Antibiogram Reports Research Articles

Nine-year trend in Escherichia coli resistance to ciprofloxacin: cross-sectional study in a hospital in Colombia

Ciprofloxacin is a critically important antibiotic for human health. The increase of Escherichia coli resistance to ciprofloxacin is a global public health problem due to its importance in the treatment of complicated urinary tract infections and other serious infections; however, its prescription is high in the Colombian Caribbean. The objective was to determine the resistance trend of E. coli to ciprofloxacin in a Colombian hospital of high complexity. From antibiogram reports, isolates were categorized according to Clinical and Laboratory Standards Institute criteria for each year studied; proportions were calculated and differences in sensitivity were explored using the χ2 test. The Cochran-Armitage test was used to evaluate the resistance trend. Significance was considered when p-value ≤ 0.05. In total, 6,848 isolates were analyzed, and 49.31% resistance was found. According to origin, the highest resistance was in community samples (51.96% - 95%CI: 50.51; 53.41), and by type of sample, in skin and tissues (61.76% - 95%CI: 56.96; 66.35) and urine (48.97% - 95%CI: 47.71; 50.23). Increasing trends were observed for resistance per year (p < 0.0001), community samples (p = 0.0002) and urine (p < 0.0001). Resistance to ciprofloxacin is high and tends to increase in the community and in urine, exceeding the limit established for its use at the ambulatory level, which is of concern due to the high prescription of fluoroquinolones in the locality.

Analysis of Cumulative Antibiogram Reports in Search for Optimal Empirical Urinary Tract Infection Treatment at the Central Teaching Hospital of the Medical University of Lodz, Poland: Results of a 3-Year Surveillance.

Urinary tract infections are among the most common bacterial infections, accounting for about two-fifths of all healthcare-associated infections. Appropriate antimicrobial therapy is crucial, e.g., to avoid prolonged hospitalization and limit antimicrobial resistance spread. This study was performed to analyze the microbiological profiles of urinary tract infections in the Central Teaching Hospital in Lodz, Poland, and develop local empirical therapy guidelines. This study was a 3-year retrospective surveillance of the cumulative antibiograms from urine cultures. The procedures were based on the current EUCAST and CLSI guidelines. In 2020-2022, a total of 4656 urine cultures were performed, of which 1134 were positive. The most common bacterial isolates were Escherichia coli, followed by Klebsiella spp. and Enterococcus spp. High levels of susceptibility (>90%) have been observed for carbapenems, piperacillin/tazobactam, amikacin, and nitrofurantoin. Development of the appropriate empirical antimicrobial is a challenging task with persistently high levels of resistance to commonly used antimicrobials. Eventually, we separated the uncomplicated and complicated urinary tract infections in local guidelines and recommended nitrofurantoin and amikacin, respectively, in empiric therapy. The clinicians should make a decision based on the presented symptoms and then-with the urine culture result-correct or continue the therapy.

Urinary Tract Infections in Children: Clinical and Antibiotic Susceptibility Data from a Tertiary Care Hospital

Aim: Urinary tract infections (UTIs) are among the most common bacterial infections in children.&#x0D; Empirical antibiotic treatment is recommended until the antibiogram reports of urine culture are&#x0D; available. It is essential to initiate local UTI agents and their antimicrobial susceptibility patterns in&#x0D; specific geographical regions to choose the best empirical antibiotics. The current study aimed to&#x0D; determine causative microorganisms and antibiotic resistance patterns in children diagnosed with UTI.&#x0D; Material and Methods: The study was carried out retrospectively with 216 children diagnosed with&#x0D; UTIs for the first time. The patients were categorized into two groups according to age (≤1 year and &gt;1&#x0D; year). Demographic data, presenting symptoms, imaging findings, and urine and culture analysis results&#x0D; were collected and compared between these two groups.&#x0D; Results: Cefazolin and nitrofurantoin use may be preferred in the empirical treatment of UTIs caused&#x0D; by Escherichia coli and Enterococcus spp. Additionally, amoxicillin/clavulanate was recommended in&#x0D; the empirical therapy of UTIs caused by Enterococcus spp., Klebsiella spp., and Proteus spp. The&#x0D; trimethoprim-sulfamethoxazole and nitrofurantoin resistance of E. coli was found to be statistically&#x0D; significantly higher in the ≤1 year group (p=0.03 and p=0.01, respectively), while the nitrofurantoin&#x0D; resistance of Klebsiella was statistically significantly higher in the &gt;1 year group (p=0.01). The gentamicin&#x0D; resistance of Klebsiella spp. was statistically significantly higher in the ≤1 year group (p=0.03).&#x0D; Conclusion: It is important to detect regional antibiotic resistance patterns to manage UTIs and minimize&#x0D; related complications. Antibiotic susceptibility studies are necessary to reduce improper antibiotic use&#x0D; and resistance rates of antibiotics.

