scholarly journals Microbial Predominance and Antimicrobial Resistance in a Tertiary Hospital in Northwest China: A Six-Year Retrospective Study of Outpatients and Patients Visiting the Emergency Department

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Caifeng Wang ◽  
Wen Li ◽  
Juanjuan Gao ◽  
Dancheng Zhang ◽  
Yali Li ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Antimicrobial Resistance ◽  
Northwest China ◽  
Tertiary Hospital ◽  
Diffusion Method ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Local Healthcare

Background. With the wide use of antibiotics, antimicrobial resistance becomes a serious issue. Timely understanding of microbial pathogen profiles and the change of antimicrobial resistance provide an important guidance for effective and optimized use of antibiotics in local healthcare systems. The aim was to investigate the characteristics of microbial species and their antimicrobial resistances in a tertiary hospital with an Emergency Department and outpatient clinics for a period of six years. Methodology. A retrospective study was conducted using the HIS database of a tertiary hospital between 2013 and 2018. Antimicrobial susceptibility was tested by automated systems and/or the Kirby–Bauer disc diffusion method. The data were analyzed using the WHONET 5.6 software. The Cochran-Armitage test was used to study the trends over the period of research. Results. In a total of 19,028 specimens submitted for microbial tests during the period from 49 units of the hospital, only the samples from the Emergency Department and Kidney Transplantation Clinic showed an annually significant increase ( P < 0.001 ). More than 200 species with 46.4% gram-positive cocci and 45.3% gram-negative bacilli were identified in the 3,849 nonrepetitive isolates. The methicillin-resistant S. aureus and S. epidermidis rates were 25.1% and 74.6%, respectively. 60.9% E. coli and 33.5% K. pneumonia samples carried extended-spectrum-β-lactamase. All Staphylococci and Enterococci samples were not resistant to linezolid, vancomycin, and tigecycline. In addition, only 0.01% E. coli, 1.1% K. pneumonia, and 18.7% P. aeruginosa isolates showed resistance to carbapenems. Conclusions. Vancomycin, linezolid and tigecycline were the most effective antibiotics for outpatients with gram-positive infection. Carbapenems were the most effective antibiotics for gram-negative infection. There was no significant annual increase of common multidrug resistances.

scholarly journals Microbial Predominance and Antimicrobial Resistance in a Tertiary Hospital: A Six-year Retrospective study from Outpatients and Patients Visiting the Emergency Department

2020 ◽  
Author(s):  
CaiFeng Wang ◽  
Wen Li ◽  
Juanjuan Gao ◽  
Dancheng Zhang ◽  
Yali Li ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Antimicrobial Resistance ◽  
Tertiary Hospital ◽  
Diffusion Method ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Antimicrobial Susceptibility Tests ◽  
Susceptibility Tests

Abstract Objective: To assessing the characteristics of of microbial species and the antimicrobial resistance in a Tertiary Hospital with 49 outpatient clinics and emergency department in Northwestern China, of six years. Methods: A retrospective study was conducted using HIS database of a tertiary hospital between the full-year period of 2013 and 2018. Antimicrobial susceptibility tests were conducted by automated systems and/or the Kary-Bauer disc diffusion method. Data were analyzed using the WHONET 5.6 software. The Cochran–Armitage test was used to study the trends over the period. Results: A total of 19,028 specimens were submitted for the laboratory tests of microbiology. Among 49 units, only Emergency Department and Kidney Transplantation Clinic with the number of submission showed a significant increase annually (P<0.001). A total of 3,849 non-repetitive isolates were identified, covering more than 200 species, of which gram-positive cocci accounted for 46.4% and gram-negative bacilli 45.3%. The methicillin-resistant rates of S. aureus and S. epidermidis were 25.1% and 74.6%, respectively. The isolates of 60.9% of E. coli and 33.5% of K. pneumonia contained extended spectrum β lactamases. Moreover, there were no Staphylococci and Enterococci resistant to linezolid, vancomycin and tigecycline. In addition, the percentages of E. coli, K. pneumonia and P. aeruginosa isolates resistant to carbapenems were low (0.0%, 1.1% and 18.7%, respectively). Conclusion: Vancomycin, linezolid and tigecycline are among the most effective treatment for outpatients with gram-positive infection. Carbapenems are among the most effective for gram-negative infection. There is no significant annual increase of common multidrug resistances.

