Likelihood of Inadequate Treatment A Novel Approach to Evaluating Drug-Resistance Patterns

2009 ◽  
Vol 30 (7) ◽  
pp. 672-677 ◽  
Author(s):  
Heinz Burgmann ◽  
Brigitte Stoiser ◽  
Gottfried Heinz ◽  
Peter Schenk ◽  
Petra Apfalter ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Agents ◽  
Rank Order ◽  
Tertiary Care ◽  
Daily Practice ◽  
University Teaching ◽  
Ventilator Associated Pneumonia ◽  
Adequate Therapy ◽  
Resistance Rates ◽  
Microbiological Data

Objective.To provide a novel way to predict the likelihood that antibiotic therapy will result in prompt, adequate therapy on the basis of local microbiological data.Design and Setting.Prospective study conducted at 3 medical intensive care units at the Viennese General Hospital, a tertiary care medical university teaching hospital in Vienna, Austria.Patients.One hundred one patients who received mechanical ventilation and who met the criteria for having ventilator-associated pneumonia.Design.Fiberoptic bronchoscopic examination was performed, and bronchoalveolar samples were collected. Samples were analyzed immediately by a single technician. Minimum inhibitory concentrations were determined for imipenem, cephalosporins (cefepime and cefpirome), ciprofloxacin, and piperacillin-tazobactam, and drug resistance rates were calculated. These drug resistance rates were translated into the likelihood of inadequate therapy (LIT; the frequency of inadequately treated patients per antibiotic and drug-resistant strain), cumulative LIT (the cumulative frequency of inadequately treated patients), and syndrome-specific LIT.Results.Amongthe 101 bronchoalveolar samples, culture yielded significant (at least 1 × 104 colony-forming units per raL) polymicrobial findings for 34 and significant monomicrobial findings for 31; 36 culture results were negative. Of the isolates from patients with ventilator-associated pneumonia who had monomicrobial culture findings, 33% were gram-positive bacteria and 20% were gram-negative bacteria. LIT suggested that 1 of 2 patients was treated inadequately for Pseudomonas aeruginosa infection. The LIT for patients with ventilator-associated pneumonia revealed that the rank order of antibiotics for appropriate therapy was (1) imipenem, (2) cephalosporins, (3) ciprofloxacin, and (4) piperacillin-tazobactam. These calculations were based solely on microbiological data.Conclusions.The novel ratio LIT may help clinicians use microbiological data on drug resistance to predict which antimicrobial agents will provide adequate therapy. In daily practice, this new approach may be helpful for choosing adequate antimicrobial therapy.

scholarly journals To determine antimicrobial susceptibility and biofilm production among coagulase negative staphylococci at a tertiary care hospital

2021 ◽  
Vol 8 (3) ◽  
pp. 230-234
Author(s):  
Naga Sri Latha Bathala ◽  
M Sasidhar ◽  
S Kusuma Bai
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Susceptibility ◽  
Biofilm Formation ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Multi Drug Resistance ◽  
Clinical Samples ◽  
Care Hospital ◽  
Coagulase Negative Staphylococci ◽  
Cross Sectional

CoNS are gaining importance due to increase in resistance rates to betalactam antibiotics and multi drug resistance. Although specific virulence factors are not as clearly established, it seems clear that factors such as bacterial polysaccharide components, and ability to form biofilm are involved in attachment and/or persistence of bacteria on foreign materials. Biofilms usually result in persistent infections that cannot be easily resolved with standard antibiotic treatments; therefore, the biofilm formation ability and the resistance to antimicrobial therapy can be intimately related. A prospective cross-sectional study was done on purely isolated CoNS from various clinical samples from both out patients and inpatients. All the test strains were subjected to antimicrobial susceptibility testing. The ability to produce biofilm was detected by tube adherence method. Among 193 CoNS isolates 156 were from inpatients and 37 were from out patients. Methicillin resistant was seen in 80.31%. Of the total, 40.41% showed moderate biofilm formation by tube adherence method. 23.32% of isolates did not form biofilm. All the isolates from blood samples showed moderate (20/26) and strong (6/26) biofilm formation. Among non biofilm producers 66.67% were MS CoNS isolates and 33.33% were MRCoNS. 94.59% of biofilm producers were MRCoNS and 5.41% were MSCoNS. Production of biofilm was relatively more (1.16) among CoNS isolates of IPD than OPD.  As Coagulase negative Staphylocooci are exhibiting multi drug resistance and are able to form biofilm, these organisms causing a major challenge for the physicians. Hence, such problems can be prevented by detection of biofilm producers and appropriate antibiotic doses modification. The issue of antibiotic resistance among CoNS needs to be addressed through a more rational use of existing antibiotics as well as the development of new antimicrobial agents.

