Microbiological profile of lower respiratory tract infections in neurological intensive care unit of a tertiary care center from Central India

Pathogenic bacteria recovered from Gene X-pert tuberculosis-negative adult patients in Gondar, Northwest Ethiopia

INTRODUCTION

Lower respiratory tract infections (LRTIs) caused by drug-resistant pathogenic bacteria is a major problem in developing countries including Ethiopia. Therefore, this study aimed to determine the pathogenic bacteria and their antimicrobial susceptibility patterns among Gene X-pert tuberculosis-negative adult patients with clinically suspected LRTIs at the University of Gondar Comprehensive Specialized Referral Hospital, Gondar, Northwest Ethiopia.

METHODS

This institutional-based cross-sectional study was conducted from February 01 to March 15, 2020. Socio-demographic data were collected by using a structured questionnaire. A total of 254 sputum specimens were collected from Gene X-pert tuberculosis-negative patients. Bacterial recovery was performed using blood, chocolate, and MacConkey agar plates. Bacterial isolates were identified based on Gram staining, colony characteristics, and biochemical reactions. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Methicillin resistance of S. aureus was confirmed using cefoxitin (30 µg). Descriptive statistics were calculated for each variable and results are shown in tables and figures.

RESULTS

In this study, the overall sputum culture positivity rate was 145/254 (57.1%). Gram-negative bacteria 111 (64.9%) were predominant compared to Gram-positive bacteria 60 (35.1%). Of the 145 culture-positive cases, 26 (14.8%) had poly-bacterial infections. S. aureus 40 (66.7%) was the predominant Gram-positive bacterium whereas K. pneumoniae 33 (29.7%), was the most isolated Gram-negative bacterium. Bacterial species, such as S. aureus were sensitive to ciprofloxacin 38/40 (95.0%), gentamicin 37/40 (92.5%), cefoxitin 36/40 (90.0%), and clindamycin 34/40 (85.0%). The proportion of Methicillin-resistant S. aureus was low, 4(10.0%). S. pneumoniae was sensitive to chloramphenicol 8/9 (88.9%) and resistant to ciprofloxacin 6/9 (66.7%). K pneumoniae, P. aeruginosa, E. coli, Serratia species, and H. influenzae also demonstrated high levels of resistance to ampicillin at rates of 21/33 (63.6%), 8/8 (100.0%), 15/17 (88.2%), 7/10 (70.0%), and 6/6 (100.0%), respectively.

CONCLUSION

This study revealed a higher burden of Gram-negative and Gram-positive pathogenic bacterial agents, which is responsible for LRTs. Therefore, routine sputum culture identification and antibiotic susceptibility testing should be performed in Gene X-pert tuberculosis-negative patients.

Sulbactam and Colistin Susceptibility Pattern Among Multidrug-Resistant Acinetobacter Isolates From Respiratory Samples

Background

Acinetobacter species are known to be important hospital-acquired pathogens. Unfortunately, multidrug-resistant Acinetobacter spp. has very limited options for an effective treatment.

Aim

To identify the common pathogens causing lower respiratory tract infections (LRTI), their antimicrobial susceptibility pattern, and determine the minimum inhibitory concentration (MIC) of sulbactam and colistin for Acinetobacter spp.

Materials and methods

A prospective study was done for a period of six months in a tertiary care hospital in Eastern India. The organisms causing LRTI were identified by conventional biochemical techniques and VITEK 2 Compact System (bioMérieux Inc., France). Antimicrobial susceptibility testing was performed using the Kirby‑Bauer disc diffusion method. MIC was also measured for Acinetobacter spp. to confirm certain antimicrobial agents using E-strips and micro broth dilution techniques.

Results

A total of 542 sputum and endotracheal tube aspirate (ETA) samples were examined during the study period. Among these, 109 samples showed growth of significant colony count of one or two organisms, yielding a sum of 115 isolates. Among these, there were 51 (44.35%) isolates of Klebsiella pneumoniae, 32 (27.83%) isolates of Pseudomonas spp., 30 (26.09%) isolates of Acinetobacter spp., and two (1.74%) isolates of Stenotrophomonas maltophilia. Although they were susceptible to colistin, Acinetobacter spp. was highly resistant to sulbactam.

Conclusion

Although colistin susceptibility was noted, the common pathogens causing LRTI were highly resistant to most drugs. Therefore, the causative organisms of LRTI and their susceptibility pattern should be determined to manage these cases effectively.