Bacterial Pattern of Community acquired Urinary Tract Infections: A Challenge for Antimicrobial Resistance

2021 ◽  
Vol 30 (3) ◽  
pp. 153-162
Author(s):  
Nader A. Nemr ◽  
Rania M. Kishk ◽  
Mohammed Abdou ◽  
Hassnaa Nassar ◽  
Noha M Abu bakr Elsaid ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Bacterial Infections ◽  
Diffusion Method ◽  
Gram Negative Bacteria ◽  
Isolation And Identification ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Tract Infections

Background: Urinary tract infection (UTI) is considered one of the most common bacterial infections seen in health care. To our knowledge, there is no available antimicrobial resistance surveillance system for monitoring of community-acquired UTIs (CA- UTIs) in our country. Objectives: we aimed to discuss the bacterial pattern and resistance profile of CA-UTIs in Ismailia, Egypt. Methods: This cross-sectional study included 400 patients suffering from symptoms of acute UTIs. Urine specimens were collected by clean-catch mid-stream method, examined microscopically and inoculated immediately on blood agar and MacConkey's agar plates. Colony counting, isolation and identification of the urinary pathogens were performed by the conventional biochemical tests according to the isolated organism. Antibiotic susceptibility testing was performed by Kirby Bauer disk diffusion method. Interpretation was performed according to Clinical Laboratory Standard Institute (CLSI) guidelines. Results: out of 400 specimens, 136 of them revealed no bacterial growth or insignificant bacteriuria. Most of participants with UTI were females (81.8%) (p=0.008) and 54.5% of them were married (P=0.1). Gram negative bacteria were more common than Gram positive representing 66 % and 34% respectively. E. coli was the most common isolated organism (39%) followed by S. aureus (32%), K. Pneumoniae and Pseudomonas (10.5% for each), Proteus (6%) and Enterococci (2%). E. coli isolates showed the highest susceptibility to imipenem, meropenem, amikacin, nitrofurantoin, levofloxacin and ciprofloxacin. Most of our patients were diabetics (64.8%) (p=0.004). The mean ± SD of HbA1c was 6.4±2.0 with 4 to 12.6 range, S.E was 0.1 and 95% C.I was 6.2- 6.7. The highest mean ± SD of HbA1c was in S. aureus infections. Conclusion: Gram negative bacteria were most common than Gram positive with predominance of E. coli with significant relation to the presence of diabetes.

scholarly journals Detection of TEM and CTX-M Genes in Escherichia coli Isolated from Clinical Specimens at Tertiary Care Heart Hospital, Kathmandu, Nepal

Diseases ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 15
Author(s):  
Ram Shankar Prasad Sah ◽  
Binod Dhungel ◽  
Binod Kumar Yadav ◽  
Nabaraj Adhikari ◽  
Upendra Thapa Shrestha ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Clinical Isolates ◽  
Diffusion Method ◽  
Gram Negative Bacteria ◽  
Bacterial Isolates ◽  
Disk Diffusion Method ◽  
Gram Negative ◽  
Clinical Specimens ◽  
E Coli ◽  
Esbl Producers

