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Antibiotic susceptibility pattern in urinary isolates of gram negative bacilli with special reference to AmpC β-lactamase in a tertiary care hospital  [cached]
Patel Mitesh,Trivedi Grishma,Patel Sachin,Vegad Mahendra
Urology Annals , 2010,
Abstract: Introduction: Resistance to higher antimicrobial agent is commonly seen in gram negative bacilli. This issue is a challenging problem to the medical practitioners in addition to it is financial impact on the health care system. Objectives: To document the prevalence of multi drug resistant gram negative bacilli isolated from urine of patients attending the Urology Department of Tertiary care Hospital of western India in year 2008. Results: Out of total 328 isolates, 118 (35.98%) E.coli, 72 (21.95 %) Klebsiella, 64 (19.51%) Pseudomonas aeruginosa, 30 (9.15%) Acinetobacter, 18 (5.49%) Proteus vulgaris, 18 (5.49%) Proteus mirabilis, 6 (1.83%) Providencia rettgerii, 2 (0.61%) Citrobacter freundii. Out of these isolates, 228 (69.51%) were b-lactamase positive, while 100 (30.51%) were β-lactamase negative. Out of 228 β-lactamase positive, 104 (45.61%) were AmpC β-lactamase positive. Conclusions: Stringent protocol such as Antibiotic policy and Hospital infection control program are mandatory to curb these microbes in a tertiary care hospital.
Antibiotic-Resistant Gram Negative Bacilli in Meals Delivered at a General Hospital, Italy  [PDF]
Maria Rosa Anna Plano,Anna Maria Di Noto,Alberto Firenze,Sonia Sciortino,Caterina Mammina
Interdisciplinary Perspectives on Infectious Diseases , 2009, DOI: 10.1155/2009/476150
Abstract: This study aimed at detecting the presence of antibiotic-resistant Gram-negatives in samples of meals delivered at the University General Hospital of Palermo, Italy. Antibiotic resistant Gram negatives were isolated in July—September 2007 ffrom cold dishes and food contact surfaces and utensils. Bacterial strains were submitted to susceptibility test and subtyped by random amplification of polymorphic DNA (RAPD). Forty-six of 55 (83.6%) food samples and 14 of 17 (82.3%) environmental swabs were culture positive for Gram negative bacilli resistant to at least one group of antibacterial drugs. A total of 134 antibiotic resistant strains, 51 fermenters and 83 non-fermenters, were recovered. Fermenters and non-fermenters showed frequencies as high as 97.8% of resistance to two or more groups of antibiotics and non fermenters were 28.9% resistant to more than three groups. Molecular typing detected 34 different profiles among the fermenters and 68 among the non-fermenters. Antibiotic resistance was very common among both fermenters and non-fermenters. However, the wide heterogeneity of RAPD patterns seems to support a prominent role of cross-contamination rather than a clonal expansion of a few resistant isolates. A contribution of commensal Gram negatives colonizing foods to a common bacterial resistance pool should not been overlooked.
Antibiotic susceptibility patterns among respiratory isolates of Gram-negative bacilli in a Turkish university hospital
Ugur Gonlugur, Mustafa Bakici, Ibrahim Akkurt, Tanseli Efeoglu
BMC Microbiology , 2004, DOI: 10.1186/1471-2180-4-32
Abstract: We cultured organisms from sputum (54%), tracheal aspirate (25%), and bronchial lavage fluid (21%). The most common organisms were Klebsiella spp (35%), A. baumanii (27%), and Escherichia coli (15%). Imipenem was the most active agent, inhibiting 90% of Enterobacteriaceae and A. baumanii organisms. We considered approximately 12% of Klebsiella pneumoniae and 21% of E. coli isolates to be possible producers of extended-spectrum beta-lactamase. K. pneumoniae isolates of the extended-spectrum beta-lactamase phenotype were more resistant to imipenem, ciprofloxacin, and tetracycline in our study than they are in other regions of the world.Our results suggest that imipenem resistance in our region is growing.Nosocomial bacterial pneumonia is frequently polymicrobial, with gram-negative bacilli predominating [1]. Because delays in antimicrobial treatment can lead to adverse outcomes, the choice of empirical therapy is vital. Many effective antimicrobial agents are available, but the treatment of nosocomial pneumonia remains challenging. We recently reported the antibiotic-resistance patterns of respiratory isolates of Pseudomonas aeruginosa in our region [2]. The current study investigates the distribution and drug resistance of other gram-negative bacteria in the respiratory secretions of hospitalized patients.Table I and Table II present the antibiotic susceptibility patterns of our isolates. The most common organisms were Klebsiella spp (35%), A. baumanii (27%), and E. coli (15%). We also isolated rare organisms such as Stenotrophomonas maltophilia, Burkholderia spp, and Hafnia alvei. All studied Enterobacteriaceae (except Enterobacter spp) were far more susceptible to ticarcillin-clavulanate than to ticarcillin alone, which suggests that the primary mechanism of resistance in these organisms is β-lactamase production.K. pneumoniae accounted for 79% of Klebsiella isolates. Klebsiella spp were generally more susceptible to the tested antimicrobials than were Enterobacter
Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the intensive care unit  [cached]
Goel Nidhi,Chaudhary Uma,Aggarwal Ritu,Bala Kiran
Indian Journal of Critical Care Medicine , 2009,
Abstract: Background: Lower respiratory tract infections (LRTIs) are the most frequent infections among patients in Intensive care units (ICUs). Aims: To know the bacterial profile and determine the antibiotic susceptibility pattern of the lower respiratory tract isolates from patients admitted to the ICU. Settings and Design: Tertiary care hospital, retrospective study. Materials and Methods: Transtracheal or bronchial aspirates from 207 patients admitted to the ICU were cultured, identified, and antibiotic sensitivity was performed by standard methods. Statistical Analysis Used: SPSS software was used for calculation of % R of 95% confidence interval (CI). Results: Of 207 specimens, 144 (69.5%) were culture positive and 63 (30.4%) showed no growth. From 144 culture positives, 161 isolates were recovered, of which 154 (95.6%) were Gram negative bacilli (GNB). In 17 (11.0%) patients, two isolates per specimen were recovered. The most common GNB in order of frequency were Pseudomonas aeruginosa (35%), Acinetobacter baumannii (23.6%), and Klebsiella pneumoniae (13.6%). A very high rate of resistance (80-100%) was observed among predominant GNB to ciprofloxacin, ceftazidime, co-trimoxazole, and amoxycillin/clavulanic acid combination. Least resistance was noted to meropenem and doxycycline. Conclusion: Nonfermenters are the most common etiological agents of LRTIs in ICU. There is an alarmingly high rate of resistance to cephalosporin and β-lactam-β-lactamase inhibitor group of drugs. Meropenem was found to be the most sensitive drug against all GNB. Acinetobacter and Klebsiella spp. showed good sensitivity to doxycycline.
Antibiotic Consumption and Healthcare-Associated Infections Caused by Multidrug-Resistant Gram-Negative Bacilli at a Large Medical Center in Taiwan from 2002 to 2009: Implicating the Importance of Antibiotic Stewardship  [PDF]
I-Ling Chen, Chen-Hsiang Lee, Li-Hsiang Su, Ya-Feng Tang, Shun-Jen Chang, Jien-Wei Liu
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0065621
Abstract: Background Better depicting the relationship between antibiotic consumption and evolutionary healthcare-associated infections (HAIs) caused by multidrug-resistant Gram-negative bacilli (MDR-GNB) may help highlight the importance of antibiotic stewardship. Methodology/Principal Findings The correlations between antibiotic consumption and MDR-GNB HAIs at a 2,700-bed primary care and tertiary referral center in Taiwan between 2002 and 2009 were assessed. MDR-GNB HAI referred to a HAI caused by MDR-Enterobacteriaceae, MDR-Pseudomonas aeruginosa or MDR-Acinetobacter spp. Consumptions of individual antibiotics and MDR-GNB HAI series were first evaluated for trend over time. When a trend was significant, the presence or absence of associations between the selected clinically meaningful antibiotic resistance and antibiotic consumption was further explored using cross-correlation analyses. Significant major findings included (i) increased consumptions of extended-spectrum cephalosporins, carbapenems, aminopenicillins/β-lactamase inhibitors, piperacillin/tazobactam, and fluoroquinolones, (ii) decreased consumptions of non-extended-spectrum cephalosporins, natural penicillins, aminopenicillins, ureidopenicillin and aminoglycosides, and (iii) decreasing trend in the incidence of the overall HAIs, stable trends in GNB HAIs and MDR-GNB HAIs throughout the study period, and increasing trend in HAIs caused by carbapenem-resistant (CR) Acinetobacter spp. since 2006. HAIs due to CR-Acinetobacter spp. was found to positively correlate with the consumptions of carbapenems, extended-spectrum cephalosporins, aminopenicillins/β-lactamase inhibitors, piperacillin/tazobactam and fluoroquinolones, and negatively correlate with the consumptions of non-extended-spectrum cephalosporins, penicillins and aminoglycosides. No significant association was found between the increased use of piperacilllin/tazobactam and increasing HAIs due to CR-Acinetobacter spp. Conclusions The trend in overall HAIs decreased and trends in GNB HAIs and MDR-GNB HAIs remained stable over time suggesting that the infection control practice was effective during the study period, and the escalating HAIs due to CR- Acinetobacter spp. were driven by consumptions of broad-spectrum antibiotics other than piperacillin/tazobactam. Our data underscore the importance of antibiotic stewardship in the improvement of the trend of HAIs caused by Acinetobacter spp.
