Details
Category: Volume 09 Issue 03 March 2021
Hits: 1184

Title: Current Challenges in Antibiotic resistance: Non-fermenting Gram-negative bacilli with Special References to Pseudomonas species and Acinetobacter species

Authors: Navin Kumar Chaudhary,  Sovana Dhakal

 DOI: https://dx.doi.org/10.18535/jmscr/v9i3.10

Abstract

Background: Non-fermenting Gram-negative bacilli (NFGNB) have emerged as a major cause of health care-associated infections and are innately resistant to many antibiotics. The aim of this study was to determine the prevalence of NFGNB isolated from various clinical specimens and evaluate their antimicrobial resistance profiles.

Materials and Methods: A prospective, cross-sectional, laboratory-based study was conducted from January 2017 to January 2020 at the Department of Microbiology, Chitwan Medical College and Teaching Hospital, Nepal. NFGNB were isolated from a different clinical specimens, plated on Nutrient agar, MacConkey agar and Blood agar and incubated aerobically at 37°C for 18-24 h. Identification was done on the basis of colony morphology, Gram stain, catalase test, oxidase test and standard biochemical tests. Antimicrobial susceptibility test was performed using the Kirby-Bauer disc diffusion method using commercially available discs on Mueller-Hinton agar. Data was analyzed using SPSS IBM version 20.

Result: A total 24550 samples were studied; where 4910 (20.00%) show bacterial growth and 982 (4.00%) were NFGNB. Majority 736 (74.95%) of NFGNB were isolated from hospitalized patients. Most of them were recovered from sputum 392 (39.22%) and 245 (24.95%) urine sample. Pseudomonas species 540 (54.99%) was the leading pathogens followed by Acinetobacter species 403 (41.04%). NFGNB showed resistance to several antibiotics tested. Overall, Colistin (100%) and Polymyxin B (91-93%) was the most effective antimicrobial agent.

Conclusion: Pseudomonas species and Acinetobacter species are the leading NFGNB; mostly recovered from respiratory specimens and are resistance to several antibiotics. Timely identification of NFGNB and monitoring their susceptibility patterns will help in proper management of infections.

Keywords: Non-fermenting Gram-negative bacilli (NFGNB), Pseudomonas, Acinetobacter, Antimicrobial susceptibility test, Piperacillin-Tazobactum, Carbapenems, Polymyxin B, Colistin.

