Majority Of Gram-negative Isolates Research Articles

BACTERIOGICAL PROFILE OF CRITICALLY ILL PATIENTS IN INTENSIVE CARE UNIT IN BANGALORE

Objective: Intensive care units (ICUs) are considered as the epicentre of infections due to its vulnerable conditions for development, amplification, and dissemination of drug-resistant microorganisms. Furthermore, the use of inappropriate or incorrect antibiotics is also closely related to development and spread of drug-resistant microorganisms. Hence, the present study was conducted in a private hospital in South Bangalore, to evaluate the spectrum of micro organisms isolated from clinical samples of patients admitted in ICU and their antimicrobial susceptibility pattern. Methods: This observational study was conducted on critically ill patients admitted in medical ICUs of private hospital in south Bangalore, Karnataka, India. The study was designed to include all patients with age 18 years or older, admitted for more than 48 h in medical ICUs of the hospital and having at least two of the clinical signs of SIRS. Depending on the clinical suspicion, clinical samples such as pus, blood, urine, body fluids, respiratory specimen were collected. The samples collected were first subjected to gram staining and then were inoculated on blood agar and MacConkey agar plates taking proper aseptic precautions. Antimicrobial sensitivity patterns of respective organisms were studied on Mueller Hinton agar media by Kirby Bauer’s disk diffusion method. Results: A total of 665 clinical samples were received in the microbiology laboratory out of which 60% samples showed significant microbial growth. The most predominant isolates were Gram-negative organisms 72.68% and Gram-positive isolates were seen in 27.3%. Sample-wise distribution of positive culture was done. Pus 33%, respiratory specimen 26%, urine 20%, blood 15%, and body fluids 6%. Majority of Gram-negative isolates were susceptible to amikacin, followed by piperacillin/tazobactum, cefeperazone/salbactum and imipenem and high resistance rates to ampicillin, amoxy clav was noted. Most of the Staphylococcus aureus were sensitive to linezolid, vancomycin, followed by amikacin, pipercillin/tazobactum, and cefeperazone/salbactum. Conclusion: The present study showed the high prevalence of aerobic bacteria in clinical samples of critically ill patients in ICUs. The study identified both Gram-positive and Gram-negative organisms to be responsible for causing blood stream infections. There should be continuous surveillance of data of clinical isolates along with their sensitivity pattern with routine surveillance for baseline resistance, stringent hospital infection policy, and their implementation in the hospital is the need of the hour to stop or reduce drug resistance.

Bacterial Contamination of Neonatal Intensive Care Unit

Background and objectives. The environmental impact assessment plays an important role in ensuring environmental media. This study aimed to assess the environmental pollution of the neonatal intensive care unit in Al-Jala hospital of obstetrics and gynecology, Tripoli, Libya through environmental monitoring of bacteria on different surfaces. Methods. A cross-sectional, descriptive study was carried out in the neonatal intensive care unit from December- to February 2022 at Al-Jala hospital, Tripoli. A total of 61 samples were collected with a sterile swab from high-contact environmental surfaces. Isolation, identification, and antibiotic resistance of bacterial isolated were performed by standard technique. Blood culture isolates from neonatal intensive care unit patients were compared with the environmental isolates during the study period. Results. Out of 61 samples, bacterial growth was observed in 58 samples, out of which 40 (68.9%) were gram-positive and 18 (31.03%) were gram-negative. The observed gram-positive bacterial isolate was Staphylococcus aureus 13(32.5%), and most of gram-positive isolates were recovered from an incubator, suction tip, stethoscope, ambu bag, and staff hand. The potential gram-negative bacterial isolates were E. coli 10 (55.5%), and the majority of gram-negative isolates were recovered from the door handle, suction tip, neonate breathing tube, and staff hand. The isolated bacteria were resistant to amoxicillin (41.3%), clindamycin (39.6%), imipenem, and tetracycline (27.5%). Common potential pathogens isolated from the blood culture of NICU patients were staphylococcus aureus. Conclusion. Bacterial contamination of objects and instruments in neonatal intensive care units was high (95%). This study emphasizes the need for rigorous decontamination protocols and hand hygiene. Clindamycin and tetracycline may be used for empirical therapy in clinically suspected cases of isolates.

