Impact of Antimicrobial Stewardship Programme on Carbapenem Resistance in Gram Negative Isolates in an Indian Tertiary Care Hospital

ABSTRACT Background: The growing increase in the rates of antibiotic resistance is a major cause for concern in both non-fermenting bacilli and isolates of the Enterobacteriaceae family. β-lactams have been the mainstay of treatment for serious infections, and the most active of these are the carbapenems. Acquired metallo-β-lactamases (MBL) have recently emerged as one of the most worrisome resistance mechanisms owing to their capacity to hydrolyze all β-lactams, including carbapenems. We have undertaken this investigation to ascertain the prevalence of MBL-producing non-fermenting bacilli and Enterobacteriaceae. Materials and Methods: The study was conducted over a period of 4 months in a 1200-bedded teaching hospital. Isolates included in the study were screened for imipenem resistance both by conventional methods and mini analytical profile index (miniAPI). The isolates that showed imipenem resistance were tested for MBL production by imipenem (IMP)-ethylenediaminetetraacetic acid combined disc test. Imipenem-resistant non-MBL isolates also tested for Modified Hodge test and AmpC β-lactamases production to detect other mechanisms of carbapenem resistance. Results: Of 638 gram negative bacilli isolates and 3.39% showed imipenem resistance, 2.9% showed MBL production, of which 1.7% were non-fermenters and 1.25% were Enterobacteriaceae, 0.3% showing non-MBL KPC carbapenemas. Most isolates were from the intensive care unit and from post-operative patients. Our findings show that there are significant numbers of isolates having MBL production along with multidrug resistance. There is a need for active surveillance to detect MBL producers.

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

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl2.2177 ◽

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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Appropriateness of Gram-Negative Agent Use at a Tertiary Care Hospital in the Setting of Significant Antimicrobial Resistance

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv009 ◽

2015 ◽

Vol 2 (1) ◽

Cited By ~ 5

Author(s):

Neil M. Vora ◽

Christine J. Kubin ◽

E. Yoko Furuya

Keyword(s):

New York ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Categorical Variables ◽

Care Hospital ◽

Antimicrobial Stewardship Program ◽

Gram Negative ◽

Stewardship Program

Abstract Background. Practicing antimicrobial stewardship in the setting of widespread antimicrobial resistance among gram-negative bacilli, particularly in urban areas, is challenging. Methods. We conducted a retrospective cross-sectional study at a tertiary care hospital with an established antimicrobial stewardship program in New York, New York to determine appropriateness of use of gram-negative antimicrobials and to identify factors associated with suboptimal antimicrobial use. Adult inpatients who received gram-negative agents on 2 dates, 1 June 2010 or 1 December 2010, were identified through pharmacy records. Clinical data were collected for each patient. Use of gram-negative agents was deemed optimal or suboptimal through chart review and according to hospital guidelines. Data were compared using χ2 or Fischer's exact test for categorical variables and Student t test or Mann–Whitney U test for continuous variables. Results. A total of 356 patients were included who received 422 gram-negative agents. Administration was deemed suboptimal in 26% of instances, with the most common reason being spectrum of activity too broad. In multivariable analysis, being in an intensive care unit (adjusted odds ratio [aOR], .49; 95% confidence interval [CI], .29–.84), having an infectious diseases consultation within the previous 7 days (aOR, .52; 95% CI, .28–.98), and having a history of multidrug-resistant gram-negative bacilli within the past year (aOR, .24; 95% CI, .09–.65) were associated with optimal gram-negative agent use. Beta-lactam/beta-lactamase inhibitor combination drug use (aOR, 2.6; 95% CI, 1.35–5.16) was associated with suboptimal use. Conclusions. Gram-negative agents were used too broadly despite numerous antimicrobial stewardship program activities.

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PHENOTYPIC DETECTION OF METALLO-Β-LACTAMASE MEDIATED CARBAPENEM RESISTANCE IN GRAM NEGATIVE BACILLI OF FAMILY ENTEROBACTERIACEAE IN A TERTIARY CARE HOSPITAL IN NORTH INDIA

Journal of Critical Reviews ◽

10.31838/jcr.07.03.64 ◽

2020 ◽

Vol 7 (03) ◽

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Carbapenem Resistance ◽

North India ◽

Care Hospital ◽

Gram Negative

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Molecular epidemiology of New Delhi metallo-β-lactamase among Gram negative bacteria in a tertiary care hospital of North India

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2020.09.091 ◽

2020 ◽

Vol 101 ◽

pp. 20

Author(s):

S. Singh ◽

A. Singh ◽

A. Pathak ◽

K.N. Prasad

Keyword(s):

Molecular Epidemiology ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

North India ◽

New Delhi ◽

Gram Negative Bacteria ◽

Care Hospital ◽

Gram Negative

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

Tropical Medicine and Health ◽

10.1186/s41182-021-00313-3 ◽

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.

