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  Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 4  |  Page : 583-586
 

Bacteriological trends and antibiotic susceptibility patterns of clinical isolates at Government Cancer Hospital, Marathwada


Department of Microbiology, Government Cancer Hospital, Aurangabad, Maharashtra, India

Date of Web Publication21-Apr-2017

Correspondence Address:
S Nazneen
Department of Microbiology, Government Cancer Hospital, Aurangabad, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_34_17

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 » Abstract 

INTRODUCTION: Preventing and starting early treatment of infections in patients whose immunity system is weak due to malignancies can reduce mortality. Since our hospital is a newly constructed one, this study aimed to determine microbial and antibiotic resistance patterns in clinical samples of patients with cancer at our center to start early treatment before the results of clinical tests are known. SUBJECTS AND METHODS: The study was carried out in the Department of Microbiology, Government Cancer Hospital during the period from January 2016 to December 2016. A total 170 clinical samples (urine, blood, sputum, pus, etc.) were collected and processed for culture, identification as per standard recommended procedures and antibiotic susceptibility testing were carried out on isolates as per Clinical Laboratory Standard Institute guidelines. RESULTS: A total of 170 specimens were cultured. Escherichia coli, Acinetobacter spp. , Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa were most commonly encountered. A high level of resistance to various antibiotics was noted among Gram-negative bacteria. Resistance among Gram-positive was not acute. CONCLUSION: The present study reveals microbiological profile in patients attending our hospital. Regular surveillance helps in implementing better therapeutic strategies to reduce morbidity and mortality associated in patients in health-care facility.


Keywords: Carbapenemases, extended-spectrum beta-lactamase, immunocompromised, multidrug resistance


How to cite this article:
Nazneen S, Mukta K, Santosh C, Borde A. Bacteriological trends and antibiotic susceptibility patterns of clinical isolates at Government Cancer Hospital, Marathwada. Indian J Cancer 2016;53:583-6

How to cite this URL:
Nazneen S, Mukta K, Santosh C, Borde A. Bacteriological trends and antibiotic susceptibility patterns of clinical isolates at Government Cancer Hospital, Marathwada. Indian J Cancer [serial online] 2016 [cited 2019 Sep 22];53:583-6. Available from: http://www.indianjcancer.com/text.asp?2016/53/4/583/204761



 » Introduction Top


Cancers are one of the top global hygiene and health issues after cardiovascular diseases, traumatic accidents, and major crises in the world. Cancer caused about 13% of all human deaths worldwide. More than half of all cancer cases and about 60% of deaths occur in developing countries.[1]

In spite of the vast advances made by medical science in cancer treatment, infections remain a major cause of morbidity and mortality in patients diagnosed with cancer.[2],[3] The cancer patient is immunocompromised because of the nature of the disease itself and also due to interventions in the form of chemotherapy, etc., in addition, there are usually other associated risk factors for acquiring infection such as long-term catheterization, changes in intestinal microbial flora due to multiple antibiotic medications, mucositis due to cytotoxic agents, neutropenia, and stem cell transplantation.[1],[3]

The increased risk of bacterial infection is further compounded by rising trends of antibiotic resistance in commonly implicated organisms worldwide. Antibiotic resistance among bacteria is becoming more and more serious problem throughout the world.[4],[5] In recent years, strains of multidrug resistant organisms (MDROs) have become quadrupled worldwide. At present, antimicrobial resistance poses a major threat to patient's treatment as it leads to increased morbidity and mortality, increased hospital stay, and severe economic loss to the patient and nation.[6] This is particularly true in the case of members of Enterobacteriaceae group such as Escherichia coli and Klebsiella spp. and nonfermenter group of bacteria such as Pseudomonas spp. and Acinetobacter spp.[4],[5]

Increasing resistance among Gram-positive organisms is also matter of concern and high rates of methicillin resistant Staphylococcus aureus (MRSA) in clinical samples have been noted. Similarly resistance to glycopeptide antibiotics such as vancomycin and teicoplanin among clinical isolates of Enterococci spp. is also increasing.[5],[7]

The pattern of bacteria causing infections and their antibiogram vary widely from one country to another as well as from one hospital to other and even among the Intensive Care Units with one hospital. There also appears to be a significant lack of studies highlighting susceptibility patterns of locally prevalent organisms.[5]

Antibiotic treatment can be administered once the symptoms of infection were manifested on the conditions that the common bacterial agents causing infection in these patients as well as their antibiotic sensitivity and resistance patterns were known. Administration of antibiotic treatment at the beginning of manifestation of symptoms of the disease can even prevent the spread of the disease and may ultimately reduce rates of deaths, disabilities, and complications due to cancer.[1]

Knowledge of etiological agents of infections and their sensitivities to available drugs is of immense value to the rational selection and use of antimicrobial agents and to the development of appropriate prescribing policies.[8] Thus, this study aims to bridge the gap in knowledge and provide the clinician with the tools to provide safe and effective empirical therapy by identifying the prevalence of common bacterial isolates and their antimicrobial susceptibility pattern of various clinical samples from patients attending cancer hospital.


