Published: 2017-02-20

Characterization of antimicrobial resistance mechanisms of multidrug resistant Gram negative bacterial wound infections and their clinical epidemiology from a tertiary care hospital in Karnataka, India

Anusha Gopinathan, Chiranjay Mukhopadhyay, Vandana K. E.


Background: Extended spectrum beta lactamases, AmpC and Metallo-betalactamases in GNB isolates are a common occurrence in most Indian hospitals. The presence of these antimicrobial resistance mechanisms contributes to prolonged hospital stay, poor quality of life, increased morbidity and mortality among patients with these infections. The aim of the study was to analyse the antimicrobial resistance mechanisms of multidrug resistant Gram negative bacterial wound infection and their clinical epidemiology.

Methods: A prospective study was conducted for one year among 100 patients of Kasturba Medical College, Manipal admitted with MDR GNB wound infections. The antibiogram and phenotypic resistance mechanisms of the bacterial isolate from these infections were identified using phenyl boronic acid and ethyl diacetate.  The empirical therapy, specific therapy and clinical outcome of the patients were also analyzed.

Results: Out of 100 study patients, 152 MDR GNB isolates were obtained.  73% patients were admitted in the surgical wards. 43% patients had diabetes. Ulcers (27%) and abscess (25%) were the most common diagnosis. Escherichia coli (39%), Klebsiella pneumoniae (24%) and Pseudomonas aeruginosa (19%) were the most common isolates. Maximum number of ESBL was seen among Enteric Gram negative bacilli (36%), MBL was seen among Pseudomonas aeruginosa and Acinetobacter species (55% each), AmpC was seen among enteric GNB (10%) and Acinetobacter species (18%). Cefaperazone sulbactam, amikacin and meropenem were the most common antibiotics given as specific therapy. Clinical response was observed among 93% patients.

Conclusions: The determination of the antimicrobial resistance mechanisms of GNB isolates from wound infections plays a major role in establishing an antibiotic policy for the treatment of these infections.



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Srivastava R, Agarwal J, Srivastava S, Kumar M, Singh M. Multidrug resistant Gram-negative bacilli from neonatal septicaemia at a tertiary care centre in North India: A phenotypic and genotypic study. Indian J Med Microbiol. 2014;32:97-8.

Basak S, Singh P and Rajurkar M. Multidrug resistant and extensively drug resistant bacteria: A study. J Pathog. 2016;(22016):1-5.

Afroz Z, Basavaraj C and Jothi P. Bacteriological Profile and antimicrobial susceptibility pattern of skin and soft tissue infections among gram negative bacilli in a tertiary care hospital of South Indian J Pharm Sci Res. 2015:7(7):397-400.

Baker TM, Satlin MJ. The growing threat of multidrug-resistant Gram-negative infections in patients with hematologic malignancies. Leuk Lymphoma. 2016;57(10):2245-58.

CLSI. Performance standards for antimicrobial susceptibility testing; twenty-first informational supplement. CLSI document M100-S21. Wayne, PA: Clinical and Laboratory Standards Institute; 2011.

Franklin C, Liolios L, Peleg AY. Phenotypic Detection of carbapenem susceptible metallobetalactamase producing Gram negative bacilli in the clinical laboratory. J Clin Microbiol. 2006;44(9):3139-44.

Couldron PE. Inhibitor based methods for detection of plasmid-mediated AmpC beta-lactamase in Klebsiella spp., Escherichia coli and Proteus mirabilis. J Clin Microbiol. 2005;43(8):4163-7.

Gadepalli R, Dhawan B, Sreenivas V. A clinic-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Dia care. 2006;29(8):1727-32.

Shen H, Lu C. Skin and soft tissue infections in hospitalized and critically ill patients: a nationwide population based study. BMC Infect Dis. 2010;10:151.

Puvanendran R, Huey JC, Pasupathy S. Necrotizing fasciitis. Can Fam Physician. 2009;55(10):981-7.

Lipsky BA, Moran GJ, Napolitano LM, Vo L, Nicholson S, Kim M. A prospective multicentre observational study of complicated skin and soft tissue infections in hospitalized patients: clinical characteristics, medical treatment and outcomes. BMC Infect Dis. 2012;12:227.

Rajan S. Skin and soft tissue infections: Classifying and treating a spectrum. Cleve Clin J Med. 2012;79(1):57-66.

Motayo BO, Akinbo JA, Ogiogwa IJ, Idowu AA, Nwanze JC, Onoh CC, et al. Bacteria colonisation and antibiotic susceptibility pattern of wound infections in a hospital in Abeokuta. Frontiers in Science. 2013;3(1):43-8.

Lipsky BA, Tabak YP, Johannes RS, Vo L, Hyde L, Weigelt JA. Skin and soft tissue infections in hospitalized patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost. Diabetologica. 2010;53(5):914-23.

Elliot D, Kufera JA, Myers RA. The microbiology of necrotizing soft tissue infections. Am J Surg. 2000;179(5):361-6.

Seni J, Najjuka CF, Kateete DP, Makobore P, Joloba ML, Kajumbula H, et al. Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Uganda. BMC Res Notes. 2013;27(6):298.

Mohanty S, Kapil A, Dhawan B, Das BK. Bacteriological and antimicrobial susceptibility profile of soft tissue infections from Northern India. Indian J Med Sci. 2004; 58: 10-5.