DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20191672

Spectrum of non-fermenting gram negative bacilli isolated from patients with blood stream infections in a tertiary care hospital in North India

Asifa Nazir, Bushra Yousuf Peerzada, Ifshana Sana

Abstract


Background: Non-fermenting Gram-negative bacilli (NFGNB) are emerging as important causes of blood stream infections (BSI) and they are a major cause of morbidity and mortality worldwide. High intrinsic resistance of NFGNB to antimicrobial compounds makes the treatment of BSIs caused by them difficult and expensive. The aim of this study was to assess frequency and antibiotic susceptibility pattern of non-fermenting gram-negative rods isolated from blood culture of patients.

Methods: A total of 3016 blood samples were received in the Department of Microbiology during the study period. All samples were processed according to standard microbiological procedures. Blood culture was done by automated blood culture system, (BacT/Alert) and identification and antibiotic susceptibility of non-fermenting gram negative bacilli was done by VITEK2 Compact System.

Results: A total of 120 NFGNB were identified out of which the most common non-fermenters isolated were Acinetobacter sp. (95) followed by Pseudomonas aeruginosa (11), Burkholderia cepacia (09) Sternotrophomonas maltophilia (03) and Sphingomonas sp. (02). Most of the non -fermenters were multi drug resistant showing a high level of antibiotic resistance to most of the first- and second-line drugs. The most effective drugs were colistin and tigecycline.

Conclusions: This study underlines the need to identify NFGNB in tertiary care hospitals and to monitor their susceptibility pattern to guide the clinician for better care and management of patients. Improved antibiotic stewardship and strict infection control measures especially hand washing need to be implemented to prevent emergence and spread of multidrug resistant NFGNB in health care settings.


Keywords


Acinetobacter sp, Antibiotic susceptibility, Nosocomial pathogens, Non-fermenters

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References


Leibovici L, Greenshtain S, Cohen O, Mor F, Wysenbeek AJ. Bacteremia in febrile patients. A clinical model for diagnosis. Arch Intern Med. 1991;151:1801.

Bates DW, Pruess KE, Lee TH. How bad are bacteremia and sepsis? Outcomes in a cohort with suspected bacteremia. Arch Intern Med. 1995;155:593.

Suárez CJ, Lolans K, Villegas MV, Quinn JP. Mechanisms of resistance to beta-lactams in some common Gram-negative bacteria causing nosocomial infections. Expert Rev Anti Infect Ther. 2005; 3:915.

Koneman E, Allen S, Janda W, Schreckenberger P, Winn W. Colour Atlas and textbook of Diagnostic Microbiology. 6th Edition. Philadelphia: Lippincott - Raven Publishers. 2006:305-91.

Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, et al. Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemotherapy. 2005 Feb 1;49(2):760-6.

Steinberg JP, Del Rio C. Other gram-negative bacilli. In: Mandell GL, Bennet JE, Dolin R, editors. Mandell’s principles and practice of infectious diseases. Philadelphia: Elsevier; 2000:2459e74. 7.

Siou CS, Mario V, Lenie D, Yu FW, Ya, LC, Tsung CC. Identication of nonfermenting Gram-negative bacteria of clinical importance by an oligonucleotide array. J Med Microbiol. 2009;58:596-605.

Yashodhara P, Shyamala S. Identifcation and Characterization of Non Fermenters From Clinical Specimens. Indian J Med Microbiol. 1997;15:195-7.

Kielhofner M, Atmar RL, Hamill RJ, Musher DM. Life-threatening Pseudomonas aeruginosa infections in patients with human immunodeficiency virus infection. Clin Infect Dis. 1992;14(2):403-11.

Quinn JP. Clinical problems posed by multiresistant nonfermenting gram-negative pathogens. Clinical Infect Dis. 1998 ;27(Supplement_1):S117-24.

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 prospective nationwide surveillance study. Clin Infect Dis. 2004;39(3):309-17.

