PATTERNS OF ANTIMICROBIAL RESISTANCE AMONG MAJOR BACTERIAL PATHOGENS ISOLATED FROM CLINICAL SAMPLES IN TWO TERTIARY’S HOSPITALS, IN SANA'A, YEMEN

Author(s):  
Huda Zaid Al-Shami ◽  
Muhamed Ahmed Al-Haimi ◽  
Omar Ahmed Esma’il Al-dossary ◽  
Abeer Abdulmahmood Mohamed Nasher ◽  
Mohammed Mohammed Ali Al-Najhi ◽  
...  

Background and objectives: At the present time, antimicrobial resistance (AMR) is a major public health hazard, with antimicrobial resistance bacteria increasing exponentially. This study estimates the epidemiological profiles and antimicrobial resistance of Gram-positive bacteria (GPB) and Gram-negative bacteria (GNB)  isolated from clinical samples among patients admitted to two University hospitals in Sana'a city for one year (2019). Methods: This was a retrospective study of clinical samples of patients collected from January 1, 2019 to December 30, 2019. All samples were appraised to determine presence of infectious agents using standard methods for isolation and identification of bacteria and yeasts from clinical samples of patients admitted to Al-Gumhouri University Hospital and Al-Kuwait University Hospital in Sana'a city. Antibiotic resistance was done using Kirby-Bauer disc diffusion methods. Results:  2,931 different pathogenic bacteria were detected from 24,690 different clinical specimens. The samples had an overall detection rate of 11.9% (2931/24,690). Among the bacterial pathogens isolated from clinical samples, 52.4% (n=1536) had GPB and 41.2% (n=1207) had GNB. The predominant GNB isolates were E.coli (22.04%), Klebsiella spp (6.03%), Pseudomonas aeruginosa (7.1%), Acinetobacter baumannii (1.46%), Enterobacter spp. (1.09%), Citrobacter spp. (1.16%), respectively. Among the GPB, S.aureus was the most common (26.3%), Coagulase-negative Staphylococcus (8.1%), Non-hemolytic Streptococcus (9.1%), Other alpha-hemolytic Streptococcus (3.9%), Streptococcus pyogenes (1.9%), and Streptococcus pneumoniae (0.5% ). A high rate of antibiotic resistance was recorded for sulfamethoxazole/trimethoprim (85.5%), ceftazidime (81.07%), ampicillin (70.4%), cefuroxime (66.4%). Conclusions:  The current study results revealed that the rate of resistance between GNB and GPB is associated with the incidence of different infections in patients attending two major tertiary hospitals in Sana'a city is very high. These results indicate ongoing screening and follow-up programs to detect antibiotic resistance, and also suggest the development of antimicrobial stewardship programs in Sana'a, Yemen.                     Peer Review History: Received: 9 September 2021; Revised: 11 October; Accepted: 23 October, Available online: 15 November 2021 Academic Editor:  Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency.  Received file:                Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Rima Benatoui, Laboratory of Applied Neuroendocrinology, Department of Biology, Faculty of Science, Badji Mokhtar University Annaba, BP12 E L Hadjar–Algeria, [email protected] Dr. Wadhah Hassan Ali Edrees, Hajja University, Yemen, [email protected] Rola Jadallah, Arab American University, Palestine, [email protected] Similar Articles: PREVALENCE OF PSEUDOMONAS AERUGINOSA (P. AERUGINOSA) AND ANTIMICROBIAL SUSCEPTIBILITY PATTERNS AT A PRIVATE HOSPITAL IN SANA'A, YEMEN EVALUATION OF ANTIBACTERIAL RESISTANCE OF BIOFILM FORMS OF AVIAN SALMONELLA GALLINARUM TO FLUOROQUINOLONES

2021 ◽  
Vol 22 (1) ◽  
pp. 52-59
Author(s):  
Z.D. Rakotovao-Ravahatra ◽  
F.M. Randriatsarafara ◽  
A.L. Rakotovao ◽  
A. Rasamindrakotroka

