Current Susceptibility Trend of Antibiotics in a Tertiary Care Hospital - Need to Emphasize on Alternate Therapeutic Agents

Main Article Content

Manisha Khandait
Tapesh Bansal
Pankaj Mandale

Abstract

Introduction: In the light of changing anti-microbial resistance pattern, the understanding of the local antibiogram is essential in the antibiotic selection procedures and preparation of hospital antibiotic policy.

Aim: This retrospective study was aimed to analyze the antibacterial susceptibility pattern of major isolates from ICU and IPD.

Materials and Methods: Antimicrobial susceptibility testing was done for a total of 565 Gram-negative isolates including E. coli, K. pnuemoniae, A. baumannnii and P. aeruginosa from ICU and IPD patients enrolled between July 2016 to December 2016.

Results: The majority of the isolates were reported from urine samples (52%) in IPD and sputum (59%) in ICU. The susceptibility to BL/BLI was 50-75% in IPD patients and Carbapenem susceptibility was reported in more than 75% except P. aeruginosa. In ICU patients, the beta-lactam/beta-lactam inhibitor (BL/BLI) susceptibility ranged between 20-60% and the carbapenem susceptibility was around 40%-75%. The susceptibility of CSE-1034 (Ceftriaxone + Sulbactam + EDTA) was almost similar to minocycline and amikacin ranging from 50-90% against different species. Compared to carbapenems, the CSE-1034 performed overall better than carbapenems against P. aeruginosa and A. baumannii and was comparable to carbapenems against Enterobacteriaceae. The susceptibility of colistin ranged from 92-97% in both IPD and ICU isolates.

Conclusion: Considering the value of carbapenems and colistin as the last option for multi-drug resistant (MDR) bacterial infections, irrational prescription of these drugs should be stopped. The use of ampicillin-sulbactam, cefepime and gentamicin from 1st line antibiotics in ICU patients can help to reduce the load on 2nd line antibiotics. Among 2nd line drugs, CSE-1034 along with amikacin should be an empirical choice of treatment for bacterial infections where the 1st line drugs are suspected to fail and the need of carbapenems arises.

Keywords:
CSE-1034, antibiotics, multi-drug resistance, carbapenems, BL/BLIs.

Article Details

How to Cite
Khandait, M., Bansal, T., & Mandale, P. (2019). Current Susceptibility Trend of Antibiotics in a Tertiary Care Hospital - Need to Emphasize on Alternate Therapeutic Agents. Microbiology Research Journal International, 29(2), 1-10. https://doi.org/10.9734/mrji/2019/v29i230160
Section
Original Research Article

References

Patel I, Hussain R, Khan A, Ahmad A, Khan MU, Hassalai MAA. Antimicrobial resistance in India. J Pharm Policy Pract [Internet]; 2017;10.
[Cited 2018 Apr 12]
Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585895/

Friedman ND, Temkin E, Carmeli Y. The negative impact of antibiotic resistance. Clin Microbiol Infect. 2016;22:416–22.

Kraker MEA de, Stewardson AJ, Harbarth S. Will 10 Million people die a year due to antimicrobial resistance by 2050? PLOS Med. 2016;13:e1002184.

Antibiotic Resistance Threats in the United States, 2013. Antibiotic/Antimicrobial Resistance. CDC [Internet]; 2018.
[Cited 2018 Apr 16]
Available:https://www.cdc.gov/drugresistance/threat-report-2013/index.html

AMR Review Paper - Tackling a crisis for the health and wealth of nations_1.pdf [Internet].
[Cited 2018 Apr 16]
Available:https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20%20Tackling%20a%
20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf

Ruppé É, Woerther P-L, Barbier F. Mechanisms of antimicrobial resistance in Gram-negative bacilli. Ann Intensive Care. 2015;5:61.

Zellweger RM, Carrique-Mas J, Limmathurotsakul D, Day NPJ, Thwaites GE, Baker S, et al. A current perspective on antimicrobial resistance in Southeast Asia. J Antimicrob Chemother. 2017;72: 2963–72.

Randrianirina F, Soares J-L, Carod J-F, Ratsima E, Thonnier V, Combe P, et al. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in Antananarivo, Madagascar. J Antimicrob Chemother. 2006;59:309–12.

Kanj SS, Kanafani ZA. Current concepts in antimicrobial therapy against resistant gram-negative organisms: Extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa. Mayo Clin Proc. 2011;86:250–9.

