Bacteriological profile and antibiotic susceptibility patterns of clinical isolates in a tertiary care cancer center

Abstract

Introduction: This increased risk of bacterial infections in the cancer patient is further compounded by the rising trends of antibiotic resistance in commonly implicated organisms. In the Indian setting this is particularly true in case of Gram negative bacilli such as Escherichia coli, Klebsiella pneumoniae and Acinetobacter spp. Increasing resistance among Gram positive organisms is also a matter of concern. The aim of this study was to document the common organisms isolated from bacterial infections in cancer patients and describe their antibiotic susceptibilities. Methods: We conducted a 6 month study of all isolates from blood, urine, skin/soft tissue and respiratory samples of patients received from medical and surgical oncology units in our hospital. All samples were processed as per standard microbiology laboratory operating procedures. Isolates were identified to species level and susceptibility tests were performed as per Clinical Laboratory Standards Institute (CLSI) guidelines -2012. Results: A total of 285 specimens from medical oncology (114) and surgical oncology services (171) were cultured. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter spp. were most commonly encountered. More than half of the Acinetobacter strains were resistant to carbapenems. Resistance in Klebsiella pneumoniae to cephalosporins, fluoroquinolones and carbapenems was >50%. Of the Staphylococcus aureus isolates 41.67% were methicillin resistant. Conclusion: There is, in general, a high level of antibiotic resistance among gram negative bacilli, particularly E. coli, Klebsiella pneumoniae and Acinetobacter spp. Resistance among Gram positives is not as acute, although the MRSA incidence is increasing.

Keywords

Antibiotics - resistance - susceptibility testing

• References

• 1 Available from: vie warticle/ 580631. [Last accessed on 2015 Feb 15].
• 2 Rudresh SM, Nagarathnamma T. Extended spectrum β-lactamase producing Enterobacteriaceae & antibiotic co-resistance. Indian J Med Res 2011;133:116-8.
• 3 Tzouvelekis LS, Markogiannakis A, Psichogiou M, Tassios PT, Daikos GL. Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: An evolving crisis of global dimensions. Clin Microbiol Rev 2012;25:682-707.
• 4 Kumar SG, Adithan C, Harish BN, Sujatha S, Roy G, Malini A. Antimicrobial resistance in India: A review. J Nat Sci Biol Med 2013;4:286-91.
• 5 Tsering DC, Pal R, Kar S. Methicillin-resistant Staphylococcus aureus: Prevalence and current susceptibility pattern in Sikkim. J Glob Infect Dis 2011;3:9-13.
• 6 Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362-86.
• 7 Forbes BA, Sahm DF, Weissfeld AS. Bailey and Scott′s Diagnostic Microbiology. 12 th ed. Elsevier -Mosby, St. Louis, Missouri 63043, USA; 2007.
• 8 Clinical Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty Second Informational Supplement M100-S22. Wayne, PA: Clinical Laboratory Standards Institute; 2012.
• 9 Yadegarynia D, Tarrand J, Raad I, Rolston K. Current spectrum of bacterial infections in patients with cancer. Clin Infect Dis 2003;37:1144-5.
• 10 Rao SP, Rama PS, Gurushanthappa V, Manipura R, Srinivasan K. Extended-spectrum beta-lactamases producing Escherichia coli and Klebsiella pneumoniae: A multi-centric study across Karnataka. J Lab Physicians 2014;6:7-13.
• 11 Shashwati N, Kiran T, Dhanvijay AG. Study of extended spectrum β-lactamase producing Enterobacteriaceae and antibiotic coresistance in a tertiary care teaching hospital. J Nat Sci Biol Med 2014;5:30-5.
• 12 Zhao ZC, Xu XH, Liu MB, Wu J, Lin J, Li B. Fecal carriage of carbapenem-resistant Enterobacteriaceae in a Chinese university hospital. Am J Infect Control 2014;42:e61-4.
• 13 Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: A molecular, biological, and epidemiological study. Lancet Infect Dis 2010;10:597-602.
• 14 Manoharan A, Chatterjee S, Mathai D; SARI Study Group. Detection and characterization of metallo beta lactamases producing Pseudomonas aeruginosa. Indian J Med Microbiol 2010;28:241-4.
• 15 Pawar M, Mehta Y, Purohit A, Trehan N, Rosenthal VD. Resistance in gram-negative bacilli in a cardiac intensive care unit in India: Risk factors and outcome. Ann Card Anaesth 2008;11:20-6.
• 16 Dash M, Padhi S, Pattnaik S, Mohanty I, Misra P. Frequency, risk factors, and antibiogram of Acinetobacter species isolated from various clinical samples in a tertiary care hospital in Odisha, India. Avicenna J Med 2013;3: 97-102.
• 17 Menezes GA, Harish BN, Sujatha S, Vinothini K, Parija SC. Emergence of vancomycin-intermediate Staphylococcus species in Southern India. J Med Microbiol 2008;57(Pt 7):911-2.
• 18 Eshwara VK, Munim F, Tellapragada C, Kamath A, Varma M, Lewis LE, et al. Staphylococcus aureus bacteremia in an Indian tertiary care hospital: Observational study on clinical epidemiology, resistance characteristics, and carriage of the Panton-Valentine leukocidin gene. Int J Infect Dis 2013;17:e1051-5.
• 19 Choudhury R, Panda S, Singh DV. Emergence and dissemination of antibiotic resistance: A global problem. Indian J Med Microbiol 2012;30:384-90.
• 20 Ghafur A, Mathai D, Muruganathan A, Jayalal JA, Kant R, Chaudhary D, et al. The Chennai declaration: A roadmap to tackle the challenge of antimicrobial resistance. Indian J Cancer 2013;50:71-3.