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MGMJMS: Vol. 4 Issue 1: p. 10
Journal Information
Journal ID (publisher-id): MGMJMS
ISSN: 2347-7946
ISSN: 2347-7962
Publisher: Jaypee Brothers Medical Publishers (P) Ltd.
Article Information
Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.
open-access:
Print publication date: Season: January-March Year: 2017
Volume: 4 Issue: 1
First Page: 10 Last Page: 18
Publisher Id: MGMJMS_Sep_008_LE
DOI: 10.5005/jp-journals-10036-1130

Spectrum of Microbial Isolates from Wound Infections in Patients admitted in a Tertiary Care Hospital, Kolkata
Ashis K Saha,1Associate Professor
Suman Nandi2Assistant Professor
Payodhi Dhar3Junior Resident
1-3 Department of General Medicine, KPC Medical College and Hospital, Jadavpur, Kolkata, West Bengal, India
Correspondence: Ashis K Saha, Associate Professor Department of General Medicine, KPC Medical College and Hospital, Jadavpur, Kolkata, West Bengal, India, Phone: +919433006157, e-mail: Asissaha2008@gmail.com

ABSTRACT

Increasing emergence of drug-resistant bacteria is becoming a major problem globally. A retrospective study of 790 culture and sensitivity reports on microbial isolates, from infected wounds was carried out in KPC Medical College and Hospital, Jadavpur, Kolkata, India. 504 patients were males and 286 females. Gram negative organisms were isolated in 561 and gram positive in 229. Among the gram negative organisms, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli were the most common, whereas Staph aureus was the only gram positive organism isolated. Antibiotic sensitivity tests revealed most gram negative organisms susceptible to carbapenems, polymyxin and colistin. Staphylococci showed sensitivity to tigecycline, clindamycin, vancomycin, teicoplanin and linezolid. Interesting differences in the type of organisms isolated in male and female patients were noted. For example Enterococcus faecalis was found only in female patients. Increasing resistance of microorganisms cultured from infected wounds to first line and even second line antibiotics is a matter of great concern and can be attributed to indiscriminate and irrational use of broad spectrum antibiotics. This has to stop forthwith if we want to prevent resistance to antibiotics; otherwise morbidity, mortality and health care costs in treating patients with wound infections are going to increase exponentially

How to cite this article

Saha AK, Nandi S, Dhar P. Spectrum of Microbial Isolates from Wound Infections in Patients admitted in a Tertiary Care Hospital, Kolkata. MGM J Med Sci 2017;4(1):10-18.


INTRODUCTION

Commonly bacteria, fungi, and viruses invade the body defense, multiply, and produce respective symptoms.1 Hence, the infectious diseases are most common cause of mortality and morbidity worldwide.2 The bacteria invade the skin either directly through open-wound contamination or through the penetration of the intact skin.3 The wound may be either postoperative, occurred after injury, or may be in birth-place.4 These wound infection sources include first from nature, including exogenous microflora present all around or those presented as traumatic damage; secondly, skin microflora including Staphylococcus epidermidis, micrococci, skin diphtheroids and propionibacteria; and thirdly, endogenous sources (oropharyngeal, urogenital tract, and gastrointestinal tract).5 Most of the open injuries are colonized by potentially pathogenic polymicrobes, but some experts considered the involvement facultative pathogens, like Staphylococcus aureus, beta-hemolytic Streptococci and Pseudomonas aeruginosa, Enterococci, Escherichia coli, and Proteus and Klebsiella species as essential drivers of prolonged recuperation and disease in both intense and constant injuries.6-9 So, in case of clinically infected injuries, the aim of administration of antibiotics is not to target one particular pathogen, rather targeting aerobic or facultative aerobic and anaerobic pathogens.10 In case of S. aureus, which is the most common organism in infected wound, cephalosporin, macrolide group of drugs, semisynthetic penicillin, clindamycin, and fluoroquinolone are the antibiotics of choice.11,12 In case of open wound, surface bacteria enter and start multiplying locally at the moist edge of the gut. So, body’s defense comes into action. Neutrophilic lymphocytes and other cytokines fight against these invaded bacteria producing local inflammation and ultimately white-colored liquid will be formed.13,14 Ultimate complications will be wound dehiscence or wound breakdown.15,16 But unfortunately the overuse, unjustified use, and missuse of the broad spectrum antibiotics may be responsible for spreading of infection resistant to those antibiotics and possibility of developing complications in future.17 So, to prevent these multidrugs-resistant bacteria, regular updates of knowledge regarding the bacteriological review of pus culture and sensitivity is very much essential.18 Hence, our aim in this study was to isolate the bacteria from pus and detection of its spectrum of antimicrobial sensitivity in our institution, which will definitely throw light of knowledge in the use of antibiotics in that type of organism.


