scholarly journals High Level Plasmid-Mediated Quinolone Resistance in Clinical Infections at a Tertiary Healthcare Institution in South-West Nigeria

2021 ◽  
Author(s):  
Abiodun Ronke Ojewuyi ◽  
Babatunde Odetoyin ◽  
Aaron Oladipo Aboderin
Keyword(s):  
Tertiary Care ◽  
Wide Distribution ◽  
Quinolone Resistance ◽  
Clinical Isolates ◽  
Care Hospital ◽  
Cross Sectional ◽  
Diffusion Technique ◽  
High Prevalence ◽  
Tertiary Healthcare ◽  
High Level

Abstract Background Plasmid-mediated quinolone resistance (PMQR) has become a growing clinical concern worldwide. Recent reports from Nigeria revealed that qunolone resistant clinical isolates have become commomplace. However, few reports regarding the prevalence of PMQR are available. Hence, this study aimed to determine the prevalence of PMQR genes in qunolone resistant clinical isolates from a tertiary care hospital in Nigeria. Methods This was a cross-sectional hospital based study involving 390 non-repetitive Gram negative bacilli from diverse clinical infections. The isolates were characterized by the MicrobactTM identification kit and their susceptibility patterns determined by the Kirby-Bauer disc diffusion technique. All quinolone resistant isolates were investigated for the carriage of PMQR genes by multiplex polymerase chain reaction (PCR). Data analysis was with appropriate descriptive and inferential statistics.Results The isolates were distributed as Escherichia coli (n=121; 31.0%), Klebsiella species (n= 112;28.7%), Pseudomonas aeruginosa (n=59;15.1%), Proteus species (n=43;11.0%), Salmonella species (n=6;1.3%) and others. They were commonly resistant to nalidixic (62.6%), co-amoxiclav (57.7%); norfloxacin (52.3%), ofloxacin(52.1%) and ciprofloxacin(51.0%), but were least resistant to imipenem; (n=36; 9.2%). Out of 244 isolates that were resistant to at least one quinolone, 180 (73.8%) harboured one or more PMQR gene with a high prevalence of efflux-mediating determinants (qepA, 22.5%; oqxAB, 21.1%), and the aminoglycoside acetyltransferase (aac(6’)-Ib-cr, 19.7%). Proportionately low level of target-protecting determinants; qnrB, 13.2%; qnrS, 8.7%; qnrA, 5.9%; qnrD, 4.5% and qnrC, 4.2% were found in these isolates.Conclusion There is high level quinolone resistance and wide distribution of PMQR genes in clinical isolates in Nigeria with a preponderance of Efflux-mediating determinants and the aminoglycoside acetyltransferase. This emphasizes the need for regular resistance surveillance and antimicrobial stewardship to guide the appropriate and judicious use of antibiotics.

scholarly journals High Level Plasmid-Mediated Quinolone Resistance in Clinical Infections at a Tertiary Healthcare Institution in South-West Nigeria

2020 ◽  
Author(s):  
Abiodun Ronke Ojewuyi ◽  
Babatunde Odetoyin ◽  
Aaron Oladipo Aboderin
Keyword(s):  
Tertiary Care ◽  
Wide Distribution ◽  
Quinolone Resistance ◽  
Clinical Isolates ◽  
Care Hospital ◽  
Cross Sectional ◽  
Diffusion Technique ◽  
High Prevalence ◽  
Tertiary Healthcare ◽  
High Level