Bacteriological profile of surgical site infections in a tertiary care hospital of western Nepal

Introduction: Surgical site infections are one of the most commonly reported nosocomial infections resulting into significant morbidity and mortality. Hospital admission and surgical procedures increase the risk of infection with multidrug resistant pathogens. This study was aimed to determine the bacterial agents associated with surgical site infections and antibiotic resistance patterns of the isolates.
 Methods: A total of 161 specimens from patients with surgical site infections were included in this study. Isolation, identification and antibiotic susceptibility testing of the isolates was performed by standard microbiological techniques.
 Results: Out of 161 samples, 94 bacterial isolates were recovered. Gram positive bacteria were isolated in 57.4% (54/94) cases and Staphylococcus aureus was the most common organism (49/54) with 65.3% (32/49) methicillin resistant Staphylococcus aureus isolates. All S. aureus isolates were susceptible to vancomycin. Gram negative bacteria constituted 42.6% (40/94) of total isolates and Escherichia coli was the commonest organism (13/40). Majority of Gram negative isolates were susceptible to amikacin, imipenem and piperacillin-tazobactam. Resistance to imipenem was detected among isolates of E coli, Pseudomonas and Acinetobacter species. 
 Conclusion: Gram positive isolates were more commonly associated with surgical site infections. High percentage of MRSA was detected among the S. aureus isolates but no vancomycin resistant S. aureus. High percentage of Gram negative isolates was susceptible to imipenem, piperacillin-tazobactam, amikacin and gentimicin.

Antibiotic profiles of Microbial Infection in Diabetic Foot Ulcers

Introduction and aim: Diabetic foot ulcers are a serious medical and economic worry. It is the most common reason for diabetic patients to be admitted to hospital. If not treated appropriately, the infection might lead to amputation of the infected foot. The current research aims to recognise the frequencies of isolated aerobic bacterial pathogens associated with diabetic foot ulcers and detect their antibiotic susceptibility and resistance patterns to reduce the risk of complications.
 Methodology: This cohort study included 140 swab samples from diabetic foot ulcers from patients referred to the surgery department at Al-Azhar University Hospital in New Damietta, Egypt, in the period between January and December 2018. All samples were processed for the identification of aerobic bacterial strains were identified using routine bacteriological culture methods and antimicrobial susceptibility by the Kirby-Bauer disc diffusion method.
 Results: Out of 140 pus and tissue samples obtained of diabetic foot ulcers, 120 (85.7%) exhibited aerobic organism growth, yielding a total of 132 isolates with an average of 1.1 isolates per specimen. Polymicrobial infection was 10%. Gram-negative isolates were prominent (62.88%), with Pseudomonas aeruginosa (26.5%) being the most common strain causing diabetic foot infections, followed by E. coli (20.5%). Staph aureus was the most common Gram-positive bacteria (8.9%). Out of 83 Gram-negative bacteria, 54 (65%) produced extended-spectrum lactamase (ESBL). The majority of Gram-negative isolates were resistant to levofloxacin, gentamicin, ampicillin-sulbactam, and gatifloxacin. All Gram-negative bacteria were sensitive to imipenem. Of the 25 Staph aureus, 15 (60%) were Methicillin Resistant Staphylococcus aureus (MRSA) and susceptible to vancomycin and linezolid.
 Conclusion: Pseudomonas sp. was the most prevalent cause of infections. Most isolates were multidrug resistant. In our study, Gram-negative bacteria were the main cause of diabetic foot infections. A significant number of MDR isolates were also observed. The inappropriate use of broad-spectrum antibiotics may be the main cause of the increase in the frequency of MDR isolates.

Bacterial Isolates of Early Onset Neonatal Sepsis and Their Antibiotic Susceptibility Pattern

