Background: Infection due to Acinetobacter spp. and Pseudomonas aeruginosa is a major worldwide concern these days. Antibiotic resistance and predisposing factors among the patients for acquiring such infection is a major challenge globally and in Nepal.
Objectives: To determine antimicrobial susceptibility pattern of Acinetobacter spp. and Pseudomonas aeruginosa isolates along with predisposing factors.
Methods: A total of 9,705 clinical samples were processed in this analytical cross-sectional study from December 2019 to November 2020. Antibiotic susceptibility pattern was determined following Clinical Laboratory Standard Institute guidelines. Patients’ information was obtained after informed consent.
Results: Acinetobacter spp. and Pseudomonas aeruginosa isolates were 92 (0.95%). Fifty-three (57.61%) samples were respiratory samples. Thirteen (20%) Pseudomonas aeruginosa and 18 (66.67%) Acinetobacter spp. were multidrug-resistant (MDR). Eight (12.31%) Pseudomonas aeruginosa strains and 13 (48.15%) Acinetobacter spp. strains were sensitive only to Colistin. Twenty-two (95.65%) prolonged hospital stayers had MDR bacteria compared to only nine (13.04%) non-prolonged hospital stayers (p-value <0.001). Sixteen (94.12%) of diabetic patients had MDR bacteria isolates in comparison to only 15 (20%) of non-diabetic patients (p-value <0.001). Thirty-one (33.69%) were elderly patients (age ?65 years) and 61 (66.31%) were of age less than 65 years old. Seventeen (54.84%) of elderly patients had MDR isolates whereas only 14 (22.95%) of patients who are not elderly had MDR isolates (p-value =0.0047).
Conclusion: Acinetobacter spp. and Pseudomonas aeruginosa strain were isolated from various samples. For effective treatment of infection by such organisms detailed microbiological diagnosis and drug susceptibility testing is needed along with identification of predisposing factors.
Cerceo E, Deitelzweig SB, Sherman BM, Amin AN. Multidrug-resistant gram-negative bacterial infections in the hospital setting: Overview, implications for clinical practice, and emerging treatment options. Microb Drug Resist. 2016 Jul;22(5):412-31. [PubMed | Full Text | DOI]
Baral S, Pokharel A, Subramanya SH, Nayak N. Clinico-epidemiological profile of Acinetobacter and Pseudomonas infections, and their antibioticresistant pattern in a tertiary care centre, western Nepal. Nepal J Epidemiol. 2019 Dec 31;9(4):804-11. [PubMed | Full Text | DOI]
Parajuli NP, Acharya SP, Mishra SK, Parajuli K, Rijal BP, Pokhrel BM. High burden of antimicrobial resistance among gram negative bacteria causing health care associated infections in a critical care unit of Nepal. Antimicrob Resist Infect Control. 2017 Jun 15;6:67. [PubMed | Full Text | DOI]
Rice LB. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J Infect Dis. 2008 Apr 15;197(8):1079-81. [PubMed | Full Text | DOI]
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. 28th ed. CLSI supplement M100. Wayne, PA: CLSI; 2018. [Full Text]
Antimicrobial-Resistant Phenotype Definitions. Analysis of antimicrobial-resistant organisms in NHSN updated 2021. Atlanta, GA: Centers for Disease Control and Prevention; 2021. [Full Text]
Moradiya Y, Murthy S, Shah S, Modi S. Risk factors and outcomes of prolonged hospitalization after intracerebral hemorrhage in the United States. Neurology. 2014 April ;82(10 Suppl)P7.140. [Full Text]
Singh S, Bajorek B. Defining ‘elderly’ in clinical practice guidelines for pharmacotherapy. Pharm Pract (Granada). 2014;12(4):489-97. [PubMed | Full Text | DOI]
Mirzaei, B, Bazgir, ZN, Goli, HR, Iranpour F, Mohammadi F, Babaei R. Prevalence of multi-drug resistant (MDR) and extensively drug-resistant (XDR) phenotypes of Pseudomonas aeruginosa and Acinetobacter baumannii isolated in clinical samples from Northeast of Iran. BMC Res Notes. 2020 Aug 10;13(1):380. [PubMed | Full Text | DOI]
Nepal R, Shrestha B, Joshi DM, Joshi RD, Shrestha S, Singh A. Antibiotic Susceptibility Pattern of Gram-negative Isolates of Lower Respiratory Tract Infection. J Nepal Health Res Counc. 2018 Mar 13;16(1):22-6. [PubMed | Full Text | DOI]
