Community Acquired Multi-drug Resistant Clinical Strains from Tracheal Aspirates of Patients in Hospital Settings in Dhaka, Bangladesh

Abstract

Background: Antimicrobial resistance is a multi-sectoral problem which poses a major threat in the treatment of infectious diseases especially in developing countries like Bangladesh. Multidrug-resistant (MDR) bacteria along with extremely drug resistant (XDR) bacteria have emerged as major clinical and therapeutic dilemma in the treatment of tracheal infections in hospitals here. Thus the aim of this study was to document the incidence of MDR and XDR producing β-lactamases in clinical isolates from tracheal aspirates of patients in Dhaka, Bangladesh. Methods: Two hundred clinical isolates from tracheal aspirates were identified and their antibiotic susceptibility profiles were evaluated by using the VITEK 2 system following the Clinical and Laboratory Standards Institute guidelines. Patient information on diagnosis, sex, age was obtained from hospital data. Results: Of 200 clinical, non-duplicate bacterial isolates obtained, Pseudomonas aeruginosa was the most frequent pathogens (N=61/200, 30.5%) followed by Acinetobacter baumannii (N=58/200, 29%), Klebsiella pneumoniae (N=45/200, 22.5%), Streptococcus pneumoniae (N = 15/200, 7.5%), Escherichia coli (N=10/200, 5%), Staphylococcus aureus (N=4/200, 2%), Proteus spp (N=3/200, 1.5%), Enterobacter spp (N=2/100, 1%), Citrobacter spp (1/200, 0.5%), Providencia spp (N=1/200, 0.5%). Of 20 different antibiotics tested, highest number of isolates (N=172/200, 86%) showed resistance to third generation cephalosporin cefixime, however least number of isolates showed resistance to polymixin antibiotics- colistin (N=25/200, 12.5%) and polymixinB (N=12/200, 6%) . The patients’ ages ranged between 1 month to 95 years with the gender distribution of 133 (66.5%) males and 67 (33.5%) females. The prevalence of infections was highest among the patients of age-group (old adults) ≥60 years (N=123/200, 61.5%). Of 200 clinical isolates, 43 (21.5%) were XDR and 125 (62.5%) were MDR bacteria. Of 200 clinical isolates, the synthesis of extended spectrum β-lactamases (ESBL) and carbepenemase were detected in 59 (29.5%) and 98 (49%) strains respectively. Conclusion: Tracheal infections caused by MDR and XDR pathogens among patients are high at hospital settings in Bangladesh. Therefore, there is an urgent need for constant surveillance and interventions in Bangladesh in order to prevent further spreading of those resistant organisms.