Antibiotic susceptibility pattern of gram-negative bacterial isolates with special mention on colistin resistance from Intensive Care Unit of a tertiary care hospital: a prospective study assessing the impact of microbial resistance on clinical outcomes

Preethika Ravi; Ravindranath C.; Deepa S.

doi:10.18203/2320-6012.ijrms20231644

Authors

Preethika Ravi Department of Microbiology, Mysore Medical College and Research Institute, Mysuru, Karnataka, India
Ravindranath C. Department of Microbiology, Mysore Medical College and Research Institute, Mysuru, Karnataka, India
Deepa S. Department of Microbiology, Mysore Medical College and Research Institute, Mysuru, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20231644

Keywords:

Antimicrobial resistance, ICU, Colistin resistance

Abstract

Background: The frequent use of broad-spectrum antibiotics in ICU leads to increased rates of antimicrobial resistance and occurrence of multidrug-resistant (MDR) micro-organisms. The aim of this study was to evaluate the antimicrobial resistance pattern and colistin susceptibility among bacterial isolates from ICU patients.

Method: It is a prospective study with 70 nonrepetitive isolates from ICU samples. The clinical data was obtained from the department records. The gram-negative bacterial isolates were identified by conventional biochemical tests. The antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion method. ESBL producers were detected by double disc diffusion test using ceftazidime, cefotaxime alone and in combination with clavulanic acid. MBL detection was done by imipenem+ EDTA combined disc diffusion test. Colistin sensitivity was determined by broth microdilution according to CLSI guidelines.

Results: Out of 70 culture positive specimens. The most common gram-negative bacteria isolated from the samples was Acinetobacter spp. (41%), followed by Klebsiella spp. (20%). Among these 45% were MBL producers, 38.5% were ESBL producers and 14% were both ESBL and MBL producers. Colistin resistance was present among 5.7% isolates in ICU.

Conclusions: Non-fermenters were the most common agent causing ICU infections. An alarmingly high rate of resistance to antibiotics especially to colistin in ICU-acquired infections, necessitates new therapeutic strategies to prevent the emergence and control of antimicrobial resistance.

Metrics

Metrics Loading ...

References

Brusselaers N, Vogelaers D, Blot S. The rising problem of antimicrobial resistance in the intensive care unit. Ann Intensive Care. 2011;1:1-7.

Clinical Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests, M02-13th edition, Melvin P. 2021.

Sodhi K, Mittal V, Arya M, Kumar M, Phillips A, Kajla B. Pattern of colistin resistance in Klebsiella isolates in an Intensive Care Unit of a tertiary care hospital in India. J Infect Publ Heal. 2020;13(7):1018-21.

Ibrahim ER, Ahmed YM, Mohamed AK, Ibrahim WA. Detection of colistin resistant Gram-negative bacilli in intensive care unit patients admitted to Ain Shams University Hospitals. Microbes Infect Dis. 2021;2(1):92-9.

Mushtaq S, Reynolds R, Gilmore MC, Esho O, Adkin R, García-Romero I et al. Inherent colistin resistance in genogroups of the Enterobacter cloacae complex: epidemiological, genetic and biochemical analysis from the BSAC Resistance Surveillance Programme. J Antimicrobial Chemotherapy. 2020;75(9):2452-61.

Ajlan SE, Elmahdy EE, Sleem AS. Assessment of Colistin Susceptibility among Carbapenem-Resistant Clinical Isolates. Egypt J Med Microbiol. 2022;31(3):109-16.

Gales AC, Jones RN, Sader HS. Global assessment of the antimicrobial activity of polymyxin B against 54 731 clinical isolates of Gram-negative bacilli: report from the SENTRY antimicrobial surveillance programme (2001-2004). Clin Microbiol Infect. 2006;12(4):315-21.

Procop GW, Church DL, Hall GS, Janda WM. Koneman's color atlas and textbook of diagnostic microbiology. Jones Bartlett Learning. 2020;1.

Ibrahim ME. High antimicrobial resistant rates among gram-negative pathogens in intensive care units: a retrospective study at a tertiary care hospital in Southwest Saudi Arabia. Saudi Med J. 2018;39(10):1035.