 » Subjects and Methods Top


The present study is a prospective study carried out at the Department of Microbiology, Government Medical College and Cancer hospital, Aurangabad, Marathwada.

We conducted a 1-year study of all isolates from samples of patients received from different oncology units from January 2016 to December 2016. All relevant samples were collected as per hospital sample collection protocol from various clinical areas; these included blood, pus/wound swabs, sputum, drain fluids, and urine. The clinical data were obtained from the requisition forms and from the respective units and wards of the patient. All samples were processed as per standard microbiology laboratory operating procedures.[9],[10] The isolates were identified by their colonial morphology, Gram-staining, and different biochemical reactions using standard techniques.[9],[10] Criteria for antimicrobial sensitivity testing were carried out as per Clinical Laboratory Standard Institute (CLSI).[11] Antimicrobial sensitivity testing was done on Muller Hinton Agar (MHA) by Kirby-Bauer's disc diffusion method. Commercially available discs (HiMedia) were used. Zones of inhibition were measured the next day and were correlated with CLSI interpretive breakpoints to characterize them as sensitive, intermediate, and resistant. For drugs for which CLSI breakpoints are not available, interpretative breakpoints were provided by the manufacturer. S. aureus ATCC 25923, E. coli ATCC 25922, and Pseudomonas aeruginosa ATCC 27853 were used for quality control.

For Gram-positive organisms, the antibiotics to be tested and reported were chosen from the following (depending on the organism isolated): Penicillin (10 units), erythromycin (15 μg), clindamycin (2 μg), gentamicin (10 mcg), and high level (30 mcg), amoxicillin-clavulanate (20/10 μg), cefoxitin (30 μg), levofloxacin (5 μg), vancomycin (30 μg/minimum inhibitory concentration), linezolid (30 μg), and cotrimoxazole (1.25/23.75 μg).

For Gram-negative, the antibiotics for respective organisms were chosen from the following: Ciprofloxacin (5 μg), levofloxacin (5 μg), norfloxacin (5 μg), gentamicin (10 μg), amikacin (30 μg), cefpodoxime (30 μg), cefotaxime (30 μg), ceftazidime (30 μg), cefepime (30 μg), piperacillin + tazobactum (100/10 mcg), imipenem (10 μg), and colistin.

MRSA was tested using MHA with cefoxitin disc (30 mcg) by Kirby-Bauer disc diffusion methods as per CLSI guidelines.[11]

Suspected extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae were confirmed by double-disk synergy test as per CLSI guidelines.[11]


 » Results Top


During the period of 1 year, total 170 samples were received and processed from different sections of the hospital. [Table 1] shows the numbers and percentage of various specimens received. One hundred and ten (64.70%) organisms were isolated. A total number of organisms isolated from various clinical samples are shown in [Table 2].
Table 1: Number and type of clinical samples received (n=170)

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Table 2: Number of organisms isolated from various clinical samples (n=110)

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Seventy-six (69.09%) were Gram-negative isolates and 26 (23.63%) were Gram-positive isolates. Most common bacteria isolated were E. coli, 25 (22.72%) followed by Acinetobacter spp. 22 (20%), S. aureus 17 (15.45%), and P. aeruginosa and Klebsiella spp. each 12 (10.90%).

