Kotwal Aarti, Biswas Debasis, Kakati Barnali, Singh Malvika
Associate Professor, Department of Microbiology, Himalayan Institute of Medical Sciences , Jolly Grant, Dehradun, Uttarakhand, India .
Additional Professor, Department of Microbiology, AIIMS B hopal, Saket Nagar, Bhopal, India .
J Clin Diagn Res. 2016 Apr;10(4):DC09-11. doi: 10.7860/JCDR/2016/18016.7612. Epub 2016 Apr 1.
Cefepime, a fourth generation cephalosporin, is widely used for the empirical treatment of serious infections in critically ill hospitalized patients. Pseudomonas aeruginosa (P. aeruginosa), one of the commonest bacteria causing nosocomial infections has a propensity to develop antibiotic resistance quite promptly.
We undertook this study to assess the efficacy of cefepime against current clinical isolates of P. aeruginosa and to study existence of different beta-lactamase enzymes among cefepime resistant P. aeruginosa isolates.
Total of 618 isolates of P. aeruginosa recovered consecutively from various clinical samples of a tertiary care hospital were analysed. Their Antimicrobial sensitivity profile against piperacilin (100μg), piperacillin/tazobactam (100μg/10μg), ceftazidime (30μg), cefoperazone (75μg), cefepime (30μg), ciprofloxacin (5μg), gentamycin (10μg), amikacin (30μg) and imipenem (10μg) (Himedia) was tested by Kirby-Bauer disc diffusion method (Clinical and Laboratory Standards Institute guidelines). We further looked for ESBL, MBL and ESBL + MBL co producers among the cefepime resistant isolates by two different methods (combined double disc synergy test, imipenem-EDTA combined disc test and vitek2).
Among 618 consecutive clinical isolates of P. aeruginosa, we observed resistance to cefepime in 457 (74%) isolates. We observed resistance to ciprofloxacin (n=506, 82%) in maximum number of isolates followed by that to Gentamycin (n=475, 77%), amikacin (n=366, 60%), and cefoperazone (n=350, 56.6%). Among all our cefepime resistant P. aeruginosa isolates only 27(6%) were ESBL producers, 18(4%) MBL producers and 2(0.4%) were ESBL+ MBL co-producers. All the ESBL and MBL isolates were also tested by VITEK 2 advanced expert system (bioMırieux Vitek Systems Inc, Hazelwood, MO, France) which revealed a 100% concordance with the phenotypic method tested.
This paper highlights the need to reconsider prescribing empirical antibiotics for Pseudomonas infections in this region and formulate a strong antibiotic policy to curb the menace of spread of multidrug resistant strains.
头孢吡肟是一种第四代头孢菌素，广泛用于重症住院患者严重感染的经验性治疗。铜绿假单胞菌是引起医院感染最常见的细菌之一，很容易迅速产生抗生素耐药性。
我们开展本研究以评估头孢吡肟对当前铜绿假单胞菌临床分离株的疗效，并研究头孢吡肟耐药的铜绿假单胞菌分离株中不同β-内酰胺酶的存在情况。
分析了从一家三级护理医院的各种临床样本中连续分离出的618株铜绿假单胞菌。通过 Kirby-Bauer 纸片扩散法（临床和实验室标准协会指南）检测它们对哌拉西林（100μg）、哌拉西林/他唑巴坦（100μg/10μg）、头孢他啶（30μg）、头孢哌酮（75μg）、头孢吡肟（30μg）、环丙沙星（5μg）、庆大霉素（10μg）、阿米卡星（30μg）和亚胺培南（10μg）（Himedia）的抗菌敏感性。我们通过两种不同方法（联合双纸片协同试验、亚胺培南-EDTA 联合纸片试验和 Vitek2）在头孢吡肟耐药分离株中进一步寻找超广谱β-内酰胺酶（ESBL）、金属β-内酰胺酶（MBL）以及 ESBL+MBL 共同产生菌。
在618株连续的铜绿假单胞菌临床分离株中，我们观察到457株（74%）对头孢吡肟耐药。我们观察到分离株中对环丙沙星耐药的数量最多（n = 506，82%），其次是对庆大霉素耐药（n = 475，77%）、阿米卡星耐药（n = 366，60%）和头孢哌酮耐药（n = 350，56.6%）。在我们所有头孢吡肟耐药的铜绿假单胞菌分离株中，只有27株（6%）是ESBL产生菌，18株（4%）是MBL产生菌，2株（0.4%）是ESBL+MBL共同产生菌。所有ESBL和MBL分离株也通过VITEK 2高级专家系统（法国生物梅里埃公司，密苏里州黑兹尔伍德）进行检测，结果显示与所测试的表型方法100%一致。
本文强调需要重新考虑该地区针对铜绿假单胞菌感染经验性使用抗生素的情况，并制定强有力的抗生素政策以遏制多重耐药菌株传播的威胁。
