Antimicrobial susceptibility pattern and multidrug resistance ındex in Pseudomonas aeruginosa among clinical isolates in Denizli, Turkey

Background: Pseudomonas aeruginosa is an important hospital infection agent causing morbidity and mortality with the ability to gain resistance to many antimicrobials. The objective of this study was to determine the sensitivity profiles of nosocomial P. aeruginosa isolates in Denizli, Turkey. Methods: A total 120 P. aeruginosa strains which were isolated from specimens sent to the microbiology laboratory between January 2015 and December 2015 were investigated. Antimicrobial resistance was determined by agar disc diffusion method using Mueller-Hinton agar according to Clinical and Laboratory Standards Institute recommendations. Results: With respect to sensitivity pattern, the most sensitive antimicrobials were Amikacin, colistin, tobramisin, netilmicin and gentamicin and the resistance rates were detected as 97%, 96%, 92%, 90%, 83%, respectively over 120 P. aeruginosa strains. The sensitivity rates for the other antimicrobials were 56% for Piperacilin and 54% for Tazobactam. P. aeruginosa strains 62 (52%) isolates showed multiple antimicrobial resistance to 13 antimicrobials Conclusion: To prevent the spread of the resistant bacteria, it is critically important to have strict antimicrobial policies while surveillance programmes for multidrug resistant organisms and infection control procedures need to be implemented. In the meantime, it is desirable that the antimicrobial susceptibility pattern of bacterial pathogens like P. aeruginosa in specialized clinical units to be continuously monitored and the results readily made available to clinicians so as to minimize the development of resistance. © 2018, National Institute for Medical Research. All rights reserved

Bacteriological Spectrum of Post Operative Wound Infections and their Antibiogram in a Tertiary Hospital, Dar es salaam, Tanzania

Surgical site infection (SSI) is among the most common problem for patients who undergo operative procedures. It remains a common and widespread problem contributing to morbidity and mortality; partly attributed to increase in infections due to antimicrobial resistant bacterial pathogens. In Tanzania there has been limited data regarding the magnitude of SSIs due to antimicrobial resistant pathogens as well as the resistant pattern to antibiotics commonly used in the treatment of these infections. To determine the spectrum of bacteria isolates from postoperative wound infections and their antimicrobial susceptibility patterns at Muhimbili National Hospital (MNH) and Muhimbili Orthopedic Institute (MOI). This was a descriptive cross sectional study which was conducted among patients with post operative wound infections in the general surgery and obstetrics/gynecology wards at MNH and Orthopedics and Trauma unit at MOI. The study participants were consecutively recruited in general surgery, obstetrics/gynecology wards at MNH and orthopedics and trauma wards at MOI from September 2011 to February, 2012. Structured questionnaires were used to collect social demographic characteristics, clinical history and operative information from patients and their case notes. Culturing for colony characteristics followed by Gram stain was used for provisional identity of pathogenic bacteria. Further identification was done by a set of biochemical tests, API 20E, and VITEK. Antimicrobial susceptibility pattern of isolated bacterial pathogens was determined by Kirby Bauer disc diffusion method. Pseudomonas aeruginosa was the most frequently isolated pathogenic organism from post operative wound infections. Most of the Gram negative bacteria isolated were multiply resistant to antimicrobial agents tested; but all were sensitive to carbapenems. Eighty eight percent (88%) of enteric gram negative rods were multi-drug resistance. ESBLs production viii was detected in 92.3% of Escherichia coli and 69% of Klebsiella pneumoniae. Forty four percent (44%) of the 18 S. aureus isolates obtained were MRSA. Pseudomonas aeruginosa was the most common isolate from SSI. Most of gram negative isolates were multiply resistant to commonly prescribed antimicrobial agents. Also there was an increase in ESBLs producing Enterobacteriaceae as well as MRSA strains. Routine culture should be performed whenever SSI is suspected and choice of antibiotics for treatment of SSIs should be guided by routine antimicrobial sensitivity (including MRSA and ESBL screening) testing. Ciprofloxacin should replace first line antibiotics for empirical treatment of SSIs; and strict guidelines for antibiotics prescriptions in treatment of SSIs should be established

Bacterial resistance to ciprofloxacin in Greece: results from the National Electronic Surveillance System. Greek Network for the Surveillance of Antimicrobial Resistance.

