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VOLUME 2 , ISSUE 3 ( 2017 ) > List of Articles

ORIGINAL ARTICLE

A Prospective Study on Prevalence and Antibiotic Susceptibility Pattern of Acinetobacter baumannii in Clinical Samples obtained from Patients admitted in Various Wards and Intensive Care Units

Ved P Mamoria

Keywords : Endotracheal, Intensive care units and wards, Multidrug-resistant Acinetobacter baumannii, Nosocomial infection

Citation Information : Mamoria VP. A Prospective Study on Prevalence and Antibiotic Susceptibility Pattern of Acinetobacter baumannii in Clinical Samples obtained from Patients admitted in Various Wards and Intensive Care Units. J Mahatma Gandhi Univ Med Sci Tech 2017; 2 (3):122-127.

DOI: 10.5005/jp-journals-10057-0050

License: CC BY-NC-ND 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction Acinetobacter baumannii is a nonfermentative and nonmotile, Gram-negative coccobacillus, which is the most often identified pathogen among Acinetobacter species that causes wide range of infection in humans. It has emerged as one of the most troublesome pathogens for health care institutions globally. Acinetobacter baumannii strains resistant [multidrug-resistant A. baumannii (MDR-Ab)] to all known antibiotics have now been reported. Aim To determine the prevalence and antimicrobial susceptibility pattern of A. baumannii isolates in the clinical samples obtained from patients admitted in various wards and intensive care units (ICUs). Materials and methods A total of 9,540 clinical specimens [from the patients of inpatient department (IPD)] were collected between March 2016 and February 2017 from various wards and ICUs of Mahatma Gandhi Hospital (MGH), Sitapura, Jaipur, Rajasthan, India. All tests were done at microbiology lab of Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, Rajasthan, India, using standard protocol. Results Of 9,540 (45%) clinical specimens, 4,293 specimens from various wards and ICUs were culture positive. Out of 4,293 positive cultures, Acinetobacter isolates were 276 (6.42%). From 276 Acinetobacter isolates, 230 (83.33%) strains were confirmed as A. baumannii strains and remaining 46 (16.67%) strains as other Acinetobacter species. Maximum frequency of Acinetobacter isolates was from respiratory tract intubated patients (endotracheal samples: 59.5%). Maximum frequency of A. baumannii isolates was recovered from ICUs (63.04%) compared with wards. In our study, most Acinetobacter isolates were resistant (80–99%) to third- and fourth-generation cephalosporins, quinolones, penicillins, aminoglycosides, carbapenems, and macrolides. Drugs of choices are colistin (99.13%), tigecycline (67.83%), cefoperazone/sulbactam (44.78%), minocycline (40.87%), ampicillin + sulbactam (36.09%), doxycycline hydrochloride (10.43%), and cotrimoxazole (9.57%). Conclusion Acinetobacter species is an emergent and global hospital-acquired pathogen. Drug resistance pattern of A. baumannii is quite alarming in our health care settings, so effective infection control practices and judicious use of antibiotics is mandatory. How to cite this article Sharma RK, Mamoria VP. A Prospective Study on Prevalence and Antibiotic Susceptibility Pattern of Acinetobacter baumannii in Clinical Samples obtained from Patients admitted in Various Wards and Intensive Care Units. J Mahatma Gandhi Univ Med Sci Tech 2017;2(3):122-127.


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  1. Tayabali AF, Nguyen KC, Shwed PS, Crosthwait J, Coleman G, Seligy VL. Comparison of the virulence potential of Acinetobacter strains from clinical and environmental sources. PLoS One 2012 May;7(5):e37024.
  2. Baumann P. Isolation of Acinetobacter from soil and water. J Bacteriol 1968 Jul;96(1):39-42.
  3. Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev 2008 Jul;21(3):538-582.
  4. Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 2006 Mar;42(5):692-699.