MATERIALS AND METHODS

This retrospective study was conducted in KPC Medical College and Hospital, Jadavpur, Kolkata only after getting permission from our local ethical committee. Most of the wounds were mainly infected injury, diabetic foot, and postoperative injuries. The data included here from the years 2010 to 2015, i.e., 6 years.

Sample collection: Samples were collected from our microbiology department. Total number of samples sent for culture and sensitivity and direct microscopy examination were 6,292. In 790 cases positive culture and sensitivity report were received.

Inoculation in broth and direct microscopy: After collection aseptically, the specimen was sent immediately to microbiological department for culture and sensitivity. The specimen was first inoculated in the thioglycollate broth and kept incubated for 24 hours at 37°C. On the following day, the broth was examined primarily to detect the growth of the bacteria, if any by doing direct gram stain smear. Then the smear was first examined in the low power field under oil immersion microscope (×100) to detect polymorph nuclear cells. Other smear was examined in high power field microscope under oil immersion (×1000) to detect the presence of bacteria.

Inoculation into the culture media: Some material was collected from the broth by using calibrated loop and inoculated in the blood agar, chocolate agar, and MacConkey’s agar by four quadrant technique and incubated at 37°C for further 24 to 48 hours for the presence or absence of bacterial growth.

Identification of isolates by biochemical tests: After 48 hours the cultures was read out by observing four quadrant growth of bacteria – it is usually read as approximate number of colony forming unit of bacteria per mL (CFU/ML). Then, to measure variable biochemical behavior of bacterial strains, the following extensive biochemical tests were performed as per manual methods of general bacteriology by American Society of Microbiology, like triple sugar iron test (TSI), citrate utilization test, motility indole urease test (MIU), oxidase test, coagulase test, catalase test, and DNAse test.19

Antibiotic sensitivity tests: The obtained bacteria was diluted in 3 to 4 mL of sterile normal saline, which was then followed by swabbing the diluted bacterial sample onto the antibiotic disk by cotton swab as per direction of Clinical and Laboratory Standard Institute guideline.20

For Gram-negative bacteria, the following antibiotic disks were used: gentamicin, tobramycin, netilmicin, amikacin, ceftriaxone, cefixime, fluoroquinolone group of drugs, like, ciprofloxacin, ofloxacin, levofloxacin, co-trimoxazole, chloramphenicol, piperacillin-tazobactam, cefoperazone-sulbactam, ceftazidime, aztreonam, cefotaxime, imipenem, meropenem, ertapenem, polymyxin B, and colistin.

Again, for Gram-positive cocci, the following antibiotics were used: piperacillin-tazobactam, cefoperazonesulbactam, semisynthetic penicillin group, like amoxicillin, oxacillin, amoxicillin-clavulanic acid, cefuroxime, ceftazidime, cefixime, ceftriaxone, carbapenem group, aminoglycoside group, chloramphenicol, co-trimoxazole, fluoroquinolone group of drugs, tigecycline, teicoplanin, vancomycin, clindamycin, linezolid, tetracycline, polymyxin B, and colistin.

After getting the data of antibiotic sensitivity spectrum of the different bacteria, they were analyzed in following sequences:

  • Year-wise culture–sensitivity report between males and females with their statistical significance.
  • Sex-wise distribution of bacterial isolates in pus.
  • Incidence of Gram-positive and Gram-negative bacteria in pus.
  • In bacterial isolates percentage of culture–sensitivity in different bacteria.

All the above data were analyzed with the help of statistical software [Statistical Package for the Social Sciences (SPSS)] version 17. Here the p-value of <0.05 was accepted as statistically significant.


