Trends in antimicrobial resistance amongst pathogens isolated from blood and cerebrospinal fluid cultures in Pakistan (2011-2015): A retrospective cross-sectional study

Javaid, Nida; Sultana, Qamar; Rasool, Karam; Gandra, Sumanth; Ahmad, Fayyaz; Chaudhary, Safee Ullah; Mirza, Shaper

doi:10.1371/journal.pone.0250226

Cited by 14 publications

(10 citation statements)

References 37 publications

(48 reference statements)

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“…Studies conducted in Karachi and Hyderabad, Pakistan also showed similar findings of antimicrobial resistance where S. typhi was resistant to most of the antibiotics while there was around 100 % sensitivity to Azithromycin and Meropenem 10,19,24 Now-a days the drug of choice is Azithromycin oral or Meropenem intravenous in the hospitalized patients 1,24 , these findings also support our study.…”

Section: Azt=aztreonam Amp=ampicillin Cefix=cefixime Ceft=ceftriaxone...supporting

confidence: 87%

Frequency and Antimicrobial Resistance Profile of Salmonella Typhi Isolated From District Buner

Ali¹,

Rahman²,

Adeeb³

et al. 2022

JMS

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Objective: The objective of this study was to investigate the frequency and drug resistance of Salmonella typhi in district Buner, Khyber Pakhtunkhwa. Methodology: This cross-section study was conducted at District Head Quarter Hospital Buner and private diagnostic centers from Jan 2020 to May 2021. A total of 460 blood samples were collected from OPD patients reported with signs and symptoms of Typhoid fever. Samples were cultured on blood and MacConkey agar and incubated at 37? for 24 hours. Bacterial identification was done on colony morphology, gram staining, and polyvalent antisera for strain identification. Finally, antibiotic susceptibility testing was done for the isolated bacteria. All commonly prescribed first-line and second-option antibiotics were tested on Mueller Hinton agar by Kirby Bauer disk diffusion method following CLSI guidelines 2020. Result: A total of 240 out of 460 samples showed bacterial growth where Salmonella typhi was found in 98 (40.8%) cases. Among them, 28(28.6%) were reported as MDR while 1 (17.4%) were XDR. Out of the XDR, 4 strains were found resistant to Vancomycin and clarithromycin as well. The isolated S. typhi was 100% sensitive to Meropenem, and Azithromycin, however showed 100% resistance to Aztreonam, Ampicillin, and Cotrimoxazole. Prevalence of S. typhi was more (50%) in females while resistance was reported more in age group 20-40 years. Conclusion: The frequency of Salmonella typhi at district Buner was 41% in patients reported with high-grade fever where 28% of the strains reported were multidrug resistant. Some extended spectrum drug-resistant S. typhi and Vancomycin and Clarithromycin resistant strains were also reported which is alarming. Meropenem, and Azithromycin were the only drugs effective against most of the strains. However, resistance to these drugs may develop soon if we do not stop the empirical excessive use of antibiotics. Keywords: Multidrug-resistant, Salmonella typhi, Typhoid fever, Extended spectrum drug-resistant

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Section: Azt=aztreonam Amp=ampicillin Cefix=cefixime Ceft=ceftriaxone...supporting

confidence: 87%

Frequency and Antimicrobial Resistance Profile of Salmonella Typhi Isolated From District Buner

Ali¹,

Rahman²,

Adeeb³

et al. 2022

JMS

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“…Travel and trade can contribute to this spread; the spread of NDM-1, from Indian sub-continent region to Europe and United States highlights the global nature of this public health disaster [ 3 ]. Reports of high levels of antibacterial resistance [ 4 – 7 ] from hospitals as well as the community [ 8 , 9 ] in Pakistan, the fifth most populous country globally [ 10 ], places an additional burden on an overstressed and under resourced health care system. Circulating mobile genetic elements in bacterial species [ 5 , 7 , 11 ] that can transfer multidrug resistance genes within and between species have also been reported.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial resistance among GLASS priority pathogens from Pakistan: 2006–2018