Abstract Background Plasmid-mediated quinolone resistance (PMQR) has become a growing clinical concern worldwide. Recent reports from Nigeria revealed that qunolone resistant clinical isolates have become commomplace. However, few reports regarding the prevalence of PMQR are available. Hence, this study aimed to determine the prevalence of PMQR genes in qunolone resistant clinical isolates from a tertiary care hospital in Nigeria. Methods This was a cross-sectional hospital based study involving 390 non-repetitive Gram negative bacilli from diverse clinical infections. The isolates were characterized by the MicrobactTM identification kit and their susceptibility patterns determined by the Kirby-Bauer disc diffusion technique. All quinolone resistant isolates were investigated for the carriage of PMQR genes by multiplex polymerase chain reaction (PCR). Data analysis was with appropriate descriptive and inferential statistics.Results The isolates were distributed as Escherichia coli (n=121; 31.0%), Klebsiella species (n= 112;28.7%), Pseudomonas aeruginosa (n=59;15.1%), Proteus species (n=43;11.0%), Salmonella species (n=6;1.3%) and others. They were commonly resistant to nalidixic (62.6%), co-amoxiclav (57.7%); norfloxacin (52.3%), ofloxacin(52.1%) and ciprofloxacin(51.0%), but were least resistant to imipenem; (n=36; 9.2%). Out of 244 isolates that were resistant to at least one quinolone, 180 (73.8%) harboured one or more PMQR gene with a high prevalence of efflux-mediating determinants (qepA, 22.5%; oqxAB, 21.1%), and the aminoglycoside acetyltransferase (aac(6’)-Ib-cr, 19.7%). Proportionately low level of target-protecting determinants; qnrB, 13.2%; qnrS, 8.7%; qnrA, 5.9%; qnrD, 4.5% and qnrC, 4.2% were found in these isolates.Conclusion There is high level quinolone resistance and wide distribution of PMQR genes in clinical isolates in Nigeria with a preponderance of Efflux-mediating determinants and the aminoglycoside acetyltransferase. This emphasizes the need for regular resistance surveillance and antimicrobial stewardship to guide the appropriate and judicious use of antibiotics.

scholarly journals A study of metabolic syndrome in patients of HIV on ART in India

2021 ◽  
Author(s):  
V K Sashindran ◽  
Anchit Raj Singh
Keyword(s):  
Metabolic Syndrome ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Noncommunicable Diseases ◽  
Care Hospital ◽  
Cross Sectional ◽  
High Prevalence ◽  
Hiv Morbidity ◽  
The Impact

AbstractMetabolic syndrome is a risk factor for cardiovascular disease. With improvement in therapy for HIV, morbidity related to metabolic syndrome becomes a focus of interest. Change in nutritional status and introduction of newer regimens of ART are changing the impact of metabolic syndrome on patients of HIV. Few studies in recent times from developing countries have addressed this question. This is a cross sectional study to study the prevalence of Metabolic Syndrome in patients of HIV on ART from clinics in a tertiary care hospital in India. Data from 1208 patients of HIV on ART was analyzed and metabolic syndrome was seen in 257(21.3%) patients.The high prevalence of metabolic syndrome in patients of HIV in India found in this study gives an insight on the morbidity of noncommunicable diseases in patients with HIV in India in recent times.

scholarly journals Anti-microbial sensitivity and resistance of organisms in blood-culture samples from prolonged fever cases: evidence from a tertiary care hospital in West Bengal, India

2018 ◽  
Vol 7 (11) ◽  
pp. 2173
Author(s):  
Somanjana Ghosh ◽  
Arista Lahiri ◽  
Siddhartha Bera ◽  
Soumyajyoti Bandyopadhyay
Keyword(s):  
Blood Culture ◽  
Tertiary Care ◽  
Systemic Infection ◽  
Cross Sectional Study ◽  
Background Information ◽  
Resistance Pattern ◽  
Coagulase Negative Staphylococcus ◽  
Care Hospital ◽  
Cross Sectional ◽  
High Level

Background: Currently there is a rise in resistance to anti-microbials which is a matter of concern in treatment of systemic infections. Blood culture is considered “gold standard” in diagnosis of suspected systemic infection. The susceptibility to antibiotics thereafter determine the future course of treatment. The current study aims to find out the sensitivity and resistance pattern of the blood culture isolates.Methods: A cross-sectional study was performed on the blood culture samples sent within 24hours of admission of the adult patients reporting fever for 7 days or more with no history of consumption of any antibiotics within last month. Total 134 blood samples were analysed. The proportion of sensitivity and resistance to anti-bacterial agents was calculated among those samples which showed growth in the culture. Background information of the patients in terms of age, sex and religion were also noted.Results: Mean age of the patients was 39.33 (±12.19) years. Overall 47.76% were female patients and remaining were male. Among the Hindu patients majority were male while among Muslims majority were female. Of the total number of blood cultures examined 46.27% showed growth of bacteria. Staphylococcus aureus was the most frequently found bacteria isolated in cultures, followed by coagulase negative Staphylococcus and Pseudomonas. Of the frequently used antibiotics, higher sensitivity was seen with vancomycin, amikacin, netilmycin, imipenem, gentamicin. High resistance was observed in use of antibiotics like cefixime, amoxicillin-clavulanic acid and azithromycin.Conclusions: High level of resistance to several commonly used advanced antibiotics warrant judicial and evidence-based use of these drugs. 

