RAMA Univ. J. Med Sci 2016;2(3):1-7

Transcription

1 MICROBIAL CHARACTERISATION OF PUS ISOLATES AND THE CHANGING TRENDS IN THEIR SENSITIVITY PATTERN AT A TERTIARY CARE HOSPITAL IN KANPUR CITY R.Sujatha 1, Ankita Tripathi 2, Vineet, 2 Nidhi Pal 3 1. Professor & Head, Department of Microbiology, Rama Medical college Hospital & research center, Kanpur 2. PG, Department of Microbiology, Rama Medical college Hospital & research center, Kanpur 3. Ph.D. Scholar, Department of Microbiology, Rama Medical college Hospital & research center, Kanpur ABSTRACT: Suppurative lesions of skin,soft tissue and wound infections are an important cause of morbidity and mortality among hospitalised patients. Continuous monitoring of the bacteriological profile of the pus samples and the changing trends of their sensitivity to the antimicrobial drugs is very essential. Aims and Objectives: To study the commonly isolated organisms from pus samples and their antibiotic susceptibility pattern. Material and Methods: Study was conducted at Rama Medical College Hospital and Research Centre, Kanpur from June 2015 to Aug Pus samples from various departments of both in and out patients were collected and processed as per the standard microbiological procedures. Results: Out of the total 200 samples,146(73%) showed growth of pathogenic microorganism.136 samples showed pure growth and rest showed mixed growth of two organisms. Staphylococcus aureus was the most common organism (35%) and 1.2% were methicilline resistant strains, followed by Klebsiella spp (21%). Majority of isolates were highly resistant to most of the commonly prescribed antimicrobial drugs but vancomycin, linezolid were showed better sensitivity for gram positive cocci whereas gram negative bacilli were sensitive to imipenem, piperacillin tazobactum, colistin, polymixin-b. Conclusion: Staphylococcus aureus continues to be the dominant isolate from pus samples. High degree of resistance was seen among the bacterial isolates which pose a great challenge in treating pyogenic infections. Key words: bacterial isolates, Antimicrobial sensitivity INTRODUCTION: Infections associated with pus formation are known as pyogenic infections. [1] Pus which is a yellowish (green) or white opaque somewhat viscid matter composed of dead leukocytes, cellular debris and necrotic tissue [2] These infections can be endogenous or exogenous.the bacteria enter the body after breakdown of first line of defence-skin and seed an infective lesion. [3] This induces an inflammatory response as a result neutrophils, macrophages and other phagocytic cells invade the site of infection. This is accompanied by liquefactive necrosis and release of pus. [4] A wide variety of aerobic and anerobic bacteria may be responsible for pyogenic infection either 1

2 singly or in combination. [5] Antibacterial agents are among the most commonly prescribed drugs worldwide.however their indiscriminate use drives up the cost of health care and fosters the emergence of bacterial resistance rendering previously valuable drugs useless. [6] Drug resistant pathogens are a major public health concern in recent times. [6] Though the bacterial isolates from pus culture remain more or less same,their drug sensitivity pattern varies.present study primarily focuses on the bacteriological profile and the changing trends in drugs sensitivity in our region. MATERIAL AND METHODS Pus samples were collected from in and out patients of various dept. of Rama Medical College and Hospital over a period of 15 months from June 2015 to Aug 2016.The specimens were either collected in sterile swabs or the pus was aspirated into sterile syringes and transported to the microbiology laboratory. It was inoculated simultaneously on CLED media and thioglycollate broth.the organisms were identified by biochemical reactions, Gram stain, and motility tests as applicable as per standard operative procedures. The antimicrobial susceptibility tests were done by Kirby Bauer s disk diffusion method on Mueller Hinton agar and interpreted as per Clinical Laboratory Standard Institution guidelines [7].Standard antibiotics for gram positive cocci like penicillin-g (10 mcg),erythromycin (15 mcg), oxacillin (1 mcg), vancomycin (30 mcg),linezolid (10 mcg),sparfloxacin(5mcg), azithromycin(15 mcg),tetracyclin(30 mcg), teicoplanin(30 mcg), cefoxitin(30 mcg), tobramycin (10 mcg), ciprofloxacin (5 mcg), co-trimoxazole (1.25/23.75 mcg), gentamicin (10 mcg), amikacin (30 mcg), and netilmycin(30 mcg) for gram positive bacteria.for gram negative bacteria levofloxacin(5mcg),ofloxacin(5 mcg), imipenem (10mcg), meropenam (10 mcg),piperacillin(30 mcg), piperacillin /tazobactum(30/6mcg), ampicillin/sulbactum (10/10mcg),colistin(10mcg), polymixinb (300uts),Ticarcillin(75mcg),ampicillin(2mcg ),ceftriaxone (30mcg), cefipime (30mcg), ceftazidime (10mcg), cefotaxime(5mcg), cefoperazone/sulbactum (50/50mcg), cefipime / tazobactum (30/10mcg) were used (Himedia,Mumbai India). RESULTS A total of 200 samples were tested. Age wise distribution of patients has mentioned in table 1. out of which 146 samples showed significant growth. In this 136 samples showed pure growth where as 10 samples showed mixed growth of two 2