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Asymptomatic Bacteriuria among Pregnant Women Attending Tertiary Care Hospital in Lucknow, India

Dubai Medical Journal ◽

10.1159/000513626 ◽

2021 ◽

pp. 1-8

Author(s):

Naimshree Sonkar ◽

Malay Banerjee ◽

Suman Gupta ◽

Absar Ahmad

Keyword(s):

Haemoglobin Level ◽

Pregnant Women ◽

Antimicrobial Susceptibility ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Asymptomatic Bacteriuria ◽

Care Hospital ◽

Gram Positive ◽

Gram Negative ◽

E Coli

Introduction: Asymptomatic bacteriuria (ASB) is the presence of actively multiplying bacteria within the urinary tract with absence of any symptoms, resulting in adverse pregnancy outcomes. This research study was done in order to review prevalence, antimicrobial susceptibility profile, and factors associated with ASB occurring in female patients who are pregnant and being treated at a tertiary care hospital in Lucknow, India. Method and Materials: This is a cross-sectional study done among 216 pregnant women attending a hospital for antenatal check-ups. Clean catch midstream urine samples were collected and examined microscopically, and semi-quantitative culture was done on blood agar and MacConkey agar. Isolates were identified by colony morphology and biochemical tests, and antimicrobial susceptibility testing was done by using the Kirby-Bauer method. Results: Of the 216 pregnant women, 36 (16.7%) tested positive for ASB. The female gestational period, haemoglobin level, and BMI were significantly associated with ASB. Logistic regression also showed that higher haemoglobin level was less likely to ASB (AOR = 0.42, 95% confidence interval: 0.202–0.88, p = 0.021). The predominant and usual isolates were E. coli (n = 22, 61.1%), followed by Cons (n = 6, 16.7%), and S. aureus (3, 8.3%). All Gram-negative isolates were mostly sensitive to most of the drugs like piperacillin-tazobactam, cefepime, nitrofurantoin, and meropenem but were 100% resistant to ampicillin. Similarly, Gram-positive isolates were sensitive to ampicillin, vancomycin, linezolid, and nitrofurantoin but 100% resistant to co-trimoxazole. Conclusion: The present study shows the existence of ASB was 16.7% among women who are pregnant. Pregnancy duration, haemoglobin level, and BMI were significantly associated with ASB. The isolates identified more frequently were E. coli (61.16%), Cons (16.7%), and S. aureus (8.3%). All isolates which were Gram-negative were mostly sensitive to most of the drugs but were 100% resistant to ampicillin. Similarly, Gram-positive isolates were sensitive to most of the drugs but 100% resistant to co-trimoxazole.

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Epidemiology and outcome of sepsis in a tertiary-care hospital in a developing country

Epidemiology and Infection ◽

10.1017/s0950268805004978 ◽

2005 ◽

Vol 134 (2) ◽

pp. 315-322 ◽

Cited By ~ 27

Author(s):

M. D. TANRIOVER ◽

G. S. GUVEN ◽

D. SEN ◽

S. UNAL ◽

O. UZUN

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Clinical Approach ◽

Gram Negative Bacteria ◽

Care Hospital ◽

Gram Negative ◽

Mortality And Morbidity ◽

Underlying Diseases ◽

Major Pathogens ◽

Very High

Sepsis continues to have a substantial mortality and morbidity despite advances in the diagnosis and management of this condition. We retrospectively analysed hospital charts of patients diagnosed to have sepsis between January 2002 and June 2003. Demographic characteristics of patients, microbiological findings and predictors of survival were evaluated. Sixty-nine sepsis episodes that occurred in 63 patients were analysed. The most common underlying diseases were hypertension, malignancies and diabetes mellitus. Renal insufficiency, respiratory distress and disseminated intravascular coagulation developed in 52·2, 30·4 and 30·4% of the episodes respectively; 47·7% of the blood cultures yielded an organism. Gram-negative bacteria were the predominant microorganisms (65·9%). Fifty-five patients (87·3%) died. Mechanical ventilation and underlying renal disease were significant determinants of mortality. In conclusion, Gram-negative bacteria remain the major pathogens in sepsis. The mortality remains very high, and a change in the clinical approach to the septic patient should be employed to improve the outcome.

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