Background: Neonatal infections are the commonest cause of neonatal mortality along with perinatal asphyxia and consequence of Prematurity and Low Birth Weight (LBW) in Bangladesh. Early Onset Neonatal Sepsis (EONS) is neonatal sepsis occurring within the first 72 hours of birth and it is much more fulminant and has a higher mortality than Late Onset Sepsis (LOS). Sepsis in neonate remains a significant cause of mortality and morbidity in developing countries. Changing bacterial flora and emergence of resistant strains adds to the problem. Thus, neonatal sepsis requires accurate and timely clinical and laboratory diagnosis and proper management for better outcome. The organisms responsible for Early Onset Sepsis (EOS) are different than Late Onset Sepsis (LOS). In this study an attempt has been made to know the positivity rate of EOS and profile of bacteria responsible for EOS and determine the antimicrobial sensitivity pattern that were investigated for rule out sepsis.
 Methods: This was a prospective observation single centre study over a period of nine months (January to September, 2017) conducted on neonates born at Ad-din Medical College Hospital (AMCH), Dhaka and subsequently admitted in Neonatal Intensive Care Unit (NICU) within 72 hours of birth that were investigated for rule out sepsis. Dual blood sample for cultures from separate area along with essential investigations were sent by collecting samples under aseptic precautions. Empirical antimicrobial therapy was started according to antimicrobial guidelines in the NICU. The blood cultures test were carried out by BD BACTEC automated blood culture system and susceptibility testing was done for all blood culture isolates according to the criteria of the National Committee for Clinical Laboratory Standards by disk diffusion method.
 Results: A total of 700 neonates were investigated to rule out sepsis and 5.43% neonates were found with culture proven sepsis in the study. The gram positive bacteria accounted for 71% and gram negative 29% of the total isolates. Out of total 38 isolates, Coagulase-Negative Staphylococci (CONS) (68.4%) was the commonest followed by Acinetobacter (18.4%) and E. coli (7.9%) was common culture isolates. Among the gram positive, CONS (96.3%) was commonest isolate and in gram negative Acinetobacter (63.6%) was the most prevalent bacteria followed by E.coli (27.3%). Gram positive isolate, especially CONS (68.4%) was the major culprit for the early onset sepsis. Among the commonly used antibiotics, the susceptibilities were remarkably low to Amikacin (16%) in comparison to Ampicillin (42%) Cefotaxime (45%) and moderately high to Gentamicin (58%) for both gram positive & gram negative isolates. All (100%) gram positive isolates were resistant to Amikacin. Majority of the gram positive showed low susceptibilities to Meropenem (22%) Ciprofloxacin (41%) Ampicillin (48%) & Oxacillin (48%) in comparison to Cefotaxime (52%) Levofloxacin (55%) Gentamicin (70%), Linezolid (70%) and Vancomycin (74%). 50% of Coagulase Negative Staphylococcus (CONS) were resistant to Methicillin/Oxacillin. The sensitivity pattern of majority of gram negative isolates showed high level of resistance to Piperacillin+Tazobacterm (9%) and Ampicillin (27%) Gentamicin (27%) Cefotaxime (27%) less sensitive to Ciprofloxacin (45%); moderately high to Levofloxacin (54%) & Amikacin (54%) and highly sensitive to Imipenem/Meropenem (73%) & Colistin (91%). Gentamicin (58%) and Levofloxacin (55%) were showed marginal superiority compared to Ampicillin (42%) and Cefotaxime (45%) for effective coverage of both.
 Conclusion: Present study indicated that gram positive species especially CONS continue to be the predominant causative organism followed by Acinetobacter and E. coli in gram negative species. The antibiotic susceptibility profile suggested that for a given cohort empiric (initial) choice of Ampicillin and Gentamicin in EOS. Routine bacterial surveillance and their sensitivity patterns must be an essential component of neonatal care
 Chatt Maa Shi Hosp Med Coll J; Vol.17 (1); Jan 2018; Page 3-8

Emerging Trends of Bloodstream Infections: A Six-Year Study at a Paediatric Tertiary Care Hospital in Kabul.

To determine the frequency of pathogens causing bloodstream infections and evaluate their trends and antibiogram patterns among in-patients in a paediatric tertiary care centre. Descriptive study. French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan in two phases, from January 2010 to December 2015. Results of blood cultures from suspected cases of sepsis admitted in the FMIC, from January 2010 to December 2012 (Period-1), and from January 2013 to December 2015 (Period-2) were completed. Standard microbiological methods were followed for blood culture and antibiotic sensitivity testing. Out of total 1,040 cases of culture proven sepsis, 528 (50.77%) Gram-negative bacilli (GNB), 474 (45.58%) Gram-positive cocci (GPC), and 38 (3.65%) Candida species were isolated during the entire study period. Out of 528 GNB isolates, 373 (70.64%) belonged to the Enterobacteriaceae and 155 (29.36%) were non-fermenters. Among Enterobacteriaceae, 168 (31.82%) were Klebsiella species (K. pneumoniae=124, K. oxytoca=44), 70 (13.26%) were Enterobacter species (E. cloacae=52, E. aerogenes=18), 65 (12.31%) were E. coli, 37 (7.01%) were Serratia marcescens and 31 (5.87%) were others. Out of 155 non-fermenters, 88 (16.67%) were Pseudomonas aeruginosa, 39 (7.39%) were Burkholderia cepacia and 18 (3.41%) were Stenotrophomonas maltophilia. There was a drop in the frequency of Enterobacteriaceae from 85% in Period-1 to 58.68% in Period-2. There was an increase in the frequency of nonfermenters from 15% to 41.32%, particularly 18 new cases of sepsis caused by Stenotrophomonas maltophilia during Period-2. Among GPC, there was an overall rise of 16.14% in the prevalence of Staphylococcus epidermidis during Period-2 and a drop of 9.64% in the frequency of Staphylococcus aureus during Period-2. The majority of Gram-negative isolates were multidrug-resistant to commonly used antibiotics. However, most of the isolates were sensitive to amikacin and imipenem (except S. maltophilia). The frequency of those producing ESBL reduced by 11.22% during the Period-2. Among Gram-positive cocci, the pattern of antibiogram did not show a significant change during both periods, and majority remained resistant to commonly used antibiotics. All Staphylococci were sensitive to vancomycin but resistant to penicillin. There was a substantial decline of 18.87% in the frequency of Methicillin-resistant Staphylococci (MRSA/MRSE) during Period-2. Staphylococci and Klebsiellae remain the most important bacteria responsible for bloodstream infections in a tertiary healthcare facility in Kabul. Yet, there has been an increase in the prevalence of Pseudomonas and Burkholderia cepacia. Moreover, Stenotrophomonas maltophilia emerged as a new hospital acquired pathogen. This study could possibly help in suggesting choices eluding the misuse of appropriate antibiotics.

