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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 1  |  Issue : 4  |  Page : 200-203

Sensitivity profile of multidrug resistant Acinetobacter Spp. isolated at ICUs of tertiary care hospital


Department of Microbiology, Sri Aurobindo Institute of Medical Sciences Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India

Date of Web Publication16-Apr-2014

Correspondence Address:
Gunjan Shrivastava
Department of Microbiology, Sri Aurobindo Institute of Medical Sciences Medical College, MR 10 Crossing, Indore Ujjain Road, Indore - 453 111, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.130731

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  Abstract 

Context: In the hospital environment, Acinetobacter baumannii (A. baumannii) can colonize the respiratory, urinary, gastrointestinal tract and wounds of the patients and can cause infections in burn, trauma, mechanically ventilated and immunocompromised patients. It shows a special predilection for the ICU. The most alarming problems encountered during this period are the organism's ability to accumulate diverse mechanisms of resistance and the emergence of strains that are resistant to all commercially available antimicrobials coupled with the lack of new antimicrobial agents. Aims: To study the resistance pattern of multidrug resistant (MDR) Acinetobacter spp. in ICU. Settings and Design: This is a 6-month retrospective study conducted in the Microbiology department. Materials and Methods: The present study was carried out in the Microbiology department of a tertiary care hospital and teaching institute. During the study period (Jan-June 2013), 370 samples were collected aseptically and processed immediately following collection. Growth was identified by observing the colony characteristics on the blood agar and MacConkey agar plates and biochemical reaction using standard microbiological methods. The bacterial isolates were subjected to antibiotic susceptibility testing by standard Kirby Bauer Disc Diffusion methods. Statistical Analysis Used: No. Results: Out of 370 samples, 83 (22.4%) samples were found to be positive for Acinetobacter spp. Among the 83 Acinetobacter isolates, 29 (34.9%) extended spectrum beta-lactamase (ESBL) and 8 (9.6%) were carbapenemase producers and 3 were MDR. Conclusions: Emergence of MDR Acinetobacter strains alarms us to take care of risk factors like irrational prescription of higher antibiotics, prolonged stay in ICU and use of mechanical ventilation. However, polymixin B and tigicycline are effective to treat infection caused by MDR Acinetobacter.

Keywords: Acinetobacter, multidrug resistant, Polymixin B


How to cite this article:
Shrivastava G, Bhatambare GS, Bajpai T, Patel KB. Sensitivity profile of multidrug resistant Acinetobacter Spp. isolated at ICUs of tertiary care hospital. Int J Health Syst Disaster Manage 2013;1:200-3

How to cite this URL:
Shrivastava G, Bhatambare GS, Bajpai T, Patel KB. Sensitivity profile of multidrug resistant Acinetobacter Spp. isolated at ICUs of tertiary care hospital. Int J Health Syst Disaster Manage [serial online] 2013 [cited 2019 Oct 15];1:200-3. Available from: http://www.ijhsdm.org/text.asp?2013/1/4/200/130731


  Introduction Top


Members of the genus Acinetobacter have emerged from organisms of questionable pathogencity to resistant nosocomial pathogens worldwide in the past two or three decades, especially from 2005-6. [1] In the hospital environment, A. baumannii can colonize the respiratory, urinary, gastrointestinal tract and wounds of the patients and can cause infections in burn, trauma, mechanically ventilated and immunocompromised patients. It shows a special predilection for the ICU. [2] The most alarming problems encountered during this period are the organism's ability to accumulate diverse mechanisms of resistance and the emergence of strains that are resistant to all commercially available antimicrobials coupled with the lack of new antimicrobial agents. [3] This has resulted in a limited choice of antimicrobial for treatment of MDR isolates of A. baumannii. Nosocomial infections, ventilator associated pneumonia (VAP), catheter associated blood stream infection (CA-BSI), surgical site infection (SSI) and catheter associated urinary tract infections (CA-UTI) were evaluated. This was done by following the standard definitions of nosocomial infections according to Centers for Disease Control and Prevention (CDC) guidelines [4] and analyzing the role of A. baumannii in the causation of hospital acquired infections. Until 1970, Acinetobacter spp. was considered to be a rare cause of nosocomial infections in the intensive care unit (ICU). [5] In recent years, however, the incidence of Acinetobacter infections have reached a point of concern and pose a threat to hospitalized populations around the world. [6],[7],[8],[9],[10],[11],[12],[13]