scholarly journals High incidence of plasmid-mediated quinolone resistance genes among ciprofloxacin-resistant clinical isolates of Enterobacteriaceae at a tertiary care hospital in Puducherry, India

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e1995 ◽  
Author(s):  
Thiyagarajan Yugendran ◽  
Belgode Narasimha Harish
Keyword(s):  
Postgraduate Medical Education ◽  
Tertiary Care ◽  
Class Ii ◽  
Quinolone Resistance ◽  
Clinical Isolates ◽  
Class I ◽  
Care Hospital ◽  
Consumption Data ◽  
High Incidence ◽  
Jawaharlal Institute

Background.Plasmid-mediated quinolone resistance (PMQR) has received considerable attention recently. Data analysis in Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) revealed 75% of the Enterobacteriaceae isolates to be ciprofloxacin-resistant in 2012. Few reports regarding the prevalence of PMQR are available from India. Hence, the present study was carried out to ascertain the prevalence of PMQR genes among clinical isolates of ciprofloxacin-resistant Enterobacteriaceae in JIPMER.Methods.The study included 642 ciprofloxacin-resistant clinical Enterobacteriaceae isolates. JIPMER hospital’s annual consumption data for fluoroquinolones were retrieved from the Department of Pharmacy. The test isolates were screened for the presence ofqnr A,B,D,Sandaac(6′)-Ib-crgenes. PMQR-positive isolates alone were tested for the presence of class I (intI1) and class II (intI2) integrons. Randomly selected PCR amplicons were sequenced and analysed using MEGA software. A total of 30 PMQR strains chosen at random were assessed for the transferability of the PMQR genes.Results.A majority of the strains exhibited high MIC values with 106 strains exhibiting MIC values >256 µg/mL. Theaac(6′)-Ib-crgene had the highest prevalence at 64% (414) while,qnrBandqnrSgenes were present in 15% (97) and 10% (64) of the isolates respectively. None of the strains were positive forqnrAandqnrD. All PMQR-positive isolates were screened for class I (intI1) and class II (intI2) integrons. Class I integron was found to be predominant among the test isolates with a few of them carrying both the classes of integrons. Transferability of PMQR genes to transconjugants was identified.Conclusion.The incidence of PMQR genes in the tertiary-care setup of the JIPMER hospital was found to be high which could be probably due to the increased prescription of fluoroquinolones. Thus, there is a need for rational usage of fluoroquinolones.

scholarly journals Practices regarding prescription and dispensing of drugs in a tertiary care hospital in rural West Bengal, India

2017 ◽  
Vol 6 (11) ◽  
pp. 2712
Author(s):  
Alapan Bandyopadhyay ◽  
Debdut Dhar ◽  
Abhijit Mukherjee ◽  
Sharmistha Bhattacherjee ◽  
Samir Dasgupta
Keyword(s):  
West Bengal ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
International Standards ◽  
Care Hospital ◽  
Cross Sectional ◽  
Prescription Practices ◽  
Patient Interviews ◽  
Essential Drug List ◽  
Tertiary Healthcare

Background: Irrational prescription practices are a distressing global problem, especially in the developing countries. A study was conducted to assess the patterns of prescribing and dispensing drugs in a tertiary healthcare centre serving a large rural population in the eastern India.Methods: A cross-sectional observational study was conducted from July-September 2016 in the general out-patient department and the institution pharmacy of a tertiary care hospital of West Bengal, India. Data were congregated by collection and review of individual prescriptions, measuring the time of interaction between patients and prescribers/dispensers, and conducting patient interviews at exit.Results: Analysis of the collected and tabulated data revealed that after average, 2.5 medicines were prescribed per prescription, with 95.26% being under their generic name. Of the drugs prescribed, 95.79% were from the essential drug list. The average consultation time was 150.0s (SD 62.3s) and average dispensing time was 81.5s (SD 51.2s). Of the drugs prescribed, 86.12% of drugs were actually dispensed from the institution pharmacy but none of the drugs were labeled. The percentage of prescriptions with an antibiotic was 47.83%, while injections were recorded on in 2.83% of the prescriptions. Percentage of patients who had knowledge of the dosage of the drugs prescribed to them was 91.67%.Conclusions: While the study found high percentages of drugs prescribed under generic names high percentage of drugs actually prescribed from the Institution Pharmacy, prescription of drugs from the Essential Drugs List, and a low number of injections per prescription conforming to WHO set standards, it also found a lack of drug labelling, high percentage of prescription of antibiotics to be indicators that do not conform with the WHO set international standards.