According to 1997 susceptibility data from the National Electronic System for the Surveillance of Antimicrobial Resistance, Greece has high rates of ciprofloxacin resistance. For most species, the frequency of ciprofloxacin-resistant isolates (from highest to lowest, by patient setting) was as follows: intensive care unit > surgical > medical > outpatient. Most ciprofloxacin-resistant strains were multidrug resistant

Pseudomonas aeruginosa bacteraemia in an academic hospital in South Africa

This study aimed at determining the clinical manifestations, outcome and prognostic factors associated with P. aeruginosa bacteraemia at the Chris Hani Baragwanath Hospital during the period 1998-99; to describe and quantify resistance to anti-pseudomonal drugs, and characterization of bacteraemic isolates, investigate the genetic relationship among drug susceptible and multiply resistant strains in the hospital. Clinical and laboratory investigations, culture and antimicrobial susceptibility testing were performed. Bacteraemic isolates were typed by endonuclease macrorestriction. Those with ≥97% band pattern similarity were assigned genotype status. Of 91 P. aeruginosa blood isolates, 52 (57%) were nosocomially acquired. Underlying conditions associated with episodes were burns in 24 (26.4%) and HIV infection in 21 (23%). Multi-drug resistance was present in 14 isolates (15.4%). Outcome was poor and death was associated with 36 (45.56%) of episodes. Case fatality rates were 60% in adults and 27.3% in children. Being a child, receiving appropriate antimicrobial treatment and admission to specialized care units were significantly associated with improved prognosis. P. aeruginosa bacteraemia was associated with outbreaks caused by two multiply resistant genotypes. Eighteen, antimicrobial susceptible isolates from bacteraemic episodes in paediatric wards, 9 in HIV-seropositive children, could be linked to small outbreaks in both hospitalised and community-based children. South African Medical Journal Vol. 98 (8) 2008: pp. 626-62

Are liquids an efficient vehicle of healthcare associated infections? A review of reported cases in Italy (2000- 2014)

INTRODUCTION: In the field of healthcare-associated infections (HCAIs), one of the most reported, studied and discussed sources of infections is water, partly due to its controllability, but also because healthcare facilities, especially hospitals, require a significant quantity of water per day. In addition to water, during healthcare procedures, other liquids can serve as source of infections. The present study reports a review of those HCAIs associated to liquid vehicles occurred in Italy during the period 2000-2014. METHOD: The review focused on cases of liquid-associated HCAIs in both sporadic cases and outbreaks according to the definition provided by both Word Health Organization and United States' Centers for Disease Control and Preventions in 2011. The review included all original papers published in peer-reviewed journals, in which the association between the infection and the exposure to contaminated water/other fluid was demonstrated by epidemiological and/or molecular methods. Articles describing cases due to parenteral transmitted pathogens (by blood or blood-derived fluids) were excluded. RESULTS: During the period 2000-2014, 34 episodes have been described for a total of about 400 cases of infection. Isolations included genus Legionella, Pseudomonas, Serratia, Ralstonia, Burkolderia, Klebsiella and other pseudomonadaceae. The results confirm that HCAIs can be associated also to liquids other than piped water. The large majority of articles refers to hospital wards where patients with high risk of infections are usually admitted. DISCUSSION: The review highlights a great number of HCAIs, but if we consider that the large part of HCAIs are not reported in literature, it is clear that the burden of this phenomenon is by far higher. Many cases of HCAI were identified in the context of local surveillance systems, demonstrating their role in HCAI control. With regard to diagnosis, the isolation and identification of the etiological agent is critical to reach the source of infection and to plan the necessary disinfection measures. Therefore, it is possible to conclude that, through a multiple approach of engineering and hygiene measures, as well as surveillance ad management of hospital liquids, the risk for contracting "water born" HCAIs may be controlled

Prevalence and Evaluation of Multidrug Resistance Pattern of Pseudomonas Aeruginosa among Critical and Non-Critical Areas at a Tertiary Care hospital of Multan

Pseudomonas aeruginosa is an extremely wide spread microorganism linked to nosocomial illnesses. Effective inspection of variations in antimicrobial resistance patterns of P. aeruginosa is vital for selecting suitable antimicrobial drugs for pragmatic treatment. The current research has been performed for assessing antimicrobial sensitivity profile of P. aeruginosa isolated as of a variety of medical specimens collected from critical and non-critical admitted patients of Nishtar Hospital, Multan. The isolates were detected utilizing standard lab practices, as well as the sensitivity was examined employing Kirby-Bauer disk diffusion method corresponding to Clinical and Laboratory Standard Institute (CLSI) recommendations 2019. Out of 373 samples, 110 (29.49 %) P. aeruginosa isolates were from admitted patients in different wards. 82 (74.5 %) came from non-critical units along with 28 (25.4 %) belonged to critical units. Prevalence of P. aeruginosafrom the non-critical units was detected from surgical ward 35 (42.6 %) followed by medical ward 25 (30.48 %), gynecology 15 (18.29 %) and orthopedics 7 (8.5 %). The highest prevalence of P. aeruginosa among critical areas were from Medicine Intensive Care Unit 14 (50 %) followed by Surgery Intensive Care Unit 9 (32.14 %) and Respiratory Intensive Care Unit 5 (17.85 %). All were observed as multidrug-resistant against different antibiotics. The current research facilitates estimating the occurrence of MDR strains in intensive care units. Therefore, routine investigation of antibiotic sensitivity patterns is crucial for lowering the healthcare-linked infection levels as well as antimicrobial resistance