Background: Antimicrobial resistance (AMR) among Gram-negative pathogens, predominantly ESBL-producing clinical isolates, are increasing worldwide. The main aim of this study was to determine the prevalence of ESBL-producing clinical isolates, their antibiogram, and the frequency of ESBL genes (blaTEM and blaCTX-M) in the clinical samples from patients. Methods: A total of 1065 clinical specimens from patients suspected of heart infections were collected between February and August 2019. Bacterial isolates were identified on colony morphology and biochemical properties. Thus, obtained clinical isolates were screened for antimicrobial susceptibility testing (AST) using modified Kirby–Bauer disk diffusion method, while ESBL producers were identified by using a combination disk diffusion method. ESBL positive isolates were further assessed using conventional polymerase chain reaction (PCR) to detect the ESBL genes blaTEM and blaCTX-M. Results: Out of 1065 clinical specimens, 17.8% (190/1065) showed bacterial growth. Among 190 bacterial isolates, 57.4% (109/190) were Gram-negative bacteria. Among 109 Gram-negative bacteria, 40.3% (44/109) were E. coli, and 30.2% (33/109) were K. pneumoniae. In AST, 57.7% (n = 63) Gram-negative bacterial isolates were resistant to ampicillin and 47.7% (n = 52) were resistant to nalidixic acid. Over half of the isolates (51.3%; 56/109) were multidrug resistant (MDR). Of 44 E. coli, 27.3% (12/44) were ESBL producers. Among ESBL producer E. coli isolates, 58.4% (7/12) tested positive for the blaCTX-M gene and 41.6% (5/12) tested positive for the blaTEM gene. Conclusion: Half of the Gram-negative bacteria in our study were MDR. Routine identification of an infectious agent followed by AST is critical to optimize the treatment and prevent antimicrobial resistance.

scholarly journals Antibacterial Activity and Chemical Composition of Red Peacock Flower (Caesalpinia pulcherrima L.) Leaf Essential Oil

2019 ◽  
Vol 22 (6) ◽  
pp. 269-274
Author(s):  
Novena Risnalani Rintank Constani ◽  
Hartati Soetjipto ◽  
Sri Hartini
Keyword(s):  
Antibacterial Activity ◽  
Essential Oil ◽  
Essential Oils ◽  
Inhibition Zone ◽  
Diffusion Method ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Gram Positive Bacteria ◽  
Leaf Essential Oil

Peacock flower (Caesalpinia pulcherrima L.) leaves contain essential oils which can be used as an ingredient in cosmetics, perfume, aromatherapy, medicine, and supplements. The study was conducted to obtain essential oils from peacock flower leaves and determine the antibacterial activity against gram-positive bacteria (Bacillus subtilis and Staphylococcus aureus) and gram-negative (Escherichia coli and Pseudomonas aeruginosa). Antibacterial activity test was carried out by the agar diffusion method, using paper discs. Measurements were made for the inhibition zone diameter (IZD) that appeared, while the essential oil component was analyzed using GC-MS. The results showed that the peacock flower leaves (C. pulcherrima) had a moderate to strong antibacterial effect at a concentration of 7.5%-20% against gram-positive bacteria (B. subtilis and S. aureus) and gram-negative bacteria (E. coli and P. aeruginosa). Gram-negative E. coli bacteria are relatively more sensitive to peacock flower leaf essential oil compared to other test bacteria. Peacock flower (C. pulcherrima) leaf essential oil is composed of 7 main components namely β-Cubebene 33.87%; Caryophyllene 23.00%; γ-Elemene 13.18%; α-Pinene 10.96%; Cadina-1(10),4-diene 10.20%; Copaene; 7.09%; β-Pinene 1.70%.

scholarly journals Alarming Pattern of Antimicrobial Resistance in Neonatal Sepsis Observed in Neonatal Intensive Care Unit of a Tertiary Care Hospital in Bangladesh

KYAMC Journal ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 3-7
Author(s):  
Tania Rahman ◽  
Sharmeen Sultana ◽  
Taslima Akber Happy ◽  
Kamrunnahar Alo ◽  
Momtaz Begum
Keyword(s):  
Antimicrobial Resistance ◽  
Neonatal Sepsis ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Diffusion Method ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Isolation And Identification ◽  
Gram Positive ◽  
Gram Negative

