PREVALENCE OF MULTI DRUG RESISTANT GRAM-NEGATIVE BACTERIA AND ITS SUSCEPTIBILITY PATTERNISOLATED FROM ADMITTED PATIENTSIN A HOSPITAL OF CENTRAL INDIA;AN EMERGING GLOBAL PROBLEM

Main Article Content

Dr.Ashish Saraswat
Deepak Gawali
Abhi Mishra
Dr Nidhi Sharma
Ashok Kumar Rastogi
Mehrunisha Ansari

Keywords

Multi drug resistant, Pulmonary infiltrate, Excessive use of antibiotics

Abstract

Introduction:The multi-drug resistant gram-negative bacterial infections are the principle threats tothe critically ill patients.Multidrug-resistant Gram-negative rods (MDR-GNR) are emerging as amajor challenge to human health.The prevalence of drug-resistant cases is increasing globally.However, the impact of these infections on the patient’s clinical outcome has not yet been clearlyevaluated.


Aim:Todetermine the incidence and associated clinical outcome of multi-drug resistant gram-negative bacterial infections.


Materials and Methods:This record-based retrospective cross-sectional study was designed toanalyseMDR-GNB positive cases at a tertiary care hospital of central India. MLBMedical collegewith attached.Hospital is a700-bedreferral tertiary care centre.An increase of MDR-GNB was seenfrom September 2022 to June 2023 in the hospital. A retrospective analysis of blood culture GNB-positive samples was performed to evaluate MDR-GNB-positive cases at admission.


Results:The total number of positive blood cultures inSeptember2022toJune2023, November toJanuary 2023and February to April2023 were 236,186and206, respectively, with 76.83%,80.%and71.83% GNB-positive. Total MDR-GNB-positive cases were27.08%,34.98% and32.65%,


respectively, and amongst these MDR-GNB, 24%, 32% and5% where positive at time of admissiontothe hospital. The MDR-GNB wereEscherichiacoli,Klebsiella,Acinetobacter,Pseudomonasand
Enterobacter,Klebsiellapneumoniae,Acinetobacterspp.,Pseudomonas aeruginosaandEscherichiacolihave alarming degrees of antimicrobial resistance and are associated with high mortality andmorbidity.


Conclusion:The incidence of multi-drug resistant gram-negative bacterial infections was remarkablyhigh in our hospitals and showed a significant association with healthcare-associated infections andin-hospital-mortality.

