scholarly journals Prevalence of multidrug-resistant and extended-spectrum beta-lactamase producing Gram-negative isolates from clinical samples in a tertiary care hospital of Nepal

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Aryatara Shilpakar ◽  
Mehraj Ansari ◽  
Kul Raj Rai ◽  
Ganesh Rai ◽  
Shiba Kumar Rai
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Confirmatory Test ◽  
Clinical Samples ◽  
Care Hospital ◽  
Gram Negative ◽  
Extended Spectrum ◽  
Esbl Producers

Abstract Background The existence of multidrug-resistant organisms, including extended-spectrum beta-lactamases (ESBLs), is on rise across the globe and is becoming a severe problem. Knowledge of the prevalence and antibiogram profile of such isolates is essential to develop an appropriate treatment methodology. This study aimed to study the prevalence of Gram-negative isolates exhibiting ESBL at a tertiary care hospital and study their antibiogram profile. Methods A cross-sectional study was conducted at Shahid Gangalal National Heart Centre, Kathmandu, Nepal, from June 2018 to November 2018. A total of 770 clinical samples were collected and identified using the conventional biochemical tests following the Clinical and Laboratory Standard Institute (CLSI) guidelines. Antimicrobial susceptibility testing (AST) was performed using the standardized Kirby-Bauer disk diffusion method. The screening test for ESBL producers was performed as recommended by the CLSI and the confirmatory test was performed phenotypically using the E-test. Results Out of the 92 isolates, 84 (91.3%) were multidrug-resistant, and 47 (51.1%) were found to be potential ESBL producers. Of these, 16 isolates were confirmed ESBL producers by the E-test. Escherichia coli and Klebsiella pneumoniae were the predominant isolates and were also the major ESBL producers. Besides polymyxin B (100% sensitive), meropenem and imipenem showed high efficacy against the ESBL producers. Conclusion Multidrug resistance was very high; however, ESBL production was low. Polymyxin B and carbapenems are the choice of drugs against ESBL producers but should be used only as the last line drugs.

scholarly journals Prevalence of MDR and ESBL producing Gram-negative isolates from various clinical samples from patients visiting a tertiary care hospital in Kathmandu, Nepal

2021 ◽  
Author(s):  
Aryatara Shilpakar ◽  
Mehraj Ansari ◽  
Kul Raj Rai ◽  
Ganesh Rai ◽  
Shiba Kumar Rai
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Polymyxin B ◽  
Confirmatory Test ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Care Hospital ◽  
Severe Problem ◽  
Gram Negative ◽  
Esbl Producers

Abstract BackgroundThe existence of multi-drug resistance organisms, including extended-spectrum beta-lactamases (ESBLs), is on the rise and is becoming a severe problem. Knowledge of the prevalence and antibiogram profile of such isolates is essential to develop an appropriate treatment methodology. This study aimed to study the prevalence of Gram-negative isolates exhibiting ESBL at a tertiary care hospital and study their antibiogram profile.MethodsA cross-sectional study was conducted at Shahid Gangalal National Heart Centre, Kathmandu, Nepal, from June 2018 to November 2018. A total of 770 clinical samples were collected and identified by using the conventional biochemical tests following the Clinical and Laboratory Standard Institute (CLSI) guidelines. Antimicrobial susceptibility testing (AST) was performed using the Kirby Bauer disc diffusion method. The screening test for ESBL producers was performed as recommended by the CLSI and the confirmatory test was performed phenotypically using the E-test.ResultsOut of 92 isolates, 84 (91.3%) isolates were multidrug resistant, and 47 (51.1%) isolates were found to be potential ESBL producers. Of these, 16 isolates were confirmed ESBL producers by the E-test. Escherichia coli and Klebsiella pneumoniae were the predominant isolates and were also the major ESBL producers. Besides polymyxin B (100% sensitive), meropenem and imipenem showed high efficacy against the ESBL producers.ConclusionMultidrug resistance was very high, however, ESBL production was low. Polymyxin B and carbapenems are the choice of drugs against ESBL producers but should be used only as the last line drugs.

