Gram positive bugs - bugging us in today’s era. A study from a tertiary care hospital in Punjab (North India)
Background: Recently there has been a rapid increase in the incidence of infection and colonization of patients with gram positive organisms such as Enterococcus and Staphylococcus which display resistance to many commonly used antimicrobial agents.
Materials and methods: A prospective study was conducted over a period of four months in the department of Microbiology of a North Indian hospital. Various clinical samples were collected from the patients, the isolates were identified using standard microbiological methods and subjected to in vitro antimicrobial susceptibility testing by disc diffusion method and newer antimicrobials such as Vancomycin, Teicoplanin and Daptomycin by E test also.
Results: A total of 220 isolates of, Enterococci (132) and MRSA (88) were tested. Resistance among Enterococci to various drugs was; Penicillin (88.63%), Erythromycin (76.06%), high level Gentamycin (51.03 %) and Ciprofloxacin (46.21 %). By disc diffusion method Vancomycin and Teicoplanin showed 15.15 % and 7.58 % resistance. Whereas, E test demonstrated lower resistance to Vancomycin (11.36 %) and Teicoplanin (9.09 %). Resistance among MRSA to Erythromycin, Ciprofloxacin, Clindamycin, Vancomycin and Teicoplanin was 64.77, 48.87, 62.50, 4.54 and 2.27 per cent, respectively. Zero percent resistance was seen towards Linezolid. By E test resistance to Daptomycin was 2.27%, whereas all the isolates were sensitive to Vancomycin and Teicoplanin.
Conclusions: The spread of antibiotic resistance among organisms, to the point where some isolates are resistant to all standard therapies highlights the looming prospect of a ‘post antibiotic era’. Antibiotic policies need to be updated regularly, along with comprehensive monitoring of antibiotic prescription and consumption.
Keywords: Gram Positive Organisms, E Test, Vancomycin, Teicoplanin and Daptomycin.
Davies, Julian, and Dorothy Davies. Origins and evolution of antibiotic resistance. Microbiology and Molecular Biology Reviews, 74.3 (2010): 417-433.
In Forbes BA, Sahm DF, Weissfeld AS, editors. Laboratory methods for detection of antibacterial resistance, Chapter 18. In Bailey and Scott's Diagnostic Microbiology. 10th ed. London: Mosby; 1998. p. 250-72. Back to cited text no. 6
Woodford, Neil, et al. Current perspectives on glycopeptide resistance. Clinical Microbiology Reviews 8.4 (1995): 585-615.
Modi, G. B., Soni, S. T., Patel, K. J.,et al. Prevalenace of Vancomycin Resistant Enterococci in Tertiary Care Hospital, Western, India. International Journal of Microbiology Research, Volume 4, Issue 2, 2012, pp.-182-185.
Baird D. Staphylococcus: cluster-forming Gram positive cocci. 16. In: Collee AG, Fraser BP, Marmion JG, Simmons A, editors. Mackie and McCartney practical medical microbiology, 14th Ed. New York: Churchill Livingstone; 1996. p. 245-61.
Facklam RR, Collins MD. Identification of 17. Enterococcus species isolated from human infections by a conventional test scheme. J Clin Microbiol 1989; 27: 731-4.
Clinical Laboratory Standards Institution: Performance standards for antimicrobial susceptibility testing. In NCCLS approved standard M2-A8. Wayne, PA USA: CLSI; 2004.
Clinical and Laboratory Standards Institute. Performance standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational Supplement. CLSI document M100-S23.Wayne, PA: Clinical and Laboratory Standards Institute, 2013:74.
Kali, Arunava, et al. Changing Trends in Resistance Pattern of Methicillin Resistant Staphylococcus aureus. Journal of clinical and diagnostic research: JCDR 7.9, (2013): 1979.
Desai PJ, Pandit D, Mathur M, Gogate A. The prevalence identification and the distribution of various species of enterococci which were isolated from clinical samples, with special reference to the urinary tract infections in catheterized patients. India J Med Microbial 2001; 19:132-7.
Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection. Am J Med 1991; 91: 72S-75S.
Chitnis, Sheetal, et al. In vitro activity of daptomycin & linezolid against methicillin resistant Staphylococcus aureus & Vancomycin resistant enterococci isolated from hospitalized cases in Central India.The Indian journal of medical research 137.1 (2013): 191.
Telkar, A. Change in the Prevalence and the Antibiotic Resistance of the Enterococcal Species Isolated from Blood Cultures.
Pandya, A., Shah, M. B., Trivedi, S., & Singh, S. Identification, characterization and antimicrobial susceptibility testing of Enterococcus species isolated from various clinical specimens.
Sharma, R., & Pai, C. Prevalence of Various Enterococcal Infections and Its Antibiotic Susceptibility with Special Reference to Vancomycin and High Level Gentamicin Resistance in a Tertiary Care Centre in Navi Mumbai.
Ranjan KP, Arora DR, Ranjan N. An approach to Linezolid and Vancomycin against Methicillin resistant Staphylococcus Aureus. Webmed Central MICROBIOLOGY 2010; 1:WMCOO590.
Rajaduraipandi, K., et al. Prevalence and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus: A multicentre study. Indian Journal of Medical Microbiology. 24.1 (2006): 34.
Deshpande, Vaibhav R., Mohan G. Karmarkar, and Preeti R. Mehta. Prevalence of multidrug-resistant enterococci in a tertiary care hospital in Mumbai, India. The Journal of Infection in Developing Countries. 7.02 (2013): 155-158.
Tandel, K., A. K. Praharaj, and S. Kumar. Differences in Vancomycin MIC among MRSA isolates by agar dilution and E test method. Indian journal of medical microbiology. 30.4. (2012): 453.
Wang, Zhen, et al. Investigation of the prevalence of patients co-colonized or infected with methicillin-resistant Staphylococcus aureus and Vancomycin-resistant enterococci in China: a hospital-based study. Chin Med J. 122.11 (2009): 1283-1288.
Biedenach DJ, Bell JM, Sader HS, Fritsche TR, Jones RN, 6. Turnidge JD. Antimicrobial susceptibility of gram positive bacterial isolates from the Asia Pacific region and an in vitro evaluation of the bactericidal activity of daptomycin, Vancomycin and teicoplanin: a SENTRY program report (2003-2004). Int J Antimicrob Agents. 2007; 30: 143-9.
Mathai D, Biedenbach DJ, Jones RN, Bell JM, Turnidge 14. J Sader HS; India Daptomycin Study group. Activity of daptomycin against Gram positive bacterial isolates from Indian medical centre (2006-2007). Int J Antimicrob Agents. 2009; 34: 497-9.
Diederen BMW, Duijn IV, Willemse P, Klutymans JW. 5. In vitro activity of daptomycin against methicillin resistant Staphylococcus aureus including heterogeneously glycopeptide resistant strains. Antimicrob Agents Chemother. 2006; 50: 3189-91.
Sader HS, Wallers AA, Fritsche TR, Jines RN. Daptomycin 8. Antimicrobial activity tested against methicillin resistant staphylococci and Vancomycin resistant enterococci isolated in European medical centres (2005). BMC Infect Dis. 2007; 18: 29.
Philip IH, Susan JK. Datpomycin a review of its use in the 3. Management of complicated skin and soft tissue infections and Staphylococcus aureus bacteraemia. Drug .2007; 67: 1483-512.
Kaur, Rajneet, et al. Daptomycin susceptibility of methicillin resistant Staphylococcus aureus (MRSA). The Indian journal of medical research.136.4 (2012): 676.