Antibiotic Resistance Threats in the United States, 2013. Antibiotic/Antimicrobial Resistance. CDC [Internet].
[Cited 2016 Sep 6]
Available:http://www.cdc.gov/drugresistance/threat-report-2013/

Wattal C, Goel N, Oberoi JK, Raveendran R, Datta S, Prasad KJ. Surveillance of multidrug resistant organisms in tertiary care hospital in Delhi, India. J Assoc Physicians India. 2010;58(Suppl):32–6.

CLSI Antimicrobial Susceptibility Testing (AST) Standards [Internet]. Clin. Lab. Stand. Inst.
[Cited 2018 Sep 12]
Available:https://clsi.org/education/microbiology/ast/

Hudzicki J. Kirby-Bauer disk diffusion susceptibility test protocol [Internet]; 2009.
[Cited 2018 Sep 12]
Available:http://www.asmscience.org/content/education/protocol/protocol.3189

WHO. WHO publishes list of bacteria for which new antibiotics are urgently needed [Internet]. WHO.
[Cited 2018 Apr 16]
Available:http://www.who.int/mediacentre/news/releases/2017/bacteria-antibiotics-needed/en/

Abdul KG, Vidyalakshmi PR, Jayalakshmi VA, Poojary I. Susceptibility profile of Gram-negative bacteremic isolates to beta lactam-beta lactamase inhibitor agents in comparison to other antibiotics. Indian J Cancer. 2014;51:450.

Datta S, Wattal C, Goel N, Oberoi JK, Raveendran R, Prasad KJ. A ten year analysis of multi-drug resistant blood stream infections caused by Escherichia coli & Klebsiella pneumoniae in a tertiary care hospital. Indian J Med Res. 2012;135:907–12.

Trivedi M, Patel V, Soman R, Rodriguez C, Singhal T. The outcome of treating ESBL infections with Carbapenems vs. Non Carbapenem Antimicrobials. 2012;60:3.

Pilmis B, Jullien V, Tabah A, Zahar J-R, Brun-Buisson C. Piperacillin–tazobactam as alternative to carbapenems for ICU patients. Ann Intensive Care [Internet]. 2017;7.
[Cited 2018 Apr 16]
Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681454/

Chaudhary M, Mir MA, Ayub SG, Protocol 06 Group. Safety and efficacy of a novel drug elores (ceftriaxone+sulbactam+disodium edetate) in the management of multi-drug resistant bacterial infections in tertiary care centers: a post-marketing surveillance study. Braz J Infect Dis Off Publ Braz Soc Infect Dis.; 2017.

Chaudhary M, Payasi A. Clinical, microbial efficacy and tolerability of Elores, a novel antibiotic adjuvant entity in ESBL producing pathogens: Prospective randomized controlled clinical trial. ResearchGate. 2013;7:275–280.

Chaudhary M, Payasi A. Synergy of a novel antibiotic adjuvant entity against multi drug resistant ENTEROBACTERIACEAE. Am J Infect Dis. 2013;9:94–103.

Chaudhary M, Ayub SG, Mir MA. Comparative efficacy and safety analysis of CSE-1034: An open labeled phase III study in community acquired pneumonia. J Infect Public Health [Internet]; 2018.
[Cited 2018 May 30]
Available:https://www.jiph.org/article/S1876-0341(18)30042-X/fulltext

Chaudhary M, Payasi GA, Ayub SG. Advancing in the direction of right solutions: Treating multidrug-resistant pneumonia; 2017.
Available:https://www.intechopen.com/books/contemporary-topics-of-pneumonia/
advancing-in-the-direction-of-right-solutions-treating-multidrug-resistant-pneumonia

Nation RL, Li J. Colistin in the 21st Century. Curr Opin Infect Dis. 2009;22:535–43.

Qureshi ZA, Hittle LE, O’Hara JA, Rivera JI, Syed A, Shields RK, et al. Colistin-resistant Acinetobacter baumannii: Beyond carbapenem resistance. Clin Infect Dis Off Publ Infect Dis Soc Am. 2015;60:1295–303.

Arjun R, Gopalakrishnan R, Nambi PS, Kumar DS, Madhumitha R, Ramasubramanian V. A study of 24 patients with colistin-resistant Gram-negative isolates in a tertiary care hospital in South India. Indian J Crit Care Med. 2017;21:317.