scholarly journals PROFILE OF STAPHYLOCOCCUS AUREUS ISOLATED FROM PATIENTS ADMITTED IN A TERTIARY CARE HOSPITAL WITH ESPECIAL REFERENCE TO METHICILLIN RESISTANCE

2020 ◽  
pp. 1-2
Author(s):  
Asmita Singh ◽  
Anita Pandey ◽  
Amit Singh ◽  
Priyanka Chaturvedi
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Agents ◽  
Tertiary Care Hospital ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Clinical Isolates ◽  
Care Hospital ◽  
Wide Range ◽  
High Level

BACKGROUND: Staphylococcus aureus is a major human pathogen that causes wide range of clinical infections. Methicillin-resistant Staphylococcus aureus(MRSA) is endemic in India and is a dangerous pathogen causing hospital acquired infection leadings to signicant morbidity and mortality. OBJECTIVE:To study the prole of Staphylococcus aureusisolated from patients admitted in a tertiary care hospital. RESULT: Majority of clinical isolates of S.aurueswas obtained from patients of skin and soft tissue infection(54.66%) followed by those suffering from respiratory infection (13.33%), blood stream infection (13.33%) and UTI(8%). S.aureus was predominantly isolated from IPD samples, maximum cases were in the age group of 31-40 years and males outnumbered females. There was predominance of MRSA 112 (74.66%)which showed high level of resistance to penicillin (100%), ciprooxacin (82.14 %), co-trimoxazole (79.46%) and moxioxacin(85.71%). All the clinical isolates of S.aureuswere sensitive to linezolid andvancomycin (MIC <1ugm/ml). CONCLUSIONS: The clinical isolates of S.aureusshowed high level of resistance to various antimicrobial agents which is a signicant nosocomial threat. Surveillance and infection control practices should be carried out to prevent cross transmission of such resistant pathogen within the hospital setting

scholarly journals Drug utilization study in patients visiting dermatology outpatient department in tertiary care hospital

2020 ◽  
Vol 9 (10) ◽  
pp. 1533
Author(s):  
Salman H. Rizvi ◽  
Ujwala P. Gawali ◽  
Prashant S. Mishra
Keyword(s):  
Tertiary Care ◽  
Cross Sectional Study ◽  
Outpatient Department ◽  
Essential Medicines ◽  
World Health ◽  
Care Hospital ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Research Activities ◽  
Tertiary Healthcare

Background: With the surge of basic and clinical research activities, and subsequent recognition of newer dermatological disorders; dermatology is now considered to be one of the most important specialties in a healthcare setup. Dermatological problem in India manifests as primary and secondary cutaneous complaints. The aim of this study was to assess current prescribing practices among physicians for dermatology patients in tertiary care hospital.Methods: A prospective, observational and cross-sectional study was conducted in Department of Pharmacology in collaboration with Department of Dermatology in a tertiary healthcare hospital. As per inclusion criteria, patients visiting Dermatology Outpatient department (OPD) from October 2018 to December 2018 were enrolled in the study.Results: The average number of drugs per encounter was 4.9. 100% of the drugs were prescribed by their generic name and those prescribed from World Health Organization (WHO) list of essential medicines were 68.9%. Analysis of polypharmacy showed maximum 11 and minimum 2 drug was prescribed. Overall analysis of the drugs showed, the most common route of administration was orally. Antihistamines, antifungals and steroids constitute the major bulk of drug prescribed.Conclusions: In our study, though polypharmacy was found but it was necessary as per the conditions. Anti-fungal, antihistamines and steroids were the most common drugs prescribed. Prescriptions with injections and steroids were less in the study population. All the drugs were prescribed by their generic name and most were present in the essential list of medicines. Use of Nonsteroidal anti-inflammatory drugs (NSAIDs) was higher in our study as compared to other studies.

scholarly journals High incidence of plasmid-mediated quinolone resistance genes among ciprofloxacin-resistant clinical isolates of Enterobacteriaceae at a tertiary care hospital in Puducherry, India