Background: The extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae are a major cause of nosocomial bacteraemia. The objectives of this study are to describe the antibiotic resistance pattern of ESBL producing Enterobacteriaceae responsible for bacteraemia and identify factors associated with these infections in a University Hospital in Madagascar.Methodology: This is a descriptive cross-sectional study of 300 randomly selected patients with clinical features of bacteraemia whose blood cultures were processed for isolation and identification of bacterial pathogens over a period of six months (October 2019 to March 2020) at the laboratory of the University Hospital of Befelatanana. Blood culture samples were processed by conventional microbiological method for isolation of Enterobacteriaceae, which were identified to species level using Analytical Profile Index (API) 20E® test system. Antibiotic susceptibility of each isolate was performed by the disk diffusion technique and ESBL production was detected by the ‘synergy’ method.Results: Of the 300 patients, 54 were positive for bacteria, giving a prevalence rate of 18% for microbiologically documented bacteraemia. Of the 54 bacterial pathogens, Enterobacteriaceae isolates constituted 37 (68.5%), with 23 (42.6%) being ESBL producing and 14 (25.9%) non-ESBL producing isolates, 14 (25.9%) were staphylococci and 3 (5.6%) were streptococci isolates. All 23 (100%) ESBL producing Enterobacteriaceae isolates were resistant to amoxicillin, amoxicillin-clavulanic acid and the third generation cephalosporins (3GC), 19 (82.6%) to gentamycin and 18 (78.3%) to cotrimoxazole. On the other hand, the non-ESBL producing isolates were more sensitive because only 10 (71%) were resistant to amoxicillin, 7 (50%)to cotrimoxazole, 2 (14%) to amoxicillin-clavulanic acid, 1 (7.1%) to gentamycin, and none (0%) was resistant to 3GC. All 54 Enterobacteriaceae isolates were sensitive to amikacin and imipenem. Age less than 20 years (93.8%) (p=0.001) and hospitalization in intensive care units (90.9%) (p=0.04) were significant risk factors associated with infection by ESBL producing Enterobacteriaceae.Conclusion: ESBL producing Enterobacteriaceae responsible for bacteraemia in University Hospital of Befelatanana, Madagascar, are resistant to many classes of antibiotics. Carbapenems and amikacin are the antibiotics of choice. Keywords: ESBL, Enterobacteriaceae, bacteraemia, antibiotic resistance   French Title: Prévalence et facteurs associés à la bactériémie à entérobactéries productrices de β-lactamases à spectre étendu dans l'hôpital universitaire de Befelatanana, Madagascar Contexte: Les entérobactéries productrices de β-lactamases à spectre étendu (BLSE) sont une cause majeurede bactériémie nosocomiale. Les objectifs de cette étude sont de décrire le profil de résistance aux antibiotiques des entérobactéries productrices de BLSE responsables de bactériémie et d'identifier les facteurs associés à ces infections dans un hôpital universitaire de Madagascar.Méthodologie: Il s'agit d'une étude transversale descriptive de 300 patients sélectionnés au hasard présentantdes caractéristiques cliniques de bactériémie dont les hémocultures ont été traitées pour l'isolement etl'identification des bactéries pathogènes sur une période de six mois (octobre 2019 à mars 2020) au laboratoiredu Hôpital universitaire de Befelatanana. Les échantillons d'hémoculture ont été traités par une méthodemicrobiologique conventionnelle pour l'isolement des entérobactéries, qui ont été identifiées au niveau del'espèce à l'aide du système de test Analytical Profile Index (API) 20E®. La sensibilité aux antibiotiques dechaque isolat a été réalisée par la technique de diffusion sur disque et la production de BLSE a été détectée parla méthode «synergie».Résultats: Sur les 300 patients, 54 étaient positifs pour les bactéries, ce qui donne un taux de prévalence de18% pour une bactériémie microbiologiquement documentée. Parmi les 54 bactéries pathogènes, les isolatsd'entérobactéries constituaient 37 (68,5%), 23 (42,6%) produisant des BLSE et 14 (25,9%) isolats neproduisant pas de BLSE, 14 (25,9%) étaient des staphylocoques et 3 (5,6%) l'étaient isolats de streptocoques.Les 23 isolats (100%) de BLSE produisant des Enterobacteriaceae étaient tous résistants à l'amoxicilline, àl'amoxicilline-acide clavulanique et aux céphalosporines de troisième génération (3GC), 19 (82,6%) à lagentamycine et 18 (78,3%) au cotrimoxazole. En revanche, les isolats non producteurs de BLSE étaient plussensibles car seuls 10 (71%) étaient résistants à l'amoxicilline, 7 (50%) au cotrimoxazole, 2 (14%) àl'amoxicilline-acide clavulanique, 1 (7,1%) à la gentamycine, et aucun (0%) n'était résistant à la 3GC. Les 54isolats d'Enterobacteriaceae étaient tous sensibles à l'amikacine et à l'imipénème. L'âge de moins de 20 ans(93,8%) (p=0,001) et l'hospitalisation en unité de soins intensifs (90,9%) (p=0,04) étaient des facteurs derisque importants associés à l'infection par les entérobactéries productrices de BLSE.Conclusion: Les entérobactéries productrices de BLSE responsables de bactériémie à l'hôpital universitaire deBefelatanana, Madagascar, sont résistantes à de nombreuses classes d'antibiotiques. Les carbapénèmes etl'amikacine sont les antibiotiques de choix. Mots clés: BLSE, entérobactéries, bactériémie, résistance aux antibiotiques    