Analysis of cumulative antibiogram reports in intensive care units at an Egyptian University Hospital

BackgroundInstitutions must have access to antibiograms to monitor changes in antimicrobial resistance and direct empirical antibiotic therapy. The first facility-specific cumulative antibiogram was launched in the ICU in 2019. Consequently, many antibiogram-operation-related actions have been adopted in the institution based on reported data. This study aimed to analyze the cumulative antibiogram reports for multiple intensive care units (ICUs) for 2020, and compare the antimicrobial susceptibility testing (AST) patterns between the 2019 and 2020 years in an academic medical center. MethodsThis cross-sectional study was performed of routine bacterial culture and AST data extracted from a laboratory information system in a 2252-bed capacity hospital. Only the first diagnostic isolate of a given species per patient per year was included in the study. Interpretation and reporting were done in accordance with the applicable Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines. ResultsOf the 46,791 clinical isolates, the Gram-negative bacilli isolation rate witnessed a significant increase: 35,670 isolates in 2020 versus. 33,652 isolates in 2019. Klebsiella pneumoniae showed a statistically significant increase, mainly in pediatric, emergency, and cardiothoracic ICUs (p < 0.001). Neonatal and pediatric ICUs showed statistically significant increases in Pseudomonas aeruginosa and Proteus mirabilis isolates (p < 0.001). A statistically significant decrease was noted in the prevalence of Acinetobacter, Escherichia coli, Burkholderia cepacia, and Enterobacter cloacae. The sensitivities of K. pneumoniae and E. coli to imipenem and tigecycline significantly improved (p < 0.001). The sensitivity to colistin was significantly decreased (p < 0.001). The sensitivity of P. aeruginosa isolates to colistin and carbapenems was improved (p < 0.001). We reported a statistically significant decrease in all Gram-positive cocci (11,121 in 2020 versus. 11,528 in 2019). Staphylococcus aureus showed a statistically significant increase (p < 0.001), particularly in the medical ICU. ConclusionThe high susceptibility rates of Enterobacteriaceae toward colistin and tigecycline, should be cautiously considered in empiric therapy while looking for alternatives. The majority of isolates of Gram-positive cocci were coagulase negative staphylococci (CONS), we still need to confirm whether they are true pathogens or commensals before considering anti-staphylococcal agents in the empirical therapy. We underscored some corrective actions that might have improved the susceptibility rates, such as antibiotic cycling

Application of new indicators to assess the quality of antimicrobial use in intensive care units

This study explored the feasibility of a bundle of indicators aimed at assessing the quality of antimicrobial use in intensive care units (ICUs) through an observational prospective study spanning 12 quarters (January 2019-December 2021) in a 1290-bed teaching hospital in Spain. Members of the antimicrobial stewardship programme team selected the indicators to analyse the quality of antimicrobial use based on consumption data from a list proposed in a previous study. Antimicrobial use in the ICU was measured as defined daily dose (DDD) per 100 occupied bed-days. Trends and points of change were analysed with segmented regression. The intravenous macrolides/intravenous respiratory fluoroquinolones ratio in the ICU increased progressively, although not significantly, by 11.14% per quarter, likely related to prioritization of the use of macrolides in serious community-acquired pneumonia and the coronavirus disease 2019 pandemic. A remarkable upward trend of 2.5% per quarter was detected in the anti-methicillin-susceptible Staphylococcus aureus/anti-methicillin-resistant S. aureus agents ratio in the ICU, which could be explained by the low prevalence of methicillin-resistant S. aureus at the study centre. Patterns of amoxicillin-clavulanic acid/piperacillin-tazobactam ratio and diversification of anti-pseudomonal beta-lactams showed an increment in use over the study. The use of these novel indicators provides additional information for the current analysis of DDD. Implementation is feasible, and led to the detection of patterns that agree with local guidelines and cumulative antibiogram reports, and foster targeted improvement actions within antimicrobial stewardship programmes.

Prevalence of Carbapenem-Resistant Enterobacteriaceae in Western Saudi Arabia and Increasing Trends in the Antimicrobial Resistance of Enterobacteriaceae.