Background: Resistance of micro-organisms to multiple broad-spectrum antimicrobial agents is a major problem in treating neonatal sepsis. It is a matter of utmost importance to have knowledge of trends in changing pattern of antimicrobial resistance. Objective: This study was done to observe antimicrobial resistance of gram-positive and gram-negative bacteria isolated from cases of neonatal sepsis Material and Methods: This cross sectional descriptive study was conducted in Department of Microbiology in collaboration with Department of Neonatology, Dhaka Medical College Hospital, Dhaka. Antimicrobial resistance of all the isolated bacteria was performed by Modified Kirby-bauer disk diffusion method following standard guideline after isolation and identification of bacteria from blood samples of suspected septicemic neonates by automated blood culture and standard microbiological protocol. Results: All of the isolated Staphylococcus aureus, Coagulase negative Staphylococcus, Group-B Streptococcus and Micrococcus showed 100% resistance to ceftriaxone, cefotaxime and ceftazidime. Among the isolated gram-negative bacteria, all of Enterobacter spp., Pseudomonas aeruginosa and Citrobacter spp. showed 100% resistance to amoxiclav, amikacin, ceftriaxone, cefixime, ceftazidime. Conclusion: Majority of the gram-positive and gram-negative bacteria are developing resistance to multiple antimicrobial agents and surveillance is necessary to tackle this alarming situation. KYAMC Journal.2021;12(01): 03-07

scholarly journals Antibacterial Activity of Borassus flabellifer Vinegar-Graphene Quantum Dots Against Gram-Positive and Gram-Negative Bacteria

2021 ◽  
Vol 33 (11) ◽  
pp. 2662-2666
Author(s):  
Amnuay Noypha ◽  
Paweena Porrawatkul ◽  
Nongyao Teppaya ◽  
Parintip Rattanaburi ◽  
Saksit Chanthai ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Quantum Dots ◽  
Antibacterial Activity ◽  
Graphene Quantum Dots ◽  
Diffusion Method ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli

Borassus flabellifer vinegar–graphene quantum dots (BFV-GQDs) were successfully synthesized using a pyrolysis method with Borassus flabellifer vinegar (BFV) as the precursor. All the samples were characterized using ultraviolet-visible spectrophotometry (UV-Vis), scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). The antibacterial activities of BFV-GQDs against strains of Gram-negative bacteria (Escherichia coli) and Gram-positive bacteria (Staphylococcus aureus) were determined using the agar well diffusion method for preliminary screening, while minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined using the broth macro-dilution method. The zones of inhibition were compared with those of citric acid–graphene quantum dots (CA-GQDs). It was observed that the synthesized BFV-GQDs demonstrated excellent antibacterial activity against Staphylococcus aureus (82.3%) and good antibacterial activity against Escherichia coli (73.3%). The MIC of BFV-GQDs against E. coli was 6.25 mg/mL and S. aureus was 12.5 mg/mL, whereas the MBC of BFV-GQDs against E. coli was 12.5 mg/mL and S. aureus was 25.0 mg/mL.

Bactericidal and Fungicidal Activity of Polyetherguanidinium Chloride

2021 ◽  
Vol 83 (1) ◽  
pp. 49-57
Author(s):  
M.Ya. Vortman ◽  
◽  
Yu.B. Pysmenna ◽  
A.I. Chuenko ◽  
A.V. Rudenko ◽  
...  
Keyword(s):  
Antimicrobial Activity ◽  
Fungicidal Activity ◽  
Heterotrophic Bacteria ◽  
Diffusion Method ◽  
Klebsiella Pneumonia ◽  
Microscopic Fungi ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Wide Range