2021 ◽  
Vol 43 (1) ◽  
pp. 19-24
Author(s):  
Santosh K Yadav ◽  
Sangita Sharma ◽  
Shyam K Mishra ◽  
Jeevan B Sherchand

Introduction In this era of modern medicine, antimicrobial resistance can be regarded as a major health calamity. The emergence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains poses therapeutic challenges and lead to treatment failure in hospitalized patients. This study was conducted to determine various types of β-lactamases among MDR P. aeruginosa isolates recovered from hospitalized patients. MethodsThis study was conducted at Tribhuvan University Teaching Hospital, Maharajgunj, Nepal. The clinical samples collected from inpatients were processed for detection of P. aeruginosa isolates and antibiotic susceptibility profile was determined. The MDR strains were identified and ceftazidime-resistant isolates were subjected for detection of extended-spectrum-β-lactamase (ESBL), metallo-β-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC). ResultsA total of 161 P. aeruginosa isolates were recovered during the study period encompassing 73.3% (n=118) MDR isolates. The MDR isolates included 50.0% (n=59) from lower respiratory tract infections; and 39.8% (n=47) were from the intensive care unit patients. The MDR isolates showed a high resistance profile towards piperacillin, cephalosporins, and fluoroquinolones (>85%). Resistance to carbapenems and aminoglycosides were up to 80% and 60% respectively. Extended spectrum-β-lactamase, MBL, and KPC mediated resistance were seen in 34.7%, 43.6%, and 14.4% MDR isolates, respectively. ConclusionMultidrug resistance as well as resistance mediated by β-lactamases production were high among P. aeruginosa isolates.  Therefore, early detection of antimicrobial resistance and rational use of antibiotics play a critical role to fight against this MDR pathogen.


2019 ◽  
Vol 70 (5) ◽  
pp. 1778-1783
Author(s):  
Andreea-Loredana Golli ◽  
Floarea Mimi Nitu ◽  
Maria Balasoiu ◽  
Marina Alina Lungu ◽  
Cristiana Cerasella Dragomirescu ◽  
...  

To determine the resistance pattern of bacterial pathogens involved in infections of the patients aged between 18-64 years, admitted in a ICU from a 1518-bed university-affiliated hospital. A retrospective study of bacterial pathogens was carried out on 351 patients aged between 18-64 years admitted to the ICU, from January to December 2017. In this study there were analysed 469 samples from 351 patients (18-64 years). A total of 566 bacterial isolates were obtained, of which 120 strains of Klebsiella spp. (35.39%%), followed by Nonfermenting Gram negative bacilli, other than Pseudomonas and Acinetobacter (NFB) (75- 22.12%), Acinetobacter spp. (53 - 15.63%), Pseudomonas aeruginosa and Proteus (51 - 15.04%), and Escherichia coli (49 - 14.45%). The most common isolates were from respiratory tract (394 isolates � 69.61%). High rates of MDR were found for Pseudomonas aeruginosa (64.70%), MRSA (62.65%) and Klebsiella spp. (53.33%), while almost all of the isolated NFB strains were MDR (97.33%). There was statistic difference between the drug resistance rate of Klebsiella and E. coli strains to ceftazidime and ceftriaxone (p[0.001), cefuroxime (p[0.01) and to cefepime (p[0.01). The study revealed an alarming pattern of antibiotic resistance in the majority of ICU isolates.


