scholarly journals The Usage of Antibiotics by COVID-19 Patients with Comorbidities: The Risk of Increased Antimicrobial Resistance

Antibiotics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 35
Author(s):  
Basit Zeshan ◽  
Mohmed Isaqali Karobari ◽  
Nadia Afzal ◽  
Amer Siddiq ◽  
Sakeenabi Basha ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
Bacterial Infections ◽  
Tertiary Care ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
E Coli ◽  
Tract Infections

Antimicrobial resistance (AMR) is a global health issue that plays a significant role in morbidity and mortality, especially in immunocompromised patients. It also becomes a serious threat to the successful treatment of many bacterial infections. The widespread and irrelevant use of antibiotics in hospitals and local clinics is the leading cause of AMR. Under this scenario, the study was conducted in a tertiary care hospital in Lahore, Pakistan, from 2 August 2021 to 31 October 2021 to discover the prevalence of bacterial infections and AMR rates in COVID-19 patients admitted in surgical intensive care units (SICUs). Clinical samples were collected from the patients and we proceeded to identify bacterial isolates, followed by antibiotic susceptibility testing (AST) using the Kirby Bauer disk diffusion method and minimum inhibitory concentration (MIC). The data of other comorbidities were also collected from the patient’s medical record. The current study showed that the most common pathogens were E. coli (32%) and Klebsiella pneumoniae (17%). Most E. coli were resistant to ciprofloxacin (16.8%) and ampicillin (19.8%). Klebsiella pneumoniae were more resistant to ampicillin (13.3%) and amoxycillin (12.0%). The most common comorbidity was chronic kidney disease (CKD) and urinary tract infections (UTIs). Around 17 different types of antibiotic, the carbapenem, fluoroquinolones, aminoglycoside, and quinolones, were highly prevalent in ICU patients. The current study provides valuable data on the clinical implication of antibiotics consumed by COVID-19 patients in SICUs and the AMR rates, especially with different comorbidities.

scholarly journals Prevalence of carbapenemase-producing Klebsiella pneumoniae at a tertiary care hospital in Kathmandu, Nepal

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Susil Pyakurel ◽  
Mehraj Ansari ◽  
Smriti Kattel ◽  
Ganesh Rai ◽  
Prasha Shrestha ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Resistant Bacteria ◽  
Growth Media ◽  
Care Hospital ◽  
Drug Resistant ◽  
Biochemical Tests

Abstract Aim Although carbapenem is the last-resort drug for treating drug-resistant Gram-negative bacterial infections, prevalence of carbapenem-resistant bacteria has substantially increased worldwide owing to irrational use of antibiotics particularly in developing countries like Nepal.  Therefore, this study was aimed to determine the prevalence of carbapenemase-producing K. pneumoniae and to detect the carbapenemase genes (blaNDM-2 and blaOXA-48) in at a tertiary care hospital in Nepal. Materials and methods A hospital-based cross-sectional study was carried out from June 2018 to January 2019 at the Microbiology Laboratory of Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal. Different clinical samples were collected and cultured in appropriate growth media. Biochemical tests were performed for the identification of K. pneumoniae. Antibiotic susceptibility testing (AST) was performed by the Kirby–Bauer disc diffusion method. The modified Hodge test (MHT) was performed to detect carbapenemase producers. The plasmid was extracted by the modified alkaline hydrolysis method. Carbapenemase-producing K. pneumoniae were further confirmed by detecting blaNDM-2 and blaOXA-48 genes by PCR using specific forward and reverse primers followed by gel electrophoresis. Results Out of the total 720 samples, 38.9% (280/720) were culture positive. K. pneumoniae was the most predominant isolate 31.4% (88/280). Of 88 K. pneumoniae isolates, 56.8% (50/88) were multi-drug resistant (MDR), and 51.1% (45/88) were MHT positive. Colistin showed the highest sensitivity (100%; 88/88), followed by tigecycline (86.4%; 76/88). blaNDM-2 and blaOXA-48 genes were detected in 24.4% (11/45) and 15.5% (7/45) of carbapenemase-producing K. pneumoniae isolates, respectively. Conclusion The rate of MDR and carbapenemase production was high in the K. pneumoniae isolates. Colistin and tigecycline could be the drug of choice for the empirical treatments of MDR and carbapenemase-producing K. pneumoniae. Our study provides a better understanding of antibiotic resistance threat and enables physicians to select the most appropriate antibiotics.