RESULTS

Total number of samples sent were 6,292. In 6 years’ study, total number of positive cases were 790, out of which 504 were males and 286 females (p = 0.00) (Table 1). In case of sex-wise distribution of bacterial isolates from pus, males were significantly affected by all bacteria (p = 0.00 to <0.02) except Enterobacter species (p = 0.35). Again in case of Klebsiella oxytoca and Acinetobacter, only males were affected, whereas only females were affected by E. faecalis (Table 2). These data demonstrated significant number of Gram-negative organism (n = 504) in comparison to Gram-positive organism (n = 229) (p = 0.00) (Table 3).

Methicillin-sensitive S. aureus (MSSA) was moderately sensitive to piperacillin-tazobactam (77.03%), netilmicin (77.03%), tobramycin (77.77%), moderately high sensitive to tigecycline and linezolid (80–88.14%), but high sensitive to vancomycin and teicoplanin (90.85%). Nonextended spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae and Enterobacter was not more than 50% sensitive to all the antibiotics, but ESBL producing Klebsiella were moderately to highly sensitive to carbapenem group of drugs (76.27–81.35%), tigecycline (88.13%), polymyxin B, and colistin (76.27%). P. aeruginosa were moderately high sensitive to imipenem (86.95%), meropenem (80.86%) and highly sensitive to polymyxin B and colistin (91.30%). Non-ESBL producing E. coli were moderate to moderately high sensitive to carbapenem group of drugs, polymyxin B, and colistin (77.90–86.04%), but less sensitive to aminoglycoside group (62.79–68.60%) except amikacin which was moderately sensitive (73.25%), whereas ESBL producing E. coli were moderately sensitive to carbapenem group (74.13–81.03%) but mildly increased sensitivity to polymyxin B and colistin (65.51%). Again, K. oxytoca (n = 6) were moderately sensitive to carbapenem groups, tigecycline (83.33%) but 100% sensitive to polymyxin B and colistin. Citrobacter were moderately high sensitive to piperacillin-tazobactum (73.02%), carbapenem group of drugs (76.92–84.61%) except imipenem which was highly sensitive (92.30%). E. faecalis (n = 10) was 100% sensitive to piperacillin-tazobactam, imipenem, chloramphenicol, tigecycline, vancomycin and linezolid, 90% sensitive to amoxicillin, but 70 to 80% sensitive to meropenem, ciprofloxacin, and gentamicin. Proteus mirabilis (n = 55) was highly sensitive to piperacillin-tazobactum (90.90%), moderately highly sensitive to imipenem (83.63%), meropenem (76.36%), levofloxacin (74.54%) and mildly increased sensitive to aminoglycoside group of drugs (60–69.09%). Methicillin-resistant S.aureus (MRSA) were highly sensitive to vancomycin, teicoplanin, and linezolid (94.33–98.4%), mildly increased sensitive to aminoglycoside group of drugs (66.03–69.81%), teicoplanin, and clindamycin (71.69%). Acinetobacter baumannii demonstrated high sensitivity to imipenem and meropenem (90.90%), polymyxin B, moderate to moderately high sensitivity to gentamicin and fluoroquinolone group of drugs (72.72–81.81%), but mildly increased sensitivity to other aminoglycoside group of drugs. Coagulase-negative Staphylococcus demonstrated very high sensitivity to tigecycline, vancomycin, teicoplanin (90.24–92.68%), moderately high sensitive to tetracycline, linezolid, chloramphenicol (78.04–87.80%) (Tables 4 to 7).


DISCUSSION

Nowadays, surgery are well advanced, techniques are being modernized, good numbers of newly invented antibiotics are being used for prophylaxis, but with the inadvertent and irrational use of these antibiotics. The nosocomial bacteria get upper hand and are frequently encountered in the wound infections – these are mainly hospital-acquired. These bacterial infections are mostly responsible for worldwide morbidity and mortality.21,22 According to Center of Disease Control (CDC), in USA and UK nosocomial infection surveillance, incidence of positive bacterial isolates was 15.45 and 11.32% respectively, which were very close to our study results because it showed 12.55% positivity.23 It may be due to uncontrolled infections, which in turn may produce depressive type of illness, septicemia, and eventual death.24,25