10.3823/846 ◽  
2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Abdelraouf A Elmanama ◽  
Suhaila Al-Sheboul ◽  
Renad I Abu-Dan

Abstract Pseudomonas aeruginosa threatens patient’s care. It is considered as the most complicated health care associated pathogen to be eliminated from infection site. The biofilm forming ability of P. aeruginosa, being a major virulence factor for most pathogenic microorganism, protects it from host immunity and contribute to antibiotic resistance of this organism. It is estimated that about 80% of infectious diseases are due to biofilm mode of growth. Biofilm forming ability of bacteria imparts antimicrobial resistance that leads to many persistent and chronic bacterial infections. The world is becoming increasingly under the threat of entering the “post-antibiotic era”, an era in which the rate of death from bacterial infections is higher than from cancer. This review focus on P. aeruginosa biofilm forming ability; definition, developmental stages, and significance. In addition, the quorum sensing and the antibiotic resistance of this pathogen is discussed. Keywords: Biofilm; bacterial adhesion; Pseudomonas aeruginosa; antimicrobial resistance; quorum sensing.


Author(s):  
S. L. Owolabi ◽  
I. A. Azeez

The alarming increase of antibiotic resistance of Escherichia coli has posed a great challenge in the public health sector. Thus, this microorganism is a leading cause of different human infections and it can be found in various environments. The aim of this study is to investigate the antimicrobial susceptibility patterns and the multiple antimicrobial resistance profile of Escherichia coli isolates obtained from some hospitals in Abeokuta, Ogun State, Nigeria. Isolates of E. coli were obtained from different clinical samples and were re-identified morphologically and biochemically. E. coli was isolated from 30% out of a total of 70 clinical samples analyzed for isolation and identification. The isolation rate of E. coli was highest in urine samples 10(47.6%) when compared to other clinical samples. There was significant increase in the resistance rate of E. coli to tetracycline (14.3%), ceftazidime (14.2%), and ampicillin (14.2%).Also, an increased sensitivity rate to augmentin (71.4%), ofloxacin (66.7%), cefuroxime (66.7%), ciprofloxacin (61.9%) and ceftazidime (61.9%) were observed. Furthermore, the overall multiple drug resistance rates obtained was 14(66.7%) and it was established that, multiple antimicrobial resistance of the E. coli isolates was plasmid mediated. E. coli isolates exhibited high resistance rate to multiple antimicrobial agents, however, its sensitivity to augmentin, ofloxacin, cefuroxime, ciprofloxacin and ceftazidime showed that these antimicrobials are still effective against E. coli infections in the study area.


ANKEM Dergisi ◽  
2021 ◽  
Author(s):  
Nilüfer Uzunbayır Akel ◽  
Yamaç Tekintaş ◽  
Fethiye Ferda Yılmaz ◽  
İsmail Öztürk ◽  
Mustafa Ökeer ◽  
...  

Pseudomonas aeruginosa is one of the most important causes of hospital infections. Although different antibiotic groups are used for the treatment of P.aeruginosa infections, quinolone groups are distinguished by the advantages of oral administration. However, in recent years, resistance against members of this group has made treatment more difficult. The aim of this study was to investigate the epidemiological relationship and possible mechanisms of resistance in ciprofloxacin resistant P. aeruginosa isolates from Ege University Hospital. The identification of P.aeruginosa bacteria isolated from clinical samples in Ege University Medical Faculty Medical Microbiology Laboratory was determined by VITEK MS automated systems by VITEK compact, antimicrobial susceptibility. The epidemiological relationships of the ciprofloxacin resistant isolates were determined by Enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR). The presence of qnrA, qnrB, qnrS, qepA genes, the quinolone resistance genes and nfxB, mexR, the regulatory genes of the efflux pump, was determined by PCR. The phenylalanine-arginine β-naphthylamide (PAβN) assay was used to determine the activation of the efflux pump. Twenty-two isolates (26.5 %) were found resistant to ciprofloxacin. According to the ERIC-PCR results, 11 unrelated clones were detected. Ciprofloxacin minimum inhibitory concentration (MIC) values were decreased 2-64 times in 10 isolates in the presence of PAIN. No ciprofloxacin MIC change was detected in one isolate. The presence of pump regulatory genes was determined in 10 of the 11 representative isolates, while only qnrB of the genes associated with quinolone resistance was detected in seven representative isolates. qnrA, qnrS, qepA genes were not detected in any isolate. Ciprofloxacin resistant P.aeruginosa isolates are isolated from our hospital. It is noteworthy that the isolates belonging to different genetic groups are in circulation in clinics. Basic resistance mechanisms are thought to be efflux pumps and qnrB genes.