  5. Falagas ME, Karveli EA. The changing global epidemiology of Acinetobacter baumannii infections: a development with major public health implications. Clin Microbiol Infect 2007 Feb;13(2):117-119.
  6. Dijkshoorn L, Nemec A, Seifert H. An increasing threat in hospitals: multidrug-resistant Acinetobacter baumannii. Nat Rev Microbiol 2007 Dec;5(12):939-951.
  7. Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008 Apr;46(8):1254-1263.
  8. Rodríguez-Baño J, Cisneros JM, Fernández-Cuenca F, Ribera A, Vila J, Pascual A, Martínez-Martínez L, Bou G, Pachón J; Grupo de Estudio de Infección Hospitalaria (GEIH). Clinical features and epidemiology of Acinetobacter baumannii colonization and infection in Spanish hospitals. Infect Control Hosp Epidemiol 2004 Oct;25(10):819-824.
  9. Lin MF, Yang CM, Lin CH, Huang ML, Tu CC, Liou ML. Clinical features and molecular epidemiology of multidrug resistant Acinetobacter calcoaceticus-A baumannii complex in a regional teaching hospital in Taiwan. Am J Infect Control 2009 Nov;37(9):e1-e3.
  10. Falagas ME, Bliziotis IA, Siempos II. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case control studies. Crit Care 2006 Apr;10(2):R48.
  11. Joshi SG, Litake GM, Niphadkar KB, Ghole VS. Multidrug resistant Acinetobacter baumannii isolates from a teaching hospital. J Infect Chemother 2003 Jun;9(2):187-190.
  12. Hood MI, Mortensen BL, Moore JL, Zhang Y, Kehl-Fie TE, Sugitani N, Chazin WJ, Caprioli RM, Skaar EP. Identification of an Acinetobacter baumannii zinc acquisition system that facilitates resistance to calprotectin-mediated zinc sequestration. PLoS Pathog 2012 Dec;8(12):e1003068.
  13. Xia Y, Lu C, Zhao J, Han G, Chen Y, Wang F, Yi B, Jiang G, Hu X, Du X, et al. A bronchofiberoscopy-associated outbreak of multidrug-resistant Acinetobacter baumannii in an intensive care unit in Beijing, China. BMC Infect Dis 2012 Dec;12:335.
  14. Mirza IA, Hussian A, Abbasi SA, Malik N, Satti L, Farwa U. Ambu bag as a source of Acinetobacter baumannii outbreak in an intensive care unit. J Coll Physicians Surg Pak 2011 Mar;21(3):176-178.
  15. Hua X, Zhou H, Jiang Y, Feng Y, Chen Q, Ruan Z, Yu Y. Genome sequences of two multidrug-resistant Acinetobacter baumannii strains isolated from a patient before and after treatment with tigecycline. J Bacteriol 2012 Dec;194(24):6979-6980.
  16. Wan Nor Amilah WA, Noor Izani NJ, Ng WK, Ashraful Haq J. A simple screening test for the detection of metallo-β-lactamase-producing Pseudomonas aeruginosa and Acinetobacter in a tertiary care hospital. Trop Biomed 2012 Dec;29(4):588-597.
  17. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing Standard. Twenty Fourth informational supplement. CLSI document M100-S24. Wayne (PA): CLSI; 2014.
  18. CLSI. Performance standards for antimicrobial disc susceptibility tests: M-100.S-22. Vol. 32, No.3. Wayne (PA): CLSI; 2012.
  19. Saleem AF, Ahmed I, Mir F, Ali SR, Zaidi AK. Pan-resistant Acinetobacter infection in neonates in Karachi, Pakistan. J Infect Dev Ctries 2009 Nov;4(1):30-37.
  20. Kim YJ, Kim SI, Hong KW, Kim YR, Park YJ, Kang MW. Risk factors for mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia: impact of appropriate antimicrobial therapy. J Korean Med Sci 2012 May;27(5):471-475.
  21. 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 Jul;1(2):62-66.