References

  1. Malini A, Deepa EK,  Gokul BN, and Prasad Nonfermenting Gram-Negative Bacilli Infections in a Tertiary Care Hospital in Kolar, Karnataka. J Lab Physicians. 2009; 1(2): 62–66.
  2. Chakhtoura NGE, Saade E, Iovleva A, Yasmin M, Wilson B, Perez F, and Bonomo Therapies for multidrug resistant and extensively drug-resistant non-fermenting gram-negative bacteria causing nosocomial infections: a perilous journey toward “molecularly targeted” therapy. Expert Rev Anti Infect Ther. 2018; 16(2): 89-110.
  3. Benachinmardi K, Padmavathy M, Malini J, Naveneeth BV. Prevalence of non-fermenting Gram-negative bacilli and their in vitro susceptibility pattern at a tertiary care teaching hospital. J Sci Soc. 2014;41(3):162-6.
  4. Frota CC, Moreira J. Frequency of non-fermentative gram-negative bacilli isolated from clinical materials of patients at Brazil. Revised Microbiology. 1998; 29(3):1-5.
  5. Steinberg J. Other gram-negative and gram-variable bacilli. Principles and practice of infectious disease. 2005:2753-4.
  6. Quinn J. Clinical problems posed by multi resistant non-fermenting gram-negative pathogens. Clin Infect Dis. 1998;27(1):117-24.
  7. Samanta P, Gautam V, Thapar R, Ray P. Emerging resistance of non-fermenting gram negative bacilli in a tertiary care Centre. Indian J Pathol Microbiol. 2011;54(1):666-7.
  8. Meharwal SK, Taneja N, Sharma SK, Sharma M. Complicated nosocomial UTI caused by non-fermenters. Indian J Urol. 2002;18(2):123-8.
  9. Nagoba BS, Deshmukh SR, Ulka G Gude et al. Invitro susceptibility of Pseudomonas aeruginosa to different antibiotics. Indian J MedMicrobiol. 1997;15(1):185-6.
  10. Gales A, Jones R, Forward K, Linares J, Sader H, Verhoef J. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonasmaltophilia as pathogens in seriously ill patients: geographic patterns,epidemiological features, and trends in the sentry. Antimicrobial surveillance program. Clin Infect Dis. 2001;32(2):104-13.
  11. Rubin, S. J., P. A. Granato, and B. L. Wasilauskas. 1985. Glucose-nonfermenting gram-negative bacteria, p. 330-49. In E. H. Lennette, A. Balows, W. J. Hausler, Jr., and H. J. Shadomny (ed.), Manual of clinical microbiology, 4th ed. American Society for Microbiology, Washington, D.C.
  12. Gokale S, Metgud S. Characterization and antibiotic sensitivity pattern of nonfermenting gram negative bacilli from various clinical samples in a tertiary care hospital, Belgaum. J Pharm Biomed Sci. 2012; 17(17):1-5.
  13. Simgamsetty S, Yarlagadda P, Yenigalla BM, Myneni RB. Ease with vitek two systems, biomerieux in identification of non-lactose fermenting bacteria including their antibiotic drug susceptibility: our experience. Int J Res Med Sci. 2016;4(3):813-7.
  14. Berezin E, Towner K. Acinetobacer spp as Nosocomial pathogens: Microbiological, clinical and epidemiological features. Clin Microbiol Rev. 1996; 9(2):148-65.
  15. Malini A, Deepa E, Gokul B, Prasad S. Non-fermenting gram-negative bacilli infections in a tertiary care hospital in Kolar, Karnataka. J Lab Physicians. 2009;1(2):62-6.
  16. McGowan J. Resistance in non-fermenting gram negative bacteria: multidrug resistance to the maximum. Am J Med. 2006;119(6):29-36.
  17. Gales A, Jones R, Forward K, Linares J, Sader H, Verhoef J. Emerging importance of multidrug‑resistant Acinetobacter species and Stenotrophomonas maltophila as pathogen in seriously ill patients: Geographical patterns, Epidemiological features, and trends in the sentry antimicrobial surveillance Clin Infect Dis. 2001;32(2):104‑13.
  18. Fernandez F, Martinez L, Conejo M, Ayala J, Perea, Pascual A. Relationship between β-lactamase production, outer membrane protein and penicillin-binding protein profiles on the activity of carbapenems against clinical isolates of Acinetobacter baumannii. JAntimicrob Chemother.2003;51(3):565-74.
  19. Vikas Manchanda, Sinha Sanchalta and NP Singh. Multi drug resistant Acinetobacter. J Global Infect Dis.2010;2(3):291-304.
  20. Buck AC, Cooke EM. The fate of ingested Pseudomonas aeruginosa in normal persons. JMedMicrobiol. 1969;2(1):521–
  21. Collee, J.G., Miles, S.R. and Watt, B. 1996b. Test for identification of bacteria. Collee J.G., Marmion, B.P., Simmons, A., Mackie and MicCarteny Practical Medical Microbiology. 14th London: Churchil Livingstone Inc. 131-149 pp.
  22. Wayne P. Clinical and Laboratory Standards Institute: Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard-Twelfth Edition. CLSI document M02-A12. 2015.
  23. Benachinmardi K, Padmavathy M, Malini J, Naveneeth B. Prevalence of non-fermenting gram-negative bacilli and their in-vitro susceptibility pattern at a tertiary care teaching hospital. J Sci Soc. 2014;41(3):162-6.
  24. Rit K, Nag F, Raj HJ, Maity PK. Prevalence and Susceptibility Profiles of Non-fermentative gram-negative bacilli infection in a tertiary care hospital of eastern India. Indian J Clin Practice. 2013;24(5):1-5.
  25. Mahajan R, Neeraj D, Sarika D, Mahajan B. Original research article isolation and identification of Non-fermenting gram negative bacilli in a tertiary care hospital. Sch JApp Med Sci. 2016;4(3):872-6.
  26. Grewal US, Bakshi R, Walia G, Shah PR. Antibiotic susceptibility profiles of non-fermenting gram-negative Bacilli at a Tertiary Care Hospital in Patiala, India. Niger Postgrad Med J. 2017;24(2):121-5.
  27. Nautiyal S, Jauhari S, Goel N, Mahawal BS. Current trend of non-fermenting gram negative bacilli, in a tertiary care hospital in Dehradun, Uttarakhand. Int J Adv Res. 2014;2(2):322-8.
  28. Sharma D, Vyas N, Sinha P, Mathur A. Non-fermentative gram negative bacilli as nosocomial pathogens: Identification and antibiotic sensitivity in clinical samples of indoor patients. Nepal J Med Sci. 2015;3(2): 101-5.
  29. Bhargava D, Kar S, Saha M. Prevalence of non-fermentative gram negative bacilli infection in tertiary care hospital in Birgunj, Nepal. International journal current microbiology. 2015;4(7):301-7.
  30. Maniyan G, Vedachalam D, Chinnusamy N. Characterization and antimicrobial susceptibility pattern of non-fermenting gram negative bacilli from various clinical samples in a tertiary care hospital. Surgery. 2016;32(1):29-39.
  31. Bhatnagar R, Kumar S, Bansal G, Mehra SK. Identification and antimicrobial susceptibility pattern of clinical isolates of non-fermentative gram negative bacilli. International journal of pharmacology research and health sciences. 2014;2(4):347-51.
  32. Simgamsetty S, Yarlagadda P, Myneni RB, Penmetcha U. Identification and antimicrobial susceptibility patterns of non-fermentative gram negative bacilli in a tertiary care hospital: Our experience. International journal of health sciences and research. 2016;6(8):105-11.
  33. Meghna C, Bhat S, Vidyalakshmi K. Risk factors and antibiotic susceptibility pattern among non-fermenting gram negative bacilli in a teaching hospital. Journal of pharmaceutical and biomedical sciences. 2014; 4(8):715-8.

Corresponding Author

Dr Navin Kumar Chaudhary

Associate Professor, Department of Microbiology, Chitwan Medical College, Bharatpur, Nepal