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Year : 2011  |  Volume : 54  |  Issue : 3  |  Page : 666-667
Emerging resistance of non-fermenting gram negative bacilli in a tertiary care centre

1 Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Microbiology, Swami Devi Dayal Hospital and Dental College, Barwala, Haryana, India

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Date of Web Publication20-Sep-2011

How to cite this article:
Samanta P, Gautam V, Thapar R, Ray P. Emerging resistance of non-fermenting gram negative bacilli in a tertiary care centre. Indian J Pathol Microbiol 2011;54:666-7

How to cite this URL:
Samanta P, Gautam V, Thapar R, Ray P. Emerging resistance of non-fermenting gram negative bacilli in a tertiary care centre. Indian J Pathol Microbiol [serial online] 2011 [cited 2022 Jan 18];54:666-7. Available from: https://www.ijpmonline.org/text.asp?2011/54/3/666/85150


Non-fermenting Gram negative bacilli (NFGNB) including Pseudomonas spp., Acinetobacter spp., Stenotrophomonas maltophilia, Burkholderia cepacia complex (BCC), are emerging as important causes of blood stream infections (BSI) worldwide particularly in immunocompromised patients, patients with hematological malignancies and patients admitted in intensive care units (ICUs). [1] Currently, Pseudomonas aeruginosa and  Acinetobacter calcoaceticus Scientific Name Search aumannii complex are commonly resistant to all available antibiotics. [2] There are few studies that provide the antibiogram data of NFGNB especially. [3],[4] Thus, there is an urgent need to study the antibiotic sensitivity pattern of commonly isolated NFGNB. With this view, we have identified all NFGNBs isolated from blood samples and analyzed their antimicrobial susceptibility profile from April 2007 to March 2009. In positive cases, isolates were identified to species level by conventional biochemical tests. For the molecular identification and typing of BCC, recA polymerase chain reaction-restriction fragment length polymorphism (recA PCR-RFLP) was performed in collaboration with International B. cepacia Working group, Belgium. [5] The drug susceptibility was done against trimethoprim-sulphamethoxazole combination (TMP-SMX, 1.25 μg/23.75 μg), ceftazidime (30 μg), tetracycline (30 μg), levofloxacin (5 μg), and piperacillin-tazobactam (100 μg/10 μg) combination for S. maltophilia and in addition against meropenem (10 μg) for BCC, against cefotaxime (30 μg), ceftazidime (30 μg), gentamicin (10 μg), amikacin (30 μg), cefoperazone (75 μg), and cefoperazone-sulbactam (75 μg/10 μg) combination for Pseudomonas and Acinetobacter spp. as per Clinical and Laboratory Standards Institute (CLSI), 2007 guidelines.

Out of 58,717 blood cultures performed at the hospital from April 2007 to March 2009, 21% (12,331/58717) tested positive for bacterial culture and 1256 (1256/12331, 10%) of these positive cultures grew NFGNB. Of 1256 NFGNB, the most commonly isolated NFGNB in the present study was Acinetobacter spp. (66%) followed by Pseudomonas spp. (26%), BCC, (5%) and S. maltophilia (3%). Twelve (12/1256, 1%) isolates could not be identified. Isolates of Acinetobacter spp. were susceptible to cefoperazone-sulbactam combination (329/588, 54%), ciprofloxacin (227/825, 28%), amikacin (215/825, 26%), gentamicin (163/825, 20%), cefotaxime (159/825, 19%), and ceftazidime (166/825, 20%). Pseudomonas spp. isolates were sensitive to cefotaxime (24/58, 41%), ceftazidime (156/324, 48%), gentamicin (149/324, 46%), amikacin (181/324, 56%), ciprofloxacin (150/324, 46%), cefoperazone (167/324, 52%), and cefoperazone-sulbactam (238/324, 73%) combination. Among the antibiotics used for susceptibility testing for BCC, piperacillin-tazobactam (54/60, 90%) combination showed the highest sensitivity, followed by ceftazidime (51/60, 85%), TMP-SMX (48/60, 80%), meropenem (36/60, 60%), levofloxacin (35/60, 58%), and tetracycline (27/60, 45%). S. maltophilia isolates were sensitive to TMP-SMX (32/35, 91%) and levofloxacin (29/35, 83%) but resistant to tetracycline (23/35, 66%), ceftazidime (21/35, 60%), and piperacillin-tazobactam combination (21/35, 60%).

Because of high intrinsic resistance of different NFGNB to different antimicrobial agents, the value of proper identification comes to the forefront. BCC is intrinsically resistant to many b-lactam drugs, aminoglycosides, colistin and polymixin B, the first-line therapeutics of choice against serious pseudomonal infections. [1] Limited sensitivity of BCC isolates to meropenem is significant as it is one of the first line drugs against Pseudomonas spp. Although there were no significant difference in the susceptibility pattern of NFGNB other than BCC, BCC showed higher resistance to tetracycline (26/30, 87%) and levofloxacin (20/30, 67%) during April, 2008 to March, 2009 compared to 23% (7/30) and 17% (5/30) respectively during April, 2007 to March, 2008. This shows emerging resistance of BCC to the commonly used antibiotics. S. maltophilia isolates were mostly sensitive to TMP-SMX (91%) and levofloxacin (83%). As combinations of antimicrobial agents are often prescribed as empiric therapy for suspected BSI, appropriate choice of antimicrobials is very important as it improves outcome and cost to the patients in terms of the expenses of costly antibiotics as well as duration of hospital stay. Thus, it is important for the clinicians to remain updated with current antimicrobial susceptibility pattern of the circulating pathogens, and the antimicrobials to be used for empiric therapy should be selected accordingly.

   Acknowledgments Top

The authors wish to thank Prof. P Vandamme, Universteit Gent, Gent, Belgium for his assistance to standardize the molecular techniques for the identification of Burkholderia cepacia complex.

   References Top

1.Ramphal R. Infections due to Pseudomonas species and related organisms, Chapter 145. Harrison's Principles of Internal Medicine, 17 th Ed. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. USA: McGraw-Hill Medical; 2008. p. 949-56.  Back to cited text no. 1
2.Leibovisi L, Konisberger H, Pitlik SD. Bacterimia and fungemia of unknown origin in adults. Clin Infect Dis 1992;14:436-9.  Back to cited text no. 2
3.Mehta M, Dutta P, Gupta V. Antimicrobial susceptibility pattern of blood isolates from a teaching hospital in north India. Jpn J Infect Dis 2005;58:174-6.  Back to cited text no. 3
4.Kaul S, Brahmadathan KN, Jagannati M, Sudarshanam TD, Pitchamuthu K, Abraham OC, et al. One year trend in gram negative bacterial antibiotic susceptibility patterns in a medical intensive care unit in south India. Ind J Med Microbiol 2007;25:230-5.  Back to cited text no. 4
5.Gautam V, Ray P, Vandamme P, Chatterjee SS, Das A, Sharma K, et al. Identification of lysine positive non-fermentating gram negative bacilli (Stenotrophomonas maltophilia and Burkholderia cepacia complex). Ind J Med Microbiol 2009;27:128-33.  Back to cited text no. 5

Correspondence Address:
Vikas Gautam
Department of Medical Microbiology, 3243/21-D, Chandigarh - 160 022
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.85150

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