  22. Markogiannakis H, Pachylaki N, Samara E, Kalderi M, Minettou M, Toutouza M, Toutouzas KG, Theodorou D, Katsaragakis S. Infections in a surgical intensive care unit of a university hospital in Greece. Int J Infect Dis 2009 Mar;13(2):145-153.
  23. Christianson S, Golding GR, Campbell J, Mulvey MR; The Canadian Nosocomial Surveillance Programme. Comparative genomics of Canadian epidemic lineages of MRSA. J Clin Microbiol 2007 Jun;45(6):1904-1911.
  24. Ntusi NB, Badri M, Khalfey H, Whitelaw A, Oliver S, Piercy J, Raine R, Joubert I, Dheda K. ICU-associated Acinetobacter baumannii colonisation/infection in a high HIV prevalence resource-poor setting. PLoS One 2012 Dec;7(12):e52452.
  25. Mohammadi-Mehr M, Feizabadi MM. Antimicrobial resistance pattern of gram-negative bacilli isolated from patients at ICUs of Army hospitals in Iran. Iran J Microbiol 2011 Mar;3(1):26-30.
  26. Sabir R, Alvi FD, Fawwad A. Antimicrobial susceptibility pattern of aerobic microbial isolates in a clinical lab in Karachi—Pakistan. Pak J Med Sci 2013 May-Jun;29(3):851-855.
  27. Fayyaz M, Khan IU, Hussain A, Mirza IA, Ali S, Akbar N. Frequency and antimicrobial susceptibility pattern of Acinetobacter species isolated from pus and pus swab specimens. J Coll Physicians Surg Pak 2015 May;25(5):346-349.
  28. Goossens H. MYSTIC (Meropenem Yearly Susceptibility Test Information Collection) results from Europe: comparison of antibiotic susceptibilities between countries and centre types. J Antimicrob Chemother 2000 Sep;46(Suppl T2):39-52.
  29. Gupta N, Gandham N, Jadhav S, Mishra RN. Isolation and identification of Acinetobacter species with special reference to antibiotic resistance. J Nat Sci Biol Med 2015 Jan-Jun;6(1):159-162.
  30. Tahseen U, Talib MT. Acinetobacter infections as an emerging threat in intensive care units. J Ayub Med Coll Abbottabad 2015 Jan-Mar;27(1):113-116.
  31. Saleem AF, Shah MS, Shaikh AS, Mir F, Zaidi AK. Acinetobacter species meningitis in children: a case series from Karachi, Pakistan. J Infect Dev Ctries 2011 Nov;5(11):809-814.
  32. Chim H, Tan BH, Song C. Five-year review of infections in a burn intensive care unit: high incidence of Acinetobacter baumannii in a tropical climate. Burns 2007 Dec;33(8):1008-1014.
  33. Alvarez-Lerma F, Palomar M, Insausti J, Olaechea P, Cerdá E, Castillo F, Martínez-Pellús A; Grupo de Estudio Nacional de Vigilancia de Infección Nosocomial en UCI. Infections caused by Acinetobacter Spp. In critically ill ICU patients. Enferm Infecc Microbiol Clin 2005 Nov;23(9):533-539.
  34. Amudhan MS, Sekar U, Kamalanathan A, Balaraman S. bla (IMP) and bla (VIM) mediated carbapenem resistance in Pseudomonas and Acinetobacter species in India. J Infect Dev Ctries 2012 Nov;6(11):757-762.
  35. Sinha N, Agarwal J, Srivastava S, Singh M. Analysis of carbapenem-resistant Acinetobacter from a tertiary care setting in North India. Indian J Med Microbiol 2013 Jan-Mar;31(1):60-63.
  36. Purohit M, Mendiratta DK, Deotale VS, Madhan M, Manoharan A, Narang P. Detection of metallo-b-lactamases producing Acinetobacter baumannii using microbiological assay, disc synergy test and PCR. Indian J Med Microbiol 2012 Oct-Dec;30(4):456-461.