Monitoring of Frequency and Antimicrobial Susceptibility of Pathogens on the Hands of Healthcare Workers in a Tertiary Hospital.

To monitor microbes, focusing on drug resistance, on the hands of the personnel of four departments of a tertiary hospital (ICU, neonatal unit, internal medicine ward and surgical ward) and explore differences between departments, professions and genders. Hand sampling from 125 healthcare employees was conducted followed by isolation, identification and antibiotic resistance profiling of different microbial species. Staphylococcus spp was the most prevalent microbe (76/125, 60.8%), followed by different Gram-negative pathogens (45.6%). ICU employees had a significant probability to have Gram-negative contamination [OR 3.627 (95% CI 1.220-10.782)], independently of gender or profession. Staphylococcus spp presence was associated with working in the internal medicine ward [OR 6.976 (95% CI 1.767-25.540)] and the surgical ward [OR 5.795 (95% CI 1.586-21.178)]. Staphylococcus spp was more prevalent in males vs. females (81.3% vs. 54.9%, p=0.008) and in medical vs. nursing personnel (76.9% vs. 54.8, p=0.019). In the majority of Gram-negative isolates (56.1%), at least one multi-drug resistant (MDR) or extensively drug resistant (XDR) strain was isolated. A statistically significant higher prevalence of XDR Gram-negative microbes was found on the hands of nursing personnel (22.2% vs. 2.3% for medical doctors, p=0.014). Only 2 methicillin resistant Staphylococcus Aureus (MRSA) out of the 12 Staphylococcus aureus positive samples were identified. Employees in the ICU are more prone to Gram-negative and not to Gram-positive hand contamination. MDR and XDR pathogens are prevalent, and are associated with nursing profession.

AmpC β-lactamases producing Gram-negative clinical isolates from a tertiary care hospital

Introduction: AmpC βlactamases are clinically significant since these confer resistance to cephamycins as well as other extended-spectrum cephalosporins and are not affected by βlactamase inhibitors. Objectives: This prospective study was planned to detect AmpC producers among Gram-negative clinical isolates and to compare drug resistance in AmpC and non-AmpC producers. Materials and Methods: In this 1-year prospective study, all Gram.negative isolates were identified by colony characteristics, Gram.staining, biochemical reactions as per standard procedures. Antimicrobial susceptibility was done by as per Clinical and Laboratory standards Institute guidelines. The AmpC was detected by AmpC disc test. Results: Of 2100 samples received, 581 samples showed growth of Gram-negative isolates. Monomicrobial growth was seen in 79.8% and polymicrobial in 20.1%. There were 711 Gram-negative isolates. Of which Acinetobacter baumannii (32.5%), Klebsiella pneumoniae (29.2%), and Pseudomonas aeruginosa (22.3%) were common. Antimicrobial susceptibility pattern showed increased sensitivity toward carbapenems, polymixin B, and tigecycline. AmpC- β-lactamase production was seen in 13.3% isolates and AmpC producers showed high resistance to various antimicrobial agents as compared to non-AmpC producers. Conclusion: Majority of Gram-negative isolates were multidrug resistant and AmpC production was seen in 13.3% isolates. A. baumannii and K.pneumoniae showed maximal AmpC production. AmpC testing is therefore recommended as a mandatory test in a hospital set up.