scholarly journals Antimicrobial Sensitivity Pattern in the Mixed Intensive Care Unit in a Tertiary Care Hospital of Eastern Nepal

2020 ◽  
Vol 2 (2) ◽  
pp. 9-15
Author(s):  
Niraj Kumar Keyal ◽  
Mahendra Shrestha ◽  
Partima Sigdel Ghimire
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Polymyxin B ◽  
Clinical Samples ◽  
Care Hospital ◽  
Gram Negative ◽  
Sensitivity Pattern

 Background: Empirical antibiotics are used in the intensive care unit based on developing countries’ guidelines due to a lack of a bacteriological profile of individual ICU and institution policy. Therefore, this study was conducted to know the antibiogram of the intensive care unit and to make institution policy for antibiotic use in ICU. Materials and methods: It was a prospective descriptive cross-sectional study conducted in the mixed surgical and medical intensive care unit of a tertiary care hospital for one year in 625 patients. Various clinical samples were collected aseptically and organisms were identified by the cultural characteristics, morphology, gram stain, and different biochemical test. Antimicrobial susceptibility was done with a disc diffusion test. Data collection was done in a preformed sheet that included all tested antibiotic and demographic variables. Statistical analysis was done by using statistical package for the social sciences. The result was presented as frequency and percentage. Results: Out of 625 samples, 135(22%) showed growth in culture. Among them, 96(71%) and 39(29%) were gram-negative bacilli and gram-positive cocci respectively. The tracheal aspirate was the most common type of specimen which comprised 49(36.29%) isolates. The most common organism was Staphylococcus aureus which accounts for 27(20%) isolates, followed by Acinetobacter baumanni 25(18.51%), Klebsiella pneumoniae 22(16.29%) and Pseudomonas aeurignosa 21(15.55%). The incidence of multidrug-resistant and extended drug resistance was 44(32.5%) and 45(33%) respectively. Meanwhile, the incidence of methicillin-resistant staphylococcus aureus was 70%. However, in the case of Acinetobacter baumannii and Enterobacteriaceae, all were sensitive to polymyxin B and meropenem. Conclusion:Antibiotics should be prescribed based on the antibiogram of individual intensive care units that can decrease antibiotic resistance. Polymyxin B and meropenem can be prescribed for gram-negative bacilli and vancomycin for Staphylococcus aureus.

scholarly journals Detection of Extended Spectrum Beta-lactamase (ESBL) Producing Gram Negative Bacteria from Clinical Specimens of Sir Salimullah Medical College and Mitford Hospital.

2017 ◽  
Vol 10 (1) ◽  
pp. 8-12
Author(s):  
Shikha Paul ◽  
Sanya Tahmina Jhora ◽  
Prashanta Prasun Dey ◽  
Bilkis Ara Begum
Keyword(s):  
Tertiary Care ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Beta Lactamase ◽  
Gram Negative ◽  
Clinical Specimens ◽  
Extended Spectrum Beta Lactamase ◽  
Medical College ◽  
Extended Spectrum ◽  
Esbl Producers

Detection of Extended spectrum beta lactamase (ESBL) enzyme producing bacteria in hospital settings is vital as ESBL genes are transmissible. This study was carried out to determine the distribution of ESBL producing gram negative isolates at a tertiary care hospital in Dhaka city which deals with the patients hailing from relatively low socioeconomic status.Onehundred and twenty four gram negative bacteria isolated from different clinical specimens from outpatient and inpatient departments of Sir Salimullah Medical College and Mitford Hospital (SSMC & MH) were tested for ESBL by E test ESBL method in the department of microbiology of Sir Salimullah medical college (SSMC) from March 2013 to August 2013.Out of 124 gram negative bacteria 69 (55.65%) were positive for ESBL. Among the ESBL producers, Esch.coli was the highest (46.38%) which was followed by Serratia spp (11.59%), Enterobacter spp (10.14%), Proteus spp, (8.70%), Acinetobacter spp.(7.24%) and Klebsiella spp.(5.79%). Out of 32 Esch.coli isolated from outpatient department, 10 (31.25%) were positive for ESBL. On the other hand out of 27 Esch. coli isolated from inpatient department, 22 (81.48%) were positive for ESBL. The difference was statistically significant (p<0.001).So the present study reveals that the distribution of ESBL producers is more among the hospitalized patients than the patients of the community.Bangladesh J Med Microbiol 2016; 10 (1): 8-12

scholarly journals TO STUDY ANTIBIOTIC SENSITIVITY PATTERN OF NONFERMENTATIVE GRAM NEGATIVE BACILLI FROM VARIOUS CLINICAL SAMPLES IN A TERTIARY CARE HOSPITAL, JAIPUR.