There is information in the literature about the salts of polyhexamethylene guanidine (PGMG), which are effective biocidal and sterilizing drugs and disinfectants due to the wide range of their antimicrobial activity against gram-positive and gram-negative bacteria (including Mycobacterium tuberculosis), viruses, and fungi. The aim of this work is to study the bactericidal and fungicidal activity of the synthesized polyetherguanidinium chloride against a number of bacteria and microscopic fungi. Methods. Cultivation of microorganisms. Bacteria were grown on meat-peptone agar for 48 hours at a temperature of 28±2°C. Test cultures of micromycetes were cultured on beer wort agar (6°B), incubated for 14 days in a thermostat at a temperature of 28±2°C. Antimicrobial activity of newly synthesized polyetherguanidinium chloride was determined by standard disco-diffusion method, and fungicidal activity was determined by agar diffusion method. Results. The synthesis of polyetherguanidinium chloride was carried out in two stages. The first stage was the synthesis of a guanidinium-containing oligoether with terminal guanidine moieties by the reaction between an aromatic oligoepoxide and guanidine. The second stage was the synthesis of polyetherguanidinium chloride by the reaction between a guanidinium-containing oligoether with terminal guanidine moieties and oligooxyethylenediamine. The bactericidal and fungicidal activity of polyetherguanidinium chloride against various heterotrophic bacteria and microscopic fungi has been shown. It was found that polyetherguanidinium chloride at concentrations of 1–3% inhibited the growth of gram-negative (Escherichia coli 475, Klebsiella pneumonia 479) and gram-positive (Staphylococcus aureus 451) bacteria. The proposed 1% solution of polyetherguanidinium chloride shows a 1.5 times higher antimicrobial activity than the polymeric disinfectant polyhexamethyleneguanidinium chloride for E. coli 475 and K. pneumoniae 479 bacteria and lower antimicrobial activity for S. aureus 451 bacteria. According to the obtained data, it was noted that polyetherguanidinium chloride at a concentration of 1% had a high fungicidal activity against almost all investigated isolates: Aspergillus versicolor F-41250, Acremoneum humicola F-41252, Acremoneum roseum F-41251, Cladosporium sphaerospermum F-41255, Paecilomyces lilacinus F-41256 and Scopulariopsis candida F-41257. Conclusions. Received polyetherguanidinium chloride at a concentration of 1% showed bactericidal activity against S. aureus 451, E. coli 475, K. pneumoniae 479 and fungicidal effect to all fungi studied by us, and so can be used as a disinfectant for building materials.

scholarly journals Profile of antimicrobial resistance in oncologic pediatric patients

2014 ◽  
Vol 2 (4) ◽  
Author(s):  
Mauricio García-Luna ◽  
José Antonio Madrid Gómez-Tagle ◽  
Jessica P. O’Brien
Keyword(s):  
Antimicrobial Resistance ◽  
Lymphoblastic Leukemia ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Development Of Resistance ◽  
Drug Resistant Bacteria ◽  
Clinical Records

The development of resistance to antibiotics is due to the widespread use of a wide variety of antimicrobials, coupled with the ability of bacteria to acquire and spread resistance and the ability of humans to disseminate them. The possible consequences of antimicrobial resistance leads to greater chances of hospitalization, prolongation of hospital stay and increased mortality. Furthermore, treatment of drug resistant bacteria requires the use of more toxic drugs and more expense for the patient and hospitals. The main objective of the present study was to determine the frequency and nature of antimicrobial resistance of microorganisms in oncologic and hematologic patients at a Mexican Pediatric Hospital. A retrospective, observational, and analytical study was realized, where we reviewed the clinical records of 20 cases. Blood cultures were obtained from the Laboratory of our institution from 2010 to 2011. The data obtained were organized and analyzed. We observed that the E. coli and S. aureus were the bacteria most resistant, showing the same percentage between gram-positive and gram-negative bacteria. The cancer diagnosis most common in our study was acute lymphoblastic leukemia. It may be concluded that multidrug-resistant bacteria in these patients are of a nosocomial origin, without a specific group of germ (gram positive vs. gram negative).

scholarly journals Prevalence and Antibiograms of Uropathogens from the Suspected Cases of Urinary Tract Infections in Bharatpur Hospital, Nepal

2019 ◽  
Vol 15 (4) ◽  
pp. 260-266
Author(s):  
Sanjib Adhikari ◽  
Sujan Khadka ◽  
Sanjeep Sapkota ◽  
Jid Chani Rana ◽  
Santosh Khanal ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antibiotic Susceptibility ◽  
Susceptibility Test ◽  
Effective Control ◽  
Diffusion Method ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Antibiotic Susceptibility Test ◽  
Tract Infections