The aim of the study is to estimate the prevalence rate of carbapenem-resistant Enterobacteriaceae (CRE) and to determine the types of carbapenemase genes present in patients admitted to King Abdulaziz Medical City (KAMC-J) and King Abdulaziz University Hospital (KAUH), both in Jeddah, Saudi Arabia. A total of 180 isolates were analyzed which were included on the basis of retrospective chart review of patients from KAMC-J and KAUH between 1st April 2017 to 30th March 2019. The prevalence of carbapenemase genes( blaIMP, blaVIM, blaKPC, blaNDM-1, and blaOXA-48)was evaluated by Xpert® Carba-R (Cepheid, Sunnyvale, CA, USA). We assessed the CRE prevalence and described their susceptibility to antimicrobial agents based on antibiogram reports. Results:Klebsiella pneumoniaeshowed a higher frequency of bla OXA-48 (79%) than bla NDM (11.7%) genes (p=0.007). The CRE prevalence in KAUH was 8% in 2017 and increased to 13% in 2018. In KAMC-J, the prevalence was 57% in 2018 and 61% in 2019. K. pneumoniae was found to be the most frequently isolated causative organism followed byEscherichia coli .The bla OXA-48 (76.1%) gene was predominantamong overall isolates followed by bla NDM (13.9%); both genes coexisted in 6.1% of the isolates. During the study period, the prevalence of CRE considerably rose in the two tertiary care institutions from western Saudi Arabia. In the CRE isolates, bla OXA-48was discovered to be the most common gene. We recommend an antimicrobial resistance surveillance system to detect the emergence of resistant genes through use of new rapid diagnostic tests and monitor antimicrobial use in order to improve clinical outcomes of CRE infections given the severity of infection associated with the CRE isolates as well as the limited treatment options available.

Incidence of fever and bleeding after percutaneous nephrolithotomy: a prospective cohort study.

Despite relative agreement on the need for immediate peri-operative antibiotic prophylaxis in percutaneous nephrolithotomy (PCNL), there is no consensus regarding antibiotic use the days leading up to PCNL. This study aimed to report the incidence of complications during and after PCNL based on a cohort study design. We included 101 patients in a prospective schedule for PCNL. Patients were divided into 2 groups. In the exposed patients (positive urine culture) the antibiotic was indicated according to the antibiogram report, 7 days before surgery, and 7 days after surgery, and in the non-exposed patient's intravenous antibiotic empirically was administered 8 h and 1 h before surgery. The incidence of complications for both groups was 19%. The exposed group presented complications in 27%, and 16% for the non-exposed. The relative risk of complications, in general, was 1.68 (95% CI, 0.77-3.6), the attributable risk was 11.09, and the percentage of attributable risk was 40.68%. The presence of positive urine culture is the main risk factor for the development of post-PCNL fever. Each treatment center needs to standardize its protocols to reduce the morbidity associated with surgery and to identify the main risk factors.

1234. Can Susceptibility to One Carbapenem be Conferred to Another? Frequency of Discordance in Gram-negative Clinical Isolates

BackgroundCarbapenem-Resistant Enterobacterales (CRE) and Carbapenem-Resistant Pseudomonas aeruginosa (CRPA) can exhibit resistance to one carbapenem while remaining susceptible to another. While case reports describing discrepant carbapenem susceptibilities are available, the authors are unaware of any literature reporting aggregate carbapenem susceptibility discrepancies at a hospital level. MethodsSusceptibility data from April 1, 2017 - December 31, 2017 was extracted through an antibiogram report for a 706-bed hospital. Ertapenem, imipenem-cilastatin, and meropenem susceptibilities were captured and compared for common Enterobacterales and Pseudomonas aeruginosa. Organism identification was performed using Matrix Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) mass spectrometry. Antibiotic susceptibility testing was performed using BD PhoenixTM. Carbapenem susceptibilities were interpreted using the most updated Clinical and Laboratory Standards Institute (CLSI) breakpoints at the time of assessment (2021). Carbapenem discordance was defined as an organism being susceptible to one carbapenem and non- susceptible (intermediate or resistant) to another. Approval was obtained from the institution’s Institutional Review Board.ResultsMeropenem proved to be the most active antimicrobial for all organisms (Figure 1). Carbapenem susceptibility discordance ranged from 0%-23.8% (Table 1). There was a significant difference in the incidence of discordance between Enterobacterales and Pseudomonas aeruginosa isolates (2.6% vs. 6.1%, p < 0.001). Of the 20 Pseudomonas aeruginosa isolates with discordant carbapenem susceptibilities, 70% were meropenem susceptible/imipenem non-susceptible and 30% were imipenem susceptible/meropenem non-susceptible. The most common site for discordance was urine for both Enterobacterales and Pseudomonas aeruginosa. However, while there was a significant rate of discordance between sites for Pseudomonas isolates, this was not the case for Enterobacterales (Table 2).Figure 1: Carbapenem Susceptibility by Isolate Table 1: Frequency of Carbapenem Discordance Table 2: Frequency of Carbapenem Discordance by Site ConclusionDue to the wide range of susceptibility discordance, clinical implications can be drastic if an institution is relying on susceptibility of one carbapenem to confer susceptibility to another carbapenem.Disclosures All Authors: No reported disclosures