2016 ◽  
Author(s):  
Thiyagarajan Yugendran ◽  
Belgode Narasimha Harish
Keyword(s):  
Tertiary Care ◽  
Class Ii ◽  
Quinolone Resistance ◽  
Clinical Isolates ◽  
Class I ◽  
Care Hospital ◽  
Consumption Data ◽  
High Incidence ◽  
Increasing Trend ◽  
Clinical Breakpoints

Background: Plasmid-mediated quinolone resistance (PMQR) has received considerable attention recently. Data analysis in JIPMER revealed 75% of the Enterobacteriaceae isolates to be ciprofloxacin-resistant in 2012. Few reports regarding the prevalence of PMQR are available from India. Hence, the present study was carried out to ascertain the prevalence of PMQR genes among clinical isolates of ciprofloxacin-resistant Enterobacteriaceae in JIPMER. Methods: The study included 642 ciprofloxacin-resistant clinical Enterobacteriaceae isolates. JIPMER hospital’s annual consumption data for fluoroquinolones were retrieved from the Department of Pharmacy. The test isolates were screened for the presence of qnr A, B, D, S and aac(6’)-Ib-cr genes. PMQR-positive isolates alone were tested for the presence of class I (intI1) and class II (intI2) integrons. Randomly selected PCR amplicons were sequenced and analysed using MEGA software. A total of 30 PMQR strains chosen at random were assessed for the transferability of the PMQR genes. Results: Majority of the strains exhibited high MIC values with 106 strains exhibiting MIC value ˃256µg/mL. The aac(6’)-Ib-cr gene had the highest prevalence at 64% (414) while, qnrB and qnrS genes were present in 15% (97) and 10% (64) of the isolates respectively. None of the strains were positive for qnrA and qnrD. All PMQR-positive isolates were screened for class I (intI1) and class II (intI2) integrons. Class I integron was found to be predominant among the test isolates with a few of them carrying both the classes of integrons. Transferability of PMQR genes to transconjugants was identified. Discussion: PMQR genes were found to exhibit an increasing trend of prevalence among the clinical isolates in this study. Thus, the need for rational usage of fluoroquinolones and reconsideration of their clinical breakpoints has arisen.

Phenotypic Detection of Inducible Clindamycin Resistance among Clinical Isolates of Staphylococcus aureus in Bharatpur Hospital

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Ramesh Sharma Regmi ◽  
Sujan Khadka ◽  
Sanjeep Sapkota ◽  
Swekshya Thapa Magar ◽  
Sanjib Adhikari ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Failure ◽  
Tertiary Care ◽  
Clinical Isolates ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Care Hospital ◽  
Disc Diffusion ◽  
Cross Sectional ◽  
Inducible Clindamycin Resistance

Background: Clindamycin is regarded as a reserve drug in the treatment of staphylococcal infections. Among few therapeutic alternatives available for treatment of erythromycin-resistant Staphylococcus aureus infections, clindamycin has several advantages but major limitation in its use is the development of resistance resulting in treatment failure. Routine clindamycin susceptibility test may fail to detect such inducible resistance which can be detected by Double disc diffusion test (D-test). The present study was undertaken to determine the incidence of inducible clindamycin resistance among clinical isolates of S. aureus in a tertiary care hospital in central Nepal. Methods: A cross-sectional study was carried out among the patients visiting Bharatpur Hospital from September to November 2019. A total of 1279 clinical samples were examined for the identification of S. aureus by standard microbiological procedures. Antibiotic susceptibility testing of the isolates was done by Kirby-Bauer disc diffusion method and all the erythromycin-resistant isolates were subjected to D-test for the phenotypic detection of inducible clindamycin resistance according to CLSI guidelines (2016). Results: S. aureus was recovered from 4.5% (58/1279) samples of which 35 isolates were Methicillin-Resistant Staphylococcus aureus (MRSA) and 23 were multi-drug resistant (MDR). Tetracycline was found to be the most effective antibiotic whereas erythromycin was the least effective. D-test revealed that 39.7% isolates showed iMLSB phenotype, 3.5% showed cMLSB phenotype and 56.8% showed MS phenotype. The percentage of inducible and constitutive resistance was seen higher amongst MRSA isolates compared to Methicillin-Sensitive Staphylococcus aureus (MSSA) isolates. Incidence of S. aureus was found higher among females and in the age group 20-30 years and in pus samples (p<0.01). Conclusions: Routine testing of inducible clindamycin resistance is suggested among the clinical isolates of erythromycin-resistant Staphylococci to avoid treatment failure.  

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