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Kirti Hemwani ◽  
P. S. Nirwan ◽  
Preeti Shrivastava ◽  
Abhiraj Ramchandani
Keyword(s):  
Tertiary Care ◽  
Antibiotic Sensitivity ◽  
Polymyxin B ◽  
Hospital Environment ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Care Hospital ◽  
Pathogenic Potential ◽  
Gram Negative ◽  
Sensitivity Pattern

Background: Nonfermentative gram negative bacilli (NFGNB) frequently considered as commensals or contaminants but the pathogenic potential of nonfermenters has been proved beyond doubt. They are resistant to commonly used antimicrobials. Aim: This study was undertaken to identify the nonfermenters isolated from various clinical samples and to know their Antibiotic sensitivity pattern. Materials and Methods: The present study was carried out on 150 strains of Nonfermenters isolated from 1200 various non repetitive clinical samples received in Department of Microbiology, NIMS Jaipur. Nonfermenters were identified using a standard protocol and their antibiotic susceptibility testing was performed with the help of the modified Bauer disc diffusion method. Results: Out of 150 nonfermenters isolated, Pseudomonas aeruginosa was the most common isolate 134 (89.33%) followed by Acinetobacter baumannii 16 (10.67%). Among all clinical samples Pus and Wound Discharge yield maximum isolates of NFGNB i.e. 54 (36%) % followed by sputum (39.0%). Most sensitive drug against NFGNB was Polymyxin-B (100%) followed by Imipenem (86 %) and Amikacin (71.33 %). Conclusion: Nonfermenters have a great potential to survive in a hospital environment so implementation of antibiotic stewardship programs and strict infection control practices will be required to prevent or slow down their emergence and spread. Keywords:  Nonfermenters,  Polymyxin-B, Pseudomonas, Acinetobacter.

scholarly journals Emerging resistance to carbapenem among Gram-negative bacteria in a tertiary care hospital

2020 ◽  
Vol 11 (SPL2) ◽  
pp. 153-156
Author(s):  
Pooja Nair ◽  
Renu Mathews ◽  
Kalyani M
Keyword(s):  
Minimum Inhibitory Concentration ◽  
Inhibitory Concentration ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Clinical Samples ◽  
Care Hospital ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Diffusion Technique

The emergence of bacterial antibiotic resistance is a cardinal concern in the health care system. The spread of resistance in Enterobacteriaceae and non-fermenters to the currently available drugs make the treatment of serious nosocomial infections troublesome.  The purpose of the study is to find out the carbapenem resistance among Gram-negative bacilli in a tertiary care hospital. Antibiotic susceptibility pattern of 1913 aerobic Gram-negative bacilli isolated from clinical samples was made for a period of 6 months. All the isolates were tested for susceptibility to antibiotics by the Kirby-Bauer disc diffusion technique according to CLSI guidelines. Carbapenemase production was confirmed by the Modified Hodge Test (MHT). Minimum Inhibitory Concentration (MIC) by Epsilometer (E) test was performed (for Imipenem and Meropenem) for carbapenem-resistant strains. A total of 1731 clinical samples, 1913 Gram-negative bacilli were isolated. 1476 (77.1%) were Enterobacteriaceae and 433 (22.6%) were non-fermenters. 54 were carbapenemase-producing Gram-negative bacilli. Meropenem E test was done for carbapenemase-producing Gram-negative bacilli. The minimum inhibitory concentration for Meropenem ranged from 0.002μg/ml to 32μg/ml. To overcome the problem of emerging resistance, combined interaction and cooperation of microbiologists, clinicians and the infection control team is needed.

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