Susceptibility of Gra Negative Bacteria to Cotrimoxazole in Specimens Sent to the Laboratory of Shahidbeheshti Hospital

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1 Middle-East Journal of Scientific Research 21 (3): , 2014 ISSN IDOSI Publications, 2014 DOI: /idosi.mejsr Susceptibility of Gra Negative Bacteria to Cotrimoxazole in Specimens Sent to the Laboratory of Shahidbeheshti Hospital Alireza Sharif, Mohammad Reza Sharif and Javad Alizargar 1 Department of Infectious Disease, Kashan University of Medical Sciences, Kashan, Iran 2 Department of Pediatrics, Kashan University of Medical Sciences, Kashan, Iran 3 Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran Abstract: Antibiotic resistance represents a complex dynamics problem, results in increasing cost of treatment, morbidity and mortality. As the use of Cotrimoxazole increases in the treatment of Gram-negative infections, pattern of infection and bacterial susceptibility of Gram-negative bacteria to Cotrimoxazole in specimens sent to the laboratory of Shahidbeheshti Hospital from 2010 to 2011 was evaluated. Most of the samples (64.4%) were E. coli from which, 40.4% were sensitive to Cotrimoxazole, 9.8% were intermediate while there were 49.8% resistant. Gram negative bacteria were dramatically resistant to Cotrimoxazole and these resistance rates make Cotrimoxazole practically useless in treating Gram-negative strains. Key words: Antimicrobial Bacteria Resistance Escherichia coli INTRODUCTION was conducted in South Africa 48.5% of the Enterobacteriaceae samples taken from the three Despite the great costs of antibiotics, many of the hospitals showed antibiotic resistance [12]. infectious diseases bring comorbidity and mortality Broad spectrum beta lactams antibiotics are the last to the patients. Gram-negative bacilli that were line of treatment that had high sensitivity, but in recent considered unusual in past, they account for 15-20% of years, emerging of resistant species by production of new meningitis causes in adults, nowadays [1] and represent extended-spectrum beta-lactamases (ESBLs), made a great the most important causes of infection in hospitals [2]. concern [13]. Third, even forth generations of There are great deals of mortality related to these cephalosporin and other known effective broad spectrum infections [3]. antibiotics, are dealt with antibiotic resistance [14]. Antibiotic resistance, a complex dynamics problem, As the use of Cotrimoxazole increases in the results in increasing cost of treatment, morbidity and treatment of Gram-negative infections and also there is a mortality [4-7]. Misuse and overuse of antibiotics, lack of access to accurate information on regional especially in developing countries result in emergence of sensitivity pattern of these antibiotics, we decided to those resistant bacteria [5], as a strong association evaluate pattern of infection and bacterial susceptibility between antibiotic use and resistance has been seen and of Gram-negative bacteria to Cotrimoxazole in the it has been shown that in places like intensive care unit specimens sent to the laboratory of Shahidbeheshti with wide use of antibiotics, antibiotic resistance is also Hospital in increased [4]. Resistant bacteria is a serious problem, especially in certain geographic areas [8]. MATERIALS AND METHODS Pseudomonas aeruginosa and Enterobacteriaceae family had shown high rates of antibiotic resistance This study was approved by Kashan University of [6, 9, 10] that threaten patients' life as most of them are Medical Sciences Ethical Committee. In this retrospective immunocompromised [11]. According to research that study, by referring to the Shahidbeheshti Hospital Corresponding Author: Mohammad Reza Sharif, 5th Km-Qotb-e Ravandi Boulevard, P.O. Box: , Kashan, Iran. Tel: , Fax:

