IPRC - 2018

Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/19163

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Author: search.filters.author.Wijesooriya, L.I.Subject: search.filters.subject.Antibiotic Resistance

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    Analysis of antibiotic sensitivity pattern of clinically significant Staphylococcus aureus at a Base Hospital, Sri Lanka
    (19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Jayawardana, G.P.C.; de Silva, S.H.N.A.
    INTRODUCTION: Staphylococcus aureus. is a major organism that causes skin and soft tissue infections. Moreover, it causes an array of other infections. It is treated with flucloxacillin/cloxacillin. However, a significant proportion of S. aureus has developed resistance to flucloxacillin/cloxacillin; hence, they are termed as MRSA. Though MRSA is likely to present in hospital settings, it has crept to the community as well. Accordingly, the number of MRSA infections is increasing.OBJECTIVE: To analyze theantibiotic sensitivity (ABST) pattern of clinicallysignificant S. aureus. METHOD: A retrospective, cross-sectional study was conductedover one year from 01/08/2017 to 31/07/2018involving patients infectedwith S. aureus in Base Hospital, Wathupitiwala. Demographic & clinical data & ABST results were analyzed. ABST (John Stokes method) was performed for chloramphenicol, ciprofloxacin, erythromycin, fusidic acid, linezolid, co-trimoxazole, gentamicin, clindamycin, teicoplanin & vancomycin. MRSA was identified using cefoxitin disc. The ABST pattern of MSSA was compared with that of MRSA. Statistical analysis was done via the R programming language (level of significance P<0.05). RESULTS: Of 210 patients,48 % (101/210) were males while 52% (109/210) were females. In study cohort,88.1% (185/210) was inpatients & the rest (11.9% - (25/210)) was outpatients. Of the isolated S. aureus, 42.9% (90/210) were from pus, 14.8% (31/210) from blood, 29.5% (62/210) from sputum & 12.4% (26/210) from urine. As per ABST, 69.1% (145/210) was MRSA & 31% (65/210) was MSSA. Sensitivity of MSSA was 84.6% (11/13) for chloramphenicol, 62.3% (33/53) for gentamicin, 55.8% (29/52) for ciprofloxacin, 68.9% (31/45) for clindamycin, 45.7% (21/46) for erythromycin, 84.2%(16/19) for nitrofurantoin, 69.2%(27/39) for fusidic acid, 92.1%(35/38) for linezolid, 74.6%(41/55) for co-trimoxazole, 84.6%(33/39) for teicoplanin & 92.3%(60/65) for vancomycin. Sensitivity of MRSA was 83.3% (20/24) for chloramphenicol, 35.6% (32/90) for gentamicin, 24.6% (30/122) for ciprofloxacin, 34.1% (42/123) for clindamycin, 8.0% (9/112) for erythromycin, 75%(12/16) for nitrofurantoin,65.8%(73/111) for fusidic acid, 99%(96/97) for linezolid, 58.9%(76/129) for co-trimoxazole, 87%(80/92) for teicoplanin & 98.5%(134/136) for vancomycin. Sensitivity of MRSA was significantly low compared to the sensitivity of the MSSA against erythromycin (P = 0.000), ciprofloxacin (P = 0.000), clindamycin (P = 0.000) & gentamicin (P = 0.002). CONCLUSION: Skin & soft tissue infections were the most common infections caused by S. aureus. MRSA rates were alarmingly high in the study cohort. Less than 50% of MRSA were sensitive to erythromycin, ciprofloxacin, gentamicin, & clindamycin and it was significantly low compared to the sensitivity of MSSA against same antibiotics. Vancomycin and linezolid are effective empiric antibiotics for both MSSA & MRSA.
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    Analysis of Clinically Significant Acinetobacter Spp Isolated from a Base Hospital (BH) of Sri Lanka during a One-Year Period
    (19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Jayawardana, G.P.C.; de Silva, S.H.N.A.
    Introduction: Acinetobacter spp are potential opportunistic pathogens. Being a water-trophic organism, it stays in humidifier water, sink basins, suction apparatus, disinfectant fluids etc. Number of cases due to Acinetobacter spp are increasing globally & locally. Treatment of Acinetobacter infections is a great challenge due to its resistance to most antibiotics. However, awareness about antibiotic sensitivity (ABST) pattern of the organism would streamline empiric antibiotic therapy. Objective: To identify the burden & ABST pattern of Acinetobacter spp isolated duringa one-year period. Method: A descriptive, cross-sectional study was carried out involving patients with clinically significant Acinetobacter infection at BH, Wathupitiwala from 01/08/2017 to 31/07/2018. The number of Acinetobacter spp identified from the total number of positive cultures obtained during the same period was analyzed. Demographic& clinical data of patients infected with Acinetobacter spp were also analyzed. ABST (John-Stokes method) of Acinetobacter spp were analyzed for gentamicin, amikacin, cefotaxime, ceftazidime, ceftriaxone, cefepime, cefoperazone-sulbactam, piperacillin-tazobactam, ampicillin-sulbactam, ticarcillin-clavulanic