In the study done by Rao et al26 and Rameshkannan et al,27 the most common bacteria isolated were Staphylococcus (24.29%) and E. coli (61%). Similarly, Verma28 demonstrated in her study Staphylococcus as most common causative organism (40%). Similar incidence was found also in our study (MSSA – 17%, MRSA – 6.70%, and CNS – 5.18%, total being 29.88%). The second most common bacteria isolated in our study was Klebsiella species (14.43 + 0.75% +7.46% = 22.64%) followed by E. coli (10.88 + 7.34% = 18.22%) and Pseudomonas species (14.55%). Similarly, Verma28 in her study demonstrated Klebsiella species as the second most common organism (33%) followed by Pseudomonas (18%) and E. coli (16%). Whereas Rameshkannan et al27 in their study showed second most common bacteria as S. epidermidis (21%) followed by S. aureus (10%) and Pseudomonas (4%). So, from all the studies it can be interpreted that four most common bacteria responsible for infection are S. aureus, E. coli, Pseudomonas species, and Klebsiella species. These infections may be due to chronic morbid disease, like diabetes, chronic liver disease, immunosuppression, aging, low socioeconomic status, and poor nutritional status.

In our study MSSA was moderately sensitive to piperacillin-tazobactam, netilmicin, amikacin (≈ 77%), moderately high sensitive to tigecycline and linezolid (80–88%), and highly sensitive to vancomycin and teicoplanin (≈ 91%), whereas MRSA was very highly sensitive to vancomycin, teicoplanin, and linezolid (94–98%). In our study, MRSA was 6.70% and MSSA was 17%, but in other studies, the incidence of MRSA was 15 to 30%.29,30 In the study of Perim et al,31 the incidence of resistance of MRSA to vancomycin was 26%. Later on, in that study modified Kirby-Bauer disk diffusion demonstrated only three isolates resistant to vancomycin. So, in any diabetic wound infections without any risk factor for MRSA, the treatment should be started with vancomycin. More and more genetic studies should be performed to analyze nonvancomycin susceptible to MRSA.32 In our study, 90 to 100% isolates of MRSA were resistant to penicillin and methicillin group of antibiotics, whereas in the study of Hailu et al,33 65.4 and 34.6% S. aureus demonstrated resistance to penicillin and oxacillin respectively with more or less similar results were found in the study done by Hwang et al,34 Abera et al,35 and Seid et al.36 Our study as well as other different studies suggest that a large-scale study is required on the prevalence and spectrum of susceptibility of community-acquired MRSA. The study showed 40 to 90% resistance to co-trimoxazole, chloramphenicol, ciprofloxacin, erythromycin with only 30% resistance to clindamycin, whereas only 0 to 31% resistance to ciprofloxacin, chloramphenicol, clindamycin, erythromycin, and co-trimoxazole was evidenced in the study done by Hailu et al,33 Seid et al,36 Abera and Kibrad.35

Our study demonstrated 80 to 86% sensitivity of Pseudomonas to imipenem which was consistent with the study done by Rajalakshmi et al.37 On the contrary, only 50% Pseudomonas was sensitive to imipenem in the study done by Perim et al.31 Sivanmaliappan and Sevanan in their study demonstrated 100% resistance of Pseudomonas to ampicillin, 83% to tetracycline, 66.6% to gentamicin, and 16.6% to cefotaxime. There was some similarity as well as dissimilarity evidenced in our study.38 More or less similarity in observations was demonstrated in the study of Perim et al.31 In our study, Pseudomonas was 100% resistant to ampicillin, amoxicillin, tetracycline, erythromycin, cefotaxime, clindamycin, vancomycin, teicoplanin, linezolid and around 50% resistant to aminoglycoside group of antibiotics. In the study, of Hailu et al,33 it was demonstrated that P. aeruginosa was highly sensitive to ciprofloxacin, gentamicin, amikacin, and chloramphenicol. This was contrary to our study where Pseudomonas was 52 to 55% sensitive to gentamicin, amikacin, ciprofloxacin, whereas 5.21% sensitive to chloramphenicol. Perim et al31 demonstrated 25% Pseudomonas isolates were resistant to polymyxin B as determined with diffusion test using validated broth dilution method. Though different studies throughout the world demonstrated poor correlation among the different methods of testing for polymyxin B and colistin, but some studies including our study demonstrated good correlation because of use of validated broth dilution method.

