High rate of non-susceptibility to metronidazole and clindamycin in anaerobic isolates: Data from a clinical laboratory from Karachi, Pakistan

Sheikh, Sadia Omer; Jabeen, Kauser; Qaiser, Saba; Ahsan, Syed Tanwir; Khan, Erum; Zafar, Afia

doi:10.1016/j.anaerobe.2015.03.006

Cited by 22 publications

(19 citation statements)

References 22 publications

(34 reference statements)

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“…Our study however lacked details on severity of disease, data of patient assessment using critical care scoring systems (APACHE II and SOFA scores) and antimicrobial therapy (single drug or combined regimen). A previous study conducted in our setup showed higher proportion of metronidazole resistance in patients with bacteremia [12]. However, this analysis showed that anaerobic strains isolated from cases of bacteremia had lower odds of metronidazole resistance.…”

Section: Discussioncontrasting

confidence: 58%

“…Imipenem is now widely used in hospital settings in case of complicated intra-abdominal infections. The previous data from Pakistan showed no resistance to carbapenems whereas our study shows 24.1% of imipenem resistance in metronidazole resistant strains, reflecting emerging resistance to carbapenems [12]. Imipenem resistance was also seen in at least one of the metronidazole susceptible isolates tested.…”

Section: Discussioncontrasting

confidence: 47%

“…Organisms inherently resistant to metronidazole were excluded from the comparison of metronidazole resistance in both study periods. An increasing trend of resistance was noted in metronidazole, as 12.4% tested strains were metronidazole resistant in 2010–2011 [12] compared to 17.5% in current study but the rise was found to be of no statistical significance (Table 1). Results were similar when assessed individually amongst the species.…”

Section: Resultsmentioning

confidence: 51%

“…Resistance was most frequently seen in Bacteroides species which was also the most commonly isolated organism. There is also an increasing trend of metronidazole resistance (12.4% in 2010–2011 to 17.5% in 2014–2017) [12]. Previous study conducted by the same group assessing resistance in clinical anaerobic isolates collected from AKUH laboratory using similar sampling strategy had reported 12.4% metronidazole resistance.…”

Section: Discussionmentioning

confidence: 99%

“…An earlier study from Pakistan conducted by same study group during 2010–2011 had reported metronidazole resistance rate of 12.3% amongst anaerobic isolates [12]. Metronidazole is one of the highly prescribed agents in the country and as per published reports its empirical use is 23.4% in cases of community acquired gastroenteritis in the country to cover parasitic etiology [5, 13].…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial susceptibility against metronidazole and carbapenem in clinical anaerobic isolates from Pakistan

Shafquat

Jabeen

Farooqi

et al. 2019

Antimicrob Resist Infect Control

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Background Globally metronidazole and carbapenem resistance in anaerobic organisms is increasing necessitating continuous surveillance to guide selection of empirical treatment. In this study we have determined metronidazole resistance in anaerobes using MIC Evaluator strips (M.I.C.E strips). Carbapenem resistance was evaluated only in metronidazole resistant isolates. Material and methods The study was conducted at the Aga Khan University (AKU) Hospital laboratory, Karachi, Pakistan (2014–2017). Metronidazole and imipenem resistance was evaluated using M.I.C.E strips and minimum inhibitory concentrations (MICs) were interpreted using Clinical Laboratory Standards Institute (CLSI) criteria. Clinical details including demographics, prolonged hospital stay, malignancy, transplant, dialysis, diabetes, site of infection and outcome were analyzed for association with metronidazole resistance. Results Of the 223 clinically significant isolates, 39 (17.5%) were metronidazole resistant (excluding the inherently resistant organisms; for example Cutibacterium species). Imipenem resistance was determined in 29 metronidazole resistant isolates and of these 7 (24.1%) were found to be resistant. Proportion of metronidazole resistant strains was highest amongst Bacteroides species. A significant increase in metronidazole resistance from 12.3% in 2010–2011 to 17.5% in the current study was found. Carbapenem resistance also emerged in the period 2014–2017. Isolates from malignancy and transplant patients showed lower odds of developing metronidazole resistance (0.003(95% CI: 1.7–17.9)). Prolonged hospital stay was not associated with metronidazole resistance (1.1((95% CI: 0.5–2.5)). Conclusion The rising trend of metronidazole resistance and emergence of carbapenem resistance in anaerobic bacteria is alarming. Continued surveillance with strengthening of laboratory capacity regarding anaerobic susceptibility testing is urgently needed in Pakistan.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussioncontrasting

confidence: 47%

Section: Resultsmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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