Among the Gram-negatives, the most prevalent organisms isolated were E. coli (32.89%) followed by Acinetobacter (28.94%) and Klebsiella (15.78%) and Pseudomonas (15.78%). Other organisms isolated were Proteus and Gram-negative nonfermenter [Table 3]. Among the Gram-positives, the most prevalent organisms isolated were S. aureus (65.38%) followed by Enterococcus (34.61%) [Table 4].
Table 3: Gram-negative isolates (n=76)

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Table 4: Gram-positive isolates (n=26)

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Our study showed a very high resistance among the Gram-negative bacteria (GNB) against various antibiotics. Seventy-one percent of the total GNB turned out to be ESBL producers. ESBL production in E. coli and Klebsiella was 68% and 66%, respectively. Resistance to carbapenems was highest among Pseudomonas (25%) and Klebsiella (25%) followed by Acinetobacter [22%]. Refer [Table 5] and [Table 6] for detailed antibiogram of GNB and Gram-positive cocci, respectively. 17.64% Gram-positive isolates turned out to be MRSA.
Table 5: Resistance to antibiotics among common Gram-negative isolates (%)

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Table 6: Resistance to antibiotics among common Gram-positive isolates (%)

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 » Discussion Top


Since our hospital is a newly constructed 100 bedded cancer hospital, the study was undertaken to evaluate the developing bacterial trends and their susceptibility patterns to understand the prevalent resistance patterns and to determine the effectiveness of prescribed drugs for treatment of infections. Pneumonia and bacteremia are common infections seen in cancer patients followed by a urinary tract, skin and soft tissue, and gastrointestinal infections.[3] Our study population showed higher numbers of skin and soft tissue infections and lesser numbers of urinary tract infections. The same outcome was also observed in another study by Bhat et al.,[3] Our study showed that GNB were the predominant isolates, which has also been experienced by various researchers in their studies.[2],[3],[5],[8],[12] In our study, the prevalence of various organisms was as follows: E. coli (22.72%), Acinetobacter [20%], S. aureus [15.45%], and Klebsiella (10.90%). Similar findings were also observed by Kotgire Santosh et al.[5] and Kala Yadav et al.[13] A study conducted at Karnataka [14] has shown similar prevalence of Acinetobacter (22.2%). Among the Gram-negative isolates, the predominant organism in our study was E. coli (32.89%) followed by Acinetobacter (28.94%) and Klebsiella (15.78%). Similar findings were observed by Singh et al.[2] among Gram-positive isolates, S. aureus (65.38%) was most commonly isolated followed by Enterococcus (34.61%). Similar pattern was also seen by Singh et al.[2] and Prabhash et al.[15] Overall, there has been an increase in the prevalence of MDROs in the last decade globally, which is much more in India compared to Western populations.[16] Our study showed a very high percentage of resistance among organisms to betalactam antibiotics, combination of betalactam/betalactamase inhibitors. Similar high rates of resistance to these drugs have been noted by Bhat et al.[3] and Kotgire Santosh et al.[5] Of major concern was the observation that there was a very high prevalence of ESBL among the GNB's (71%). This resistance was uniform irrespective of the source of specimen, causative organism, or time period. Same trend was observed by Kapoor et al.[17] The incidence is somewhat higher as compared to a study done in the parent institute and medical college of our hospital but situated at a different location.[18] A significant production of ESBL was seen in E. coli (68%) followed by Klebsiella (66%). Similar findings were cited down by Shivaprakasha et al.[19] and Mathur et al.[20] Resistance to carbapenems was seen to be prevalent in Pseudomonas (25%) and Klebsiella (25%) followed by Acinetobacter (22%), the resistance to carbapenems at our institute was lower than that seen by Bhat et al.[3] but higher than the findings depicted by Kotgire Santosh et al.[5]

The problem of antibiotic resistance is fortunately not as high among the Gram-positive organisms. We did not encounter any vancomycin resistance among staphylococci, and MRSA rates have been approximate 17.64% which was lower as compared to other studies.[3],[5]

There is a scarcity of studies describing the microbiological profiles and antibiotic susceptibility patterns of organisms isolated from infections in the Indian oncology setting and more reports from similar centers would provide greater insights to this very important emerging issue in this patient population.


 » Conclusion Top


Infection rates in patients with immunosuppressed state are much higher and severe as compared to immunocompetent patients. It is necessary to know the trends of bacteriological isolates in cancer patients so as to develop much needed antibiotic policy to combat these infections in a proper way and at an earlier stage.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

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Abdollahi A, Hakimi F, Doomanlou M, Azadegan A. Microbial and antibiotic susceptibility profile among clinical samples of patients with acute leukemia. Int J Hematol Oncol Stem Cell Res 2016;10:61-9.  Back to cited text no. 1
    