  37. Arora S, Gautam V, Ray P. Changing susceptibility patterns of non-fermenting Gram-negative bacilli. Indian J Med Microbiol 2012 Oct-Dec;30(4):485-486.
  38. Irfan S, Zafar A, Guhar D, Ahsan T, Hasan R. Metallo-beta-lactamase producing clinical isolates of Acinetobacter species and Pseudomonas aeruginosa from intensive care unit patients of a tertiary care hospital. Indian J Med Microbiol 2008 Jul-Sep;26(3):243-245.
  39. Karah N, Haldorsen B, Hegstad K, Simonsen GS, Sundsfjord A, Samuelsen Ø; Norwegian Study Group of Acinetobacter. Species identification and molecular characterization of Acinetobacter spp. blood culture isolates from Norway. J Antimicrob Chemother 2011 Apr;66(4):738-744.
  40. Khaleel ME, Lone DS, Munir M, Khan JK, Zahra K, Hanif A. A study of microbial isolates from blood at a university teaching hospital. Ann King Edward Med Univ 2010;16(3):194-197.
  41. Khan MA, Mahomed MF, Ashshi AM, Faiz A. Drug resistance patterns of Acinetobacter baumannii in Makkah, Saudi Arabia. Pak J Med Res 2012 Oct-Dec;51(4):127-131.
  42. Shields RK, Clancy CJ, Gillis LM, Kwak EJ, Silveira FP, Massih RC, Eschenauer GA, Potoski BA, Nguyen MH. Epidemiology, clinical characteristics and outcomes of extensively drug-resistant Acinetobacter baumannii infections among solid organ transplant recipients. PLoS One 2012 Dec;7(12):e52349.
  43. Prashanth K, Badrinath S. In vitro susceptibility pattern of Acinetobacter species to commonly used cephalosporins, quinolones and aminoglycosides. Indian J Med Microbiol 2004 Apr-Jun;22(2):97-103.
  44. Armin S, Karimi A, Fallah F, Tabatabaii RS, Alfatemi SM, Khiabanirad P, Shiva F, Fahimzad A, Rahbar M, Mansoorghanaii R, et al Antimicrobial resistance pattern of Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus isolated from patients with nosocomial infection admitted to Tehran hospitals. Arch Pediatr Infect Dis 2015 Oct;3(4):e32554.
  45. Qureshi ZA, Abbasi SA, Mirza IA, Malik N, Amjad A, Sattar A, Ikram A. Antimicrobial susceptibility pattern of Acinetobacter species-one year experience in a tertiary care setting. Infect Dis J 2011 Mar;20(1):269-272.
  46. Spencer L, Bubner T, Bain E, Middleton P. Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health. Cochrane Database Syst Rev 2015 Sep;9:CD011263.
  47. Li M, Yao Q, Xing A. A clinical analysis of 188 cases of pregnancy complicated with critical heart disease. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2014 Nov;39(11):1145-1150.
  48. Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, Talwar KK. Cardiac disease in pregnancy. Int J Gynaecol Obstet 2003 Aug;82(2):153-159.
  49. Gelson E, Curry R, Gatzoulis MA, Swan L, Lupton M, Steer P, Johnson M. Effect of maternal heart disease on fetal growth. Obstet Gynecol 2011 Apr;117(4):886-891.
  50. Arora N, Kausar H, Jana N, Mandal S, Mukherjee D, Mukherjee R. Congenital heart disease in pregnancy in a low-income country. Int J Gynaecol Obstet 2015 Jan;128(1):30-32.
  51. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000 Jul;183(1):S1-S22.
  52. Agency for Healthcare Research and Quality. Management of chronic hypertension during pregnancy. Evidence Report/Technology Assessment no.14. AHRQ publication no. 00-E011. Rockville, MD: Agency for Healthcare Research and Quality; 2000.
  53. Ferrer RL, Sibai BM, Mulrow CD, Chiquette E, Stevens KR, Cornell J. Management of mild chronic hypertension during pregnancy: a review. Obstet Gynecol 2000 Nov;96(5 Pt 2):849-860.