et al. 2021

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Background In 2018 Pakistan initiated its national antimicrobial resistance (AMR) surveillance aligned with Global Antimicrobial Surveillance System (GLASS). To complement this surveillance, we conducted a situational analysis of AMR rates among GLASS organisms in the country. Data from published studies and from antibiograms was compared and role of antibiograms as potential contributors to national AMR surveillance explored. Methods AMR rates for GLASS specified pathogen/antimicrobials combination from Pakistan were reviewed. Data sources included published studies (2006–2018) providing AMR rates from Pakistan (n = 54) as well as antibiograms (2011–2018) available on the Pakistan Antimicrobial Resistance Network (PARN) website. Resistance rates were categorized as follows: Very low: 0–10%, Low: 11–30%, Moderate: 30–50% and High: > 50%. Results Published data from hospital and community/laboratory-based studies report resistance rates of > 50% and 30–50% respectively to 3rd generation cephalosporins, fluoroquinolones and cotrimoxazole amongst Klebsiella pneumoniae and Escherichia coli. Carbapenem resistance rates amongst these organisms remained below 30%. High (> 50%) resistance was reported in Acinetobacter species to aminoglycosides and carbapenems among hospitalized patients. The evolution of ceftriaxone resistant Salmonella Typhi and Shigella species is reported. The data showed > 50% to fluoroquinolones amongst Neisseria gonorrhoeae and the spread of methicillin resistant Staphylococcus aureus (< 30%; 2008) to (> 50%; 2010) in hospital settings. Resistance reported in published studies aligned well with antibiogram data. The latter also captured a clear picture of evolution of resistance over the study period. Conclusion Both published studies as well antibiograms suggest high rates of AMR in Pakistan. Antibiogram data demonstrating steady increase in AMR highlight its potential role towards supplementing national AMR surveillance efforts particularly in settings where reach of national surveillance may be limited.

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“…(7.3%), data from Pakistan suggested a sharp increase of CR among Acinetobacter spp. from 50% in 2011 to 95.5% in 2015 [ 64 , 65 , 66 ], 61.89% imipenem resistant Acinetobacter spp. in 2018 and 84.0% in 2022 [ 56 , 67 ].…”

Section: Discussionmentioning

confidence: 99%

Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan

et al. 2023

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Carbapenem resistance has become major concern in healthcare settings globally; therefore, its monitoring is crucial for intervention efforts to halt resistance spread. During May 2019–April 2022, 2170 clinical strains were characterized for antimicrobial susceptibility, resistance genes, replicon and sequence types. Overall, 42.1% isolates were carbapenem-resistant, and significantly associated with Klebsiella pneumoniae (K. pneumoniae) (p = 0.008) and Proteus species (p = 0.043). Carbapenemases were detected in 82.2% of isolates, with blaNDM-1 (41.1%) associated with the ICU (p < 0.001), cardiology (p = 0.042), pediatric medicine (p = 0.013) and wound samples (p = 0.041); blaOXA-48 (32.6%) was associated with the ICU (p < 0.001), cardiology (p = 0.008), pediatric medicine (p < 0.001), general surgery (p = 0.001), general medicine (p = 0.005) and nephrology (p = 0.020); blaKPC-2 (5.5%) was associated with general surgery (p = 0.029); blaNDM-1/blaOXA-48 (11.4%) was associated with general surgery (p < 0.001), and wound (p = 0.002), urine (p = 0.003) and blood (p = 0.012) samples; blaOXA-48/blaVIM (3.1%) was associated with nephrology (p < 0.001) and urine samples (p < 0.001). Other detected carbapenemases were blaVIM (3.0%), blaIMP (2.7%), blaOXA-48/blaIMP (0.1%) and blaVIM/blaIMP (0.3%). Sequence type (ST)147 (39.7%) represented the most common sequence type identified among K. pneumoniae, along with ST11 (23.0%), ST14 (15.4%), ST258 (10.9%) and ST340 (9.6%) while ST405 comprised 34.5% of Escherichia coli (E. coli) isolates followed by ST131 (21.2%), ST101 (19.7%), ST10 (16.0%) and ST69 (7.4%). Plasmid replicon types IncFII, IncA/C, IncN, IncL/M, IncFIIA and IncFIIK were observed. This is first report describing the carbapenem-resistance burden and emergence of blaKPC-2-ST147, blaNDM-1-ST340 and blaNDM-1-ST14 in K. pneumoniae isolates and blaNDM-1-ST69 and blaNDM-1/blaOXA-48-ST69 in E. coli isolates coharboring extended-spectrum beta-lactamases (ESBLs) from Pakistan.

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Trends in antimicrobial resistance amongst pathogens isolated from blood and cerebrospinal fluid cultures in Pakistan (2011-2015): A retrospective cross-sectional study

Cited by 14 publications

References 37 publications

Frequency and Antimicrobial Resistance Profile of Salmonella Typhi Isolated From District Buner

Frequency and Antimicrobial Resistance Profile of Salmonella Typhi Isolated From District Buner

Antimicrobial resistance among GLASS priority pathogens from Pakistan: 2006–2018

Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan

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