2.
Singh R, Jain S, Chabbra R, Naithani R, Upadhyay A, Walia M. Characterization and anti-microbial susceptibility of bacterial isolates: Experience from a tertiary care cancer center in Delhi. Indian J Cancer 2014;51:477-80.  Back to cited text no. 2
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3.
Bhat V, Gupta S, Kelkar R, Biswas S, Khattry N, Moiyadi A, et al. Bacteriological profile and antibiotic susceptibility patterns of clinical isolates in a tertiary care cancer center. Indian J Med Paediatr Oncol 2016;37:20-4.  Back to cited text no. 3
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4.
Rudresh SM, Nagarathnamma T. Extended spectrum ß-lactamase producing Enterobacteriaceae and antibiotic co-resistance. Indian J Med Res 2011;133:116-8.  Back to cited text no. 4
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5.
Kotgire Santosh A, Sunil Hatkar S, Siddique S, Deshmukh AB, Afreen U, Mariya S. Bacteriological profile and antimicrobial sensitivity pattern of clinical isolates from patients attending tertiary care hospital. Ann Pathol Lab Med 2016;4:357-61.  Back to cited text no. 5
    
6.
Basak S, Singh P, Rajurkar M. Multidrug resistant and extensively drug resistant bacteria: A Study. J Pathog 2016;2016:4065603.  Back to cited text no. 6
    
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Tsering DC, Pal R, Kar S. Methicillin-resistant Staphylococcus aureus: Prevalence and current susceptibility pattern in Sikkim. J Glob Infect Dis 2011;3:9-13.  Back to cited text no. 7
    
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El-Astal Z. Bacterial pathogens and their antimicrobial susceptibility in Gaza Strip, Palestine. Pakistan J Med 2005;20:365-70.  Back to cited text no. 8
    
9.
Koneman EW, Allen SD, Janda WM, Schreckember PC, Winn WC. Koneman's Colour Atlas and Textbook of Diagnostic Microbiology. 6th ed. New York: Lippincott; 2006. p. 97-9.  Back to cited text no. 9
    
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Forbes BA, Sahm DF, Weissfeld AS. Bailey and Scott's Diagnostic Microbiology. 12th ed. Missouri: Mosby Elsevier; 2007. p. 779.  Back to cited text no. 10
    
11.
CLSI – Clinical and Laboratory Standards Institute 2016. Performance Standards for Antimicrobial Susceptibility Testing. Twenty-second Informational Supplement. Wayne, PA, USA: Clinical and Laboratory Standards Institute; 2016.  Back to cited text no. 11
    
12.
Karanwal AB, Parikh BJ, Goswami P, Panchal HP, Parekh BB, Patel KB. Review of clinical profile and bacterial spectrum and sensitivity patterns of pathogens in febrile neutropenic patients in hematological malignancies: A retrospective analysis from a single center. Indian J Med Paediatr Oncol 2013;34:85-8.  Back to cited text no. 12
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13.
Kala Yadav ML, Raja A. Bacteriological profile and antibiogram of gram negative clinical isolates from tertiary care hospital. International J Res Health Sci 2014;3:734-9.  Back to cited text no. 13
    
14.
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;1:62-6.  Back to cited text no. 14
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Prabhash K, Medhekar A, Ghadyalpatil N, Noronha V, Biswas S, Kurkure P, et al. Blood stream infections in cancer patients: A single center experience of isolates and sensitivity pattern. Indian J Cancer 2010;47:184-8.  Back to cited text no. 15
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Thacker N, Pereira N, Banavali SD, Narula G, Vora T, Chinnaswamy G, et al. Alarming prevalence of community-acquired multidrug-resistant organisms colonization in children with cancer and implications for therapy: A prospective study. Indian J Cancer 2014;51:442-6.  Back to cited text no. 16
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Kapoor G, Sachdeva N, Jain S. Epidemiology of bacterial isolates among pediatric cancer patients from a tertiary care oncology center in North India. Indian J Cancer 2014;51:420-4.  Back to cited text no. 17
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Siddiqui N, Bhakre J, Damle A, Bajaj J. Prevalence of extended spectrum beta lactamase (ESBL) producing gram negative bacilli from various clinical isolates.IOSR J Dent Med Sci 2014;13:8-11.  Back to cited text no. 18
    
19.
Shivaprakasha S, Radhakrishnan K, Gireesh A, Shamsul Karim P. Routine screening for ESBL production, a necessity of today. Internet J Microbiol 2007;3(1).  Back to cited text no. 19
    
20.
Mathur P, Kapil A, Das B, Dhawan B. Prevalence of extended spectrum beta lactamase producing gram negative bacteria in a tertiary care hospital. Indian J Med Res 2002;115:153-7.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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