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Retrospective comparative study of Pseudomonas aeruginosa antibiotic resistance isolated from intensive care units (ICUs) patients from tertiary hospital in Nepal


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Abstract

This finding has examined the persistent emergence of resistance among P. aeruginosa strains to common antimicrobial drugs vis a-vis the increasing number of reports documented world-wide. Our study objectives were finding the antimicrobial resistance patterns of P. aeruginosa from clinical isolates obtained from hospitalized patients. The main purpose of this study was aimed to perform antibiotic resistance patterns among the P aeruginosa isolates from ICU units in tertiary hospitals in Nepal. Two hundred and fifty strains of P. aeruginosa were isolated from different clinical specimens and fully characterized by regular standard bacteriological proceedings between March 1998 and November 2003. Antimicrobial susceptibility patterns of each isolate were carried out by the Kirby- Bauer disk diffusion method as per guidelines of CLSI. These initial laboratory findings of antibiotic resistance of P. aeruginosa isolates have been compared for next successive 17 years to find the significant antimicrobial resistances rise if any from the data. Primarily for the initial 3 years of study, Majority of high antibiotic resistance isolates of P. aeruginosa were obtained from specimens of pus, sputum, urine, and tracheal aspirates. The isolated pathogens showed resistance to amikacin (18.45%), ciprofloxacin (28.32%) and Cefoperazon-sulbactam (36.42%). Resistance rates to Co-trimoxazole, piperacillin, ceftriaxone and chloramphenicol varied from 49.00% to 71.00%. Most of the isolates were susceptible to imipenem. 21.67% of P. aeruginosa isolates were found to be multi-drug resistant. The results also established clear evidence of drug resistant strains of P. aeruginosa. Imipenem, amikacin, and ciprofloxacin were found to be the mainly effective antibiotics. From ICUs isolates, resistance rates were found to be the highest. It therefore demands a very well thought-out and cognizance treatment regimen by the general practitioners to hinder the further spread of P. aeruginosa antimicrobial resistance. We therefore analyzed current and long-term trends of antibiotic resistance within our hospitals, including separate analysis of trends for ICUs. Secondly, pathogenic P. aeruginosa species isolated at the tertiary teaching hospital throughout the 17-year period from the records was analyzed. There was a considerable rise in resistance over a decade in the bacterial species of P. aeruginosa in the successive years. The tendency of ciprofloxacin resistance was on the rise for the entire tertiary teaching hospital from 2.5% in 2003 to 12.5% in 2011 (P<0.01, Spearman rank order correlation). In addition to this, there was an increase in resistance in the ICUs, but in common lower than that for the whole hospital. A remarkable resistance increase was observed for imipenem first and foremost noticeable in the ICUs compared to the other hospital units. Similarly, the resistance to ceftazidime, piperacillin and gentamicin at the tertiary teaching hospital noticed a noticeable rise, specifically in the ICUs.

Keywords

antimicrobial resistance, intensive care unit clinical isolates, Nepal, Pseudomonas aeruginosa

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