Bacterial profile and drug susceptibility among adult patients with community acquired lower respiratory tract infection at tertiary hospital, Southern Ethiopia

BACKGROUND

Lower respiratory tract infection is a global problem accounting over 50 million deaths annually. Here, we determined the bacterial profile and antimicrobial susceptibility pattern of lower respiratory tract infections among adult patients attending at Tertiary Hospital, Southern Ethiopia.

METHODS

A cross sectional study was conducted among adult patients with lower respiratory infection at the medical outpatient department of the Hospital. A sputum sample was collected and processed for bacterial culture and antimicrobial susceptibility test. Semi structured questionnaires were used to collect data. SPSS version 22 software was used for statistical analysis and a p value of < 0.05 was considered as statistically significant.

RESULTS

Out of 406 sputum samples of participants 136(33.5%) were culture positive for 142 bacterial isolates. Klebsiella pneumoniae 36(25.4%) was the predominant isolate followed by Pseudomonas species 25(17.6%). Gram-negative bacteria were sensitive to cefepime (86.0%) and ciprofloxacin (77.8%) antibiotics while gram-positive (76.5%) to clindamycin.

CONCLUSION

Community acquired lower respiratory tract Infection was highly prevalent in the study area and the isolates showed resistant to common antibiotics such as ampicillin, augmentin, ceftazidime and tetracycline. Therefore, culture and susceptibility test is vital for appropriate management of lower respiratory tract infection in the study area.

Antimicrobial susceptibility patterns of clinical isolates of Pseudomonas aeruginosa isolated from patients of respiratory tract infections in a Tertiary Care Hospital, Peshawar

Objective:

This study aims to determine the prevalence and susceptibility pattern of Pseudomonas aeruginosa and multidrug-resistant (MDR) isolates in patients suffering from respiratory tract infection.

Methods:

A cross sectional study was conducted from January to December 2014 in Northwest General Hospital and Research Centre, Peshawar. A total of 615 sputum samples were collected from both in and out-patients. Sputum samples were collected as per standard procedure and were inoculated on Blood, MacConkey and Chocolate agar. The isolates were identified by standard protocols using biochemical tests. The antibiotic susceptibility pattern of each isolate was checked as per Clinical and Laboratory Standards Institute (CLSI) guidelines using Kirby-Bauer’s disc diffusion method.

Results:

Out of 615 sputum samples, 354 (57.56%) were culture positive. Out of these a total of 71 (20.05%) strains of Pseudomonas were isolated, where 54.93% was from males and 45.07% were from females (Mean age was 44.29 ± 22.72:). Highest sensitivity was seen to Amikacin (92.86%) followed by Meropenem (91.55%) while lowest sensitivity was seen to Cefoperazone + Sulbactam (16.9%). There were 39.44% MDR strains, out of which 25% were Extensively Drug Resistant (XDR) and 10.71% were Pan Drug Resistant (PDR). In vitro susceptibility of MDR isolates showed highest sensitivity to Amikacin (82.14%) followed by Carbapenems (78.57%). All MDR isolates were resistant to Cefoperazone + Sulbactam. Resistance to Piperacillin + Tazobactam was 96.43%.

Conclusion:

Pseudomonas aeruginosa is one of the commonly isolated organisms and it is becoming more resistant to commonly used antibiotics. Carbapenems and aminoglycosides were the two classes of drugs that showed highest activity against Pseudomonas aeruginosa.

[Multidrug-resistant bacteria in Germany. The impact of sources outside healthcare facilities]

BACKGROUND

Currently, there is an ongoing discussion about the question whether the emergence of multidrug-resistant microorganisms (MDRO) among humans is due to transfer of these bacteria from animals.

OBJECTIVES

This review summarizes data on the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL) producing enterobacteria in animals and humans, and describes knowledge about transmission pathways.

MATERIAL AND METHODS

After a scientific literature analysis, relevant articles were identified by screening of titles and abstracts, amended by publications of infection control authorities and the respective reference lists.

RESULTS

MDRO are both transmitted in the nosocomial setting and are increasingly detected as sources of infection outside healthcare facilities.

CONCLUSIONS

Due to new transmission pathways of MDRO an inter-disciplinary approach towards prevention is necessary, involving medical, pharmaceutical and veterinary expertise.