Our study demonstrated that P. mirabilis (n = 55) was highly sensitive to piperacillin-tazobactam (90.90%), imipenem (83.63%), moderately sensitive to cefoperazone-sulbactam (65.45%), ertapenem (65.45%), aminoglycoside group of antibiotics (60–69%), chloramphenicol (63.63%) which was partially similar to the studies done by Hailu et al,33 Seid et al,36 and Wasihun and Zemune.39 These studies demonstrated low level of resistance (5–28%) to ciprofloxacin, piperacillin-tazobactam, ceftazidime, gentamicin, and ceftriaxone. Similarly, our study indicated very low level of sensitivity to ampicillin, amoxicillin, oxacillin which was also evidenced in the above studies.33,36,39 The high resistance of P. aeruginosa, S. aureus, and P. mirabilis to ampicillin, amoxicillin, and oxacillin may be due to the following factors, like lack of up-to-date knowledge of antimicrobial resistance amongst nurses, physicians, lack of presence of proper antibiogram data, unnecessary, unethical, and irrational uses of antibiotics, self-intake by the patients, push by the pharmacists, irregular intake of antibiotics by the patients. Again, it is known fact that proteus species produces a unique beta-lactamase (cefuroximase) having high activity against cefuroxime, second-generation cephalosporin.

K. pneumoniae showed only 50% sensitivity to piperacillin-tazobactam and cefoperazone-sulbactam. But both K. oxytoca and ESBL producing Klebsiella demonstrated high sensitivity to carbapenem group (75–83%), tigecycline (83.33–88.13%), polymyxin B, and colistin (76.22–100%), which was similar to the study done by Rameshkannan et al27 and Rao et al26 where Klebsiella showed high sensitivity to meropenem, linezolid, and levofloxacin. On the contrary, our study demonstrated nearly 100% sensitivity and low level of resistance to levofloxacin.

Enterobacteriaceae group was resistant to most of the antibiotics as evidenced in the study done by Banashankari et al,40 whereas the study done by Perim et al31 demonstrated gentamicin and imipenem were most effective to this group. The latter study was nearly consistent with our own study where enterobacteriaceae was nearly 50% sensitive to piperacillin-tazobactam (57.14%), imipenem (47.61%), chloramphenicol (52.38%), vancomycin (42.85%). The fact for the resistance of these bacteria is the ability to produce highly effective beta-lactamase enzyme which make them resistant to all beta-lactam antibiotics except carbapenem, cephamycins (cefoxitin, cefotetan).41

Non-ESBL producing E. coli were moderate to highly sensitive to carbapenem group, polymyxin, and colistin, 62.79 to 75.25% sensitive to aminoglycoside group of antibiotics, levofloxacin, chloramphenicol, and piperacillin-tazobactam, and ESBL producing E. coli were moderately sensitive to carbapenem group (74.13–81.03%) and 65.51% sensitive to polymyxin and colistin. Our study was contrary to the study done by Ali et al,42 where 100% sensitivity to piperacillin-tazobactam followed by carbapenem group. Again, Perim et al demoed in their study that E. coli was highly resistant to all the antibiotics except gentamicin and imipenem. The study by Rao et al26 and Rameshkannan et al27 demonstrated high sensitivity to vancomycin, linezolid in addition to other antibiotics as per our study. But our study specifically demonstrated 100% resistance of E. coli to vancomycin and linezolid. So, from the above studies, it was observed that E. coli were highly sensitive to carbapenem group.


