Bacterial resistance Medical Presentation

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Slide 1-

IN THE NAME OF GOD
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Study of the antibiotic sensitivity profile of the bacterial isolates from the blood sample of the patients in different wards of Shahid Faghihi hospital, Shiraz, Iran 2015-2016
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By : Aida Salehi Nobandegani Advisor: Mohammad Motamedifar PhD Associated professor of bacteriology
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Introduction
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Introduction Infectious diseases have always constituted the most serious health issue in the world.
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Introduction The explosive characteristics and unpredictability of epidemics are a cause of fear and insecurity even today, as could be clearly seen during the recent SARS epidemic.
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An illness caused by a specific infectious agent or its toxic product that results from transmission of that agent or its products from an infected person, animal, or reservoir to a susceptible host.
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Infectious agent All micro-organisms or macro-organisms capable of producing an infection or an infectious disease.
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Infection The entrance and development of an infectious agent in a human or animal body, whether or not it develops into a disease.
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Bloodstream infection Also known as bacteremia, or septicemia occurs when a bacterial infection elsewhere in the body enters the bloodstream.
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Pathogens The causative organisms for sepsis have evolved over many years. Originally sepsis was described, and strongly considered to be, a disease specifically related to Gram-negative bacteria.
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We now recognize that sepsis may occur from any bacteria, as well as from fungal and viral organisms. Yet the prevalence is different in various parts of the world. Pathogens
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As soon as antibacterial drugs were used, bacteria responded by manifesting various forms of resistance. As antimicrobial usage increased, so did the level and complexity of the resistance mechanisms exhibited by bacteria. introduction
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The struggle to win against infections continues to this day as bacteria evolve more and more clever mechanisms of resistance
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Resistance Antibiotic resistance occurs when bacteria change in a way that reduces the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections.
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Bacterial resistance complication difficult-to-treat infection untreatable infections with conventional antimicrobials Increased course of hospitalization Increased cost high morbidity Mortality
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Review of articles
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Morei et al in Tanzania in 2015 3330 microbiological culture 13.2% positive culture samples The most isolated bacteria : 1.S.aureus (22.8%) → 34.6% MRSA 2.K.pneumoniae (14.8%) → 38.5% 3rd generation cephalosporin resistance 3.E.coli (9.3%) → 29.3% 3rd generation cephalosporin resistance
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Gohel et al in India in 2014 1440 microbiological culture 9.2% positive culture samples The most isolated bacteria : 1. Gram-positive (58.3%) → 70.6% MRSA 2. gram negative (40.2%) → 39.6% ESBL 3.fungi (1.5%)
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Wasihun et al in Ethiopia in 2014 514 febrile patients 28% positive culture samples The most isolated bacteria : 1. S.aureus 37.5% 2. Coagulase-negative staph 30.6% 3. E.coli 3.1% 4. Citrobacter spp. 1.7% 5. S.typhi 1.6%,
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Rabirad et al in Tehran in 2014
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Alam et al in India in 2013
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Because the early identification of causative microorganisms and their antimicrobial susceptibility patterns in patients with bacteremia and other serious infections is lacking in many health care settings, broad spectrum antibiotics are liberally and mostly unnecessarily used . Importance of our study
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Dramatic increases in emerging resistance occur and, when coupled with poor infection control practices, resistant bacteria can easily be disseminated to the other patients and environments Importance of our study
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Availability of updated epidemiological data on antimicrobial resistance in frequently encountered bacterial pathogens will be useful not only for deciding on treatment strategies but also for devising an effective antimicrobial stewardship program in hospitals Importance of our study
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The main goal Determining the antibiotic sensitivity profile of the bacterial isolates from the blood sample of the patients in different wards of Shahid Faghihi hospital, Shiraz, Iran 2015-2016
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The practical goal By finding most common pathogens causing bacteremia and their antibiotic sensitivity profile, we can suggest the most proper antibiotic for empirical therapy in order to reduce treatment failure, course of hospitalization, , cost and morbidity and morality rate.
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Objectives Determine the prevalence of bacterial pathogens causing septicemia Determine the bacterial sensitivity and resistance to antibiotics Determine the effectiveness of antibiotics on different species of bacteria
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Method retrospective study 12-month period (September 2015 to September 2016) Patients with nosocomial or community acquired infections who were admitted at the different ward of Faghihi Hospital
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Data gathering form patients' data: 1.age 2.sex 3.culture results 4.antibiogram test results
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Method Laboratory records of the blood cultures The bactec bottles were incubated at 37°C for 10 days aerobically. Routine sub culturing was performed on MacConkey agar and 5% sheep blood agar after 24 hours, 48 hours, 5 days and 10 days.