Imipenem-Resistant Pseudomonas aeruginosa: Risk Factors for Nosocomial Infections

The aim of this study was to determine the risk factors for nosocomial infections of imipenem-resistant Pseudomonas aeruginosa (IRPA). A prospective case-control study was performed at a tertiary care hospital in Ankara from January to December 2004. The patients with nosocomial P. aeruginosa infection were included in the study. The features of the patients with IRPA infections were compared to those with imipenem-sensitive P. aeruginosa (ISPA) infections. Only the first isolation of P. aeruginosa was considered. Nosocomial infections were defined according to Center for Disease Control (CDC) criteria. IRPA was isolated from 75 (44.1%) patients, and ISPA was isolated from 95 (55.9%) patients during the study period. IRPA were most frequently isolated from endotracheal aspirate (19%) cultures (p=0.048), whereas ISPA were most frequently isolated from urine (28%) cultures (p=0.023). In multivariate analysis, a longer duration of hospital stay until P. aeruginosa isolation (odds ratio [OR], 1.027; 95% confidence interval [CI], 1.002-1.054, p=0.034), arterial catheter administration (OR, 2.508; 95% CI, 1.062-5.920, p=0.036), vancomycin (OR, 2.882; 95% CI, 1.130-7.349, p=0.027), piperacillin-tazobactam (OR, 6.425; 95% CI, 2.187-18.875, p=0.001), and imipenem (OR, 3.580; 95% CI, 1.252-10.245, p=0.017) treatment within the 14 days before isolation of IRPA were independently associated with imipenem resistance. It was concluded that treatment with imipenem, vancomycin and piperacillin-tazobactam were major risk factors for IRPA infections in hospitalized patients. The nosocomial occurrence of IRPA was also strongly related to the duration of hospital stay, arterial catheter administration

Análise epidemiológica de cepas bacterianas envolvidas em infecção hospitalar em um Hospital Universitário no Brasil

As infecções hospitalares representam um aumento na morbidade e mortalidade de pacientes internados, com significativo aumento no custo de internação hospitalar. Teve-se como objetivo fazer uma análise epidemiológica de casos de infecção hospitalar ocorridos num Hospital Universitário na cidade do Rio de Janeiro. Assim, foram analisadas 238 cepas isoladas a partir de 14 espécimens clínicos diferentes oriundos de 166 pacientes internados no período de 08 de 1995 a 07 de 1997. A idade média dos pacientes foi de 33,4 anos, 72,9% faziam uso de antimicrobiano antes de apresentar a cultura positiva, as patologias de risco mais comuns foram: Cirurgia (19,3%), HIV ou AIDS positivo (18,1%) e Patologia Pulmonar (16,9%). Foram identificadas 24 espécies bacterianas distintas, com predominância de S. aureus (21%) e P. aeruginosa (18,5%). Foram detectados 36% de MRSA (Methicilin Resistant S. aureus). Os Gram negativos apresentaram altos níveis de resistência para aminoglicosídeos e cefalosporinas. Foi detectado um surto de diarréia em berçário patológico, provocado pela Salmonella sorovar Infantis, com altos níveis de resistência para antimicrobianos e um plasmídio de alto peso molecular (98Mda), codificador do fator R.Hospital infections cause an increase in morbidity and mortality of hospitalized patients with significant rise in hospital costs. The aim of this work was an epidemiological analysis of hospital infection cases occurred in a public University Hospital in Rio de Janeiro. Hence, 238 strains were isolated from 14 different clinical materials of 166 patients hospitalized in the period between August 1995 and July 1997. The average age of the patients was 33.4 years, 72.9% used antimicrobials before having a positive culture. The most common risk conditions were surgery (19.3%), positive HIV or AIDS (18.1%) and lung disease (16.9%). 24 different bacterial species were identified, S. aureus (21%) and P. aeruginosa (18.5%) were predominant. Among 50 S. aureus isolated strains 36% were classified as MRSA (Methicillin Resistant S. aureus). The Gram negative bacteria presented high resistance to aminoglycosides and cephalosporins. A diarrhea outbreak, detected in high-risk neonatology ward, was caused by Salmonella serovar Infantis strain, with high antimicrobial resistance and a plasmid of high molecular weight (98Mda) containing virulence genes and positive for R factor