Polymicrobial Keratitis: Risk Factors, Clinical Characteristics, Bacterial Profile, and Antimicrobial Resistance.

To describe clinical characteristics, complications, and the most prevalent microorganisms causing polymicrobial keratitis and their antibiotic sensitivities. A cross-sectional study including a consecutive analysis of patient's records with a diagnosis of bacterial keratitis with a positive culture and antibiogram report were included. Patients were grouped into those having monomicrobial and polymicrobial infection. Features studied included demographic and clinical characteristics, risk factors, Gram stain, cultures, and antibiotic sensitivity. We included 656 patients; in 31.5% more than one microorganism was found. Seven hundred and twenty-three gram-positive bacteria were isolated, and 336 (46.5%) had polymicrobial keratitis. One hundred sixty-one gram-negative bacteria were isolated, and 99 (61.5%) from polymicrobial keratitis. Fourteen (0.60%) patients presented ring infiltrate, and 10 (71.42%) of those patients had polymicrobial keratitis (X2 10.654, P=0.001). Multivariate analysis showed that patients with history of contact lens use (odds ratio [OR] of 1.78, P=0.042), coexistent autoimmune disease (OR 4.64, P=0.03), irregular edges of the infiltrate (OR 2.06, P=0.005), and ring infiltrate (OR 6.034, P=0.005) have a higher risk for developing polymicrobial infection. In the polymicrobial group, gram-positive and gram-negative organisms showed a high sensitivity to Netilmicin. We found a high incidence of polymicrobial keratitis. Our results suggest that it should be suspected in patients with a history of contact lens use, coexistent autoimmune disease, infiltrates with indistinct edges, and ring infiltrates. Sensitivities to moxifloxacin are lower than those reported in previous studies, but sensitivity to Netilmicin is higher.

Genotyping and phenotyping patterns of Escherichia coli from UTI specimens from patients referred to the urology ward of Baqiyatallah hospital

Urinary tract infections are one of the most common infections in the hospital, which can cause complicity in treatment. The purpose of this study was to determine genotyping patterns based on antibiotic resistance genes and bag isolated from the UTI sample in female and male patients referring to the Urology Department of Baqiyatallah Hospital in 2017–2018. This descriptive study was performed on 100 isolates of Escherichia coli isolated from the urine sample of patients with recurrent urinary tract infection referred to Baqiyatallah Hospital after culture and differential tests. To determine the antibiotic susceptibility, the diffusion method was used to. To determine the susceptibility to the disk, Piperacillin, Cefotaxime, Ofloxacin, Ciprofloxacin, Neurofloxacin, Gentamicin, Nitrofurantoin, Amikacin, Imipenemn, and Meropenem were used. Finally, using the PCR method, the prevalence of antibiotic resistants ESBL (SHV, Ampc, Tem) and aacc3, aac6, and INT) in hospital isolates were investigated. According to the results of this study, it was found that 100% of the strains were resistant to Piperacillin and Cefotaxime, 98% of the strains to Ofloxacin, Ciprofloxacin, and Norrofloxacin, 80% of the strains to Gentamicin, 50% of strains to Nitrofurantoin, 42% of the strains to Amikacin, 40% of strains to Imipenem, and 32% of the samples were resistant to meropenem. Also, according to the results of PCR, antibiotic resistance was found to be due to antibiotic resistance genes in the strains.Due to the potential lack of attention to antibiogram reports, the risk of resistance genes may increase. It is also due to the chronicity of infection and the plasmid resistance genes being highly drug-resistant.