2 laboratory, cultures of Gram-negative bacteria isolated RESULTS from different samples of patients admitted to the hospital from1st Jun 2010 to 1st December 2011, were Data of 205 samples were analyzed. From biochemically identified [15]. Sex, age, type of specimen these samples 97 (47.3%) were from male patients and antibiotic susceptibility of every case has been added and 108 (52.7%) were from female ones. Distribution of to checklists and all data were analyzed with SPSS age groups and sample types can be seen in Figures 1 software version Names of the patients remained and 2. unrevealed. Antimicrobial susceptibility was evaluated by Most of Gram-negative bacteria (64.4%) were E coli. the Kirby-Bauer disk diffusion method in guide lines of Other species of Gram-negative bacteria consisted 35.6% Clinical and Laboratory Standards Institute [15]. of the isolates (Figure 3). Fig. 1: Distribution of age groups positive patients for Gram-negative bacteria sample Fig. 2: Distribution of the recovered Gram-negative bacteria from different specimen origins Fig. 3: Distribution of bacterial types among patients with positive Gram-negative bacteria sample 441

3 Fig. 4: Distribution of bacterial type's resistance pattern among patients with positive Gram-negative bacteria. There were 83 (40.4%) samples fully sensitive to conducted in 2005 by Oteo et al. [20], the resistance rate Cotrimoxazole. Twenty samples (9.8%) were intermediate of E. coli was announced 32.6%. This resistance rate is while there were 102 (49.8%) fully resistant samples. also much lower that our results and may reflect better Different bacterial resistance pattern can be seen in the policies of health care systems compared to ours. Figure 4. Our results of 35 samples of Klebsiella shows 48.3% resistance rate. This result is high when compared with DISCUSSION the results of other studies like those of Obaseiki-Ebor et al. [21] that showed 26% of resistance in this strain. The discussion section could be improved by Our results regarding Pseudomonas resistance relating the resistance in different bacterial species to the showed 60% resistance rate. These results are lower than age groups, sex and isolation origin. the results of the other study that conducted by Amadi In addition, discuss the cause behind the reported et al. [22] that showed 76.5% resistance rate to sensitivity of Brucella cotrimoxazole. Cotrimoxazole. This shows that this strain is highly This study conducted in Shahidbeheshti Hospital on resistant to Cotrimoxazole. Gram-negative bacterial isolates and found 49.8% Our results regarding other bacterial types cannot be resistant rate of Cotrimoxazole. Extensive use of judged because of limited numbers in each group. Results broad-spectrum antibiotics may cause selective pressure of our study showed the most prevalent age of patients and emerge multi drug resistant bacterial strains [16]. In a with Gram-negative isolates was years and after that study by Mbanga et al. [17] in 2010 that conducted on under 15 years. From 15 years to 65 years there is an 257 samples showed 68.5 % resistance to Cotrimoxazole. increasing number in each decade (Figure 1). This may be This rate of resistance is much higher in the mentioned due to increased prevalence of Gram-negative infection study compared to our study. This may be because of in school years and prostatitis as the patients get older lower consumption of Cotrimoxazole in Shahidbeheshti [23]. Hospital of Kashan compared to Zimbabwe. Gram-negative bacteria were dramatically resistant to In another study by Karaka et al. [18] stated that Cotrimoxazole and these resistance rates make Cotrimoxazole resistance rate increased from 30.7% in 1996 Cotrimoxazole practically useless in treating Gramto 61.5% in 2003 and recommend that antibiotic usage negative bacterial infection. New drugs should be sought policies, especially empirical therapies, should be based in treatment of these kinds of infection but it is wise to on antimicrobial resistance surveillance studies. control drug resistance to avoid their soon being useless. Johnson et al. [19], on a study on 170 E. coli strains It is recommended to do an annual survey on antibiotic showed 17% resistance to Cotrimoxazole. This is much resistance in Shahidbeheshti hospital and make firm higher in our study that shows 53% resistance rate. This policies toward restriction of prescribing some still difference may be due to increasing resistance rate day to sensitive antibiotics. Prescribing the antibiotics based on day and of course due to excessive use of this antibiotic culture and sensitivity results may play a key role in in our hospital environment. In another study that controlling antibiotic resistance. 442

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