Prasad Niranjan Gunjal,Shraddha Gunjal,Sudheer Kher
International Journal of Biomedical and Advance Research , 2012, DOI: 10.7439/ijbar.v3i5.375
Abstract: The present study was conducted to track down commonest gram negative bacilli along with their pattern of resistance to antibiotics from various clinical specimens, from patients admitted to intensive care unit. A total of 182 clinical specimens were analyzed using standard techniques. Out of 182 specimens 105 were culture positive, whereas the remaining 77 were culture negative. From 105 culture positive specimens 65 (61.90%) showed growth of gram negative bacilli, remaining 40 (38.09%) with growth of gram positive organisms. In this study E .coli was found to be the predominant isolate with 44.61% rate of isolation, followed by Klebsiella pneumoniae 15.38%, rate of isolation of Proteus mirabilis, Citrobacter fruendii each accounting for 9.23%. Pseudomonas aeruginosa 7.69%, Proteus vulgaris 3.07%, Acinetobacter species and Salmonella typhi accounted for 1.53 % each. To conclude, aerobic gram negative bacilli were predominant clinical isolates from patients admitted to intensive care unit. Amikacin and gentamicin were found to be effective antibiotics against gram negative bacilli in this particular setting
Beta lactamases mediated resistance amongst gram negative bacilli in burn infection  [PDF]
Nitin Bandekar,Vinodkumar CS, Basavarajappa KG, Prabhakar PJ, Nagaraj P
International Journal of Biological and Medical Research , 2011,
Abstract: Introduction: Burn is one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of Immuno- suppression, which predisposes infectious complications in burn patients. In burn patient infections arise from multiple sources and infect burn wounds by a variety of micro-organisms. Gram negative bacterial infection results from translocation from colon, further more burn patients are infected by Hospital acquired bacteria by various invasive and non invasive procedures Early diagnosis of microbial infections and screening for mechanism of drug resistance is aimed to institute the appropriate antibacterial therapy and to avoid further complications. Objectives: Beta lactamases are enzymes responsible for the resistance to beta lactam antibiotics. This study is aimed at the detection of various types of beta lactamases present among the gram negative bacilli isolated from burn infection. Methods: patients admitted to burn intensive care unit were included in the study.83 gram negative bacilli were isolated and screened for the presence of extended spectrum beta lactamase, AmpC lactamase, Metallo beta lactamase and confirmed by the respective confirmatory tests. Results: 39.8% produced extended spectrum beta lactamases, 22.9% AmpC beta lactamase and 15.7% strains produced metallo beta lactamases. Pseudomonas aeruginosa was the predominant bacteria producing ESBL and AmpC mediated resistance, whereas Acinetobacter baumannii was the predominant MBL producer. Conclusion: It is important to monitor the bacteriology in burn patients at all time, and understand the changing pattern of bacterial flora, antibiotic susceptibility and bacterial strains spreading in burn ward. Extended-spectrum beta-lactamases is the cause of resistance. After sulbactam added to the third generation of cephalosporins, the beta-lactamases were inhibited, but it lead to increase use of carbapenems leading to emergence of metallo beta lactamase mediated resistance. Hence, screening techniques should be performed routinely to detect these β-lactamase producers so that suitable antimicrobial therapy can be instituted.
