resistant to multiple antibiotics. The finding of methicillin-resistant staphylococci from bovine mastitis is the first report in Algeria and revealed the status of resistant isolates in herd that might be helpful in treatment, controlling of resistant strains and for deciding culling of cows.

Characterization of Antimicrobial Susceptibility Profile of Biofield Treated Multidrug-resistant Klebsiella oxytoca

Klebsiella are opportunistic pathogens that cause a wide spectrum of severe diseases. The aim of the present study was to investigate the impact of biofield treatment on multidrug resistant strain of K. oxytoca with respect to antibiogram pattern along with biochemical study and biotype number. Clinical lab isolate of K. oxytoca was divided into two groups i.e. control and treated. Control group remain untreated and treated group was subjected to Mr. Trivedi’s biofield. The analysis was done on day 10 after biofield treatment and compared with control group. Control and treated groups were analyzed for antimicrobial susceptibility pattern, minimum inhibitory concentration (MIC), biochemical reactions and biotype number using MicroScan Walk-Away® automated system. Experimental results showed the impact of biofield treatment on K. oxytoca and found alteration in both antimicrobial sensitivity and MIC values as compared with untreated group. Antimicrobial sensitivity of about 26.67% tested antimicrobials out of thirty was altered with respect to control. MIC results showed about 12.50% alterations in tested antimicrobials as compared to control. Biochemical study showed 24.24% alteration in tested biochemical reactions after biofield treatment. A significant change in biotype number (7713 5272) was identified after biofield treatment as compared to control (7775 4332). In treated group, a new species was identified as Kluyvera ascorbata, as compared to control, K. oxytoca. Study findings suggest that biofield treatment has a significant effect in altering the antimicrobial sensitivity, MIC values, biochemical reactions and biotype number of multidrug resistant strain of K. oxytoca. Biofield treatment could be applied to alter the antibiogram-resistogram pattern of antimicrobials.