Background:Lower respiratory tract infections (LRTI's) are the most frequent infections among patients in intensive care units. The consequences of increased drug resistance are far reaching since bacterial infection of the lower respiratory tract (LRT) is a major cause of death from infectious disease.Objective:The study was conducted with the aim of determining the bacterial etiology of LRTI in the neuro intensive care unit (NICU) as well as to update the clinicians with the various antimicrobial alternatives available in the treatment of LRTI.Subjects and Methods:The study was conducted for the period of 3 years from January 2010 to December 2012 in the Microbiology Department of a Teaching Tertiary Care Hospital. The LRT specimens from 230 patients admitted in a NICU during the study period were processed. Following culture, the isolated organisms were identified and antimicrobial sensitivity was performed by standard methods.Results:Out of the 230 LRT specimens evaluated, 198 (86.08%) were culture positive. A total of 254 pathogens were recovered with a predominance of Gram-negative isolates (n = 243; 96.05%) Pseudomonas aeruginosa was the most dominant pathogen followed by Klebsiella pneumoniae. Alarmingly high percentage of extended spectrum beta-lactamase and methicillin resistant Staphylococcus aureus isolates were detected. The resistance to cephalosporins, aminoglycosides and carbapenem were remarkable.Conclusions:Therefore, we can conclude that for effective management of LRTI's, an ultimate and detailed bacteriological diagnosis and susceptible testing is required to overcome global problem of antibiotic resistance.
A total number of 201 various clinical samples were processed during the study. 91 strains of Klebsiella pneumoniae were isolated. They were studied for ESBL production by screening test, CLSI disc diffusion method & phenotypic confirmation by disc potentiation test. RESULT:-Out of 91 strains, 71 were found positive for ESBL production by screening test. Out of 71 strains 59 were confirmed by disc potentiation test. So out of 91 strains 59 (64.8%) were confirmed as ESBL producers. Among the ESBL producer Klebsiella pneumoniae, 11(18.64%) were sensitive to Cefotaxime, 06(10.16%) to Ceftriaxone & 10(16.94%) to Ceftazidime by routine Kirby Bauer disc diffusion method. All the Klebsiella pneumoniae isolates were sensitive to Imipenem. Resistance against Ampicillin (10ug) is 100%, Ciprofloxacin (5ug) is 93.22%, Gentamicin (10ug) is 88.13%, Tetracycline (30ug) is 72.9% and Amikacin (30ug) is 18.64%. CONCLUSION: Our study shows presence of ESBL producer Klebsiella pneumoniae in clinical specimens and their prevalence is 64.8%. The routine antimicrobial sensitivity test may fail to detect ESBL. Detection of ESBL production should be carried out as a routine in diagnostic laboratories by disc potentiation test as it is a simple and cost effective test. Antibiotics resistance is significantly more prevalent in ESBL positive isolates as compared to ESBL negative.
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