  Materials and Methods Top


Present study was carried out in the Microbiology department of a tertiary care hospital and teaching institute. During the study period (Jan-June 2013) 370 samples were collected and processed during the course of routine diagnostic work, from patients in the ICU of the hospital. The hospital has five different ICUs (NICU, INCU, SICU, GICU, MICU). For the identification of isolates, routine microbiological techniques were used and confirmed. Acinetobacter isolates were picked up for further studies. Urine, respiratory samples (sputum, bronchoalveolar lavage (BAL), ET) blood, pus and body fluids were collected aseptically and processed immediately following collection. Growth was identified by observing the colony characteristics on the blood agar and MacConkey agar plates and biochemical reaction using standard microbiological methods [14],[15] The bacterial isolates were subjected to antibiotic susceptibility testing by standard Kirby Bauer Disc Diffusion methods. [16] Susceptibility patterns of the bacterial isolates were determined following panel of antimicrobial agents as recommended by CLSI (Clinical laboratory of standard institute). Zone diameter was measured in mm, interpreted as per CLSI guidelines. [17] The identification of bacterial isolates and their antimicrobial susceptibilities were also confirmed using VITEK-2 Compact [Bio mericux France]. The entire testing was done under strict internal quality control using the American type culture collection (ATCC) strains. The present study has been approved by the ethical committee of our institute.


  Results Top


During the study period 370 samples were processed. Out of 370 samples 83 (22.4%) were found to be positive for Acinetobacter spp. Out of 83 samples which revealed Acinetobacter, 23 (27.7%) were urine, 48 (57.8%) were blood and 12 (14.4%) were respiratory samples. Among the 83 Acenetobacter isolates, three (3.6%) were ESBL and carbapenemase producers, 29 (34.9%) were ESBL and 8 (9.6%) were carbapenemase producers. ESBL producing Acinetobacter were sensitive to Polymixin B, Levofloxacin, Meropenum, Imepenum, Pipraciline, Pipracillinetazobactam, Gentamycin, Tetracycline, Tobramycin, Trymethoprium, Amikacin. Sensitivity pattern of Multi drug resistant Acinetobacter also noted in study [Table 1].
Table 1: The percentage antimicrobial susceptibility of the Acinetobacter spp towards the various antimicrobial agents

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Carbepenemase producer Acinetobacter were sensitive to Polymixin B, Tigicycline, Levofloxacin, Pipraciline, Pipracilline tazobactam, Amikacin. The strains of carbepenemase and ESBL both produced were sensitive to Tigicycline and Polymixin B.