scholarly journals Incidence and Susceptibility of Uropathogens Isolated among the Patients at Tertiary Care Hospital in Eastern Nepal

2016 ◽  
Vol 5 (2) ◽  
pp. 51-55 ◽  
Author(s):  
Bigu Kumar Chaudhari ◽  
Ganesh Kumar Singh ◽  
Kamal Prasad Parajuli ◽  
Kewal Shrestha
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Diffusion Method ◽  
Care Hospital ◽  
E Coli ◽  
Medical College ◽  
Tract Infections

Background Urinary Tract Infection (UTI) is one of the most common infectious diseases which affect almost all ages groups of population. Production of â-lactamases is responsible for antibacterial resistance which is frequently observed in Enterobacteriaceae isolates, particularly by E. coli and Klebsiella pneumoniae. This investigation has been carried out to determine the current status of prevalence and susceptibility of uropathogens isolated among the patients at tertiary care hospital in eastern Nepal.Material and Methods This study was done at the department of Microbiology, Nobel Medical College Teaching Hospital, Biratnagar, Nepal during May 1st 2015 to October 31st 2015. Midstream cleancatch urine was sampled from 1730 suspected urinary tract infection patients of different age and sex groups. Uropathogens were recognized in term of standard and specific microbiological techniques and antimicrobial susceptibility pattern was determined by Kirby Bauer Disc diffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines.Results Out of 1730 suspected specimens Culture resulted a total of 761 (43.98 %) positive and 969 (56.02%) negative among that significant growths of uropathogens including 700 (91.98 %) unimicrobial and 60 (7.88 %) polymicrobial growths. In term of Gender distribution 443 (25.60 %) were male and 1287 (74.40 %) were female hence the ratio is 0.34:1, respectively. E. coli was the leading isolate (66 %), followed by Klebsiella spp. (12 %), Enterococcus spp. (8 %), Pseudomonas spp. (6 %), Acinetobacter anitratus (5 %), Proteus spp. (3 %).Conclusion The high frequency of multidrug resistance in bacterial uropathogens was seen. Principally, resistance patterns were seen higher for amoxycillin, co-trimoxazole, flouroquinolones and third-generation cephalosporins, Existing uropathogens highlights the highest rate of vulnerability to nitrofurantoin, amikacin and gentamicin which provide much better antibiotic coverage and can be adapted for practical treatment of urinary tract infections.  Journal of Nobel Medical College Vol.5(2) 2016; 51-55

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 Biofilm formation and antibiotic resistance of Klebsiella pneumoniae isolated from clinical samples in a tertiary care hospital, Klaten, Indonesia

2019 ◽  
Vol 13 (S11) ◽  
Author(s):  
Hera Nirwati ◽  
Kian Sinanjung ◽  
Fahrina Fahrunissa ◽  
Fernando Wijaya ◽  
Sarastia Napitupulu ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Klebsiella Pneumoniae ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Resistance Pattern ◽  
Care Hospital ◽  
Disk Diffusion Method ◽  
Wide Range

