Incidence and sensitivity pattern of Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa in a tertiary care hospital
Keywords:Antimicrobial sensitivity, Gram-negative bacteria, Resistance, Stewardship
Background: Antimicrobial resistance is a serious problem worldwide and differs from region to region. This study was planned to determine the incidence and sensitivity pattern of Klebsiella pneumoniae (K. pneumoniae), Escherichia coli (E. coli) and Pseudomonas aeruginosa (P. aeruginosa) in our region and discuss the general issues related to antimicrobial resistance.
Methods: Prospective study was carried out between March to October 2015. Samples of urine, blood, pus, CSF and miscellaneous samples (fluids, swabs, sputum and stool) were collected from indoor and outdoor patients for isolation and antimicrobial susceptibility of K. pneumoniae, E. coli and P. aeruginosa in the Department of Microbiology G.R. Medical College, Gwalior (MP).
Results: Out of the 5000 samples analyzed 1684 showed growth. K. pneumoniae (38.50%), E. coli (33.29%) and P. aeruginosa (28.19%) constituited a total of 805 isolates. Both E.coli and K. pneumoniae showed highest sensitivity for doxycycline (75%; 67% resp.) and second highest for levofloxacin (70%; 64% resp.), whereas, P. aeruginosa showed highest 57% sensitivity for amikacin followed by 48% for levofloxacin. β-lactam antibiotics and aminoglycosides showed high mean resistance (K.pneumoniae-83%, E.coli-79%, P. aeruginosa-86.4%) and (K. pneumoniae-75%, E. coli-61%, P. aeruginosa-70%) resp.
Conclusions: The data indicates high resistance among the gram-negative bacteria for β-lactam and aminoglycoside antibiotics. Increasing resistance to doxycycline and flouroquinolones for K. pneumoniae and E. coli and multidrug resistance to P. aeruginosa is a cause of concern in this region. Thus, there is a need to stop misuse of antibiotics with immediate effect and to implement a strong antimicrobial stewardship program.
Oteo J, Campos J, Baquero F. Antibiotic resistance in 1962 invasive isolates of Escherichia coli in 27 Spanish hospitals participating in the European Antimicrobial Resistance Surveillance System. J. Antimicrob Chemother. 2002;50:945-52.
Hsu LY, Tan TY, Jureen R, Koh TH, Krishnan P, Lin RTP, et al. Antimicrobial drug resistance in Singapore hospitals. Emerg Infect Dis; 2007.
Tripathi KD. Essentials of Medical Pharmacology. 7th ed. New Delhi: Jaypee Brothers Medical Publishers; 2013.
US Food and Drug Administration. National antimicrobial resistance monitoring system- enteric bacteria (NARMS): 2008 executive report. Rockville (MD); 2010.
Pier G, Ramphal R. Pseudomonas aeruginosa. In: Mandell G, Bennett J, Dolin R, eds. Principles and practice of infectious diseases. Philadelphia, PA: Elsevier Churchill Livingstone; 2005:2587-2615.
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement (M100-S24); Table 3A. 2014;34(1):110-3.
Asati RK. Antimicrobial sensitivity pattern of Klebsiella pneumonia isolated from pus from tertiary care hospital and issues related to the rational selection of antimicrobials. J. Chem. Pharm. Res. 2013;5(11):326-31.
Ravichitra KN, Prakash PH, Subbarayudu SU, Rao S. Isolation and antibiotic sensitivity of Klebsiella pneumonia from pus, sputum and urine samples. Int. J. Curr. Microbiol. App. Sci. 2014;3(3):115-9.
Manikandan C, Amsath A. Antibiotic susceptibility pattern of Klebsiella pneumoniae isolated from urine samples. Int. J. Curr. Microbiol. App. Sci. 2013;2(8):330-7.
Petri WA. Penicillins, Cephalosporins and Other B-Lactam Antibiotics. In: Laurence LB, editor, Bruce AC, Bjorn CK, assoc. editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 12th ed. China: McGraw Hill; 2011:1472,1480-1481.
Jethwani U, Shah N, Trivedi P. Antibiotic Sensitivity Pattern of Gram Negative Bacilli Isolated from the Lower Respiratory Tract of Ventilated Patients in the Intensive Care Unit. Indian Medical Gazette. 2014;180-184.
Asati RK. Antimicrobial sensitivity pattern of Escherichia coli isolated from urine samples of UTI patients and issues related to the rational selection of Antimicrobials. Int J of pharmacology and therapeutics. 2013;3(3):52-8.
Mohan BS, Lava R, Prashanth HV, Nambiar V, Basavaraj M, Venkatesh NR, et al. Prevalence and Antibiotic sensitivity pattern of Pseudomonas aeruginosa; an emerging nosocomial pathogen. Int J Biol Med Res. 2013;4(1):2729-31.
Rakesh RM, Govind NL, Mistry K, Parmar R, Patel K, Vegad MM. Antibiotic resistance pattern in Pseudomonas aeruginosa species isolated at a Tertiary care Hospital, Ahmadabad. Nat J Med Res. 2012;2(2):156-9.
Syed A, Thakur M, Syed S, Sheikh A U. In-vitro sensitivity patterns of pseudomonas aeruginosa strains isolated from patients at skims - role of antimicrobials in the emergence of multiple resistant strains. JK-Practitioner. 2007;14(1):31-4.
Mesaros N, Nordmann P, Ple´siat P, Roussel-Delvallez M, Van Eldere J, Glupczynski Y, et al. Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium. Clin Microbial Infect. 2007;13:560-78.