MULTIDRUG-RESISTANT NON-FERMENTING GRAM-NEGATIVE BACILLI OTHER THAN P. AERUGINOSA AND A. BAUMANNII COMPLEX CAUSING INFECTIONS AT A TERTIARY CARE HOSPITAL: A THERAPEUTIC CONCERN
DOI:
https://doi.org/10.22159/ajpcr.2024v17i8.51003Keywords:
antimicrobial resistance, multidrug-resistant, colistin resistance, broth microdilutionAbstract
Objective: This study aimed to identify the various unusual multidrug-resistant non-fermenting Gram-negative bacilli (MDR-NFGNB) other than Pseudomonas aeruginosa and Acinetobacter species isolated from the clinical specimens and to evaluate their antibiotic susceptibility pattern.
Methods: This cross-sectional study conducted from January 2021 to June 2022 at a tertiary care teaching hospital identified unusual MDR NFGNB from clinical specimens using standard procedures and antibiotic susceptibility was done as per Clinical and Laboratory Standards Institute guidelines (including colistin susceptibility testing by broth microdilution).
Results: A total of 523 unusual NF-GNB were isolated from 21,019 culture-positive clinical samples, of which 185 (35.3%) were MDR. Majority of these unusual NF-GNB isolated were from pus specimen (43.2%) followed by blood (22.7%). Out of 185 non-duplicate MDR non-fermenters, the most common were Acinetobacter lwoffii, Acinetobacter haemolyticus, Pseudomonas fluorescens, Pseudomonas putida, Pseudomonas stutzeri, Pseudomonas luteola, Stenotrophomonas maltophilia, Burkholderia cepacia, Elizabethkingia meningoseptica, Alcaligenes, Ralstonia pickettii, Sphingomonas, and Chryseobacterium indologenes.
Conclusion: Any unusual NFGNB culture isolates from clinically significant infections should be correlated clinically for its pathogenic potential and identified using standard methods, to provide adequate and timely antibiotic coverage.
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References
Ayoub Moubareck CA. Polymyxins and bacterial membranes: A review of antibacterial activity and mechanisms of resistance. Membranes(Basel). 2020;10(8):1-30. doi: 10.3390/membranes10080181
Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, Van Duin D, Clancy CJ. Infectious Diseases Society of America guidance on the treatment of AmpC β-lactamase-producing Enterobacterales, Carbapenem-resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia infections. Clin Infect Dis. 2022;74:2089-114.
El Chakhtoura NG, Saade E, Iovleva A, Yasmin M, Wilson B, Perez F, et al. Therapies for multidrug resistant and extensively drug-resistant non-fermenting gram-negative bacteria causing nosocomial infections: A perilous journey toward “molecularly targeted” therapy. Expert Rev Anti Infect Ther. 2019;16(2):89-110.
Ndzabandzaba S, Mothibi L, Von Knorring N. Non-fermenter Gram-negative bacilli at a tertiary hospital, South Africa. S Afr J Infect Dis. 2023;38(1):538.
Malini A, Deepa E, Gokul B, Prasad S. Nonfermenting Gram-negative bacilli infections in a tertiary care hospital in Kolar, Karnataka. J Lab Physicians. 2009;1(2):62-6. doi: 10.4103/0974-2727.59701, PMID 21938252
Juyal D, Negi V, Prakash R, Shanakarnarayan S, Sharma M, Sharma N. Prevalence of non-fermenting gram negative bacilli and their in vitro susceptibility pattern in a tertiary care hospital of Uttarakhand: A study from foothills of Himalayas. Saudi J Health Sci. 2013;2(2):108-12.
Gajdács M, Burián K, Terhes G. Resistance levels and epidemiology of non-fermenting gram-negative bacteria in urinary tract infections of inpatients and outpatients (RENFUTI): A 10-year epidemiological snapshot. Antibiotics (Basel). 2019;8(3):143. doi: 10.3390/ antibiotics8030143, PMID 31505817
Chawla K, Vishwanath S, Munim FC. Nonfermenting Gram-negative bacilli other than Pseudomonas aeruginosa and Acinetobacter spp. Causing respiratory tract infections in a tertiary care center. J Glob Infect Dis. 2013;45(4):144-8. doi: 10.4103/0974-777X.121996, PMID 24672175.
Soni M, Kapoor G, Perumal N, Chaurasia D. Emergence of multidrug-resistant non-fermenting Gram-negative bacilli in a tertiary care teaching hospital of central India: Is colistin resistance still a distant threat? Cureus 2023;15(5):e39243. doi: 10.7759/cureus.39243, PMID 37342731
Clinical and Laboratory Standards Institute (CLSI). M100 Performance Standards for Antimicrobial Susceptibility Testing. Vol. M100-Ed32. United States: Clinical and Laboratory Standards Institute (CLSI); 2021. p. 260.
Test CS, Gram A, Bacteria N. Broth - microdilution Colistin Susceptibility Test for Aerobic Gram - Negative Bacteria Standard Operating Procedure; 2020 (August).
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81. doi: 10.1111/j.1469-0691.2011.03570.x, PMID 21793988
Gupta N, Gandham N, Jadhav S, Mishra RN. Isolation and identification of Acinetobacter species with special reference to antibiotic resistance. J Nat Sci Biol Med. 2015;6(1):159-62. doi: 10.4103/0976-9668.149116, PMID 25810655
Umar Z, Ashfaq S, Parikh A, Ilyas U, Foster A, Bhangal R, et al. Stenotrophomonas maltophilia and urinary tract infections: A systematic review. Cureus. 2022;14(6):e26184. doi: 10.7759/cureus.26184, PMID 35891807
Batra P, Mathur P, Misra MC. Clinical characteristics and prognostic factors of patients with Stenotrophomonas maltophilia infections. J Lab Physicians. 2017;9(2):132-5. doi: 10.4103/0974-2727.199639, PMID 28367030
Govan JR, Brown AR, Jones AM. Evolving epidemiology of Pseudomonas aeruginosa and the Burkholderia cepacia complex in cystic fibrosis lung infection. Future Microbiol. 2007 April;2(2):153-64. doi: 10.2217/17460913.2.2.153, PMID 17661652
Suhartono S, Mahdani W, Muzayanna NN. Prevalence of Burkholderia cepacia recovered from clinical specimens in the Zainoel Abidin general hospital, Banda Aceh, Indonesia. Iran J Microbiol. 2023;15(1):38-44. doi: 10.18502/ijm.v15i1.11916, PMID 37069904
Mali S, Dash L, Gautam V, Shastri J, Kumar S. An outbreak of Burkholderia cepacia complex in the paediatric unit of a tertiary care hospital. Indian J Med Microbiol. 2017;35(2):216-20. doi: 10.4103/ ijmm.IJMM_16_258, PMID 28681809
Izaguirre-Anariba DE, Sivapalan V. Chryseobacterium indologenes, an emerging bacteria: A case report and review of literature. Cureus. 2020;12(1):e6720. doi: 10.7759/cureus.6720
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