Gogry FA, Siddiqui MT, Sultan I, Haq QM. Current update on intrinsic and acquired colistin resistance mechanisms in bacteria. Frontiers Med. 202;8:677720.

Xiao S, Zhuo C, Zhuo C. In Vitro Activity of Various Sulbactam Compounds and Piperacillin/ Tazobactam against Clinical Isolates of Different Gram-Negative Bacteria. Computational Mathematical Methods in Med. 2021;252021.

Souli M, Kontopidou FV, Koratzanis E, Antoniadou A, Giannitsioti E, Evangelopoulou P et al. In vitro activity of tigecycline against multiple-drug-resistant, including pan-resistant, gram-negative and gram-positive clinical isolates from Greek hospitals. Antimicrobial Agents Chemotherapy. 2006;50(9):3166-9.

Pien BC, Sundaram P, Raoof N, Costa SF, Mirrett S, Woods CW et a. The clinical and prognostic importance of positive blood cultures in adults. Am J Med. 2010;123(9):819-28.

Falagas ME, Bliziotis IA. Pandrug-resistant Gram-negative bacteria: the dawn of the post-antibiotic era? Int J Antimicrobial Agents. 2007;29(6):630-6.

Siwakoti S, Subedi A, Sharma A, Baral R, Bhattarai NR, Khanal B. Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal-a prospective cohort study. Antimicrobial Resistance Infect Control. 2018;7(1):1-8.

Tran TN, Vu DH, Nguyen HA, Abrams S, Bruyndonckx R, Nguyen TT et al. Predicting mortality in intensive care unit patients infected with Klebsiella pneumoniae: A retrospective cohort study. J Infect Chemotherapy. 2022;28(1):10-8.

Iswarya M, Shrihari N. Detection of ESBL and MBL Producing Gram Negative Bacilli from various Clinical Samples at a Tertiary Care Hospital. Int J Curr Microbiol App Sci. 2019;8(9):1678-84.

Panigrahi K, Pathi BK, Poddar N, Sabat S, Pradhan S, Pattnaik D et al. Colistin Resistance Among Multi-Drug Resistant Gram-Negative Bacterial Isolates From Different Clinical Samples of ICU Patients: Prevalence and Clinical Outcomes. Cureus. 2022;14(8).

Lim LM, Ly N, Anderson D, Yang JC, Macander L, Jarkowski III A, Forrest A, Bulitta JB, Tsuji BT. Resurgence of colistin: a review of resistance, toxicity, pharmacodynamics, and dosing. Pharmacotherapy: J Human Pharmacol Drug Therapy. 2010;30(12):1279-91.

Narimisa N, Goodarzi F, Bavari S. Prevalence of colistin resistance of Klebsiella pneumoniae isolates in Iran: A systematic review and meta-analysis. Anna Clin Microbiol Antimicrobials. 2022;21(1):1-9.

Wand ME, Sutton JM. Mutations in the two component regulator systems PmrAB and PhoPQ give rise to increased colistin resistance in Citrobacter and Enterobacter spp. J Med Microbiol. 2020;69(4):521-9.

Sami H, Sultan A, Rizvi M, Khan F, Ahmad S, Shukla I et al. Citrobacter as a uropathogen, its prevalence and antibiotics susceptibility pattern. Chrismed J Health Res. 2017;4(1):23.

Ali AM, Rafi S, Qureshi AH. Frequency of extended spectrum beta lactamase producing gram negative bacilli among clinical isolates at clinical laboratories of Army Medical College, Rawalpindi. J Ayub Med College Abbottabad. 2004;16(1).

Neuhauser MM, Weinstein RA, Rydman R, Danziger LH, Karam G, Quinn JP. Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA. 2003;289(7):885-8.

Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing, 31st ed. CLSI standard M100. Clinical and Laboratory Standards Institute, Wayne, PA. 2021.

Clinical and Laboratory Standards Institute. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved standard-10th ed. M07-A11. Clinical and Laboratory Standards Institute, Wayne, PA. 2018.