Antimicrobial Susceptibility Pattern of Gram-Negative Bacteria Causing Lower Respiratory Tract Infections in Kathmandu University Hospital

Abstract

Background: Respiratory tract infection due to Gram-negative bacteria is a common cause of morbidity and mortality worldwide. This study was carried out to determine the antimicrobial susceptibility pattern of Gram-negative bacteria from patients with lower respiratory tract infection visiting Kathmandu University Hospital.Methods: A total of 3,403 respiratory samples including sputum and endotracheal aspirates were processed and antibiotic resistance pattern was determined following Clinical Laboratory Standard Institute guidelines. Patients’ information was obtained after informed consent.Results: Growth of Gram-negative bacteria was 210 (6.17%). 83(39.52%) were Klebsiella pneumoniae followed by Escherichia coli, Pseudomonas aeruginosa, Acinetobacter species, Klebsiella oxytoca, Enterobacter species, Proteus mirabilis and Haemophilus influenzae. 151(71.90%) isolates were multidrug resistant. None of the strains were resistant to colistin. 51(24.29%) were resistant to carbapenem and out of these 3(1.43%) were metallo-? lactamase producers. 89(65.92%) of the patients having both pneumonia along with other respiratory illnesses were above 60 years of age indicating that old age might be a predisposing factor. (p value is less than 0.0001). 92(81.42%) of patients of age above 60 years had multidrug resistant isolates indicating that old age might be a predisposing factor for getting infection my multidrug resistant isolates. (p value equals 0.0012) Among 36 diabetic patients 33(91.67%) had multidrug resistant isolates. Whereas out of 174 non-diabetic patients only 118(67.82%) had multidrug resistant isolates (p value equals 0.0037).Conclusions: Multidrug-resistant Gram negative bacteria were observed in respiratory samples. Effective treatment of lower respiratory tract infection need detailed microbiological diagnosis and drug susceptibility testing.Keywords: ESBL; LRTI; MBL; MDR

Study of bacterial respiratory infections and antimicrobial susceptibility profile among antibiotics naive outpatients visiting Meru teaching and referral hospital, Meru County, Kenya in 2018

“…This is contrary to a study conducted in Kenya that reported 95.4% growth of bacterial pathogens [ 19 ]. Previous studies carried out in Nepal reported no bacterial growth in 56.4% and 49.6% of the samples [ 20 , 21 ]. The varying results in this study could be due to other etiological agents of respiratory infections which include viruses and fungi.…”

Antibiotic resistance spectrum ofE. colistrains from different samples and age-grouped patients: a 10-year retrospective study

“…Also, this might be caused by the lengthy usage of antibiotics in the elderly patients who are vulnerable to respiratory tract infections. 25 The drug resistance rates against ceftriaxone and sulbactam/ampicillin were lower in neonatal group than in non-neonatal group, compared with infants and children, possibly because of less chance of exposure to broad-spectrum antibiotics. 26 In contrast, a previous multicentre study revealed a higher ESBL-positive percentage in children than in the old patients.…”

“…Antibiotic resistance rates of sputum isolates were higher in older patients than in younger patients, partly due to the higher prevalence of ESBL-positive strains in the older patients. Also, this might be caused by the lengthy usage of antibiotics in the elderly patients who are vulnerable to respiratory tract infections 25. The drug resistance rates against ceftriaxone and sulbactam/ampicillin were lower in neonatal group than in non-neonatal group, compared with infants and children, possibly because of less chance of exposure to broad-spectrum antibiotics 26.…”

retrospecRisk factors of carbapenem-resistant Gram-negative bacteria pneumonia and mortality

“…Recent studies have found that coronary heart disease, diabetes, shock, renal insufficiency and deep venous catheterization are the main risk factors for death from carbapenem-resistant Gram-negative bacteria pneumonia (24)(25). Some scholars have pointed out in the study that patients with coronary heart disease often suffer from cardiac insufficiency under the blow of refractory infection, resulting in death (26)(27); Diabetic patients with vascular diseases of other organs, severe acute complications of diabetes will increase the mortality of patients. It is necessary to strengthen the monitoring of diabetic patients to prevent complications (28)(29).…”