Characterisation of "ESKAPE" Pathogens with Special Reference to Multidrug Resistance and Biofilm Production in a Nepalese Hospital

Abstract

Background: “ESKAPE” is an acronym for group of organisms as Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter calcoaceticus baumannii complex, Pseudomonas aeruginosa and Enterobacter spp. They are associated in causing life threatening infections. Global efforts on controlling multidrug resistant (MDR) organisms have been hampered by their rapid emergence, inadequate tests for rapid detection and their ability to escape the antibacterial drugs. The objective of this study was to determine the prevalence of ESKAPE pathogens with prime focus on biofilm production and antibiotic resistance. Methods: A total of 8756 clinical specimens were processed for the isolation and identification of ESKAPE pathogens following standard microbiological protocol. These isolates were subjected to antibiotic sensitivity test as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Detection of resistance phenotypes, viz., extended-spectrum-beta-lactamase (ESBL), metallo-beta-lactamase (MBL), Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE) was done by disk diffusion method and E- test method as applicable. The VRE isolates were subjected for detection of Van A and Van B genes. All the isolates were processed for biofilm detection by tube adherence method. Results: The percentage distribution of Staphylococcus aureus was 33.5%, followed by Klebsiella pneumoniae 33.0%, Pseudomonas aeruginosa 18.3%, Acinetobacter calcoaceticus baumannii complex 8.7%, Enterococcus faecium 5.6% and Enterobacter aerogenes 0.9%. MRSA was 57.6% and Vancomycin resistance among Enterococcus faecium was 20%. ESBL and MBL producing Klebsiella pneumoniae were 16.1%, and 8.1%, Acb complex 10.3% each and Pseudomonas aeruginosa 10.7% and 8.3% respectively. A total of 42.3% of isolates were biofilm producers. Linezolid was drug of choice for VRE isolates. Piperacillin- tazobactam was found to be effective against Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter aerogenes; Ampicillin-sulbactam was the most effective drug against Acb complex excluding polymyxins. Van A gene was detected in all the VRE isolates. Conclusion: This study estimates the burden of the ESKAPE organisms and their antibiotic resistance pattern in a Nepalese hospital. The increasing percentages of drug resistance among these biofilm-producing pathogens pose great threat in medical setting. Surveillance targeting ESKAPE pathogens should be incorporated in infection control policy in Nepal.

Risk Factors for E2SKAPE Infections and Mortality among Liver Transplant Recipients

“…Seventy-ve (90.4%) of 83 E 2 SKAPE isolates were MDR which was higher than another Chinese study performed on burn patients with the rate being 55% [21]. More than 95% of all Gram-positive E 2 SKAPE pathogens and 85% of Gram-negative isolates were found to be MDR which is higher than in studies conducted in a Nepalese Hospital, where more than 68% of Gram-positive and nearly 27% of Gram-negative ESKAPE pathogens were found to be MDR [19]. The probable explanations included that these studies were conducted in different hospitals, time period, and types of patients.…”

“…The median (IQR) length of hospital stay and preoperative Model for End-Stage Liver Disease (MELD) score prior to LT were 9 (1-24) days and 24 (16-30), respectively. Eighty-one (35.4%) patients received antibiotics within 2 weeks prior to LT. One hundred (43.7%) patients were infected within 2 months but not within 2 weeks before LT. [19,20]. Seventy-ve (90.4%) of 83 E 2 SKAPE isolates were MDR which was higher than another Chinese study performed on burn patients with the rate being 55% [21].…”

“…E 2 SKAPE bacteria, in particular MDR-E 2 SKAPE bacteria, are becoming the most common nosocomial organisms that can bring about life-threatening infections in SOT, especially LT recipients[7][8][9][10][11]. Pandey R et al reported that the ESKAPE isolates had a high level of antimicrobial resistance and bio lm formation responsible for one of the key factors for their dissemination of antimicrobial resistance[19].Over the present study period, 83 strains of E 2 SKAPE bacteria were isolated from 53 (23.1%) of 229 LT recipients. In our study, the proportion of Gram-positive E 2 SKAPE bacteria was slightly higher than that of Gram-negative ones, in line with our previous study between 2002 and 2013 in LT recipients with ESKAPE bacteremias where the majority of ESKAPE pathogens were Gram-positive[8].…”

Relationship between Biofilm-Formation, Phenotypic Virulence Factors and Antibiotic Resistance in Environmental Pseudomonas aeruginosa

“…In recent years, many studies have been published detailing the possible correlation or co-occurrence of the antibiotic-resistant (or the MDR) phenotype and biofilm-formation in various bacterial genera [25,26]; biofilm provides a form of "adaptive" resistance against antimicrobial drugs (resulting in lower capacity for diffusion, low oxygen tension and emergence of dormant phenotypes), in addition to some researchers suggesting common regulatory mechanisms behind biofilm-production and the expression of resistance genes [27,28]. However, the presently available evidence is contradictory and is often influenced by the heterogeneity of bacterial isolates and the methods used [29].…”

Nosocomial Infections in Surgical Patients at a Central Academic Hospital in South Africa

“…The commonly involved bacteria include E. faecium, S. aureus, K. pneumonia, P. aeruginosa, A. baumannii, and Enterococcus species which are the so-called ESKAPE pathogens. Less than 5% of nosocomial infections are caused by Candida species [1,7,8]. Gram-negative bacteria currently account for more than 60% of nosocomial infections [2].…”