Bacteriological profile of wound infections and antimicrobial resistance in selected gram-negative bacteria

Background: Managing wound infections is a challenging task. Understanding their resistance pattern is an essential step at reducing its burden in hospital settings. Objective: To determine the bacteriological diversity of wound infections and the antimicrobial resistance exhibited by a selected Gram-negative bacterium in the Aljouf region of Saudi Arabia. Methods: The study retrospectively analysed the antibiograms of wound infections from hospitalized patients for the year 2019. The European Centre for Disease Control guidelines were adopted for the classification of resistant bacteria. Multidrug-, extensive drug-, and carbapenem-resistant isolates are presented as frequencies and percentages. Results: A total of 295 non-duplicate wound swab antibiograms were retrieved, 64.4% (190) and 35.6% (105) isolates were Gram-negative and Gram-positive bacterial infections respectively. Predominant pathogens included Staphylococcus species 21.0% (62), E. coli 16.3% (48) and K. pneumoniae 13.5% (40). 148 (77.9%), 42 (22.1%) and 43 (22.6%) of the Gram-negative isolates were multidrug-, extensively drug- and carbapenem-resistant. The antibiotic resistance exhibited by gram-negative bacteria was 43.4% (234/539), 59.1% (224/379) and 53.7% (101/188) towards carbapenems, 3rd - and 4th – generation cephalosporins. Conclusions: The majority of wound infections are caused by multidrug-, extensively drug- and carbapenem-resistant Gram-negative bacteria. Further studies should focus on the molecular basis of this resistance. Keywords: Wound infections; hospital; Gram-negative bacteria; antibiograms; multidrug-resistance; E. coli

Molecular epidemiology of antibiotic resistant ESKAPE pathogens isolated from public sector hospitals in uMgungundlovu District, KwaZulu-Natal, South Africa.

Doctor of Philosophy in Medical Microbiology. University of KwaZulu-Natal. Durban, 2017.Multi-drug resistant Enterococcus faecium, staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp termed ESKAPE pathogens are commonly implicated in difficult-to-treat infectious diseases in developed and developing countries. The prevalence, risk factors, phenotypic and genotypic profiles including but not limited to clonal relatedness, genetic diversity, resistance and virulence associated with ESKAPE bacteria were investigated in carriage and clinical isolates from patients in a rural, district and an urban tertiary hospital in the public health sector in uMgungundlovu District, Kwazulu- Natal, South Africa. The overall carriage of MDR ESKAPE Gram-negative bacteria in both hospitals was 37.21%, 42.31% and 57.14% at admission, after 48 hours and at discharge, respectively. The prevalence of MDR ESKAPE Gram-negative bacteria in faecal carriage (46%) was higher than clinical samples (28%) and colonization was mainly associated with referral from the district to the tertiary hospital with high statistical significance (OR: 14.40, 95% CI 0.98-210.84). blaCTX-M-group-9, blaCTX-M-group-1 and blaSHV were the main resistance genes identified. Similarly, the overall prevalence of faecal VRE carriage was 53% with patients at the district hospital being more likely to be colonized by VRE at admission (44%), after 48 hours (64%) and discharge (100%) than those of the tertiary level. Fifteen (39%) E. faecium and 23 (61%) E. faecalis, were detected and displayed high level of antibiotic resistance. Extensive genetic diversity of E. faecalis and E. faecium and clonal dissemination of various lineages were observed across wards and within hospitals. The high levels of resistance in S. aureus were attributed to the multi-drug resistant efflux pumps mepA, mexE, AcrB, MATE, qac and qacA. Whole genome analysis revealed that the circulating S. aureus isolates belonged to the extremely virulent ST121 clone that harboured a total of 18 virulence genes. The high prevalence, genetic diversity and virulence of antibiotic-resistant ESKAPE bacteria elucidated in this study necessitates routine screening and surveillance in communities and hospitals, stringent infection prevention and control measures and antibiotic stewardship to monitor epidemiological changes, to contain their spread and inform appropriate antibiotic treatment options respectively