The surveillance of antibiotics resistance in Indonesia: a current reports

Background. Antimicrobial resistance (AMR) has become serious problem globally. Surveillance AMR is important to be part of quality indicator in antimicrobial stewardship program (ASP).Method. Surveillance of microbial pattern and their antibiotics susceptibility in Indonesia 2017 were developed by Indonesian Association of Clinical Pathology and Laboratory Medicine. Data aggregation was sourced from 31 hospitals antibiogram report which were joined the system of national data collection in forlabinfeksi.or.id. with standardized inclusion criteria. Data was analyzed descriptively, based on hospital type-A-B-C.    Result. There were 15.302 isolates included, 4.761 (31,1%) were positive Gram and 10.541 (68,9%) were negative Gram, 61,6% reported by type-A hospital, 16,4% by type-B and 22% by type-C. Positive and negative Gram patterns respectively were E. faecalis and E.coli (blood and urine), Streptococcus spp and K. pneumoniae (sputum), S. aureus and E.coli (pus), E. faecalis and E.coli (wound), coagulase negative Staphylococcus and Enterobacteriaceae (CSF). Antibiotic susceptibility pattern was slightly different among various types of hospital and among various clinical specimens. Positive Gram bacteria had good vancomycin susceptibility in all hospital types, except in sputum from Type-A and B hospital, also in blood and urine from Type-C hospital, similarly with linezolide susceptibility. Susceptibility pattern among Gram negative- bacteria for carbapenem and amikacin was good, in all hospital types, except on A. baumannii. For A. baumannii, antibiotic carbapenem, amikacin and ceftazidime susceptibility were 20-66%, 35-80%, and up to 83%, respectively. For P. aeruginosa, antibiotic susceptibility pattern was equal among all hospital types. Their susceptibility against cephalosporin (ceftazidime), fluoroquinolone (ciprofloxacin) and aminoglycoside (amikacin) were better in higher type-hospital. Conclusion. This result may become part of national epidemiological data for ASP program evaluation. This data may also be referred for local empirical antibiotic guideline among limited resources appropriate hospital. There will be improvement forward for more representative beneficial data.

Antibiotic resistance profile in eye infections in a reference centre in Floridablanca, Colombia

Abstract Background and objective In view of the increasing bacterial resistance to antibiotics, it is necessary to determine it locally in order to serve as a guide in clinical management. The purpose of this study was to characterize the pattern of antibiotic sensitivity in cases of eye infections in a third level ophthalmological institution in Floridablanca (Colombia). Materials and methods An observational cross-sectional study in which an analysis was made of the culture and antibiogram reports of specimens taken from cases of conjunctivitis, infectious keratitis, and endophthalmitis between January 2013 and June 2016. Results A total of 833 specimens were positive for bacteria. Considering both gram-positive and gram-negative microorganisms gentamicin, tobramycin, and ciprofloxacin showed high resistance rates (64.4%, 40.3%, and 29.1%, respectively). Moxifloxacin, vancomycin, imipenem, and gatifloxacin showed low percentages of resistance: 2.6%, 2.1%, 0.6%, and 0.4%, respectively. When comparing the results with previous studies in our institution, there was a decrease in sensitivity to the fourth-generation quinolones and imipenem, especially within the gram-negative ones. Conclusion Fourth generation quinolones, imipenem and vancomycin continue to have a low in vitro resistance to bacteria that cause eye infections. However, there was a tendency to an increase in the resistance of gram-negative bacteria. Measures should be taken to try to control this phenomenon, and consider possible antimicrobial therapy alternatives to infections caused by these microorganisms.

Dynamism in Resistance Pattern of Escherichia coli - A Drift from Indian Council of Medical Research (ICMR) - Antimicrobial Use Guidelines

