DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20195779

Study of resistance pattern of isolated micro-organisms towards commonly used anti-microbial agents in medical intensive care unit of a tertiary care teaching hospital

Mansij Biswas, Nirmala N. Rege, Niteen D. Karnik, Gita Nataraj

Abstract


Background: The objective of the study was to find out different types of biological samples from admitted patients tested for culture and sensitivity (C&S), prevalence of different types of organisms isolated from those samples, and to analyze the resistance pattern of those isolated organisms against commonly used or tested anti-microbial agents (AMAs).

Methods: Following institutional ethics committee approval and written informed consent, adult patients of both genders, receiving AMAs were enrolled from June 2014 to July 2015 and followed up daily till they were in medical intensive care unit (MICU). Demographic data, diagnosis, culture-sensitivity (antibiogram) and other investigation reports and treatment details were recorded. Descriptive statistical analysis of collected data was done.

Results: Of the 514 samples (from 600 patients enrolled) sent for C&S testing, 143 were reported as sterile while from the rest 371 samples, 504 organisms were isolated; commonly isolated organisms were Pseudomonas aeruginosa (30%), Acinetobacter baumannii (23%), Klebsiella pneumoniae (16%), Providencia sp. (7.1%), Escherichia coli (5.7%), and Enterobacter sp. (4.2%). Samples were sent in 63% of enrolled patients, the commonest being broncho-alveolar lavage (48% of total). Microbial resistance was high for cephalosporins (ceftriaxone, cefepime, ceftazidime), carbapenems (meropenem, imipenem), penicillins (piperacillin), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin, netilmicin, amikacin) and cotrimoxazole. Most organisms were sensitive to colistin (100%), polymyxin B (92%) and tigecycline (69%).

Conclusions: The information regarding commonly isolated organisms and their resistant pattern would aid in rational selection of AMAs and thus the present study is useful to clinicians managing MICU and the hospital infection committee to plan future policies regarding AMA use in MICU.


Keywords


Multi-drug resistance, Superbugs, Antibiotic stewardship, Rational use of antibiotics, Antimicrobial resistance

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References


John LJ, Devi P, John J, Guido S. Drug utilization study of antimicrobial agents in medical intensive care unit of a tertiary care hospital. Asian J Pharm Clin Res. 2011;4:81-4.

Smythe MA, Melendy S, Jahns B. An exploratory analysis of medication utilization in a medical intensive care unit. Crit Care Med. 1993;21(9):319-23.

Lin S, Foster KJ, Debellis RJ, Smith BS. Drug dosing in renal and hepatic failure: a pharmacokinetic approach to the critically ill patient. In: Irwin RS, Rippe JM, editors. Irwin and Rippe’s Intensive Care Medicine. 7th ed. Philadelphia: Lippincott‐Raven Publishers; 2011: 893-916.

Granowitz EV, Brown RB. Adverse reactions to antibiotics. In: Cunha BA, editor. Infectious diseases in critical care medicine. 2nd ed. New York: Informa Healthcare USA, Inc.; 2007: 575-594.

Enzler MJ, Berbari E, Osmon DR. Antimicrobial Prophylaxis in Adults. Mayo Clin Proc. 2011;86(7):686-701.

Niederman MS. Appropriate use of antimicrobial agents: Challenges and strategies for improvement. Crit Care Med. 2003;3:608‐16.

Niederman MS. Use of broad-spectrum antimicrobials for the treatment of pneumonia in seriously ill patients: maximizing clinical outcomes and minimizing selection of resistant organisms. Clin Infect Dis. 2006;42:72-81.

Pulcine C, Pradier C, Samat‐Long C, Hyvernat H, Bernardin G, Ichai C. Factors associated with adherence to infectious diseases advice in two intensive care units. J Antimicrob Chemother. 2006;57:546‐50.

Banerjee T, Anupurba S, Singh DK. Poor compliance with the antibiotic policy in the intensive care unit of a tertiary care hospital in India. J Infect Dev Ctries. 2013;7(12):994-8.

Goldman DA, Weinstein RA, Wenzel RP. Strategies to prevent and control the emergence of antimicrobial resistant micro-organisms in hospital. JAMA. 1996;275:234-49.

Davey P, Brown E, Charani E, Fenelon L, Gould IM, Homes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Syst Rev. 2013;4:CD003543.

Indian Council of Medical Research, Department of Health Research New Delhi, India. Treatment Guidelines for Antimicrobial use in Common Syndromes; 2017. Available at: http://www.icmr. nic.in/guidelines/treatment%20guidelines%20for%20antimicrobial.pdf. Accessed on 20 October 2018.

Mcgrath B, Drake J. Bronchoscopy in the ICU: An overview of broncho-alveolar lavage and bronchial washing. 2014. Available at: http://www.airwaye-learning.com/awel/articles/articles-1.aspx? Action=1&NewsId=2115&M=NewsV2&PID=7165. Accessed on 20 October 2018.

Wattal C, Raveendran R, Goel N, Oberoi JK, Rao BK. Ecology of blood stream infection and antibiotic resistance in intensive care unit at a tertiary care hospital in North India. Braz J Infect Dis. 2014;18(3):245-51.

Sharma PR, Burman P. Antimicrobial consumption and impact of “Reserve antibiotic indent form” in an intensive care unit. Indian J Pharmacol. 2010;42(5):297-300.

Brusselaers N, Vogelaers D, Blot S. The rising problem of antimicrobial resistance in the intensive care unit. Ann Intensive Care. 2011;1:47.

Highlights Of Prescribing Information, MERREM® I.V. Available at: https://www.accessdata. fda.gov/drugsatfda_docs/label/2014/050706s035lbl.pdf. Accessed on 20 October 2018.

Highlights Of Prescribing Information, LEVAQUIN®. Available at: https://www.accessdata. fda.gov/drugsatfda_docs/label/2013/020634s065,020635s071,021721s032lbl.pdf. Accessed on 20 October 2018.

Sydnor ERM, Perl TM. Hospital Epidemiology and Infection Control in Acute-Care Settings. Clin Microbiol Rev. 2011;24:141-73.

Gu B, Kelesidis T, Tsiodras S, Hindler J, Humphries RM. The emerging problem of linezolid-resistant Staphylococcus. J Antimicrob Chemother. 2013;68:4-11.

Greer ND. Tigecycline (Tygacil): the first in the glycylcycline class of antibiotics. Proc (Bayl Univ Med Cent). 2006;19(2):155-61.

Gupta S, Govil D, Kakar PN, Prakash O, Arora D, Das S, et al. Colistin and polymyxin B: A re-emergence. Indian J Crit Care Med. 2009;13(2):49-53.

Karnik ND, Sridharan K, Jadhav SP, Kadam PP, Naidu RK, Namjoshi RD, et al. Pharmacokinetics of colistin in critically ill patients with multidrug­resistant Gram­negative bacilli infection. Eur J Clin Pharmacol. 2013;69(7):1429­36.

Brown EM, Nathwani D. Antibiotic cycling or rotation: a systematic review of the evidence of efficacy. J Antimicrob Chemother. 2005;55:6-9.

Bergstrom CT, Lo M, Lipsitch M. Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals. Proc Nat Acad Sci. 2004;101(36):13285-90.

Wiesch PA, Kouyos R, Abel S, Viechtbauer W, Bonhoeffer S. Cycling Empirical Antibiotic Therapy in Hospitals: Meta-Analysis and Models. PLoS Pathog. 2014;10(6):e1004225.

Chaudhry D, Prajapat B. Intensive care unit bugs in India: How do they differ from the Western world?. J Assoc Chest Physicians. 2017;5(1):10-7.