CONCLUSION

In our study, males were significantly involved than females. Again, male patients were affected by all types of bacteria except Enterobacteriaceae species. Males were only affected by Klebsiella oxytoca and Acinetobacter species, whereas females were only affected by Enterobacter faecalis. The presence of gram-negative bacteria was higher than the gram-positive bacteria. It demonstrated that the incidence of most common bacterial isolates was MRSA, MSSA, and coagulase-negative Staphylococcus, followed by Klebsiella species and E. coli (both ESBL and non-ESBL producers) as 3rd and 4th most common bacterial isolates respectively. Carbapenem group was highly sensitive in case of ESBL producing E. coli and Klebsiella, Acinetobacter, K. oxytoca (except meropenem), Pseudomonas (except ertapenem), E. faecalis (except ertapenem), and P. mirabilis. Aminoglycoside group of antibiotics sensitivity was high in case of non-ESBL producing E. coli, P. mirabilis, Acinetobacter. Levofloxacin sensitivity was high in case of E. coli, P. mirabilis, Acinetobacter, coagulase-negative S. aureus. Polymyxin B and colistin were highly sensitive to Pseudomonas, E. coli, ESBL producing Klebsiella, K. oxytoca, Citrobacter, whereas Staphylococcus was highly sensitive to vancomycin, teicoplanin, linezolid, tigecycline, tetracycline, vancomycin (except coagulase-negative Staphylococcus). It provided a clear understanding of the spectrum of culture and sensitivity of bacterial isolates from pus or from wound with secondary infection and surgical wound infection. After a thorough review of the literature as well as our extensive study, it can be concluded that E. coli, Pseudomonas, S. aureus, Klebsiella, and P. mirabilis are the most common causative organism in the pus. Irrational, inadvertent use of broad spectrum antibiotics to treat infection is responsible for the emergence of resistance to ampicillin, amoxicillin, amoxicillin-clavulanic acid. So, very cautious as well as continuous monitoring should be carried out over the bacterial culture and sensitivity to choose most appropriate broad spectrum antibiotics, both for treatment as well as prophylaxis. If it happens so, then there will be better patient management. There should be continuous cooperation between bacteriologist, physicians, and surgeon for the sake of the treatment of the patients with wound infections.


Notes

Source of support: Nil

Conflict of interest: None

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Tables

Table 1: Year-wise male–female distribution of bacterial isolates from pus


YearsTotal cases (790)Males (504)Females (286)
2010109 (13.79%)7138
2011131 (16.58%)8942
201289 (11.26%)6227
2013142 (17.97%)10240
2014158 (20%)9860
2015161 (20.37%)8279

Table 2: Sex-wise distribution of bacterial isolates from pus


Bacterial isolates (790)Males (504)%Females (286)%p-value
K. pneumoniae (114) (14.43%)7666.663833.330.00
MSSA (135) (17%)8663.704936.290.00
P. aeruginosa (115) (14.55%)6758.264841.730.01
E. coli (86) (10.88%)5665.113034.880.00
C. freundii (26) (3.29%)2284.61415.380.00
K. oxytoca (6) (0.75%)610000
E. coli (ESBL) (58) (7.34%)3560.342339.650.02
Klebsiella (ESBL) (59) (7.46%)3661.012338.980.01
Enterobacter (21) (2.65%)942.851257.140.35
E. faecalis (10) (1.26%)0010100
P. mirabilis (55) (6.96%)3869.091730.900.00
MRSA (53) (6.70%)3566.031833.960.00
Acinetobacter (11) (1.39%)1110000
CNS (41) (5.18%)2765.851434.140.00

Table 3: Comparison between Gram-positive and Gram-negative bacteria in pus


Gram-negative organism (561)Gram-positive organism (229)p-value
K. pneumoniae (114)Methicillin sensitive Staphylococcus (MSSA) (135)0.00
P. aeruginosa (115)Methicillin resistant Staphylococcus (MRSA) (53)
E. coli (86)Coagulase negative Staphylococcus (CNS) (41)
C. freundii (26)
K. oxytoca (6)
E. coli (ESBL) (58)
Klebsiella (ESBL) (59)
Enterobacter (21)
E. faecalis (10)
P. mirabilis (55)
Acinetobacter (11)

Table 4: Antibiotic sensitivity of bacterial isolates in penicillin, amoxicillin, oxacillin, ampicillin, piperacillin-tazobactam, cefoperazone-sulbactam, cefuroxime, cefotaxime, and cofoxitin