scholarly journals Bacteriological profile and antimicrobial resistance pattern of ventilator associated pneumonia in tertiary care hospital

2021 ◽  
Vol 8 (3) ◽  
pp. 191-195
Author(s):  
Eshwar Rajesh ◽  
Radhika Katragadda ◽  
C P Ramani
Keyword(s):  
Mechanical Ventilation ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Diffusion Method ◽  
Resistance Pattern ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Mortality And Morbidity ◽  
Endotracheal Aspiration ◽  
Life Threatening

With an occurrence ranging from 6-52%, ventilator-associated pneumonia (VAP) is the most common ICU acquired infection, accounting for a significant portion of hospital-acquired infections (HAIs). VAP is pneumonia that develops after a period of more than 48 hours of mechanical ventilation or endotracheal intubation. To isolate and identify the potential pathogens causing VAP and to study their antimicrobial susceptibility patterns. Endotracheal aspiration (ETA) or bronchoalveolar lavage (BAL) were collected from patients on mechanical ventilation >48 hours. Bacterial isolates were identified based on culture colony characteristics and biochemical parameters. Antibiotic susceptibility profile was determined for these isolates by Kirby-Bauer disc diffusion method as per Clinical and laboratory Standards Institute (CLSI) 2020 guidelines and studied. The collected data was entered in Excel, and analyzed by using SPSS version 16. Among the isolates, the most common were (31.31%) and (31.31%). These were followed by (22.22%), (7.07%), (3.03%) and (3.03%) and (2.02%).Multi Drug Resistant (MDR) microbes causing VAP are on the increase. The patient population at risk will benefit by the application of the results of this study. The antibiotic resistance pattern of these isolates will aid clinicians in selecting the appropriate antimicrobial agents. Hence, it can lead to decreased mortality and morbidity due to life-threatening VAP.

scholarly journals Antimicrobial Resistance among Clinical Isolates ofStreptococcus pneumoniae in the United States during 1999–2000, Including a Comparison of Resistance Rates since 1994–1995

2001 ◽  
Vol 45 (6) ◽  
pp. 1721-1729 ◽  
Author(s):  
Gary V. Doern ◽  
Kristopher P. Heilmann ◽  
Holly K. Huynh ◽  
Paul R. Rhomberg ◽  
Stacy L. Coffman ◽  
...  
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
Antimicrobial Agents ◽  
Rank Order ◽  
The United States ◽  
Clinical Isolates ◽  
Beta Lactam ◽  
High Level ◽  
Resistance Rates

ABSTRACT A total of 1,531 recent clinical isolates of Streptococcus pneumoniae were collected from 33 medical centers nationwide during the winter of 1999–2000 and characterized at a central laboratory. Of these isolates, 34.2% were penicillin nonsusceptible (MIC ≥ 0.12 μg/ml) and 21.5% were high-level resistant (MIC ≥ 2 μg/ml). MICs to all beta-lactam antimicrobials increased as penicillin MICs increased. Resistance rates among non-beta-lactam agents were the following: macrolides, 25.2 to 25.7%; clindamycin, 8.9%; tetracycline, 16.3%; chloramphenicol, 8.3%; and trimethoprim-sulfamethoxazole (TMP-SMX), 30.3%. Resistance to non-beta-lactam agents was higher among penicillin-resistant strains than penicillin-susceptible strains; 22.4% of S. pneumoniae were multiresistant. Resistance to vancomycin and quinupristin-dalfopristin was not detected. Resistance to rifampin was 0.1%. Testing of seven fluoroquinolones resulted in the following rank order of in vitro activity: gemifloxacin > sitafloxacin > moxifloxacin > gatifloxacin > levofloxacin = ciprofloxacin > ofloxacin. For 1.4% of strains, ciprofloxacin MICs were ≥4 μg/ml. The MIC90s (MICs at which 90% of isolates were inhibited) of two ketolides were 0.06 μg/ml (ABT773) and 0.12 μg/ml (telithromycin). The MIC90 of linezolid was 2 μg/ml. Overall, antimicrobial resistance was highest among middle ear fluid and sinus isolates of S. pneumoniae; lowest resistance rates were noted with isolates from cerebrospinal fluid and blood. Resistant isolates were most often recovered from children 0 to 5 years of age and from patients in the southeastern United States. This study represents a continuation of two previous national studies, one in 1994–1995 and the other in 1997–1998. Resistance rates with S. pneumoniae have increased markedly in the United States during the past 5 years. Increases in resistance from 1994–1995 to 1999–2000 for selected antimicrobial agents were as follows: penicillin, 10.6%; erythromycin, 16.1%; tetracycline, 9.0%; TMP-SMX, 9.1%; and chloramphenicol, 4.0%, the increase in multiresistance was 13.3%. Despite awareness and prevention efforts, antimicrobial resistance with S. pneumoniae continues to increase in the United States.

