Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King khalid University, Abha 61421, Saudi Arabia.
Public Health Department, Health Sciences college at Al-Lieth, Umm Al-Qura University, Saudi Arabia.
J Infect Public Health. 2023 Dec;16 Suppl 1:61-68. doi: 10.1016/j.jiph.2023.09.019. Epub 2023 Oct 23.
Multi Drugs Resistance (MDR) is among the most worrisome healthcare issues resulting from inappropriate and indiscriminate utilization of antimicrobial agents which has compromised the efficacy and reliability of antimicrobial agents (AMAs). This has not only put a huge burden on the health care system but also is a major cause of morbidity and mortality. This project was designed to evaluate the prevalence of various microbial strains among patients admitted to various teaching hospitals and to assess their susceptibility and resistance towards clinically approved antibiotics.
The study was conducted during August 2021-February 2022 to determine the prevalence of common resistant strains of bacteria and to analyze their susceptibility pattern to the commonly prescribed antibiotics using standard procedures. One hundred and thirty biological samples including urine, blood, cerebrospinal fluid (CSF), wound swabs, pus and sputum were collected from the site of infection from the patients admitted at different wards of North West General Hospital (NWGH), Peshawar, Pakistan, Khyber Teaching Hospital (KTH), Peshawar Pakistan, and Hayat Abad Medical Complex (HMC) Peshawar Pakistan. Samples were collected and cultured following standard hospital procedures. The cultured samples were subjected to identification procedures including Gram staining, morphological characterization of bacterial colonies and biochemical assessments. The identified bacteria were tested for their susceptibility using Kirby-Bauer disc diffusion method. The diameter of Inhibitory Zones (DIZ) was analyzed following Clinical and Laboratory Standards Institute (CLSI) criteria. Minimum Inhibitory Concentrations (MICs) were evaluated using agar dilution method. Antimicrobials sensitivity were presented as antibiogram following CLSI M39 standard.
A total of one hundred and thirty biological samples were collected, out of which one hundred and nine samples were positive for bacterial growth and were further processed for detailed analysis. The frequency and type of bacteria isolated from various cultures indicated that Gram negative bacteria (n = 92/109) were more dominant than Gram-positive (n = 17/109) pathogens. The most prevalent bacteria isolated was Escherichia coli (29.35 %), followed by Staphylococcus aureus (15.59 %), and Klebsiella spp, (12.84 %). In addition, other pathogens including, Enterobacter spp, Citrobacter spp, and Acinetobacter spp. showed a prevalence of 9.175 %, 8.25 %, and 5.50 % respectively. As indicated in the antbiogram, several organisms exhibited considerble decline in the sensitivies towards various antibiotics. A high percentage of resistance was observed against some antibiotics including trimethoprim, co-trimoxazole, amoxicillin/clavulanate, ciprofloxacin, piperacillin/tazobactam, cefotaxime and ceftazidime.
The prevalence of resistant strains of pathogens is increasing day by day, while the antibiotics commonly prescribed against them are losing their efficacy, which is pushing the world to the era of pre-antibiotics. Unfortunately, the discovery of novel antibiotics is limited and researchers speculate that the is pushing towards pre-antibiotics era. Subsequently, efforts must be directed towards ensuring rational antibiotics use to prevent emergence of MDR pathogens. Our findings indicated that Gram negative bacteria including Escherichia coli was most prevalent. Other bacterial strains including S. aureus, Klebsiella spp, Enterobacter spp, Citrobacter spp, and Acinetobacter spp. were found among the causative agents. Unfortunately, considerable decline in the sensitivities of various bacterial isolated were observed towards the tested antibiotics. Previous studies reported the high prevalence of E. coli and S. aureus in clinical samples of Pakistani hospitals including hospitals in Peshawar and thus our findings are in agreement with the previous reports. Pharmacists being experts can play their role by promoting the optimal use of antimicrobial agents and educating healthcare professionals, patients and the public.
多药耐药性（MDR）是由于抗菌药物的不当和滥用而导致的最令人担忧的医疗保健问题之一，这损害了抗菌药物（AMAs）的疗效和可靠性。这不仅给医疗保健系统带来了巨大负担，也是发病率和死亡率的主要原因。本项目旨在评估各种教学医院住院患者中各种微生物菌株的流行情况，并评估它们对临床批准抗生素的敏感性和耐药性。
本研究于 2021 年 8 月至 2022 年 2 月进行，目的是确定常见耐药菌的流行情况，并使用标准程序分析它们对常用抗生素的敏感性模式。从巴基斯坦白沙瓦西北总医院（NWGH）、白沙瓦凯伯尔教学医院（KTH）和白沙瓦海亚特阿巴德医疗综合体（HMC）不同病房的感染部位采集了包括尿液、血液、脑脊液（CSF）、伤口拭子、脓液和痰在内的 130 个生物样本。样本按照标准医院程序进行采集和培养。培养的样本进行了鉴定程序，包括革兰氏染色、细菌菌落形态特征和生化评估。鉴定出的细菌使用 Kirby-Bauer 圆盘扩散法进行药敏试验。根据临床和实验室标准协会（CLSI）标准分析抑菌环（DIZ）的直径。使用琼脂稀释法评估最低抑菌浓度（MICs）。根据 CLSI M39 标准，将抗生素敏感性表示为抗生素图。
共采集了 130 个生物样本，其中 109 个样本细菌生长阳性，进一步进行了详细分析。从各种培养物中分离出的细菌的频率和类型表明，革兰氏阴性菌（n=92/109）比革兰氏阳性菌（n=17/109）病原体更为常见。分离出的最常见细菌是大肠杆菌（29.35%），其次是金黄色葡萄球菌（15.59%）和克雷伯菌属（12.84%）。此外，其他病原体包括肠杆菌属、柠檬酸杆菌属和不动杆菌属，其流行率分别为 9.175%、8.25%和 5.50%。药敏试验结果表明，几种病原体对各种抗生素的敏感性明显下降。一些抗生素如甲氧苄啶、复方磺胺甲噁唑、阿莫西林/克拉维酸、环丙沙星、哌拉西林/他唑巴坦、头孢噻肟和头孢他啶的耐药率较高。
耐药病原体的流行率日益增加，而常用的抗生素对它们的疗效却在下降，这将世界推向了抗生素前时代。不幸的是，新抗生素的发现受到限制，研究人员推测这将推动我们进入抗生素前时代。因此，必须努力确保合理使用抗生素，以防止出现多药耐药病原体。我们的研究结果表明，革兰氏阴性菌包括大肠杆菌最为常见。其他细菌株包括金黄色葡萄球菌、克雷伯菌属、肠杆菌属、柠檬酸杆菌属和不动杆菌属等也被发现是致病原因。不幸的是，我们发现分离出的各种细菌对测试抗生素的敏感性明显下降。以前的研究报告了巴基斯坦医院包括白沙瓦医院的临床样本中大肠杆菌和金黄色葡萄球菌的高流行率，因此我们的研究结果与以前的报告一致。药剂师作为专家，可以通过促进抗菌药物的合理使用以及教育医疗保健专业人员、患者和公众来发挥他们的作用。