3 bacteria. Thus,a total of 156 organisms were isolated. Out of these isolates 78 were Gram positive cocci, of which 54 MSSA, 21- CONS, 2-MRSA, 1-Enterococcus.(table -2) Seventy six isolates were Gram negative bacilli in which most common isolate was Klebsiella followed by E.coli, then pseudomonas and proteus.staphylococcus aureus was the most prevalent organism overall{54}.staphylococcus aureus was highly sensitive to vancomycin(100%), linezolid (98%) and cefoxitin(98%),teicoplanin(90%) and fairly sensitive to netillmicin, oxacillin and tobramycin.(table -3)High resistant was shown to penicillin, cotrimoxazole, erythromycin.most of the gram negative bacteria show variable degree of resistance to all the generations of cephalosporins such as ceftriaxone,cefipime,cefotaxime as well to the combination drugs like cefoperazone - sulbactum and cefipime tazobactum.mostly were sensitive to carbapenems-imipenem and meropenam as well to colistin and polymixin B.(Table-4) Table 1:Age wise distribution of patients: Age groups Number Percent < > Table 2:Number of organisms and their percentage Organisms isolated Number (%) MSSA CONS Klebsiella spp E.coli Pseudomonas aeruginosa Proteus spp Acinetobacter spp Citrobacter Enterobacter spp MRSA Enterococcus Candida spp DISCUSSION Wound infections are quite common among surgical patients as well as suppurative lesion of skin and soft tissues are common among hospitalized patients. [8] The majority of patients were in the age group of years which is 26 %,this is also the most common age group in a study conducted by Muluye et al [9].In our study most common gram positive isolate was MSSA(35%) which is also supported by the studies of M.Chouhan et al 46 % [5], Duggalet al 22.52% [10], and Mantravadi et al 37% [11].Study conducted in Gonder Hospital by Muluye et al [9] also showed similar findings.however in a studyconducted by Agnihotri et al [12] Pseudomonas was most 3

4 Table-3:Sensitivity pattern of gram positive cocci Antibiotic Staphylococcus auerus CONS Enterococcus Penicillin cotrimoxazole Gentamicin Amikacin Tobramycin Erythromycin Azithromycin Oxacillin Ciprofloxacin Sparfloxacin Linezolid Vancomycin Teicoplanin Netilmicin Cefoxitin Table -4: Sensitivity pattern of Gram-negative bacilli Antibiotic E.coli S R Klebsiella Pseudomonas Proteus Acinetobacter Citrobacter E.aero genes S COT GEN AK TOB CIP CTR LE OF IPM MRP NET A/S CPM PIT CAZ CFS CTX PB CL TCC CPT R- 4