CLSI. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. Twenty-Fourth Informational Supplement CLSI Document M100-S24, Wayne, PA. 2014.

Winn W Jr, Allen S, Janda W, Koneman E, Procop G, Schreckenberger P, et al. editors. Nonfermenting Gram negative bacilli. In: Koneman’s color Atlas and textbook of Diagnostic Microbiology. 6th ed. USA: Lippincott Williams and Wilkins Company; 2006:305‑91.

Rao PS, Shivananda PG. Bacteraemia due to non fermenting gram negative bacilli in immunocompromised patients. Ind J Med Microbiol. 1993;11:95-9.

Chang TC, Huang AYH. Rapid differentiation of fermentative from nonfermentative gram negative bacilli in positive blood cultures by an impendance method. J Clin Microbiol. 2000; 38:3589-94.

Enoch DA, Simpson AJ, Kibbler CC. Predictive value of isolating Pseudomonas aeruginosa from aerobic and anaerobic blood culture bottles. J Med Microbiol. 2004;53:1151-4.

Wroblewska MM, Rudnicka J, Marchel H, Luczak M. Multidrug resistant bacteria isolated from patients hospitalized in intensive care units. Int J Antimicrob Agents. 2006;27:285-9.

Juyal D, Prakash R, Shanakarnarayan SA, Sharma M, Negi V, Sharma N. Prevalence of nonfermenting gram negative bacilli and their in vitro susceptibility pattern in a tertiary care hospital of Uttarakhand: a study from foothills of Himalayas. Saudi J Health Sci. 2013;2:108-12.

Jayapriya S, Lata S, Sumathi G. Nonfermentative gram negative bacilli- characterisation and antibiotic resistant pattern study from a tertiary care hospital. Ind J Basic Applied Med Res. 2014;3(4):227-32.

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.

Vidal F, Mensa J, Almela M, Olona M, Martinez JA, Marco F, et al. Bacteraemia in adults due to glucose non‐fermentative Gram‐negative bacilli other than P. aeruginosa. QJM. 2003 Mar 1;96(3):227-34.

Malini A, Deepa EK, Gokul BN, Prasad SR. Nonfermenting gram-negative bacilli infections in a tertiary care hospital in Kolar, Karnataka. J Lab Physicians. 2009 Jul;1(2):62.

Takeyama K, Kunishima Y, Matsukawa M, Takahashi S, Hirose T, Kobayashi N, et al. Multidrug‑resistant Pseudomonas aeruginosa isolated from the urine of patients with urinary tract infection. J Infect Chemother. 2002;8:59‑63.

Jombo AG, Jonah P, Ayeni AJ. Multidrug resistant Pseudomonas aeruginosa in a contemporary Medical Practice: Findings from urinary isolates at a Nigerian University Teaching Hospital. Niger J Physiol Sci. 2008;23:105‑9.

Gautam V, Ray P, Vandamme P, Chatterjee SS, Das A, Sharma K, et al. Identification of lysine positive non-fermenting gram negative bacilli (Stenotrophomonas maltophilia and Burkholderia cepacia complex). Indian J Med Microbiol. 2009 Apr 1;27(2):128.

Kalidas RIT, Falguni NAG, Hirak JR, Maity, PK. Prevalence and susceptibility profiles of non- fermentative Gram-negative bacilli infection in a tertiary care hospital of Eastern India. Ind J Clin Pract. 2013;24(5):451-5.

Aprameya IV. Non-fermenting Gram-negative bacilli (NFGNB) other than Pseudomonas. Acad Clin Microbiol. 2013;15:59-61.

Memish ZA, Shibl AM, Kambal AM, Ohaly YA, Ishaq A, Livermore DM. Antimicrobial resistance among non-fermenting Gram-negative bacteria in Saudi Arabia. J Antimicrob Chemotherapy. 2012;67(7):1701-5.