Evaluating the Role of Antimicrobial Resistance Surveillance: A Successful Intervention: Evidence from Hamad Medical Corporation–Qatar | Chapter 6 | Microbiology and Biotechnology Research: An Overview Vol. 4

 

Antibiotic resistance is an increasing global problem. Excessive and inappropriate antimicrobial use results in strong selective pressure that facilitates the emergence of antimicrobial-resistant pathogens. The intensive care units are epicentres for the emergence of antibiotic-resistant gram-negative bacteria because of the high use of antibiotics, prolonged hospital stay, reduced patient immunity, use of medical devices, and the frequent contact between healthcare workers and patients. Surveillance of bacterial resistance is the key element to understand the size of the problem, drive interventions, and measure the effect of these measures. Several reports have linked the use of third-generation cephalosporins with β-lactam resistance in gram-negative bacteria. Several strategies were introduced by the Antibiotic Stewardship Programs to reduce antibiotic resistance, but the efficacy of these interventions is not well studied. The Microbiology Laboratory of Hamad Medical Corporation (HMC) monitors antimicrobial resistance by continuous surveillance using the National Committee for Clinical Laboratory Standards (NCCLS) - currently Clinical Laboratory Standards Institute Interpretive Criteria (CLSI). Surveillance data were released annually and shared with clinicians and policymakers for review of the antibiotic policy and the antibiotic formulary. Several measures were taken, including antibiotic cycling, antibiotic rotation and restriction.

 

Surveillance data in 2001 showed high-level β-lactam antibiotic resistance and high-level production of extended-spectrum β-lactamases (ESBL) among gram-negative bacteria. As a result, the Hospital Antibiotic Policy Committee decided to withdraw ceftazidime, a third–generation cephalosporin known to be a strong inducer of ESBL, from the hospital formulary. Subsequent resistance surveillance over the following three years in the Medical Intensive Care unit (MICU) demonstrated a gradual drop in the resistance of Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli; the commonest isolated gram-negative bacteria from MICU, not only to third and fourth generation cephalosporins, but also to Piperacillin–Tazobactam in spite of the increased use of the latter drug in the MICU.

 

The study concludes that the selection of resistance is an inevitable consequence of antibiotic usage. Regular surveillance of antimicrobial resistance is essential not only for detecting and monitoring resistance development but also for ensuring that the information gathered is effectively used to guide empirical therapy and inform strategic interventions to prevent the emergence and spread of resistance.

 

Author(s) Details

Elshafie Sittana Shamseldin
Aspetar, Qatar Orthopedic and Sports Medicine Hospital, Doha, Qatar.

Al-Khal A/Latif
Hamad Medical Corporation, Doha, Qatar.

 

A Maslamani Muna
Hamad Medical Corporation, Doha, Qatar.

Al Janahi Mohammed
Hamad Medical Corporation, Doha, Qatar.

 

Alamri Zainab
Medical Military Specialized Center, Qatar.

 

Please see the book here:- https://doi.org/10.9734/bpi/mbrao/v4/5627

The Microbial Etiology of Urinary Tract Infections in a Tunisian Orthopedic Institute | Chapter 2 | Medical Science: Recent Advances and Applications Vol. 3

Background: Urinary Tract Infections (UTIs), frequently encountered both in hospitals and community settings, are among the most common reasons for medical consultations in daily practice and constitute a significant driver of antibiotic consumption. The microorganisms most frequently isolated during these infections are Gram-negative bacilli, with Escherichia coli at the top of the list.

Aim: This study aimed to characterise the microbiological profile of Tunisian patients with UTIs and evaluate antibiotic resistance patterns over three years at the Orthopaedic Institute.

Methods: Urine samples collected between January 1, 2019, and December 31, 2021, were analysed. Standard laboratory procedures were employed to identify bacterial strains, and the Microscan Walkway 40 Plus system was used for biochemical assays and antibiotic susceptibility testing. E. coli ATCC 25922, Enterococcus feacalis ATCC 29212, Pseudomonas aeruginosa ATCC27853, Staphylococcus aureus ATCC29213 were used as a control strains. Results were interpreted according to EUCAST guidelines.