Abstract Background Klebsiella pneumoniae (K. pneumoniae) is a common cause of health-care associated infections (HAIs) and has high levels of antibiotic resistance. These bacteria are well-known for their ability to produce biofilm. The purpose of this study was to identify the antibiotic resistance pattern and biofilm-producing capacity of K. pneumoniae isolated from clinical samples in a tertiary care hospital in Klaten, Indonesia. Methods K. pneumoniae was isolated from inpatients in Soeradji Tirtonegoro Hospital Klaten from June 2017 to May 2018. Identification of K. pneumoniae isolate was done by analyzing colony morphology, microscopic examination, and by performing biochemical testing. Testing of antibiotics susceptibility and biofilm-producing capacity used the Kirby-Bauer disk diffusion method and adherence quantitative assays, respectively. Results A total of 167 (17.36%) K. pneumoniae isolates were isolated from 962 total clinical bacterial isolates during the study. Most of them were collected from patients aged more than 60 years old and were mainly obtained from respiratory specimens (51.50%). Most of K. pneumoniae isolates were extensively resistant to antibiotics. A more favorable profile was found only towards meropenem, amikacin, and piperacillin-tazobactam, showing 1.20%; 4.79% and 10.53% of resistance, respectively. The overall proportion of multidrug-resistant K. pneumoniae isolates was 54.49%. In addition, 148 (85.63%) isolates were biofilm producers, with 45 (26.95%) isolates as strong, 48 (28.74%) isolates as moderate, and 50 (29.94%) isolates as weak biofilm producers. Conclusion Most of the K. pneumoniae isolates demonstrated resistance to a wide range of antibiotics and are biofilm producers.

scholarly journals Bacterial coinfections and secondary infections in COVID-19 patients from a tertiary care hospital of northern India: Time to adhere to culture-based practices

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Bhawna Sharma ◽  
Priya Sreenivasan ◽  
Manisha Biswal ◽  
Varun Mahajan ◽  
Vikas Suri ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Rational Approach ◽  
Clinical Samples ◽  
Care Hospital ◽  
Acinetobacter Species ◽  
Secondary Infections ◽  
Tract Infections

Objective: Bacterial co-pathogens are common in various viral respiratory tract infections, leading to increased disease severity and mortality. Still, they are understudied during large outbreaks and pandemics. This study was conducted to highlight the overall burden of these infections in COVID-19 patients admitted to our tertiary care hospital, along with their antibiotic susceptibility patterns. Material and methods: During the six-month study period, clinical samples (blood samples, respiratory samples, and sterile body fluids, including cerebrospinal fluid [CSF]) of COVID-19 patients with suspected bacterial coinfections (at presentation) or secondary infections (after 48 hours of hospitalization) were received and processed for the same. Results: Clinical samples of 814 COVID-19 patients were received for bacterial culture and susceptibility. Out of the total patient sample, 75% had already received empirical antibiotics before the samples were sent for analysis. Overall, 17.9% of cultures were positive for bacterial infections. Out of the total patients with bacterial infection, 74% (108/146) of patients had secondary bacterial infections (after 48 hours of hospitalization) and 26% (38/146) had bacterial coinfections (at the time of admission). Out of the 143 total isolates obtained, the majority (86%) were gram-negative organisms, of which Acinetobacter species was the commonest organism (35.6%), followed by Klebsiella pneumoniae (18.1%). The majority (50.7%) of the pathogenic organisms reported were multidrug resistant. Conclusion: The overall rate of secondary bacterial infections (SBIs) in our study was lower (7.9%) than reported by other studies. A rational approach would be to adhere to the practice of initiating culture-based guidance for antibiotics and to restrict unnecessary empirical antimicrobial therapy.

scholarly journals Prevalence of Multidrug-resistant and Carbapenemase-producing Klebsiella Pneumoniae and Pseudomonas Aeruginosa Isolates in Tertiary Care Hospital in Kathmandu, Nepal

2021 ◽  
Vol 23 (4) ◽  
pp. 290-296
Author(s):  
Rojina Darnal ◽  
Mehraj Ansari ◽  
Ganesh Rai ◽  
Kul Raj Rai ◽  
Shiba Kumar Rai
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Klebsiella Pneumoniae ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Resistant Bacteria ◽  
Care Hospital ◽  
Disk Diffusion Method