Background: This study was conducted to determine the prevalence and antibiotic susceptibility pattern of the uropathogens among the patients attending Bharatpur Hospital. Methods: A laboratory-based cross-sectional study was carried out among the patients attending Bharatpur Hospital from December 2017 to February 2018. Aseptically collected clean catch mid-stream urine samples from 200 clinically suspected patients were cultured and processed for the identification of the uropathogens in the laboratory using standard microbiological procedures. Antibiotic susceptibility test was performed for all the isolates against commonly used antibiotics using the Kirby-Bauer disc diffusion method according to Clinical and Laboratory Standards Institute guidelines 2017. Results: Out of 200 samples collected, 59(29.5%) of the samples showed the presence of pathogens causing urinary tract infection (UTI). Among them, 43(72.9%) were Gram-negative and 16(27.1%) were Gram-positive bacteria. UTI was found to be the most prevalent in females compared to the males and in the age group of 21-30 years. E. coli (72.0%) and Staphylococcus epidermidis (50.0%) were the most predominant Gram-negative and Gram-positive isolates respectively. The isolates were resistant to cefpodoxime (54.2%) and least resistant to gentamicin (10.2%). Twenty (33.9%) isolates were found to be multi-drug resistant (MDR). Conclusions: Higher frequency of antibiotic resistance among UTI patients alerts for continuous surveillance to assure effective control of this infection. Awareness of good hygienic practice especially in females and prudent use of antibiotics in case of infection can be sug-gested. Keywords: antibiotic susceptibility test; E. coli; MDR; urine.

scholarly journals Antimicrobial Resistance Profile among clinical isolated bacteria at Wolaita Sodo University Teaching Referral Hospital, three year retrospective cohort study

2020 ◽  
Author(s):  
Temesgen Ageru Anjulo ◽  
Habtamu Seid ◽  
Temesgen Sidamo ◽  
Tamrat Balcha ◽  
Temesgen Lera
Keyword(s):  
Logistic Regression ◽  
Antimicrobial Resistance ◽  
Referral Hospital ◽  
University Teaching ◽  
P Value ◽  
Multiple Logistic Regression ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Wolaita Sodo

Abstract Background Antibiotic resistance is public threats in globally and its problem not well concerned in sub Saharan Africa including Ethiopia due to inadequate set up. However, there is information gap in resistance of antibiotic and its pattern for physicians who prescribe. Therefore, the aim of this study was to review the antimicrobial resistance pattern of bacterial isolated from different specimens inoculated retrospectively at Wolaita Sodo University Teaching Referral Hospital, Southern Ethiopia. Methods A 3 year retrospective data of culture and antibiotic sensitivity pattern analyzed from 2016–2018 among 330 patients records at Wolaita Sodo university Teaching Referral hospital. The data extracted were clinical samples taken, age, sex, bacteria growth status, bacteria isolated, antibiotic resistance profile and trend in each year.The data entry was done using Epidata version 3.5.1 and exported to SPSS version 21 software for cleaning and statistical analysis.Bivariable analysis was done and variables with p-value of less than 0.25 were made candidate for multiple logistic regression analysis. The relative contribution of each selected variables to the outcome of interest was assessed using multiple logistic regression and variables with P-value less than 0.05 were considered as statically significant. Results A total of 330 samples fulfills inclusion criteria were extracted from microbiology laboratory, 150 samples were become culture positive for bacteria isolates. From positive culture growth, 110 (73.3%) was gram positive bacteria and 40(26.7%) gram negative. A staphylococcus auras (S.auras) was the most prevalent isolate 97 (61.3%) from gram positive isolates and Escherichia coli (E. coli) 19(12.7%) was gram negative. From gram positive isolates S. auras was 53% and S. saprophytes 62%, S. pyogen 74% and S.pneumonia 52% resistance to antibiotics. Overall resistance for all antimicrobial resistance of gram negative of E. coli was 62%, P. aurogenous 75%, proteusspp 65%, shigellaspp 66%, salmonella 56% and NisseriaSpp 63%.Overall antimicrobial resistance of gram positive isolates was 54.2% gram negative bacteria was 60.0%

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