2019 ◽  
Author(s):  
Raja Ram Gurung ◽  
Prashanna Maharjan ◽  
Ganga GC

Abstract Background: Staphylococcus aureus is one of the important superbugs distributed throughout the world. It causes minor skin infections to severe complications including nosocomial infections in both hospitals and community settings. These strains have multi-drug resistant property. Hence, they are difficult to manage which increase health-related costs and simultaneously intensifying the need for new antibiotics. The extent of Methicillin-Resistant Staphylococcus aureus (MRSA) in children is largely unknown. The study determines the current status of S. aureus and MRSA causing various infections in pediatric patients visiting International Friendship Children’s Hospital (IFCH). Methods: A cross-sectional study was conducted among patients visiting a hospital. Various clinical specimens were aseptically collected and processed according to standard microbiological procedures. Isolation and identification of S. aureus were done by microscopy, mannitol fermentation, and coagulase positivity. All identified S. aureus isolates subjected to in-vitro antibiogram by Kirby-Bauer disc diffusion technique adopting Clinical and Laboratory Standards Institute (CLSI) guideline. Isolates resistant to cefoxitin were considered to be MRSA. Whereas, isolates produced D-shaped inhibition zone around clindamycin when kept near erythromycin were considered to be Inducible Clindamycin Resistant (ICR). Results: 672 various types of clinical samples were processed from the microbiology laboratory from June and November 2015. Out of 300 culture positive samples, 52 (17.3%) were S. aureus isolates, among them 39 (75.0%) were found to be MRSA. The D-test showed that Macrolide-Lincosamide-Streptogramin-B (MLSB) phenotype was 15.4%. Conclusion: The study shows the MRSA occurrence is prevalent in pediatric patients and newer classes’ drugs are found more effective than β-lactam drugs to treat S. aureus infection. However, restriction on the indiscriminate use of such drugs may be an effective strategy to control the drug resistance. Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Macrolide-Lincosamide-Streptogramin B (MLSB) phenotype, Inducible Clindamycin Resistant (ICR) test or D-zone test, Antibiotic resistance, Nepal


2017 ◽  
Vol 8 (2) ◽  
Author(s):  
Naeimeh Sadat Hashemi ◽  
Meysam Mojiri ◽  
Parivash Yazdani Kachouyi ◽  
Shiva Eskandari ◽  
Mehrsa Mohammadian ◽  
...  

Pseudomonas aeruginosa is one of the most important opportunistic pathogens responsible for various types of hospital infections. High prevalence of antibiotic resistance in P. aeruginosa strains of human clinical samples cause more severe diseases for a longer period of time. The current research was done in order to study the distribution of blaIMP-1 gene among the imipenem-resistant P. aeruginosa strains isolated from burn and urinary tract infections of hospitalized patients. Two-hundred and forty-three P. aeruginosa isolates recovered from the cases of burn and urinary tract infections of inpatients and outpatients were analysis for antibiotic resistance pattern using the disk diffusion method. Then, imipenem-resistant isolates were further analyzed for distribution of blaIMP-1 gene using the PCR. Of 243 P. aeruginosa isolates, 146 strains (60.08%) were taken from outpatients and 97 strains (39.91%) were taken from inpatients. P. aeruginosa isolates harbored the highest levels of resistance against streptomycin (100%), nalidixic acid (100%), aztreonam (100%), cotrimoxazole (95.47%), ciprofloxacin (88.47%), cefotaxime (84.36%) and gentamycin (83.95%). Inpatients had a relatively higher levels of antibiotic resistance. One-hundred and twenty-one out of 126 (96.03%) imipenem-resistant P. aeruginosa isolates harbored the blaIMP-1 gene. Inpatients also had a relatively higher prevalence of blaIMP-1 gene. High prevalence of blaIMP-1 gene and also imipenemresistant P. aeruginosa are important public health issue. Clinical laboratories should consider the detection of the blaIMP-1 gene among the P. aeruginosa isolates of clinical samples.


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