CLINICO-MICROBIOLOGICAL PROFILE OF NON-FERMENTING GRAM-NEGATIVE BACILLI IN BLOODSTREAM INFECTIONS: A RETROSPECTIVE STUDY FROM A TERTIARY CARE CENTER”
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Keywords
Non-fermenting Gram-negative bacilli, bloodstream infections, antimicrobial resistance, Pseudomonas aeruginosa, Acinetobacter, multidrug resistance, colistin
Abstract
Introduction: Non-fermenting Gram-negative bacilli (NFGNB) have emerged as important opportunistic pathogens causing bloodstream infections, particularly in hospitalised and critically ill patients. Their intrinsic resistance and increasing multidrug resistance pose significant therapeutic challenges. This study was conducted to characterise NFGNB isolated from blood samples and to determine their antimicrobial susceptibility patterns in a tertiary care hospital. Materials and Methods: This was a hospital-based, retrospective observational study conducted in the Department of Microbiology at a tertiary care hospital in Hyderabad. The study was carried out over a period of one year. A total of 1800 blood samples received for culture and sensitivity were included. Standard microbiological techniques were used for isolation and identification of NFGNB. Antimicrobial susceptibility testing was performed as per CLSI guidelines. Results: Out of 1800 blood samples, 412 (22.9%) were culture positive, of which 96 (23.3%) isolates were identified as NFGNB. Pseudomonas aeruginosa (50.0%) was the most common isolate, followed by Acinetobacter spp. (35.4%). A higher proportion of isolates were obtained from ICU patients (60.4%). High resistance was observed to cephalosporins (62.5% to ceftazidime) and fluoroquinolones (54.2% to ciprofloxacin). Carbapenems showed moderate sensitivity (imipenem 63.5%), while aminoglycosides, particularly amikacin (68.8%), were more effective. Colistin demonstrated the highest sensitivity (95.8%). Multidrug resistance was observed in 51.0% of isolates. Conclusion: NFGNB are significant pathogens in bloodstream infections with high antimicrobial resistance rates. The predominance of Pseudomonas and Acinetobacter spp. and rising multidrug resistance emphasize the need for continuous surveillance and rational antibiotic use.
References
2. Nazir A, Peerzada BY, Sana I. Spectrum of non-fermenting gram-negative bacilli isolated from patients with bloodstream infections in a tertiary care hospital. Int J Res Med Sci. 2019;7(5):1762-1766.
3. Baruah F, Hussain A, Kausalya K, Grover R. Antibiotic resistance profile of non-fermenting gram-negative bacilli isolated from blood cultures of cancer patients. J Glob Infect Dis. 2015;7(1):46-47.
4. Mathur P, Varghese P, Tak V, et al. Epidemiology of bloodstream infections at a level-1 trauma care center of India. J Lab Physicians. 2014;6(1):22-27.
5. Govindaswamy A, Bajpai V, Trikha V, et al. Multidrug resistant Elizabethkingia meningoseptica bacteremia: experience from a trauma centre in India. Intractable Rare Dis Res. 2018;7(3):172-176.
6. Malini A, Deepa EK, Gokul BN, Prasad SR. Non-fermenting gram-negative bacilli and their antimicrobial susceptibility pattern in a tertiary care hospital. Rev Soc Bras Med Trop. 2017;50(2):243-247
7. Benachinmardi KK, Padmavathy M, Malini J, Navaneeth BV. Prevalence of non-fermenting gram-negative bacilli and their in vitro susceptibility pattern. J Sci Soc. 2014;41:162-166.
8. Yadav SK, Mishra B, Shrestha A, Sharma S, Chaudhary DK, Singh NB, et al. Emergence of multidrug-resistant non-fermenting Gram-negative bacilli in clinical settings. J Lab Physicians. 2020;12(2):140–5.
9. Kaur A, Singh S, Kaur H, Kaur R, Sharma M, Kaur P, et al. Spectrum of non-fermenting Gram-negative bacilli in bloodstream infections. J Pure Appl Microbiol. 2020;14(2):1205–10.
10. Kaur A, Gill AK, Singh S. Prevalence and antibiogram of non-fermenting gram-negative bacilli isolates from clinical samples. Int J Res Med Sci. 2018;6:1228-1234.
11. Sarkar M, Jena J, Pattnaik D, et al. Prevalence and antimicrobial susceptibility profiles of non-fermenting gram-negative bacilli in a tertiary care hospital. Int J Adv Med. 2018;5:366-370.
12. Krishnan S, Santharam P, Shanmugavadivoo N, Usha B. Prevalence of non-fermenting gram-negative bacilli and their antibiotic sensitivity pattern at a tertiary care hospital in Tamil Nadu. Int J Curr Microbiol Appl Sci. 2018;7(2):2751-2758.
13. Chawla K, Vishwanath S, Munim FC. Nonfermenting Gram-negative bacilli other than Pseudomonas aeruginosa and Acinetobacter spp. as emerging pathogens. J Glob Infect Dis. 2013;5(1):3–14.
14. Bitew A. Mechanisms of antimicrobial resistance in non-fermenting Gram-negative bacilli. Infect Drug Resist. 2019;12:2787–94.
15. 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;54:666-667.
16. Gladstone P, Rajendran P, Brahmadathan KN. Incidence of carbapenem-resistant non-fermenting gram-negative bacilli in ICU patients. Indian J Med Microbiol. 2005;23:189-191.
17. Joseph NM, Sistla S, Dutta TK, et al. Reliability of disk diffusion for detecting carbapenem resistance in non-fermenting gram-negative bacilli. Indian J Pathol Microbiol. 2011;54:556-560.
18. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a retrospective nationwide surveillance study. Clin Infect Dis. 2004;39(3):309–317.
19. Rattanaumpawan P, Ussavasodhi P, Kiratisin P. Epidemiology of bacteremia caused by uncommon non-fermentative gram-negative bacteria. BMC Infect Dis. 2013;13:167.
20. Pachori P, Gothalwal R, Gandhi P. Emergence of antibiotic resistance in Pseudomonas aeruginosa in intensive care unit: a critical review. Genes Dis. 2019;6(2):109–119.
21. Prakash R, Negi V, Juyal D, Sharma M, Sharma N. Prevalence of non fermenting Gram negative bacilli and their in vitro antibiotic susceptibility pattern in a tertiary care hospital of Uttarakhand, India. Saudi J Health Sci. 2013;2:108 112.
22. Shah MH, Vaghela GM. Prevalence and antibiotic profile of non fermenters at a tertiary care hospital, Surat. Int J Biomed Adv Res. 2018;9:316 318.
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Dr Ankita Porwal
Consultant Microbiologist, Department of Microbiology, Medicover Superspecialty Hospitals, Hyderabad, Telangana
Dr P Sravanasandya Md
Assistant Professor, Department of Pharmacology, ICARE Institute of Medical Sciences and Research, Haldia
Abdullah
Clinical Pharmacist, Department of Clinical Pharmacy, Medicover Superspecialty Hospitals, Hyderabad, Telangana
Dr Srinivas
Consultant Neuropsychiatrist, Department of Psychiatry, Medicover Superspecialty Hospitals, Hyderabad, Telangana
Dr Mithilesh Krushnarap Raut
Consultant Intensivist, Department of Critical Care, Medicover Superspecialty Hospitals, Hyderabad, Telangana