Carbapenemases are the enzymes that catalyze β–lactam groups of antibiotics. The carbapenemase producers are resistant to β–lactam antibiotics and are usually multidrug-resistant bacteria challenging widely used therapeutics and treatment options. Therefore, the detection of carbapenemase activity among clinical isolates is of great therapeutic importance. We aimed to study the MDR and carbapenemase-producing Klebsiella pneumoniae and Pseudomonas aeruginosa isolated from various clinical samples at a tertiary care hospital in Nepal. A total of 3,579 clinical samples were collected from the patients visiting the Department of Microbiology, B&B Hospital, Gwarko, Lalitpur. The samples were processed to isolate K. pneumoniae and P. aeruginosa and then subjected to antibiotic susceptibility testing (AST) by the Kirby-Bauer disk diffusion method. Phenotypic detection of carbapenemase activity was performed in the imipenem-resistant isolates by the modified Hodge test (MHT). Of the total samples, 1,067 (29.8%) samples showed significant growth positivity, out of which 190 (17.3%) isolates were K. pneumoniae and 121 (11.3%) were P. aeruginosa. Multidrug resistance was seen in 70.5% of the K. pneumoniae isolates and 65.3% of the P. aeruginosa isolates. Carbapenemase production was confirmed in 11.9%, and 12.2% of the imipenem-resistant K. pneumoniae and P. aeruginosa isolates, respectively, by the MHT. This study determined the higher prevalence of MDR among K. pneumoniae and P. aeruginosa; however, carbapenemase production was relatively low.

scholarly journals A study on virulence factors and antimicrobial resistance pattern among enterococci isolated from various clinical specimens from a tertiary care hospital

2017 ◽  
Vol 5 (7) ◽  
pp. 2969
Author(s):  
Hemalatha G. ◽  
Bhaskaran K. ◽  
Sowmiya M. ◽  
Anusheela Howlader ◽  
Sethumadhavan K.
Keyword(s):  
Antimicrobial Resistance ◽  
Virulence Factors ◽  
Tertiary Care ◽  
Vancomycin Resistance ◽  
Control Measures ◽  
Hospital Environment ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Drain Tube ◽  
Care Hospital

Background: Enterococci, adult faeces commensal are important nosocomial pathogens. E. faecalis is the most common cause of infection, followed by E. faecium. In the past two decades, they have developed resistance to many commonly used antimicrobial agents. Understanding virulence factors and monitoring antimicrobial resistance among Enterococci is essential for controlling the spread of bacterial resistance and important for epidemiological surveillance within the hospital environment. The aim of the study is to evaluate antibiotic resistance and virulence factors exhibited by Enterococcus sp.Methods: One hundred consecutive isolates of Enterococci isolated from different clinical samples of patients attending AVMC and H, a tertiary care center at Pondicherry in a period of 20 months were included in the study. Enterococcus sp were identified as per standard conventional bacteriologic methods and detected for the production of virulence factors such as Hemolysin production, Gelatinase production. Antimicrobial susceptibility testing was carried out by disc diffusion method and MIC of vancomycin and teicoplanin was determined by E-test strips.Results: Among 100 Enterococcal isolates included in the study, 81% were E. faecalis and 19% were E. faecium which were isolated from urine (44%), Pus (51%) and others specimen (5%, which includes blood 80% and drain tube 20%). In this study, overall 15% of E. faecalis and 1% of E. faecium showed hemolysin production and Gelatinase was produced by 6% of E. faecalis and 4% of E. faecium. Majority of E. faecalis and E. faecium strains isolated in our study, had increased sensitivity were to be exhibited for Linezolid, Vancomycin followed by high level gentamycin and high degree of resistance to penicillin, ciprofloxacin and cotrimoxazole. Analyzing the results of MIC of vancomycin and teicoplanin, 5 isolates were classified phenotypically as VanB phenotype that possess only moderate to high levels of vancomycin resistance and one isolate obtained from drain tube which showed MIC of vancomycin as 120µg/ml and teicoplanin 16µg/ml was grouped into VanA.Conclusions: Though the prevalence of vancomycin resistant Enterococcci (VRE) is very low in our study, yet regular monitoring of vancomycin resistance is very crucial for early detection, treatment, application of preventive and control measures and most importantly to check the spread of virulent multidrug resistant Enterococcus species.

scholarly journals A STUDY ON ANTIBIOTIC SUSCEPTIBILITY PATTERN OF ESCHERICHIA COLI ISOLATES FROM EXTRA INTESTINAL INFECTIONS IN A TERTIARY CARE HOSPITAL