  Discussion Top


Our study included antibiotic susceptibility pattern of Acinetobacter spp. isolated from different samples of ICU patients. The study revealed the infection rate in the ICU patients due to Acinetobacter spp. was 22.4%. Among the 83 isolates of Acinetobacter isolated from the respiratory samples, Acinetobacter was the most common, which was similar to the report given by Pederson et al.,[18] In our study, the maximum yield of Acinetobacter was from the respiratory samples followed by blood and urine. Siau et al. reported in their study that respiratory samples from the ICU were the most common sample from which Acinetobacters were isolated. [19] This result corroborates the fact that a lot of risk factors associated with Acinetobacter infection in the ICU like environment is a reservoir for Acinetobacter and is responsible for cross-transmission and sickness. Beside the immunocompromised patients who are colonized, patients who have multiple wounds and devices implanted in them, heavy use of broad spectrum antibiotics and frequent contamination of the hands of health care workers while caring for the patients play a role for spreading the Acinetobacter infection in the ICU. In our study we found 3 isolates which were ESBL and carbapenemase producer. However there are several Indian studies showing an increased prevalence of MDR Acinetobacter. [20],[21],[22] Our study shows that 3.6% isolates were MDR and sensitive to Tigicycline (33.3%) and Polymixin B (33.3%). In a study in Korea there was high resistance to Polymixin B, however as the resistance against Polymixin B is not very high in our country, our study showed sensitivity to Polymixin B, Tigicycline retain activity against MDR isolates. So it can still be used as the drug of choice against MDR Acinetobacter. Beside that 8 isolates produced carbapenemase which were sensitive to Polymixin B (87.5%), Tigicycline (75%), Levofloxacin (50%), Pipraciline (50%), Pipracilline tazobactam (50%). 29 isolatesproduced ESBL which were sensitive to Polymixin B (93%), Tigicycline (86.2%), Levofloxacin (79.3%), Meropenum (72.4%), Imepenum (65.5%), Pipraciline (58.6%), Pipracillinetazobactam (62%), Gentamycin (55.1%), Tetracycline (41.3%), Tobramycin (38%), Trymethoprium (31%), Amikacin (31%). With the exception of imipenem, susceptibility of A. baumannii isolates to other antibiotics was low in our hospital setting. In our study, 65.5% of the isolates were susceptible to imipenem and 93% to Polymixin B. Carbapenems has been the drug of choice for the treatment of infections caused by A. baumannii in case of ESBL production. However, the number of isolates resistant to these antibiotics has increased in recent years. [23],[24],[25] The higher resistance rate of A. baumannii to imipenem in our study, i.e. year 2001, for use in our hospital. Carbapenem-resistant A. baumannii has emerged in many parts of the world. The main mechanism of resistance is through the acquisition of B and D class carbapenemases. [26] Low resistance rates of A. baumannii to imipenem (about 3%) were reported from Saudi Arabia and Japan. [20],[26] In a study from Turkey, the rate of resistance in A. baumannii for imipenem was 9.6%. [27] In another study in Turkey, this rate was found to be 43.7%. A study from Spain reported that 43% of A. baumannii isolates were resistant to imipenem. [28] Regional variation in resistance of A. baumannii to imipenem is related to pattern of antimicrobial use and risk factors. In 2009 a study from Rohtak showed that the resistance of Acinetobacter to meropenem was 25.6% (Goel et al. 2009), which were more similar to our study. In case facility for detection of ESBL and carbapenemase production is not available then the drugs which are effective against Acinetobacter are Polymixin B (92.7%) and Tigicycline (86.2%). In conclusion, emergence of MDR Acinetobacter strains is alarming and care needs to be taken against risk factors like irrational prescription of higher antibiotics, prolonged stay in ICU and use of mechanical ventilation. However Polymixin B and Tigicycline are effectivein treating infection caused by MDR Acinetobacter.


  Acknowledgement Top


The authors wish to thank the Chairperson and Dean of the institute for providing laboratory facilities and healthy working atmosphere during the study period. The authors are also thankful to the technical staff of the institute for providing necessary helping hand during the endeavour.

 
  References Top

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3.Lolans K, Rice TW, Munoz-Price LS, Quinn JP. Multicity outbreak of carbapenem-resistant Acinetobacter baumannii isolates producing the carbapenemase OXA-40. Antimicrob Agents Chemother 2006;50:2941-5.  Back to cited text no. 3
    
4.Centers for Disease control and prevention guidelines for nosocomial infections. December 3, 2009.  Back to cited text no. 4
    
5.Villers D, Espaze E, Coste-Burel M, Giauffret F, Ninin E, Nicolas F, et al. Nosocomial Acinetobacter baumannii infections: Microbiological and clinical epidemiology. Ann Intern Med 1998;129:182-9.  Back to cited text no. 5
    
6.Afzal-Shah M, Livermore DM. Worldwide emergence of carbapenem-resistant Acinetobacter spp. 1998. J Antimicrob Chemother 1998;41:576-7.  Back to cited text no. 6
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18.Pederson MM, Marso E, Picket MJ. Non fermentative bacilli associated with man III pathogenicity and antibiotic susceptibility. Am J Clin Pathol 1970; 54:178-192.  Back to cited text no. 18
    
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    Tables

  [Table 1]


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