Background/Purpose: Combating Antibiotic resistance has become a great challenge for clinicians due to inappropriate use of antibiotics. Antibiotics once considered being magic bullet is no more having that title. Recommendation in AMR situation in by Department of Biotechnology (DBT) and Treatment Guidelines for Antimicrobial Use by Indian Council of Medical Research (ICMR) India emphasized the need for regional surveillance starting from the level of state to an individual hospital has been motivation behind the study. Method: Three hospitals in region of Cuddalore in Tamilnadu (India) have been the source of specimen for isolation of Escherichia coli during the period of January to July 2017. Antibiogram reports were collected during the study period and utilized for the study. Result: Among 124 isolates Urine, High vaginal swab, Pus, Serum, Oral swab and Amniotic fluid occupied 81.45%(n-101), 08.06%(n-10), 5.64%(n-7), 2.41%(n-3), 1.62%(n-2) and 0.81%(n-1) respectively. Antibiogram for the Escherichia coli isolates revealed 90% of resistance to Cefepime, 68% to Ciprofloxacin, 50% to Tetracyclin, 30% to Meropenum etc., Similarly high percentage of sensitiveness was evident in Cefotaxime (95.94%), Imipenum (95.91%), Piperacillin/Tazobactem (86%), Meropenum (70%) etc. Conclusion: On comparison with the 2014 ICMR (Antimicrobial Susceptibility) data percentage of resistance and susceptibility has a drastic change both in resistance and sensitivity. From the study it is clear that the generic recommendations on antibiotic use at national level can't be a desirable solution or recommendations to clinicians. The study signifies the importance of local surveillance and infection control programs. Funding Statement: No funding was obtained for this study. Declaration of Interest: The authors report no conflict of interest. Ethics Approval Statement: The samples were not collected exclusively for this study, and since it is a retrospective study where we have analysed the sensitivity pattern of the isolates in reference to ICMR-Antimicrobial use guidelines. Similarly international guidelines such as Consolidated Standards of Reporting trials (CONSORT) and uniform requirements for manuscripts submitted to biomedical journals(URM) states that ethics approval is required when animal or human are to be used for teaching or new intervention research. Since our study is not coming under prospective randomised trials we have not gone for Ethical clearance.

Surveillance of resistance in the intensive care units using a cumulative antibiogram

Empiric treatment with broad-spectrum antibiotics exerts condensed pressure in intensive care units (ICUs) for the selection of multidrug-resistant bacteria. Multidrug-resistant gram-negative bacteria became the focus of interest owing to limited treatment options and negative effects on patient survival. Cumulative antibiograms can guide selection of correct empiric treatment, de-escalation treatment according to antibiogram results and development of policies in fight against antibiotic resistance. In this study, we aimed to determine the antibiotic resistance rates of gram-negative bacilli in the intensive care units of the public hospitals in the region where we are connected by using the cumulative antibiogram result and to show the change of resistance over the years and to determine whether there is any difference between the hospitals. Gram-negative bacilli were isolated from ICUs of state hospitals in the second Istanbul State Hospitals Association area during 2014-2016. Isolates were identified using Vitek MS (bioMérieux, France) system and tested for antibiotic susceptibility with Vitek 2 (bioMérieux, France) system according to the Clinical and Laboratory Standards Institute (CLSI) criteria followed during those years. Cumulative antibiogram reports for these strains were prepared according to the CLSI M39-A4 guide. Gram-negative bacilli were divided into three groups: non-fermentative, urinary enteric, and non-urinary enteric bacilli. Total number of strains isolated during three years from these groups were 2626, 1390 and 2011, respectively. Annual trends of susceptibility during the aforementioned years were evaluated. Hospitals were also classified into five groups and differences were evaluated in the susceptibility profiles of these hospitals. Among the non-fermentative bacilli, Acinetobacter baumannii complex was the most commonly isolated species and the most resistant bacteria against antibiotics. The susceptibility rates of A.baumannii complex against the beta-lactam group of antibiotics were < 10%. Colistin susceptibility rates of A.baumannii complex and Pseudomonas aeruginosa isolates were over 98%. Among the non-urinary enteric bacilli, K.pneumoniae was the most commonly isolated species displaying maximum antibiotic resistance. Susceptibility rates for colistin, which is the last resort for treating resistant gram-negative bacteria, ranged between 73% and 80%. Escherichia coli, which was the second most common isolated species among non-urinary bacilli, had susceptibility rates over 90% to carbapenems along with colistin and tigecycline. Although E.coli was the most commonly isolated species among urinary enteric bacilli, K.pneumoniae and Proteus mirabilis were the most resistant isolates. A statistically significant decrease in susceptibility rates against all antibiotics was observed in P.mirabilis isolates between the years 2015-2016. Carbapenem susceptibility rates decreased below 70%. E.coli, Serratia spp., and Stenotrophomonas maltophilia had similar susceptibility profiles among different hospitals, indicating homogenous distribution, whereas other species had different profiles, indicating a more heterogenic distribution, among hospitals. The reports of this study were generated according to a standard guide and they clearly revealed the seriousness of antibiotic resistance in our region which represents approximately one-fourth area of Istanbul. When all the results were considered, best empiric treatment option for enteric bacilli except K.pneumoniae was carbapenems. For K.pneumoniae infections there is no reliable choice other than colistin but a de-escalation treatment can be planned according to antibiogram results. Similarly colistin is the first choice in empiric treatment of infecitons due to non-enteric bacilli. However, the heterogeneity of the susceptibility profile observed in the hospitals, which are geographically close to each other, indicated the difference in the flora of the intensive care unit of hospitals. It would be appropriate to prepare cumulative antibiogram reports similar to those in the present study, to prevent complications, reduce costs and improve patient prognosis in the intensive care units of hospitals and these reports should become part of the infection control policies applied in hospitals.

