Sopi january-march 2015 -

Study of Bacteriological Profile and Antibiotic Sensitivity & Resistance Pattern in Pus Culture Isolates at Tertiary Care Teaching Hospital in Bhopal Nidhi Jain, Abhay Joshi, Rakesh Sonawane, Arun Srivastav
Objective: To study the bacteriological profile and the pattern of antibiotic sensitivity and
resistance in pus culture isolates in a tertiary care teaching hospital in Bhopal.
Materials and Methods: Pus specimens submitted to the microbiology laboratory for
routine cultures and sensitivity were analyzed prospectively for the duration of 2 months.
Antimicrobial susceptibility testing was performed by Kirby-Bauer Disk Diffusion
method.
Results: Among the total 440 samples analyzed, 319 samples (72.5%) were found to be
positive for growth. Out of 319 growths, 286 shows single isolate and 33 shows mixed
(double) isolates. Out of these positive samples, 269 samples (84.33%) were positive for
Department of Opharmacology, Gram negative bacteria while 44 samples (13.8%) were positive for Gram positive Gandhi Medical College, bacteria, 4 (1.25%)were positive for both and 2 samples (0.63%) were positive for growth Bhopal (M.P.) India other than bacteria i.e. fungal growth. Klebsiella was the most common Gram–negative bacteria isolated & other common Gram-negative bacteria isolated were Pseudomonas and E.coli species while Staphylococcus aureus & CONS were the commonest Gram–positive bacteria. Gram negative bacteria shows >35% sensitivity to Meropenem, Imipenem-cilastatin, Cefoperazone and >20% sensitivity to Piperacillin-Tazobactam and Gatifloxacin. They were most resistant to Cefpodoxime, Cefprozil. Gram positive bacteria were >70% sensitive to Lincomycin and Ampicillin-Sulbactam while most resistant to Clarithromycin, Sparfloxacin, Gatifloxacin.
Conclusion: We must use antibiotics rationally and judiciously as these are precious and
limited resources. So in order to combat the menace of resistant microorganisms, we
should join hands to formulate safe and effective antibiotic policies at loco-regional as
well as national level. Because, if such type of indiscriminate, irrational and widespread
use of antibiotics is allowed to continue, the day is not far when the resistance rates among
the micro-organisms will become so high that the most innocuous looking infections may
prove fatal for life.
KEYWORDS: Bacteriological profile, antibiotic resistance, sensitivity, pus.
development of resistance [2].
Infectious diseases have been the leading cause of death all Multi-drug resistant strains have become a matter of over the world. The discovery of antibiotics opened a serious concern. The bugs producing Extended spectrum new era in the treatment of infectious diseases. But betalactamase (ESBL) and carbepenamase are really fatal the concurrent development of antibiotic resistance as they confer resistance to the penicillins, cephalosporins illustrated the ability of the microorganisms to grow and even to carbapenems [3].The day is not far when these and survive under unfavorable conditions [1]. bacteria will get resistant to the new molecules like Development of antimicrobial resistance is increasing day tigecyclin, dorepenam and daptomycin owing to their by day at faster pace than it can be controlled. Inadequate indiscriminate and widespread use [4]. For treating antibiotic with suboptimal dose and incomplete course has antibiotic resistant infection, many billions of dollars are adverse outcome and increases the possibility of being spent every year. Therefore there is a need for regular screening of microorganisms causing various 11 J Pharmcovig Drug Safety, January-March-2015, Volume : 12, Issue :1, Page: 11-16

Jain N et al : Study of Bacteriological Profile and Antibiotic Sensitivity & Resistance Pattern in Pus Culture Isolates at Tertiary
Care Teaching Hospital in Bhopal
infections and to characterize their antimicrobial gatifloxacin, linezolid, lincomycin, clindamycin, sensitivity and resistance pattern to commonly used vancomycin, ampicillin/sulbactam, roxithromycin, antibiotics at loco-regional, national and global levels lomefloxacin, clarithromycin, teicoplanin, moxifloxacin. to guide the clinicians to select an adequate antibiotic The antibiotics tested for Gram negative bacilli (GNB) for empirical treatment of infections [1].
were cefoperazone, cefpirome, cefpodoxime, cefprozil, For selecting an effective antimicrobial agent for an ceftizoxime, gatifloxacin, imipenem/cilastatin, infection, knowledge of the potential microbial meropenem, moxifloxacin, piperacillin/tazobactam, pathogen, an understanding of the pathophysiology of ticarcillin/clavulanic acid, tobramycin, sparfloxacin, the infectious process and pharmacology of the levofloxacin. Data of micro-organisms analysed and its intended therapeutic agents are required [5]. In addition resistance and sensitivity pattern was recorded. place to place variation has also been found in the Results and Discussion
antimicrobial susceptibility patterns [6]. A number of
Total 444 samples of pus were collected during the study, studies have been carried out in the western countries to out of these 319 samples showed significant growth of monitor antimicrobial resistance at national level [7, 8]. organisms. Four samples were contaminated so were The academic and educational value of these studies is excluded from the study. The positivity rate was found to particularly useful for microbiologists and infectious be 72.5% which was comparable to those reported by the disease clinicians.
other similar studies. A study done by Muluye et al Materials and Methods
reported pus culture positivity rate 70.2% [7], while This cross sectional observational study was conducted at another study done by Kaup et al, reported it 73.5% [1]. In Hamidia Hospital, Gandhi Medical College, Bhopal, a our study, out of 319 samples, 286 (89.7%) were single tertiary care teaching hospital. The Pus specimens isolates & 37 (11.6%) were found to be mixed (double) collected from the various sites of infection routinely submitted for culture and sensitivity during the period of Gram negative Bacteria were much more common than May to June 2014 to the microbiology laboratory of the Gram Positive organisms. GNB were grown in 269 hospital were analyzed. Processing of samples and the samples which constituted 84.33% of the total samples identification of the isolates were performed by while 44 samples were positive for GPC which constituted conventional methods. 13.8%. Four samples (1.25%) were having both types of The antibiotic resistance and sensitivity test was the growth i.e. GNB & GPC and 2 samples were having performed by Kirby- Bauer's disk diffusion method on fungal growth. Other similar studies also have the Mueller Hinton agar plates. The antibiotics tested for consistent results. [1, 9] Gram positive cocci (GPC) were cefaclor, sparfloxacin, Klebsiella was the predominant organism isolated from Figure1: Percentage Growth among Pus Specimens
J Pharmcovig Drug Safety, January-March-2015, Volume : 12, Issue :1, Page: 11-16 12