5 common followed by Staphylococcus aureus.among Gram negative isolates Klebsiella sp.(21%) was most common in our study followed by E.coli(12%). In previous studies by Duggal et al [10] Pseudomonas was the most common isolate overall- 29% and E.coli (21%)was most common followed by Klebsiella(17%) in the study bymantavadi et al [11]. In our study 35% S. aureus was isolated which is in accordance with various study across India,but it is less than study conducted by Muluye et al [9] who got 65 % staphyloccus aureus. In our study S.aureus showed 100% sensitivity to vancomycin and 98% to linezolid,low sensitivity was seen in case of penicillin (52%),erythromycin(79%) which is in accordance with the studies conducted by Mantravadi et al [11] and Rao et al [13], Javeed et al [14]. In our study sensitivity to oxacillin is 91% which is higher than 61.3%inMantravadi et al [11] and 73.07%in Raghav Rao et al [13]. For gram negative bacteria high level of sensitivity was noted for Polymixin and colistin and carbapenams- imipenem though increasing resistance was seen for meropenam.combination drugs such as Piperacillin tazobactum and Cefoperazonesulbactum are sensitive especially in case of proteus.increasing resistance is seen in case of gentamicin, amikacin, tobramycin, and fluroquinolones and cephalosporins.these findings are also corraborated by Duggal et al [10], Javeed et al [14], Mantravadi et al [11]. High resistance was seen in the isolates of Acinetobacter for flouroquinolones, carbapenams and cephalosporins which isalso shown by Manchanda et al. [15] Pseudomonas isolates showed high sensitivity towards imipenem(90%), PIT (90%), and PB,these findings are also supported by Chouhan et al [5], Raghav Rao et al [13]. CONCLUSION Pyogenic infections are still a leading cause of morbidity in which staphylococcus aureus continues to be a major contributor though gram negative bacilli are also not far behind. Increasing number of multidrug resistance isolates pose a great threat to mankind. Thus the clinicians need to follow strict guidelines in prescribing antimicrobial; ensure patient compliance and appropriate infection control measures.continuous monitoring of the changing trends in antibiotic sensitivity profile should be regularly done. REFERENCES 5

6 1. Koneman WK, Allen SD, Janda WM, Schreckenberger PC, Propcop GW, Woods GL et al. Philadelphia Color Atlas and Textbook of Diagnostic Microbiology,6 th ed Lippincott-Raven 2005; Rugira Trojan, Lovely Rajdan, Nasib Singh. Antibiotic Susceptibility Patterns of Bacterial Isolates from Pus Samples in a Tertiary Care Hospital of Punjab India. International Journal of Microbiology.2016; Poonam Verma. Antibiotic Sensitivity Treatment for Gram- Positive Bacteria Isolated from Pus Samples. Bulletin of Environment, Pharmacology and Life Sciences 2012;1(10): A.G Cheng, Andrea C.DeDent, Olaf Schneewind, Dominique Messiakas.A Play in Four Acts: Staphylococcus aureus Abscess Formation.Trends Microbiology 2011;19(5): M.Chauhan, Manish S and S.Mahajan.Aerobic Bacterial Profile and Antibiotic Sensitive Pattern of Pus isolates in a tertiary care hospital.international Journal of Current Microbiologyand Applied Sciences. 2015; 4(5): Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison s Principles of Internal Medicine; vol- I(19 th ed ): page CLSI. Performance standard for Antimicrobial susptibility testing; twenty third informational supplement. M100-S ; Vol 33 No Ramakrishnan K, Salinas RC, Nelson IA Higuita. Skin and Soft Tissue Infections American Family Physician. 2015;92(6): Muluye D,Wondimeneh Y, Ferede G, Nega T, Adane K, Biadgo B, Tesfa H and Moges F. Bacterial isolates and their antibiotic susceptibility patterns among patients with pus and/or wound discharge at Gondar university hospital. BMC Research Notes 2014; 7(619): Swati Duggal, P.K.Khatri, R.S. Parihar, Rajat Arora. Antibiogram of Various bacterial Isolates from Pus Samples in a tertiary Care centre in Rajasthan. International Journal of 6

7 Science and Research.2015;Vol 4(5): Mantravadi H.B, Chinthaparthi M. R, Shravani V. Aerobic isolates in pus and their antibiotic sensitivity pattern : a study conducted in a teaching hospital in Andhra Pradesh.International Journal of Medical Science and Public Health. 2015;vol 4(8): Agnihitri N, Gupta V, Joshi RM.Aerobic bacterial isolates from burn wound infections and their antibiograms- a five year study.burns 2004;30 (3): Rao DVMVSVR, Basu R, Biswas DB.Aerobic bacterial profile and antimicrobial susceptibility pattern of pus isolates in a south Indian tertiary care hospital.iosr J Dent Med Sci 2014;13(3): Javeed I, Hafeez R, Anwar MS. Antibiotic susceptibility pattern of bacterial isolates from patients admitted to a tertiary care hospital in Lahore.Biomedica 2011;27: ManchandaV,Sinha S, and SinghNP.Multidrug Resistance Acinetobacter.Journal of Global Infectious Disease.2010 Sep- Dec;2(3): CORRESPONDING AUTHOR: Dr. R.Sujatha Professor and Head of Department of Microbiology Rama Medical College Hospital& Research Centre,Mandhana, Kanpur, U.P. ID: drsujatha152@gmail.com 7