Perfil de resistencia antibiótica en infecciones oculares en un centro de referencia en Floridablanca, Colombia

Background and objectiveIn view of the increasing bacterial resistance to antibiotics, it is necessary to determine it locally in order to serve as a guide in clinical management. The purpose of this study was to characterise the pattern of antibiotic sensitivity in cases of eye infections in a third level ophthalmological institution in Floridablanca (Colombia). Materials and methodsAn observational cross-sectional study in which an analysis was made of the culture and antibiogram reports of specimens taken from cases of conjunctivitis, infectious keratitis, and endophthalmitis between January 2013 and June 2016. ResultsA total of 833 specimens were positive for bacteria. Considering both gram-positive and gram-negative microorganisms gentamicin, tobramycin, and ciprofloxacin showed high resistance rates (64.4%, 40.3%, and 29.1%, respectively). Moxifloxacin, vancomycin, imipenem, and gatifloxacin showed low percentages of resistance: 2.6%, 2.1%, 0.6%, and 0.4%, respectively. When comparing the results with previous studies in our institution, there was a decrease in sensitivity to the fourth-generation quinolones and imipenem, especially within the gram-negative ones. ConclusionFourth generation quinolones, imipenem and vancomycin continue to have a low in vitro resistance to bacteria that cause eye infections. However, there was a tendency to an increase in the resistance of gram-negative bacteria. Measures should be taken to try to control this phenomenon, and consider possible antimicrobial therapy alternatives to infections caused by these microorganisms.

Correlation of empiric antibiotic use with susceptibility pattern of blood isolates in septicemic patients in an Intensive Care Unit

Background: Bloodstream infections remain a major cause of mortality and morbidity. Respiratory tract, genitourinary tract, and intra-abdominal foci are often the common identifiable foci of these infections. Definitive treatment based on blood cultures and susceptibility is essential to treat sepsis cases for better outcome. This study was conducted to document the bacteriological profile, their susceptibility pattern, antibiotics used for empiric and definitive treatment, escalation or de-escalation of antibiotics done following antibiogram report. Materials and Methods: descriptive study was carried out for a period of 1 year after obtaining waiver of consent from Institute Ethics Committee. Demographic details, length of hospital stay, risk factors, bacteriological profile with antimicrobial resistance pattern, empiric antibiotic and definitive antibiotic given and outcome of patient were recorded. Statistical analysis was done by using IBM SPSS version 16.0 (SPSS Inc., Chicago, IL, USA) software. Results: Overall prevalence of sepsis was 9.5%. Gram-negative bacteria were more commonly isolated (62.8%) than Gram-positive bacteria (37.2%), and Escherichia coli was the most common isolate (24.3%). Antimicrobial resistance among Gram-negative bacterial isolates was maximum with ciprofloxacin (51.3%) and ceftriaxone (45.2%), and least with amikacin, imipenem (16.7%), and polymyxin B (2.6%). Penicillin group of antibiotics were commonly used for empiric treatment, and glycopeptides/polymyxins and carbapenems were most preferred for definitive treatment. Conclusion: Knowledge about prevalence, risk factors, bacteriological profile, and their antibiogram resistance pattern is essential to select the antibiotic for the empiric treatment of suspected cases of sepsis and to formulate antibiotic policy. It is also important to de-escalate/escalate antibiotics according to the susceptibility report for a better outcome and to shorten the period of morbidity.

Inference of the phenotypic resistance profile of Pseudomonas aeruginosa through an interpretative reading of the antibiogram in a pediatric hospital. 2006-2014.