2021 ◽  
Vol 9 (11) ◽  
pp. 781-788
Author(s):  
N. Sudha ◽  
◽  
Dillirani V. ◽  
Sheeba V. ◽  
Fahad Affan ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Susceptibility ◽  
Bacterial Infections ◽  
Tertiary Care ◽  
Clinical Samples ◽  
Care Hospital ◽  
Susceptibility Pattern ◽  
Beta Lactam ◽  
Antibiotic Susceptibility Pattern ◽  
Tract Infections

Escherichia coli (E.coli), a common human intestinal commensal causes infections in bodily sites outside the gastrointestinal tract and are called Extra-intestinal pathogenic E.coli. ExPEC causes Urinary tract infections, Blood stream infections, Pneumonia, meningitis,bone, skin, and soft tissue infections including both nosocomial and community acquired infections. The increasing trend of developing antibiotic resistance in ExPEC is of global treat which causes increasing morbidity and mortality.As there is no vaccination forExPEC so it is necessary to analyze the antibiotic susceptibility pattern for empirical treatment in emergency situations.Extended spectrum beta lactamases (ESBLs) hydrolyze β-lactam antibiotics of third generation Cephalosporins, Penicillins and Monobactams. Since the ESBL enzyme genes are usually found in large plasmids, they also contain other antimicrobial resistant genes.AmpC production in E.coli is through plasmids and mutation in their porin structure. Carbapenems are the drug of choice for ESBL producing Ecoli but recent time development of resistance is increasingly reported due to production of Carbapenemase.The aim of this study is to test the Antimicrobial susceptibility pattern of Extra-intestinal Ecoli isolates. The study was conducted in the department of Microbiology, Stanley Medical College, Chennai during the period October 2018 to May 2019.The institutional ethical committee approval was obtained and clinical samples such as urine, blood, pus, sputum and sterile body fluids were received from 983 patients suspected of bacterial infections. The samples were processed and biochemical test identified 84 Ecoli Isolates. Antimicrobial testing, ESBL, AMPC screening and carbapenemase production were tested. E.coli isolates showed resistance to most of the beta lactam antibiotics such as Ampicillin, CefotaximeandCeftazidime and also to Ciprofloxacin &Cotrimoxazole.

scholarly journals Anti-Microbial Resistance in Agents Causing Urinary Tract Infections

2018 ◽  
Author(s):  
Zuhair Ali Rizvi ◽  
Ali Murad Jamal ◽  
Ali Hassan Malik ◽  
Naimat Ullah ◽  
Daneyal Arshad
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Urinary Tract Infections ◽  
Antimicrobial Susceptibility ◽  
Tertiary Care ◽  
Diffusion Method ◽  
Care Hospital ◽  
Cross Sectional ◽  
Tract Infections ◽  
Patient Department

ABSTRACTBACKGROUNDUrinary Tract Infections are usually treated with empirical therapy by physicians based on previous knowledge of predictability of causative agents and their antimicrobial susceptibilities.OBJECTIVEThe objective of this study was to determine the frequency of various pathogens causing urinary tract infections and their antimicrobial susceptibility in patients presenting in out-patient department of a tertiary care hospital.MATERIALS AND METHODSThis descriptive cross sectional study was conducted in Out-Patient department of Urology of Benazir Bhutto Hospital during a period of 6 months from January 2017 to June 2017 after ethical approval from institutional research forum of Rawalpindi Medical University. 1000 patients (12 years old or above) that were clinically suspected for urinary tract infections were included in this study. Patients with co-morbidities like diabetes mellitus, renal pathologies, Immunodeficiency disorders, malignancies and congenital urogenital disorders were also excluded. Recipients of corticosteroid therapy or with a history of intake of broad spectrum antibiotics in previous 15 days were also excluded. Modified Kirby-Bauer disc diffusion method was used for determining the antimicrobial resistance against various antimicrobials.RESULTSA total of 530 (53%) isolates were found to be culture positive for E.coli(77.4%),Klebsiella (6.4%), Enterobacter (6.0%), Pseudomonas (3.8%), Staphylococcus saprophyticus (3.4%), Citrobacter (1.1%) and Morganella (0.4%).Antimicrobial resistance against commonly used antimicrobials was alarmingly highCONCLUSIONSurveillance of trends of antimicrobial susceptibility pattern is highly important.

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