  54. Sridharan R, Murthy BN. Prevalence and pattern of epilepsy in India. Epilepsia 1999 May;40(5):631-636.
  55. Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, McCorry D, Bagary M, Mignini L, Khan KS, Zamora J, Thangaratinam S, et al. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet 2015 Nov;386(10006):1845-1852.
  56. Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 2010 Nov;5(11):2060-2068.
  57. Hazes JM, Coulie PG, Geenen V, Vermeire S, Carbonnel F, Louis E, Masson P, De Keyser F. Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use. Rheumatology (Oxford) 2011 Nov;50(11):1955-1968.
  58. Velu PP, Gravett CA, Roberts TK, Wagner TA, Zhang JS, Rubens CE, Gravett MG, Campbell H, Rudan I. Epidemiology and aetiology of maternal bacterial and viral infections in low- and middle-income countries. J Glob Health 2011 Dec;1(2):171-188.
  59. UNAIDS: UNAIDS report on the global AIDS epidemic. 2010. Available from http://www.unaids.org/globalreport/Global_report.htm
  60. Ioannidis JP, Abrams EJ, Ammann A, Bulterys M, Goedert JJ, Gray L, Korber BT, Mayaux MJ, Mofenson LM, Newell ML, et al. Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads <1000 copies/ml. J Infect Dis 2001 Feb;183(4):539-545.
  61. Anglemyer A, Rutherford GW, Horvath T, Baggaley RC, Egger M, Siegfried N. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database Syst Rev 2013 Apr;4:CD009153.
  62. Rimoin DL, Connor JM, Pyeritz RE, Korf BR. Emery and Rimoin's principles and practice of medical genetics. Churchill Livingstone Elsevier; 2007.
  63. Verma IC, Puri RD. Global burden of genetic disease and the role of genetic screening. Semin Fetal Neonatal Med 2015 Oct;20(5):354-363.
  64. White SJ, Boldt KL, Holditch SJ, Poland GA, Jacobson RM. Measles, mumps, and rubella. Clin Obstet Gynecol 2012 Jun;55(2):550-559.
  65. American College of Obstetricians and Gynecologists. ACOG educational bulletin: viral hepatitis in pregnancy. Int J Gynaecol Obstet 1998 Nov;63:195-202.
  66. Geeta MG, Riyaz A. Prevention of mother to child transmission of hepatitis B infection. Indian Pediatr 2013;50:189-192.
  67. Swamy GK, Beigi RH. Maternal benefits of immunization during pregnancy. Vaccine 2015 Nov;33(47):6436-6440.
  68. Sukumaran L, McCarthy NL, Kharbanda EO, McNeil MM, Naleway AL, Klein NP, Jackson ML, Hambidge SJ, Lugg MM, Li R, et al. Association of Tdap vaccination with acute events and adverse birth outcomes among pregnant women with prior tetanus-containing immunizations. JAMA 2015 Oct;314(15):1581-1587.
  69. Singru SA, Tilak VW, Gandham N, Bhawalkar JS, Jadhav SL, Pandve HT. Study of susceptibility towards Varicella by screening for the presence of IgG antibodies among nursing and medical students of a Tertiary Care Teaching Hospital in Pune, India. J Glob Infect Dis 2011 Jan-Mar;3(1):37-41.
  70. Nathwani D, Maclean A, Conway S, Carrington D. Varicella infections in pregnancy and the newborn. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect 1998;36 (Suppl 1):59-71.
  71. Michaan N, Amzallag S, Laskov I, Cohen Y, Fried M, Lessing JB, Many A. Maternal and neonatal outcome of pregnant women infected with H1N1 influenza virus (swine flu). J Matern Fetal Neonatal Med 2012 Feb;25(2):130-132.
  72. Smith NM, Bresee JS, Shay DK, Uyeki TM, Cox NJ, Strikas RA. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006 Jul;55(RR-10):1-42.
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