scholarly journals Prevalence and drug resistance of Salmonella in dogs and cats in Xuzhou, China

2020 ◽  
Vol 64 (2) ◽  
pp. 263-268
Author(s):  
Lingling Wei ◽  
Cheng Yang ◽  
Wangfeng Shao ◽  
Tongzheng Sun ◽  
Jianyu Wang ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Close Contact ◽  
Drug Resistant ◽  
Carriage Rate ◽  
Faecal Samples ◽  
Antimicrobial Susceptibility Tests ◽  
Susceptibility Tests ◽  
Resistance Rates

AbstractIntroductionSalmonellosis is a zoonotic disease, and Salmonella spp. can sometimes be found in dogs and cats, posing a risk to human health. In this study, the prevalence and antimicrobial susceptibility of faecal Salmonella were investigated in pet dogs and cats in Xuzhou, Jiangsu Province, China.Material and MethodsFaecal samples from 243 dogs and 113 cats, at seven pet clinics, were tested between March 2018 and May 2019. Each Salmonella isolate was characterised using serotyping and antimicrobial susceptibility tests.ResultsThe prevalence of Salmonella was 9.47% in dogs and 1.77% in cats. Among the 25 isolates, eight serotypes of Salmonella enterica subsp. enterica were detected, S. Kentucky (n = 11), S. Indiana (n = 5), and S. Typhimurium (n = 4) predominating. S. Derby, S. Toucra, S. Sandiego, S. Newport, and S. Saintpaul all occurred singly. The 23 Salmonella strains found in dogs were from seven different serovars, while the two strains in cats were from two. The highest resistance rates were found for tetracycline (92%), azithromycin (88%), cefazolin (84%), nalidixic acid (80%), ampicillin (80%), ceftriaxone (80%), and streptomycin (76%). Resistance to three or more antimicrobial agents was detected in 24 (96%) isolates. Most of the S. Kentucky and S. Indiana isolates were multi-drug resistant to more than 11 agents.ConclusionThe carriage rate was far higher in dogs than in cats from Xuzhou. Some isolated strains were highly resistant to antimicrobials used to treat infections in humans and pets, which may raise the risk of humans being infected with multi-drug resistant Salmonella via close contact with pets.

scholarly journals Antibiotic profiling of Pseudomonas aeruginosa isolates from pus sample of rural tertiary care hospital of Western Maharashtra, Loni, India

2017 ◽  
Vol 5 (7) ◽  
pp. 3076 ◽  
Author(s):  
Namita A., Raytekar, ◽  
Meghna R. Choudhari ◽  
Sonali Das
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Drug Resistance ◽  
Antibiotic Resistance ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Opportunistic Pathogen ◽  
Multi Drug Resistance ◽  
Resistance Pattern ◽  
Care Hospital ◽  
Medical College