Results: A total of 1,313 bacterial strains were isolated. The analysis revealed a predominance of Enterobacteriaceae (96.8%), with Escherichia coli (52.2%) and Klebsiella pneumoniae (19.3%) being the most common pathogens. Antibiotic resistance rates in hospital-acquired E. coli strains were as follows (in descending order): amoxicillin (73.05%), trimethoprim/sulfamethoxazole (46.9%), ofloxacin (40.3%), amoxicillin/clavulanic acid (35.05%), and gentamicin (20.5%). Resistance to fosfomycin was low for E. coli (2.6%) in hospitals but higher for K. pneumoniae (≥12.1%). Amikacin resistance remained moderate, affecting ≥20% of E. coli strains and 10% of K. pneumoniae. Nitrofurantoin resistance was minimal in E. coli (1.06%) but significant in K. pneumoniae (21.5%). The production of Extended-Spectrum Beta-Lactamases (ESBLs) was observed in 19.3% of K. pneumoniae and 14.4% of E. coli isolates.

Conclusion: The prevalence of ESBL-producing E. coli and K. pneumoniae in UTIs is on the rise. Continuous surveillance of resistance patterns is essential to guide empirical treatment and mitigate the spread of multidrug-resistant strains. In future, clinico-bacteriological studies with a high level of scientific evidence must be carried out to increase the strength of the recommendations.

 

Author (s) Details

Hajer Kilani
Microbiology Unit, Clinical Biology Laboratory, Mohamed Kassab Institute of Orthopedics, Tunis, Tunisia and Faculty of Medicine, LR99ES09 Laboratory of Antibiotic Resistance, University of Tunis El Manar, Tunis, Tunisia.

 

Salma Kaoual
Microbiology Unit, Clinical Biology Laboratory, Mohamed Kassab Institute of Orthopedics, Tunis, Tunisia and Department of Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia.

Fatma Kaabi
Microbiology Unit, Clinical Biology Laboratory, Mohamed Kassab Institute of Orthopedics, Tunis, Tunisia.

 

Ilhem Boutiba-BenBoubaker
Faculty of Medicine, LR99ES09 Laboratory of Antibiotic Resistance, University of Tunis El Manar, Tunis, Tunisia and Department of Microbiology, Hospital of Charles Nicolle, Tunis, Tunisia.

 

Sophia Bouhalila Besbes
Microbiology Unit, Clinical Biology Laboratory, Mohamed Kassab Institute of Orthopedics, Tunis, Tunisia and Department of Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v3/3851

Bacteriological Outline and Antibiogram of Uropathogens: A Study at a Tertiary Care Centre | Chapter 9 | Achievements and Challenges of Medicine and Medical Science Vol. 13

Background: Urinary tract infections (UTIs) are one of the most common infections, both in the community and in healthcare worldwide. The clinical spectrum of UTI can range from asymptomatic bacteriuria to severe forms like emphysematous pyelonephritis and sepsis. UTIs are a cause of significant morbidity and mortality requiring urgent antibiotic treatment. However, there is widespread antibiotic resistance from the bacterial causes, necessitating regular surveillance for drug-resistant bacteria and their antibiograms.

Objective: The aim of this study is to isolate and identify various bacterial causes of UTIs and determine their antibiotic susceptibility patterns.

Methods: A total of 5017 urine samples were analyzed from January 2021 to December 2022. Out of these 1014 samples were positive. Identification of the pathogen and anti-microbial sensitivity was done using the Automated system, Vitek 2 compact (Biomereiux).

Results: Culture positivity in this study was 20%. Gram-negative bacteria were predominantly isolated (79.7%), including Escherichia coli (52.8%) and Klebsiella  aerogenes (14.2%). Enterococcus faecalis was the most common Gram-positive bacterium isolated. Antibiotic susceptibility pattern among gram-negative bacilli has shown maximum sensitivity to Colistin and Fosfomycin followed by Carbapenems (Imipenem, Meropenem & Ertapenem), Amikacin and Beta lactam-beta-lactamase inhibitor (BL-BLI) combination drugs. Out-patient department (OPD) samples were found to be more susceptible to antimicrobials than In-patient department (IPD) samples. Maximum resistance was seen against Ciprofloxacin and Ceftriaxone. Klebsiella and Pseudomonas isolates were found to be more resistant when compared to E. coli. isolates were more sensitive to Nitrofurantoin (87%) than Klebsiella  (22%). Carbapenem resistance was seen in 50% of the Inpatient isolates of Klebsiella  pneumoniae and 36% of Inpatient isolates of Pseudomonas aeruginosa. Few isolates of K. pneumoniae & P. aeruginosa were found to be resistant even to Colistin. In order to prevent the development of resistance, antibiotic susceptibility patterns must be continuously and periodically evaluated to select the appropriate regimen to treat UTI and to avoid complications.

 

Author (s) Details

 

Vani Majji
KIMS Hospital Enterprises Pvt. Ltd., Kondapur, Hyderabad, 500084, Telangana, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v13/4449