Jain N et al : Study of Bacteriological Profile and Antibiotic Sensitivity & Resistance Pattern in Pus Culture Isolates at Tertiary
Care Teaching Hospital in Bhopal
Figure 2: Percentage Growth among Pus Specimens
Figure 3: Percentage Individual Growth
Figure 4: Antimicrobial sensitivity and resistance pattern among GNB
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Jain N et al : Study of Bacteriological Profile and Antibiotic Sensitivity & Resistance Pattern in Pus Culture Isolates at Tertiary
Care Teaching Hospital in Bhopal
Figure 5: Antimicrobial sensitivity and resistance pattern among GPC
the pus culture which constituted 46.4% (148 samples). resistance to Imipenem/cilastatin and Meropenem was Second most common organism isolated was quite higher in our study when compared to the previous Pseudomonas (27.3%) followed by E.coli (13.8%). Next study done by Kaup et al in which they were 100% common organism isolated was Staphylococcus aureus sensitive [1].
which was most common Gram Positive bacteria isolated, Gram positive bacteria were somewhat less resistant to constituted 11.3% of total growths. In another similar antibiotics than Gram negative bacteria according to our study, the most common GPC isolated was Staphylcoccus study. Percentage resistance was highest for aureus and most common GNB was E.coli followed by Clarithromycin (79.2%), to Sparfloxacin (72.9%) and Pseudomonas [1]. In our study other organisms isolated Gatifloxacin (72.9%). Gram positive bacteria were most were non lactose fermenting bacteria (NLF Bacteria), sensitive to Lincomycin and Ampicillin/sulbactam with coagulase negative staphylococci (CONS), proteus, their sensitivity rates approaching 77.1% and 72.9% acinetobacter, citrobacter, streptococci.
Our study showed that Gram negative bacteria have become highly resistant to cephalosporin group of drugs, We reported our results regarding the trends in the pus of which they were most resistant to Cefpodoxime culture isolates collected over the period of two months. (96.3%), Cefprozil (94%), Cefpirome (87.4%), and Most of the infectious sites from where the pus was Ceftizoxime (86.2%). Resistance to Ticarcillin/clavulanic collected were found to be gram negative bacillary acid and Flouroquinolone group of drugs was also quite infections. Organisms including Klebsiella, Pseudomonas high. According to our study, most sensitive antibiotics for and E.coli among GNB and Staphylococcus aureus among GNB were found to be Imipenem/cilastatin and GPC were the predominant isolates. This is the scenario in Meropenem. But percentage resistance in these newer most of the hospitals, medical institutes and centers in antibiotics has also found to be 60.6% and 59% for India, which is in stark contrast with the western countries Imipenem/cilastatin and Meropenem respectively. These where the major share of hospital associated infections is findings were consistent with the results obtained by constituted by gram positive organisms like previous similar study done by Kaup et al [1],but the Staphylococcus aureus since the 1980's [10].
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Jain N et al : Study of Bacteriological Profile and Antibiotic Sensitivity & Resistance Pattern in Pus Culture Isolates at Tertiary
Care Teaching Hospital in Bhopal
Recently, an extensive and indiscriminate use of Cephalosporin group of drugs especially 3rd generation Imipenem/cilastatin and Meropenem.
cephalosporins and quinolones in community has In order to rationalize the administration of empirical contributed to very high resistance rate in GNB. Even the therapy before the results of culture are available, newly introduced 4 generation cephalosporin like knowledge of the most common causative microbial Cefpirome has got very high resistance rate as it has been organisms and their antimicrobial sensitivity and Table 1: Antimicrobial sensitivity and resistance percentage among gram-negative bacilli (GNB)
Table 2: Antimicrobial sensitivity and resistance percentage among gram-positive cocci (GPC)
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Jain N et al : Study of Bacteriological Profile and Antibiotic Sensitivity & Resistance Pattern in Pus Culture Isolates at Tertiary
Care Teaching Hospital in Bhopal
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Epidemiology and prognostic determinants of bloodstream J Pharmcovig Drug Safety, January-March-2015, Volume : 12, Issue :1, Page: 11-16 16

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