Background: Pseudomonas aeruginosa (P. aeruginosa) considered as an opportunistic pathogen which can be isolated from various kinds of infection. The risk of emergence of antibiotic resistance is based on different antibiotic treatments. Antibiotic resistance and flexibility to adapt changing environment renders the pathogens a matter of concern in hospital acquired infections. Changing pattern of antimicrobial resistance pose challenge in treating pyogenic infections, hence periodical monitoring of bacterial profile and their antibiotic susceptibility pattern is important. This study deals with the infectious and drug resistance nature of P. aeruginosa with effectiveness of antimicrobial agents against it.Methods: Present study was conducted in Centre for Biotechnology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India. A total of 763 pus samples were received in the bacteriology section of department of microbiology, rural medical college, Loni from the various wards of Pravara Rural Hospital. The colonial morphology and identification was done as per standard microbiology procedures. Antibiogram testing was done as per Kirby Bauer disc diffusion method.Results: Out of 763 pus samples 154 were Pseudomonas aeruginosa thus showing 20.19% prevalence. In this study, it was observed that isolates were sensitive to Ciprofloxacin (76.63%) followed by Amikacin. However, showed 90.90 % resistant to Cefazolin followed by Co-trimoxazole 75.97% was observed. Multi drug resistance (MDR) strain 68.83% (N=106) was detected from 154 isolates strains of Pseudomonas aeruginosa. Prevalent resistance pattern was found to be GENr, AKr, CAZr, CZr, COTr for 10 (9.43%) isolates followed by GENr, CAZr, CZr, MRPr, COTr, CIPr for 9 (8.49%) isolates.Conclusions: Present study focused on antibiotic resistance pattern of P. aeruginosa from pus sample. This study contributes in understanding the emergence of MDR strains which can be considered for judicial usage of antibiotics in hospital settings. 

scholarly journals Ventilator Associated Pneumonia a challenge in intensive care unit acquired infection

2016 ◽  
Vol 15 (4) ◽  
pp. 588-595
Author(s):  
Munmundas Sarkar ◽  
Hirak Jyoti Raj ◽  
Tapan Kumar Ghosh
Keyword(s):  
Intensive Care Unit ◽  
Drug Resistance ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Tertiary Care ◽  
Multi Drug Resistance ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Beta Lactamases ◽  
Acinetobacter Spp

Background: Ventilator-Associated Pneumonia (VAP) is one of the frequent intensive-care-unit (ICU)-acquired infection. The aetiology of VAP varies with patients’ profiles and ICU settings. Due to the increasing incidence of multidrug-resistant organisms in ICUs, early and correct diagnosis of VAP is an urgent challenge for an optimal antibiotic treatment. The aim of the study was to assess the incidence of VAP in different patients by various organisms to create a database of the causative agents of VAP, their drug resistance profile in that area.Methodology: A prospective study was done over a period of 12 months in a rural tertiary care hospital enrolling patients undergoing mechanical ventilation (MV) for >48 h. Samples were collected from patients with suspected VAP, cultures were performed on all samples. VAP was diagnosed by the growth of significant pathogens. Combination disk method, EDTA disk synergy (EDS) test and cefoxitin double disc synergy test were performed for the detection of different patterns of drug resistance.Results: Culture positive cases were 52.29% of total. Acinetobacter spp, Klebsiella pneumoniae and Staphylococcus aureus were most frequent pathogen in early-onset VAP, while Pseudomonas spp. and Acinetobacter spp. dominated the list of pathogens responsible for lateonset VAP. Prior antibiotic therapy and hospitalization of five days or more were independent risk factors for VAP by MDR pathogens.Conclusions: This study highlighted high incidence of VAP in our setup. Production of ESBL, AmpC beta-lactamases and metallo beta-lactamases were responsible for the multi-drug resistance of the pathogens causing VAP, implicating the injudicious use of antimicrobial therapy. Combined approaches of rotational antibiotic therapy and education programs might be beneficial to fight against these MDR pathogens to decrease the incidence of VAP.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.588-595

Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India

2020 ◽  
pp. 004947552098245
Author(s):  
Pooja Kumari ◽  
Priya Datta ◽  
Satinder Gombar ◽  
Deepak Sharma ◽  
Jagdish Chander
Keyword(s):  
Mechanical Ventilation ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Control Measures ◽  
North India ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Infection Control Measures ◽  
Utilisation Rate

The aim of our study was to determine the incidence, microbiological profile, risk factors and outcomes of patients diagnosed with ventilator-associated events in our tertiary care hospital. In this prospective study, intensive care patients put on mechanical ventilation for >48 h were enrolled and monitored daily for ventilator-associated event according to Disease Centre Control guidelines. A ventilator-associated event developed in 33/250 (13.2%); its incidence was 3.5/100 mechanical ventilation days. The device utilisation rate was 0.86, 36.4% of patients had early and 63.6% late-onset ventilator-associated pneumonia whose most common causative pathogen was Acinetobacter sp. (63.6%). Various factors were significantly associated with a ventilator-associated event: male gender, COPD, smoking, >2 underlying diseases, chronic kidney disease and elevated acute physiological and chronic health evaluation II scores. Therefore, stringent implementation of infection control measures is necessary to control ventilator-associated pneumonia in critical care units.

Sign in / Sign up

Export Citation Format

Share Document