Mishra SK, Acharya J, Kattel HP, Koirala J, Rijal BP, Pokhrel BM. Metallo-beta-lactamase producing gram-negative bacterial isolates. J Nepal Health Res Counc. 2012 Sep;10(22):208-13. [PubMed | Full Text]
Giamarellou H, Poulakou G. Multidrug-resistant Gram-negative infections: What are the treatment options? Drugs. 2009 Oct 1;69(14):1879-901. [PubMed | Full Text | DOI]
Riera E, Cabot G, Mulet X, García-Castillo M, Campo R, Juan C, et al. Pseudomonas aeruginosa carbapenem resistance mechanisms in Spain: impact on the activity of imipenem, meropenem and doripenem. J Antimicrob Chemother. 2011 Sep;66(9):2022-7. [PubMed | Full Text | DOI]
Nagao M, Iinuma Y, Igawa J, Saito T, Yamashita K, Kondo T, et al. Control of an outbreak of carbapenem-resistant Pseudomonas aeruginosa in a haemato-oncology unit. J Hosp Infect. 2011 Sep;79(1):49-53. [PubMed | Full Text | DOI]
Livermore DM. Has the era of untreatable infections arrived? J Antimicrob Chemother. 2009 Sep;64 Suppl 1:i29-36. [PubMed | Full Text | DOI]
Sabuda DM, Laupland K, Pitout J, Dalton B, Rabin H, Louie T, et al. Utilisation of colistin for treatment of multidrug-resistant Pseudomonas aeruginosa. Can J Infect Dis Med Microbiol. 2008 Nov;19(6):413-8. [PubMed | Full Text | DOI]
Baniya B, Pant ND, Neupane S, Khatiwada S, Yadav UN, Bhandari N, et al. Biofilm and metallo beta-lactamase production among the strains of Pseudomonas aeruginosa and Acinetobacter spp. at a tertiary care hospital in Kathmandu, Nepal. Ann Clin Microbiol Antimicrob. 2017 Nov 2;16(1):70. [PubMed | [Full Text | DOI]
Moniri R, Farahani RK, Shajari G, Shirazi MN, Ghasemi A. Molecular epidemiology of aminoglycosides resistance in Acinetobacter spp. with emergence of multidrug-resistant strains. Iran J Public Health. 2010;39(2):63-8. [PubMed | Full Text]
Solomon FB, Wadilo F, Tufa EG, Mitiku M. Extended spectrum and metalo beta-lactamase producing airborne Pseudomonas aeruginosa and Acinetobacter baumanii in restricted settings of a referral hospital: A neglected condition. Antimicrob Resist Infect Control. 2017 Oct 23;6:106. [PubMed | Full Text | DOI]
Yadav SK, Bhujel R, Mishra SK, Sharma S, Sherchand JB. Emergence of multidrug-resistant nonfermentative gram negative bacterial infection in hospitalised patients in a tertiary care center of Nepal. BMC Res Notes. 2020 Jul 2;13(1):319. [PubMed | Full Text | DOI]
Raut S, Rijal KR, Khatiwada S, Karna S, Khanal R, Adhikari J, et al. Trend and characteristics of Acinetobacter baumannii infections in patients attending Universal College of Medical Sciences, Bhairahawa, western Nepal: A longitudinal study of 2018. Infect Drug Resist. 2020 Jun 8;13:1631-41. [PubMed | Full Text | DOI]
Van TD, Dinh QD, Vu PD, Nguyen TV, Pham CV, Dao TT, et al. Antibiotic susceptibility and molecular epidemiology of Acinetobacter calcoaceticusbaumannii complex strains isolated from a referral hospital in northern Vietnam. J Glob Antimicrob Resist. 2014 Dec;2(4):318-21. [PubMed | Full Text | DOI]
Mastoraki A, Douka E, Kriaras I, Stravopodis G, Manoli H, Geroulanos S. Pseudomonas aeruginosa susceptible only to colistin in intensive care unit patients. Surg Infect (Larchmt). 2008 Apr;9(2):153- 60. [PubMed | Full Text | DOI]
Jacob I, Rangappa P, Thimmegowda LC, Rao K. A study of multidrug-resistant, colistin-only-sensitive infections in intubated and mechanically ventilated patients over 2 years. J Glob Infect Dis. 2020 Feb 19;12(1):5-10. [PubMed | Full Text | DOI]
Lu Q, Luo R, Bodin L, Yang J, Zahr N, Aubry A, et al. Efficacy of high-dose nebulised colistin in ventilatorassociated pneumonia caused by multidrugresistant Pseudomonas aeruginosa and Acinetobacter baumannii. Anesthesiology. 2012 Dec;117(6):1335- 47. [PubMed | Full Text | DOI]
Mody L, Gibson KE, Horcher A, Prenovost K, McNamara SE, Foxman B, et al. Prevalence of and risk factors for multidrug-resistant Acinetobacter baumannii colonisation among high-risk nursing home residents. Infect Control Hosp Epidemiol. 2015;36(10):1155-62. [PubMed | Full Text | DOI]
Pappas G, Saplaoura K, Falagas, ME. Current treatment of pseudomonal infections in the elderly. Drugs Aging. 2009;26(5):363-79. [PubMed | Full Text | DOI]