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References

1.Chaudhry D, Prajapat B. Intensive care unit bugs in India: How do they differ from the Western
world? J Assoc Chest Physicians. 2017;5:10–7.https://doi.org/10.4103/2320-8775.196645.
2.Mendes RE, Mendoza M, BangaSingh KK, et al. Regional resistance surveillance program
results for 12 Asia Pacific nations (2011). Antimicrob Agents Chemother. 2013; 5 7(11):5721–5726. doi:https://doi.org/10.1128/AAC.01121-13.
3.Parajuli NP, Acharya SP, Mishra SK, et al. High burden of antimicrobial resistance among gram-
negative bacteria causing healthcare associated infections in a critical care unit of Nepal.
Antimicrob Resist Infect Control. 2017;6:67.https://doi.org/10.1186/s13756-017-0222-z.
4.Khanal S, Joshi DR, Bhatta DR, et al.훽-lactamase-producing multidrug-resistant bacterial
pathogens from tracheal aspirates of intensive care unit patients at National Institute ofneurological and allied sciences. Nepal ISRN Microbiology. 2013;
https://doi.org/10.1155/2013/847569.
5.Boucher HW, Talbot GH, Bradley JS, et al. Bad bugs, no drugs: no ESKAPE! An update from
the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:1–12.
6.Martin-Loeches,E.Diaz,J.Valles Risks for multidrug-resistant pathogens in the ICU Curr Opin
Crit Care,20(2014), pp.516-524
7.T.P.VanBoeckel,S.Gandra,A.Ashok,Q.Caudron,B.T.Grenfell,S.A.Levin,et al.Global
antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data LancetInfect Dis,14(2014), pp.742-750Google Scholar
8.Washington CW Jr, Stephen DA, William MJ, et al. Koneman’s color atlas and text book of
diagnostic microbiology. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.GoogleScholar
9.Clinical and Laboratory Standards Institute. Performance standards for antimicrobial
susceptibility testing; 27th ed. CLSI supplement.CLSI Document M100-S27. Wayne, PA:Clinical and Laboratory Standards Institute; 2017.
10.Yong D, Lee K, Yum JH, et al. Imipenem-EDTA disk method for differentiation of metallo-beta-
lactamase-producing clinical isolates of pseudomonas spp. and Acinetobacter spp. J ClinMicrobiol. 2002;40(10):3798–801 PMID: 12354884
ArticleCASPubMedPubMed CentralGoogle Scholar
11.WHO Fact Sheet Antimicrobial resistance (2018)http://www.who.int/en/news-room/fact-
sheets/detail/antimicrobial-resistance
12.M.Kazi,L.Drego,C.Nikam,K.Ajbani,R.Soman,A.Shetty,et al.Molecular characterization
of carbapenem-resistant Enterobacteriaceae at a tertiary care laboratory in Mumbai Eur J ClinMicrobiol Infect Dis,34(2015), pp.467-472CrossRefView in ScopusGoogle Scholar
13.G.Goel,L.Hmar,M.Sarkar De,S.Bhattacharya,M.Chandy Colistin-resistantKlebsiella
pneumoniae: report of a cluster of 24 cases from a new oncology center in eastern India InfectControl Hosp Epidemiol,35(2014), pp.1076-1077View articleCrossRefView in ScopusGoogle Scholar
14.K.P.Abhilash,B.Veeraraghavan,O.C.Abraham Epidemiology and outcome of bacteremia
caused by extended spectrum beta-lactamase (ESBL)-producingEscherichiacoliandKlebsiellaspp. in a tertiary care teaching hospital in south India J Assoc PhysiciansIndia,58(2010), pp.13-17
15.R.Srivastava,J.Agarwal,S.Srivastava,M.Kumar,M.Singh Multidrug resistant Gram-
negative bacilli from neonatal septicaemia at a tertiary care centre in North India: a phenotypicand genotypic study Indian J Med Microbiol,32(1)(2014), pp.97-98
16.P.Patel,R.N.GaralaBacteriological profile and antibiotic susceptibility pattern (antibiogram) of
urinary tract infections in paediatric patients J Res Med Dent Sci,2(2014), pp.20-25
17.R.Rajbhandari,J.ShresthaBacteriological study of urinary tract infection and itsantibiotic
sensitivity test: a hospital based studyJ Nepal Asso Med Lab Sci,4(2002), pp.26-32
18.S.Srinivasan,N.S.MadhusudhanPrevalence of multidrug resistant pathogens in children with
urinary tract infection: a retrospective analysisInt J Med Res Health Sci,3(2014), pp.954-95819.G.L.Mandell,J.E.Bennett,R.DolinPrinciples & practices of infectious diseases(7th
ed.),Elsevier,St Louis(2010)Google Scholar
20.K.Moolchandani,A.S.Sastry,R.Deepashree,S.Sistla,B.N.Harish,J.MandalAntimicrobial
resistance surveillance among intensive care units of a tertiary care hospital in Southern IndiaJClin Diagn Res,11(2017)DC01-DC07Google Scholar
21.J.R.Javeri,S.M.Patel,S.N.Nayak,K.Desai,P.PatelA study on bacteriological profile and
drug sensitivity & resistance pattern of isolates of the patients admitted in intensive care units ofa tertiary care hospital in AhmadabadNat J Med Res,2(2012), pp.330-334Google Scholar