Cross-sectional study of extended spectrum beta-lactamase producing gram-negative bacilli from clinical cases in Khorramabad, Iran
Hossein Hosain Zadegan,R Ramazanzadeh,A Hasany
Iranian Journal of Microbiology , 2009,
Abstract: Introduction: Antibiotic resistance among bacteria in particular those producing Extended Spectrum Beta lactamases (ESBLs)"nhas a very significant role in hospital acquired infections. Some of the gram negative bacilli including Klebsiella pneumonia"nand Escherichia coli are known to be ESBL producers which cause uncontrollable infections because they are also often"nresistant to other antimicrobial agents. This study was designed to assess the ESBL producing gram-negative bacilli among"nclinical isolates of inpatients at Shohada-ye Ashayer Hospital, Khorramabad, Iran."nMaterials and Methods: Samples were processed with routine laboratory methods and gram-negative bacilli were identified"nby standard tests. ESBL producing gram-negative bacilli were screened by MacConkey Agar containing 4 mg/liter ceftazidime"nand confirmed with the double disk synergy method."nResults: Fifty-three cases (23.6%) of 225 total isolated gram-negative bacilli were positive in terms of ESBL production."nKlebsiella pneumoniae comprising 20 cases (8.9%) was the dominant organism producing ESBLs followed by Escherichia"ncoli (10 cases; 4.4%) and Pseudomonas aeruginosa (10 cases; 4.4%). The most ESBL producing organisms were found in"nurine samples (21 cases; 39.6%). Ten cases (18.9%) of isolates were from samples collected with sterile bronchoscopy."nConclusion: Results of the study indicated that ESBL producing gram negative bacilli are frequently isolated from Shohadaye"nAshaier Hospital. Regarding the high resistance of these strains against many of the antibiotics and even against carbapenems,"nhealth care professionals need to plan policies to fight the induction and spread of such strains
Incidence of carbapenem resistant nonfermenting gram negative bacilli from patients with respiratory infections in the intensive care units  [cached]
Gladstone P,Rajendran P,Brahmadathan K
Indian Journal of Medical Microbiology , 2005,
Abstract: Resistance to carbapenems is commonly seen in nonfermenting gram negative bacilli (NFGNB). We document herein the prevalence of carbapenem resistance in NFGNB isolated from patients with respiratory tract infections in the intensive care units (ICUs). A total of 460 NFGNB were isolated from 606 endotracheal aspirate specimens during January through December 2003, of which 56 (12.2%) were found to be resistant to imipenem and meropenem. Of these, 24 (42.8%) were Pseudomonas aeruginosa , 8 (14.2%) were Acinetobacter spp. and 24 (42.8%) were other NFGNB. Stringent protocols such as antibiotic policies and resistance surveillance programs are mandatory to curb these bacteria in ICU settings.
Antimicrobial resistance patterns among Gram-negative bacilli isolated from patients with nosocomial infections: Disk diffusion versus E-test
Hadadi A,Rasoulinejad M,Maleki Z,Mojtahedzadeh M
Tehran University Medical Journal , 2007,
Abstract: Background: The object of this study was to investigate the antimicrobial resistance pattern among common nosocomial Gram-negative bacilli isolated from patients with nosocomial infections. Methods: From June 2004 to December 2005, 380 isolates of common Gram-negative bacilli (Klebsiella, Pseudomonas, Acinetobacter and E. coli) from 270 patients with nosocomial infections in Sina and Imam Hospitals, Tehran, Iran, were evaluated for susceptibility to Imipenem, Cefepime, Ciprofloxacine, Ceftriaxone and Ceftazidime by Disc diffusion and E-test methods. Results: The most frequent pathogens isolated were Klebsiella spp. (40%), followed by Pseudomonas (28%), Acinetobacter spp. (20%) and E. coli (12%). The most active antibiotic was imipenem (84%). 26% of all isolates were sensitive to Cefepime, 26% to Ciprofloxacin, 20% to Ceftazidime and 10% to Ceftrixone. The susceptibility rates of Klebsiella to Imipenem, cefepime, ciprofloxacin, Ceftazidime and Ceftriaxone were 91, 25, 21, 13 and 7 percent, respectively and 91, 19, 17, 21 and 21 percent, respectively, for E. coli. Among Acineto- bacter spp., the susceptibility rate was 77% for Imipenem and 21% for Ciprofloxacin. Among Pseudomonas spp., 75% of isolates were susceptible to Imipenem and 39% to Ciprofloxacin. The comparison of the resistance status of microorganisms by both Disc diffusion and E-test methods showed a clinically noticeable agreement between these two tests. Conclusions: Since antibiotic resistance among Gram-negative bacilli has increased, enforcement of policy regarding proper antibiotic use is urgently needed in order to delay the development of resistance. Although it is widely accepted that E-test is more accurate in determining the resistance of microorganisms, our study showed that the Disc diffusion test will give the same results in most occasions and is therefore still considered useful in clinical practice.

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