OrganismsPENAMXOXAMCPIPTCESCEFCFTCXT
K. pneumoniae (114)01 0.87%015 13.15%56 49.12%55 48.24%16 14.03%18 15.78%23 20.17%
MSSA (135)11 8.14%31 22.96%83 61.48%74 54.81%104 77.03%6 4.44%65 48.14%3 2.22%13 9.62%
P. aeruginosa (115)000060 52.17%56 48.69%2 1.73%01 0.8%
E. coli (86)03 3.48%022 25.58%55 63.95%47 54.65%15 17.44%22 25.58%23 26.74%
C. freundii (26)01 3.84%07 26.92%19 73.02%14 53.84%4 15.38%9 34.61%8 30.76%
K. oxytoca (6)0001 16.66%1 16.66%1 16.66%001 16.66%
E. coli (ESBL) (58)0006 10.34%33 56.89%25 43.1%01 1.72%19 32.75%
Klebsiella (ESBL) (59)000931170021
Enterobacter (21)05 23.8%06 28.57%12 57.14%6 28.57%2 9.52%2 9.52%0
E. faecalis (10)03 30%09 90%10 100%5 50%1 10%1 10%0
P. mirabilis (55)05 9.09%020 36.36%50 90.90%36 65.45%19 34.54%21 38.18%8 14.54%
MRSA (53)007 13.20%7 13.20%20 37.73%3 5.66%3 5.66%1 1.88%1 1.88%
Acinetobacter (11)00004 36.36%6 54.54%2 18.18%1 09.09%0
CNS (41)3 7.31%11 26.82%12 29.26%16 39.02%28 68.29%011 26.82%4 9.75%5 12.19%

Table 5: Antibiotic sensitivity of bacterial isolates in ceftazedime, ceftriaxone, cefepime, azithromycin, erythromycin, aztreonam, ertapenem, imipenem, and meropenem


OrganismsCFZCTRXCFPAZERAZTERTIMPMEP
K. pneumoniae (114)10 8.77%9 7.89%8 7.01%3 2.63%05 4.38%49 42.98%62 54.38%54 47.36%
MSSA (135)4 2.96%66 48.88%15 11.11%57 42.22%64 47.40%19 14.07%17 12.59%23 17.03%13 9.62%
P. aeruginosa (115)16 13.91%2 1.73%12 10.43%11 9.56%07 6.08%14 12.17%100 86.95%93 80.86%
E. coli (86)24 27.90%28 32.58%24 27.90%5 5.81%3 3.48%18 20.93%67 77.90%72 83.72%74 86.04%
C. freundii (26)9 34.61%10 38.46%9 34.61%2 7.69%05 19.23%20 76.92%24 92.30%22 84.61%
K. oxytoca (6)0000005 83.33%5 83.33%3 50%
E. coli (ESBL) (58)0001 1.72%1 1.72%043 74.13%47 81.03%45 77.58%
Klebsiella (ESBL) (59)00000045 76.27%49 83.05%48 81.35%
Enterobacter (21)3 14.28%2 9.52%2 9.52%3 14.28%3 14.28%3 14.28%3 14.28%10 47.61%6 28.57%
E. faecalis (10)03 30%3 30%2 20%4 40%1 10%5 50%10 100%7 70%
P. mirabilis (55)21 38.18%26 47.27%21 38.18%1 1.81%024 43.63%36 65.45%46 83.63%42 76.36%
MRSA (53)07 13.20%4 7.54%9 16.98%16 30.18%7 13.20%4 7.54%5 9.43%3 5.66%
Acinetobacter (11)3 27.27%3 27.27%3 27.27%1 9.09%03 27.27%3 27.27%10 90.90%10 90.90%
CNS (41)1 2.43%11 26.82%12 29.26%6 14.63%4 9.75%4 9.75%13 31.70%23 56.09%11 26.82%

Table 6: Antibiotic sensitivity of bacterial isolates in gentamicin, tobramycin, netilmicin, amikacin, ciprofloxacin, ofloxacin, levofloxacin, cotrimoxazole, and chloramphenicol