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Method Microorganisms that isolated from blood culture were recognized by: cultural characters morphology variety of standard biochemical tests oxidase TSI SIM Citrate OF Lysine decarboxylase Gelatinase MR/VP
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Kirby-Bauer disk diffusion method test antimicrobial susceptibility
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Performed antibiogram disks Vancomycin (V, 30 mcg), Ciprofloxacin (CIP, 5 mcg), Clindamycin (CD, 2 mcg) Cotrimoxasol (SXT, 30mcg) Gentamicin (GM, 10 mcg) Penicillin G (P, 10 mcg) Amikacin (AMK, 30 mcg) Rifampin (RIF, 5 mcg) Cefotaxime (CTX, 30 mcg) Ceftazidime (CAZ, 30 mcg) Ceftriaxone (CTR, 30 mcg) Cefazolin (CZ, 30mcg) Piperacillin (PIP, 100 mcg) Imipenem (IPM, 10mcg) Ampicillin (AM, 10 mcg)
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Data analysis Data analysis by SPSS software for Windows (version 22). Student’s t test pair t test Chi-square test : relationships between the variables significance level = P<0.05
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Result 6300 blood samples 20% (1262 samples) positive blood culture mean age of 55.2 years old 686 males (54.4%) 576 female (45.6%)
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The most frequent isolated microorganisms
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The most frequent isolated microorganisms
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Sensitivity and resistance of gram negatives to different antibiotics
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Sensitivity and resistance of gram positives to different antibiotics
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Sensitivity and resistance of gram positive and negative microorganisms to ciprofloxacin
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Sensitivity of Enterobacter to different antibiotic
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Sensitivity of Acintobacter to different antibiotic
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Sensitivity of E.coli to different antibiotics
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Sensitivity of Alcaligenes to different antibiotics
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Sensitivity of Klebsiella to different antibiotics
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Sensitivity of Pseudomonas to different antibiotics
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Sensitivity of Brucella to different antibiotics
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Sensitivity of Staph. aureus to different antibiotics
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Sensitivity of Staph. epidermis to different antibiotics
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Sensitivity of Enterococci to different antibiotics
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Sensitivity of Non hemolytic strep to different antibiotics
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Sensitivity of Micrococci to different antibiotics
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Sensitivity of Diphtheroid to different antibiotics
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Discussion
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Gram-negative bacteria : the most cause of bloodstream infections in many countries the most common contributing pathogens of bloodstream infections in the our study Discussion
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A study in Brazil hospitals : E. coli , Klebsiella a study in India : P.aeruginosa, E.coli, and Klebsiella pneumoniae In our study : Alcaligenes ,E. coli ,and Klebsiella Discussion the most common Gram-negative bacteria
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Discussion Acintobacter: the most resistance bacteria against antibiotics 93.5% resistant to Imipenem In the Hamishekar et al study: one of gram negative multi drug resistant strains (MDR in 25.8% of Acineobacter)
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In our study the most effective antibiotic was imipenem, piperacillin tazobactam, gentamicin, amikacin. The least effective antibiotic was cefepime. In Manjula study ceftriaxone and cefotaxime were the highest effective in gram negatives. Discussion against Gram negatives
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study in Brazil hospitals: S.aureus ,Coagulase-negative Strep study in India: S.aureus, other Strep and Staph spp In our study : S.aureus , S. epidermidis study in the ICUs in Tabriz: the same Mohammad taheri et al. and Khalili et al. in ICU and infectious ward settings in Iran: the same Discussion most common Gram-positive bacteria:
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Discussion Enterococci the most resistance gram positive bacteria against antibiotics. 22.2% resistant to Vancomycin as the best antibiotic choice against gram positives In Biswas study: 2.0% vancomycin resistant or intermediate
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Discussion against Gram positive In our study the most effective antibiotic was Vancomycin, Rifampin, Cephalotin and Cefazolin. The least effective antibiotic was penicillin. In Hamishekar study: the most active antimicrobials was vancomycin (93.5%) In a study by Jopani in Shiraz: Vancomycin was the most active antibiotics
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Discussion Gram-negative bacteria is more resistance to antibiotics than Gram-positive, in our study the total resistance of gram negative bacteria to antibiotics were 51.5% comparing to the 48.5% in gram positive strains
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Discussion Why are bacteria becoming resistant to antibiotics? Overuse misuse of antibiotics Easy availability of different antibiotics
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conclusion Resistance to majority of the antimicrobial agents for several pathogens implicated in bloodstream infections, particularly in Gram-negative bacteria, can increase complications and mortality in treatment of infection cause by them.
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Acknowledgements I would like to express my sincere gratitude to my supervisor Professor Motamedifar for the continuous support of my research, for his patience, motivation, and immense knowledge. His guidance helped me in all the time of research and writing of this thesis.
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