Emergence Of Multidrug Resistant Acinetobacter Baumannii In An ICU
Emergence Of Multidrug Resistant Acinetobacter Baumannii
Keywords:
Acinetobacter baumannii, Metallo β lactamases, Multidrug resistantAbstract
Background and objectives: Acinetobacter baumannii is emerging as an important pathogen causing hospital acquired infections. The present study was directed to find out the incidence, antibiotic susceptibility and metallo β lactamases production of Acinetobacter baumannii isolated from various clinical samples, in an intensive care unit. Methods: Isolation of Acinetobacter baumannii from various clinical samples was done. The isolates were tested for antibiotic sensitivity as per conventional methods. Imipenem resistant isolates were further tested for MBL production by double disk synergy test and MBL E test. Results: Total number of Acinetobacter baumannii isolates from clinical samples was 48. Maximum number of isolates were from blood (31.25%) followed by endotracheal aspiration (25%). Total 10 (20.83%) isolates were imipenem resistant, among which, 9(18.75%) were metallo β lactamases producers. MBL producers were more resistant to commonly used antibiotics than its non MBL producing counter parts. All isolates were susceptible to colistin (10 μg), polymyxin B (300 μg) and tigecycline (15μg).Conclusions: Multidrug resistant, metallo β lactamases producing Acinetobacter baumannii infection was not uncommon in our intensive care unit. Colistin, polymyxin B and tigecycline were very effective against such isolates.
References
2. Joseph NM, Sistla S, Dutta TK, Badhe AS, Rashitha D, Parija SC. Role of intensive care unit environment and health care workers in transmission of ventilator associated pneumonia. J Infect Dev Ctries 2010; 4: 282 – 91.
3. Perez F, Hujer AM, Hujer KM, Decker BK, Rather PN, Bonomo RA. Global challenge of multidrug resistant A.baumannii. Antimicrob Agents Chemother 2007; 51: 3471 – 84.
4. Garnacho – Montero JC, Ortiz Leyba C, Jimenez – Jimenez FJ, Barrero – Almodovar AE, Garcia – Garmendra JL, Bernabeu – Witfel M, Gallego – Lara SL, Madrazo – Osuna J. Treatment of multidrug resistant Acinetobacter baumannii ventilator associated pneumonia (VAP) with intravenous colistin: a comparison with imipenem susceptible VAP, Clin Infect Dis 2003; 36:1111 – 1118.
5. De AS, Kumar SH, Baveja SM. Prevalence of metallo β Lactamase producing Pseudomonas aeruginosa and Acinetobacter species in intensive care areas in a tertiary care hospital.Indian J Crit Care Med 2010; 14(4): 217 – 19.
6. Chapter 13: Overview of bacterial identification methods and strategies. In: Bailey and Scotts Diagnostic Microbiology 12th ed. Forbes AB, Sahm DF, Weissfeld AS, Editors. Mosby Elsevier international edition, 2007. pp 216 – 47.
7. Chapter 7: Collee JG, Miles RS, Watt B. Test for identification of bacteria. In: Mackie & McCartney’s Practical Medical Microbiology 14th ed. JG Collee, AG Fraser, BP Marmion, A Simmons, Editors. In Churchill Livingstone: Indian Reprints; 2008. pp 131 – 49.
8. Performance standard for antimicrobial susceptibility testing; Twenty first informational supplement (M 100 – S22) 2012. Vol 32, No 3: 64.
9. Heidi S, Elisha BG. Use of E test MBL strips for the detection of carbapenemases in Acinetobacter baumannii. J Antimicrobial Chemother September 2005; 56(3): 598.
10. Chapter 45: Ananthnarayan R and Paniker CKJ. Miscellaneous Bacteria. In: Ananthnarayan and Panikers Text Book of Microbiology 8th ed. Publishers. University Press Private Limited (India), 2009.pp – 397.
11. Hamphreys H, Tower KJ. Impact of Acinetobacter spp in intensive care units in Great Britain and Ireland. J Hosp Infect 1997; 37: 281 – 86.
12. Dorlet L, Legrand P, Soussy CJ and Cattoir V. Bacterial identification, clinical significance and antimicrobial susceptibilities of Acinetobacter ursingii and Acinetobacter schindleri, two frequently misidentified opportunistic pathogens. J Clin Microbiol. Dec 2006; 44 (12): 4471-78.
13. Shanthi M, Sekar U. Multidrug resistant Pseudomonas aeruginosa and Acinetobacter baumannii infections among hospitalized patients: Risk factors and outcomes. J Assoc Phys India 2009; 57: 636 – 45.
14. Jacobs AC, Hood I, Boyd KL, Olson PD, Morrison 1952 JM, Carson S, Sayood K, Iwen PC, Skaar EP,Dunman PM. Inactivation of phospholipase D Diminishes Acinetobacter baumannii pathogenesis. Infect Immun 2010; 78(5) :– 62.
15. Irfan S, Zafar A, Guhar D, Ahsan T, Hasan R. Metallo β lactamases producing clinical isolates of Acinetobacter species and Pseudomonas aeruginosa from intensive care unit patients of a tertiary care hospital. Indian J Med Microbiol 2008; 26 (3): 243 – 45.
16. Sinha M, Srinivasa H. Mechanisms of resistance to carbapenems in meropenem resistant Acinetobacter isolates from clinical samples. Indian J Med Microbiol 2007; 25: 121 – 25.
17. Noyal MJ, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Reliability of Kirby Bauer disk diffusion method for detecting meropenem resistance among non fermenting Gram negative bacilli. Indian J Pathol Microbiol 2011; 54 (3): 556 – 60.
18. Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 2006; 42: 692 – 99.
19. Takahashi A, Yomoda S, Kabayashi I, Okubo T, Tsunoda M, Iyobe S. Detection of carbapenemase producing Acinetobacter baumannii in a Hospital. J Clin Microbiol 2000; Vol 38 (2): 526 – 29.
20. Levin AS. Treatment of Acinetobacter spp infections. Exp Opin Pharmacother 2003; 4: 1289 – 96.
21. Pachon – Ibanez ME, Jimenez – Mejias ME, Pichardo C, Llanos AC, Pachon J. Activity of tigecycline (Gar 936) against Acinetobacter baumannii strains including those resistant to imipenem. Antimicrobial Agents Chemother 2004; 48 (11): 4479 – 81.
22. Neonakis IK, Stylianou K, Daphnis E, Maraki S. First case of resistance to tigecycline by Klebsiella pneumonia in a European university hospital. Indian J Med Microbiol 2011; 29: 78 – 79.