OrganismsGETTOBNITAMKCIPOFLIVCOTCHLO
K. pneumoniae (114)44 38.59%42 36.84%43 37.71%43 37.71%25 21.92%26 22.80%37 32.45%16 14.03%36 31.57%
MSSA (135)108 80%50 37.03%104 77.03%105 77.77%76 56.29%80 59.25%94 69.62%64 47.40%93 68.88%
P. aeruginosa (115)60 52.17%57 49.56%64 55.65%69 60%60 52.17%36 31.30%65 56.52%5 4.34%6 5.21%
E. coli (86)58 67.44%54 62.79%59 68.60%63 73.25%41 47.67%40 46.51%55 63.95%39 45.34%59 68.60%
C. freundii (26)5 19.23%16 61.53%15 57.69%16 61.53%13 50%14 35.84%17 65.38%11 42.30%11 42.30%
K. oxytoca (6)3 50%2 33.33%1 16.66%4 66.66%00003 50%
E. coli (ESBL) (58)25 43.10%24 41.37%28 48.27%32 55.17%9 15.51%11 18.96%14 24.13%12 20.68%31 53.44%
Klebsiella (ESBL) (59)30 50.84%27 45.76%32 54.23%35 59.32%12 20.33%13 22.03%17 28.81%10 16.94%35 59.32%
Enterobacter (21)5 23.80%1 4.765 23.80%5 23.80%6 28.57%6 28.57%10 47.61%2 9.52%11 52.38%
E. faecalis (10)8 80%1 10%4 40%2 20%7 70%6 60%8 80%1 10%10 100%
P. mirabilis (55)38 69.09%34 61.81%36 65.45%38 69.09%33 60%30 54.54%41 74.54%18 32.72%35 63.63%
MRSA (53)31 58.49%20 37.73%37 69.81%35 66.03%17 32.07%22 41.50%32 60.37%6 11.32%40 75.47%
Acinetobacter (11)8 72.72%7 63.63%7 63.63%7 63.63%8 72.72%8 72.72%9 81.81%4 36.36%6 63.63%
CNS (41)23 56.09%7 17.07%24 58.53%26 63.41%18 43.90%19 46.34%25 60.97%20 48.78%33 80.48%

Table 7: Antibiotic sensitivity of bacterial isolates in tetracycline, tigecycline, clindamycin, vancomycin, teicoplanin, linezolid, polymyxin B, colistin, ticarcillin, and cefoperazone


OrganismsTETTIGCLINVANTEILIZPOLCOLTICCEFOP
K. pneumoniae (114)20 17.54%41 35.96%1 0.87%01 0.87%065 57.01%64 56.14%1 0.87%1 0.87%
MSSA (135)107 79.25%108 80%82 60.74%124 91.85%124 91.85%119 88.14%1 0.74%03 2.22%8 5.92%
P. aeruginosa (115)01 0.86%0000105 91.30%105 91.30%5 4.34%6 5.21%
E. coli (86)35 40.69%58 67.44%000070 81.39%69 80.23%7 8.13%1 1.16%
C. freundii (26)5 19.23%15 57.69%000022 84.61%21 80.76%3 11.53%0
K. oxytoca (6)3 50%5 83.33%00006 100%6 100%1 16.66%0
E. coli (ESBL) (58)15 25.86%34 58.62%000038 65.51%38 65.51%9 15.51%0
Klebsiella (ESBL) (59)22 37.28%52 88.13%000045 76.27%45 76.27%6 10.16%0
Enterobacter (21)8 38.09%7 33.33%09 42.85%9 42.85%8 38.09%1 4.76%1 4.76%2 9.52%1 4.76%
E. faecalis (10)6 60%10 100%010 100%1 10%10 100%2 20%2 20%2 20%0
P. mirabilis (55)3 5.45%8 14.54%00001 1.81%1 1.81%15 27.27%1 1.81%
MRSA (53)34 64.15%41 49.62%38 71.69%52 98.11%52 98.11%50 94.33%002 3.77%0
Acinetobacter (11)6 54.54%7 63.63%000011 100%11 11%00
CNS (41)32 78.04%38 92.68%16 39.02%37 90.24%37 90.24%36 87.80 %0000
CNS: Coagulase negative Staphylococcus; MSSA: Methicillin-sensitive S. aureus; MRSA: Methicillin-resistant S. aureus


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Keywords: Blood culture, Gram-negative bacteria, Gram-positive bacteria, Sensitivity, Tertiary hospital.
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