acid, ciprofloxacin, levofloxacin, co-trimoxazole, meropenem& polymyxin B. Results: Of 920 total bacterial cultures performed over the study period, 44% (404/920 - urine samples, 26% (238/920) - sputum, 23% (215/920) - pus & wound swabs & 7% (63/920) - blood. Of positive blood cultures, 7% (5/63) were by Acinetobacter. Of the total, satisfactorily taken sputum samples, 21% (65/238) were positive for Acinetobacter. Acinetobacter positivitywas 7% (17/215) from pus & wound swabs. None (0/404) of the urine samples grew Acinetobacter. Of 87 patients, who had Acinetobacter infections, all were inpatients while 56.3% were males & 43.7% were females. Age distribution; 0% children (<12 years), 68.9 % adults (12- 65 years) & 31.1% elderly (>65 years) patients. As per ABST, sensitivity was 4.5% for cefotaxime, 6.9% for ceftriaxone, 9.2% for ticarcillin-clavulanic acid & ceftazidime each, 12.6% for cefepime, 16% for gentamicin & ciprofloxacin each, 14.9% for piperacillin-tazobactam & meropenem each, 16.1% for levofloxacin & co-trimoxazole each, 17.2% for ampicillin-sulbactam, 25.3% for amikacin, 60.9% for cefoperazone-sulbactam, & 94.2% for polymyxin B. Conclusion: Most Acinetobacter spp were recovered from respiratory samples indicating its preponderance to cause respiratory tract infections. Most Acinetobacter infections were from inward, adult, males. A great majority of Acinetobacter spp were sensitive to polymyxin B. Only about 2/3rd of isolates were sensitive to cefoperazone-sulbactam & sensitivity was <25% for commonly used cephalosporins, carbapenems, quinolones, aminoglycosides, co-trimoxazole, & beta-lactam – beta-lactam inhibitor combinations
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    A Descriptive Study on Antibiotic Resistant, Clinically Significant Coliform Species Isolated from the Patients at Colombo North Teaching Hospital (CNTH), Ragama, Sri Lanka
    (19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Namalie, K.D.; Sunil-Chandra, N.P.
    Introduction: Antibiotic resistance (AR) is a great therapeutic challenge globally and locally today. The rate of development of AR is far ahead compared to the discovery of a new class of antibiotics, which has not been successful in last three decades. Of the antibiotic resistant coliforms, extended spectrum beta-lactamase producers (ESBLP) play a key role in life threatening infections. Moreover, emergence of carbapenem-resistant Enterobacteriaceae (CRE) has further limited the effective therapeutic options. Objective: To investigate the AR of clinically significant Enterobacteriaceae isolated from patients in a tertiary healthcare setting. Method: A descriptive, cross-sectional study was conducted involving patients with coliform infections at CNTH from 01/03/2018 to 31/08/2018. Demographic details, clinical data & antibiotic sensitivity test (ABST) patterns were analyzed. ABST was performed according to John-Stokes method & ESBLPwere identified by the keyhole method. Resistance to either meropenem or imipenem is used to identify CRE. Statistical analysis was done via R programming language (level of significance P<0.05). Results: Of the 200 coliforms, 85.5% (171/200) were from inpatients & the rest were from outpatients. Of the studied patients, 53.5% (107/200) were females & 46.5% (93/200) were males. Of the Enterobacteriaceae spp isolated, 48.5% (97/200) were from urine, 34.5% (69/200) from pus / wound swabs, 9.5% (19/200) respiratory samples, 3% (6/200) sterile fluids & stents, & 3% (6/200) from blood & CVP tips. As per ABST, about 90% were resistant to ampicillin. Resistance was 61-70% against cefuroxime (oral), ciprofloxacin & nalidixic acid, 60% for amoxiclav, 41-50% for cefotaxime, cefuroxime (intravenous), co-trimoxazole, levofloxacin, norfloxacin & ofloxacin, 31-40% for cefepime, ceftazidime, ceftriaxone & nitrofurantoin, 21-30% for gentamicin & piperacillin tazobactam & 0-10% for amikacin & meropenem. Of the coliforms, 29% (58/200) were ESBLP & 8% (16/200) were CRE. None of the ESBLP was CRE. Of CRE, 37% (10/16) were resistant to amikacin. However, 93.8% (15/16) of CRE were colistin sensitive. Conclusion: Majority of the isolates represented infections of the inward patients & there was no statistically significant difference between male & female proportions. Coliforms were detectedmostly from urine. Majority (>50%) of clinically significant Enterobacteriaceae were resistant to most of the oral antibiotics namely cefuroxime, ciprofloxacin, nalidixic acid & amoxiclav. Of the oral antibiotics, nitrofurantoin has the lowest resistance against Enterobacteriaceae. None of the antibiotics had 100% sensitivity against Enterobacteriaceae. Results indicate that ESBLP can be safely treated with carbapenems. Colistin will be an effective empiric antibiotic for CRE.