Introduction
Antimicrobial resistance is a growing problem in the 21st Century and one of the most serious problem to global public health.1 The number of resistant microbial strains, geographic areas affected by drug resistance and the extent of resistance in each organism are escalating.2 Moreover, the percentage of organisms exhibiting antimicrobial resistance, especially resistance to multiple antibiotics, are continuingly increased.3 Resistant microorganisms lead to an increase in morbidity and mortality since it increases the risk of inappropriate therapy.4, 5 This resistance may delay and hinder treatment, resulting in complications or even death.6, 7 Moreover a patient may need more care, as well as the use of alternative and more expensive antibiotics which may have more severe side effects or may need invasive treatment such as intravenous injection to be given in hospital.6, 8
Experiences from surveillance network on antimicrobial use and antimicrobial resistance show that data where ever available, can be put to multiple uses, including orienting treatment choice, understanding antimicrobial trend, informing public health policy, identifying priority areas for interventions and monitoring the impact of interventions to certain resistance. 1 Therefore, the present study involves the screening of the antimicrobial resistant profile of carbapenem drugs that are used in the treatment of infectious diseases.
Material and Methods
A cross sectional study was conducted in the Department of Microbiology, Santosh Medical College and Hospital, Ghaziabad for a period of one year from October 2017 to 2018. Ethical clearance was obtained from the Institutional Ethical Committee. All specimens including urine, pus, blood, sputum, stool and body fluids such as cerebrospinal fluid and pleural fluid received in the bacteriology laboratory and processed further according to Standard bacteriological procedures for bacterial isolation and identification. Antimicrobial Susceptibility testing was done according to Clinical and Laboratory Standards Institute.9, 10
Result
Of the total 150 isolates, 74 (49%) isolates were from urine samples, 33 (22%) isolates from pus, 11 (7.3%) isolates from sputum, 09 (06%) isolates from blood, 07 (4.66%) isolates from catheter tips, 06 (4%) isolates from ETT & Ear swab and 04 (2.66%) isolates from stool (Figure 1).
Of the 150 Gram negative isolates bacteriological profile showed that 50% isolates were E. coli, 21% Klebsiella pneumoniae, 15% Pseudomonas aeruginosa, 08% Citrobacter species, 07% Acinetobacter baumannii and 04% Proteus species (Figure 2). Antibiotic susceptibility patters of Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii have been shown in the (Figure 3, Figure 4, Figure 5) respectively.
Discussion
Originating in a hospital setting, carbepenems are used as the last resort for treatment of Drug resistance Gram negative bacterial infection. However, since last 15 years acquired resistance to these life saving antimicrobials has been increasingly reported not only in Pseudomonas aeruginosa and Acinetobacter species,11 but also among other members of Enterobacteriaceae family. E.coli and Klebsiella pneumoniae are the most common pathogens in Enterobacteriaceae family.12 These carbapenemas producing bacteria were found in many countries such as China13 Jaipur,14 China, 15 Brazia, 16 This resistance is mainly mediated by MBLs.
Antibiotic sensitivity of Enterobacteriaceae family showed maximum sensitivity to imipenem (82.2%), gentamicin (55.5%), cefepime (42.2%) and levofloxacin (37.0%). A study by Kholy Amani et al,17 showed somewhat similar pattern with maximum sensitivity to gentamicin (42%), cefepime (40%), levofloxacin (30%). Whereas other studies have reported maximum sensitivity to imipenem (80%), gentamicin (45%), levofloxacin (42.2%), and cefepime (36.6%).
Present study showed maximum resistance to Ampicillin (85.9%), Ceftriaxone (82.9%), Levofloxacin (62.9%), Cefepime (57.7%). Vemula Sarojamma et al., reported high resistance to imipenem (84%), gentamicin (40%) in their study whereas Tanaja et al. reported high resistance to ampicillin (80%) and imipenem (86%).
In our study Pseudomonas aeruginosa showed maximum sensitivity to piperacillin/ tazobactam (80%), toberamycin and levofloxacin (66.6%), and imipenem (60%) respectively. Resistance pattern of Pseudomonas aeruginosawas maximum by Ceftazidime (55.5%), Aztreonam 46.6%, Imipenem and Levofloxacin 33.3%, Toberamycin and Piperacillin/Tazobactam 33.3% respectively. Irfan et al.17 reported sensitivity to piperacillin/tazobactam 40% and were resistance to Aztreonam 66.6%, Attal et al.,18 EL Koly Amani et al.,25%.19
Metallo beta lactamase has become a major problem worldwide and the situation is worrisome to the community. These enzymes are becoming increasingly expressed by many strains of pathogenic bacteria with a potential for dissemination.12 They compromise the activity of wide spectrum antibiotics creating major therapeutic difficulties with significant impact on the outcome of patient by appropriate antimicrobial selection, surveillance system and effective infection control procedures being the key factor in their control.
Conclusion
The spread of drug-resistant Gram negative bacilli in the hospital is seen as a worldwide problem. In the majority of hospitalized patients, those in ICUs are exposed to the risk. Routine surveillance of baseline resistance, guidelines of hospital antibiotic policy and compliance with existing guidelines will go long way in reducing multi drug resistance among pathogens. Early detection is crucial for the treatment with alternative antimicrobial and timely implementation of strict infection control practices. There is no standardized method for Metallo beta lactamase detection, although detection by polymerase chain reaction is highly accurate and reliable, thus, laboratory methods including culture and antimicrobial susceptibility testing with routine screening for MBL production should be done for proper diagnosis and management of all infection.
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