Introduction: Pseudomonas aeruginosa behaves as an opportunistic pathogen involved in hospital infections, with high capacity to generate resistance to antibiotic treatment. The interpretative reading of the antibiogram makes possible inferring these resistance mechanisms and establishing appropriate antibiotic treatment.Objective: The interpretative reading of the antibiogram seeks to infer the resistance phenotype of P. aeruginosa at Fundación Hospital de la Misericordia (HOMI, by its acronym in Spanish) between 2006 and 2014.Materials and methods: Descriptive cross-sectional study where a search of positive antibiogram reports for P. aeruginosa was performed. The resistance phenotype was deduced based on the interpretative reading of the antibiogram.Results: A sample of 463 positive antibiograms for P. aeruginosa was obtained; these samples were taken from children aged 0 to 17, showing a higher prevalence among infants and toddlers. The antibiograms mainly came from male subjects (62.2%). The most frequent hospitalization services were: PICU —pediatric intensive care unit— (30.2%) and general hospitalization (27.3%). The most common sources of isolation were: blood (24.4%) and urine (23.8%). 11 phenotypes were characterized, being the most common: natural phenotype (63.2%), loss of porin OprD (5.7%) and partial and full AmpC derepression (8.4% and 8.2%, respectively).Conclusion: Isolation of P. aeruginosa at HOMI predominantly shows a natural phenotype. The interpretative reading of the antibiogram allowed inferring 11 phenotypes.

LATEST LABORATORY DIAGNOSTIC TECHNIQUES AND ANTIBIOGRAM TESTING OF TUBERCULOSIS INFECTION

Tuberculosis (TB) ranks as the second leading cause of death from a single infectious agent, after the human immune-deficiency virus (HIV). Millions of people die because of this disease. Tuberculosis is treatable disease, patients can be saved provided the disease is timely diagnosed. With the ambitious World Health Organization (WHO) goal to end the global TB epidemic, by 2035, with the targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence (both compared with 2015). It becomes essential to focus on rapid laboratory diagnosis of the disease and subsequently starting effective first line treatment. The techniques reviewed in this paper, are conventional to automated culturing procedures. Moreover, among rapid techniques included Loop Mediated Isothermal Amplification, Line Probe Assay, Ligase chain reaction, Real time PCR. The serological techniques include Gamma interferon release assays, Enzyme-linked immunospot (ELISPOT) assays. The old conventional manual techniques for culture have been replaced by more rapid and reliable automated techniques. As long as speed of reporting is concerned the automated culturing procedures have been supplemented by real time PCR which gives report of culture and antibiogram testing report within hours. It has been justified, in order to achieve the goal set by WHO, for the eradication of TB, it is essential to improve detection techniques, including latent forms of the disease as well and timely identification of resistance strains. Real time PCR would fulfil thiscriteria, which can be performed even on OPD basis. This technique can be used as commonly as Acid Fast Bacilli (AFB) staining techniques were once used.

Challenges in Preparation of Cumulative Antibiogram Reports for Community Hospitals.

Knowledge of local antimicrobial resistance is critical for management of infectious diseases. Community hospitals' compliance with Clinical and Laboratory Standards Institute (CLSI) guidance for creation of cumulative antibiograms is uncertain. This descriptive cohort study of antibiogram reporting practices included community hospitals enrolled in the Duke Infection Control Outreach Network. Cumulative antibiograms from 2012 were reviewed for criteria on reporting practices and compliance with CLSI guidelines. Microbiology personnel were sent a voluntary, electronic survey on antibiogram preparation practices. Data were compiled using descriptive statistics. Thirty-two of 37 (86%) hospitals provided antibiograms; 26 of 37 (70%) also provided survey responses. Twelve (38%) antibiograms specified methods used for compiling data and exclusion of duplicates. Eight (25%) reported only species with >30 isolates. Of the 24 that did not follow the 30-isolate rule, 3 (13%) included footnotes to indicate impaired statistical validity. Twenty (63%) reported at least 1 pathogen-drug combination not recommended for primary or supplemental testing per CLSI. Thirteen (41%) separately reported methicillin-resistant and -susceptible Staphylococcus aureus. Complete compliance with CLSI guidelines was observed in only 3 (9%) antibiograms. Survey respondents' self-assessment of full or partial compliance with CLSI guidelines was 50% and 15%, respectively; 33% reported uncertainty with CLSI guidelines. Full adherence to CLSI guidelines for hospital antibiograms was uncommon. Uncertainty about CLSI guidelines was common. Alternate strategies, such as regional antibiograms using pooled data and educational outreach efforts, are needed to provide reliable and appropriate susceptibility estimates for community hospitals.

BIRDEM News - Microbiology: Bacteria and Antibiogram Report (July to December 2012 Report)

Birdem Med J 2013; 3(2): 126-129 DOI: http://dx.doi.org/10.3329/birdem.v3i2.17223