European Journal of Molecular & Clinical Medicine

Context: Sepsis is one of the leading causes of death in hospital settings. Timely administration of rational and effective antimicrobial therapy, as per hospital’s antibiotic policy, is one of the components of antimicrobial stewardship program. In absence of definitive pathogen identification and susceptibility pattern, initial antibiotic regimen is selected which is defined as empirical antibiotic therapy. Although an empirical antimicrobial policy is in place at our institute, it has not been evaluated since its inception for its effectiveness.
Aims: To assess the adherence to the empirical antimicrobial policy for sepsis and to evaluate its effectiveness on clinical outcome of sepsis in adult critical care patients.
Setting and study design: A prospective, cross-sectional study was conducted in adult non covid critical care units of Shree Krishna Hospital.
Methodology: Following approval from Institutional Ethics Committee, prospective cross-sectional study was conducted from 1^st August-2021 to 31st July-2022 at non-covid intensive care units. The adherence to the empirical antibiotic policy was calculated as percentage of patients with sepsis in whom antimicrobial agent was started as per the policy. The effectiveness of the antimicrobial policy was assessed on the basis of the improvement in the clinical and laboratory parameters as well as Sequential organ failure assessment (SOFA) score of the patient over a period of five days.
Statistical analysis: Microsoft Excel 2019, Version 2209 was used for data entry and data analysis. Proportions were calculated using descriptive analysis. Data was analysed using Chi-square calculation. Significance was considered at P-value <0.05.
Results: The adherence to the antimicrobial policy in sepsis was 59.80%, (n = 61 out of 102) whereas adherence to initiation of antimicrobial agent within one hour of diagnosis of clinical sepsis was 96.07% (n =98 out of 102). The antimicrobial agent started as per antibiotic policy was susceptible in culture report in 55.31% (n = 26 out of 47) of patients. Effectiveness of empirical antimicrobial policy in patients with sepsis in adult critical care units based on improvement of SOFA score after five days of diagnosis of clinical sepsis was 51.06%, (n=24 out of 47). There was no significant correlation (P ≥0.05) found between age groups, gender, risk stratification categories, type of blood stream infections and type of organisms isolated, i.e., Gram negative and Gram positive with regards to effectiveness of empirical antimicrobial policy. There was no significant difference noted between improvement in SOFA score of the patients in whom antimicrobial agent was started as per policy and in whom the antimicrobial agent was not started as per policy (P = 0.72).
Conclusion: The adherence to antimicrobial policy for sepsis was low and further studies to evaluate the reasons for low compliance need to be conducted. Although the effectiveness was not significantly different when the antimicrobial agent was started as per policy compared to when it was not started as per policy, we still recommend using antimicrobial agent as per policy in order to avoid non uniformity in prescriptions and development of antimicrobial resistance.

The rise in multi-drug resistant Gram-negative bacteria during the past few years has posed a serious danger to public health care. Our understanding of how antibiotic resistance mechanisms emerge and spread across bacterial strains has been enhanced by recent advanced molecular techniques. The resistant pathogens use a variety of resistance mechanisms, including cell membrane porosity changes, antibacterial target modification, and destruction of antibacterial agents. This section will discuss and explain the molecular characterisation of carbapenem resistance as well as their detection techniques. Understanding these mechanisms can be crucial for the development of novel antimicrobial drugs as well as for specific treatment considerations about the usage of antibiotics other than carbapenem and beta-lactams. Although the majority may be carried out quickly with a molecular device, molecular approaches are presently used for identifying carbapenem-resistant species. Whole-genome sequencing delivers clear idea on the comprehensive evaluation of whole genome and has the potential to develop into a very potent tool in regular clinical settings. The cost of genome sequencing is still high, and an automated system for data processing is needed. It might take a while before this method is routinely used in medical laboratories, especially in underdeveloped nations. To create innovative antibacterial medicines that can enhance pathogen prognosis, it can be crucial to comprehend these processes and the importance of the formation of carbapenem resistance strains.

Antibiotics are those drugs which are commonly used for therapeutic management of variety of bacterial infections. Nowadays, bacteria seem to have developed antibiotic resistance due to inappropriate use of medications. Pseudomonas aeruginosa is a nosocomial gram-negative pathogen which causes most fatal infections in humans. This species of pseudomonas is resistant to many antibiotics and is among World Health Organization pathogen list of primary concern for investigation and development of novel antibiotics. Apart from its unique potential to develop intrinsic or innate resistance to several conventional antibiotics, pseudomonas aeruginosa can also acquire resistance by mutation in its chromosomes, subsequently altering the membrane permeability, efflux system over-expression, antibiotic inactivating enzyme production and biofilm resistance. Pseudomonas aeruginosa seem to be resistant to various antibiotics such as carbapenems, penicillin & other beta-lactams, aminoglycosides and fluroquinolones. Newer antibiotic combinations such as ceftazidime-avibactam, imipenem-cilastatin/relebactam, cefiderocol have shown some promising results in treatment of antibiotic resistant Pseudomonas aeruginosa

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. Presence of 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. A total of 3900 blood samples were received in the Department of Microbiology during 6 months period. All samples were processed according to standard microbiological procedures. 131 NFGNB were identified out of which the most common non-fermenters isolated were Acinetobacter sp. (90) followed by Pseudomonas aeruginosa (41). Most of the non-fermenters were multi drug resistant. Imipenem showed good sensitivity. 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.

Introduction: Surgical site infections (SSI) constitute a major public health problem worldwide and are the second most frequently reported nosocomial infections. They are responsible for increasing the treatment cost, length of hospital stay and significant morbidity and mortality.Aim: To isolate, identify and study bacteriological profile of surgical site infections,with  antibiogram.Materials and Methods: Samples were collected using sterile cotton swabs from 190 patients clinically diagnosed of having SSIs and were processed as per standard microbiological techniques. Antimicrobial susceptibility testing was done using modified Kirby-Bauer disc diffusion method. This Prospective study was conducted for a period of one year (January 2016 to December 2016) in the Department of Microbiology at Yenepoya Medical college hospital, Mangalore, India.Results:. Out of total 190 samples, 170 (89.4%) yielded bacterial growth.Most common predisposing factors causing surgical site infections were patients having Diabetes mellitus(23.53%) followed by Smokers(14.12),Hypertension(11.76).Escherichia coli (24.12%) was the commonest organism followed by Staphylococcus aureus(18.82%), Pseudomonas aeruginosa (18.24%) and Coagulase negative Staphylococcus species (14.12%). Antimicrobial profile of gram positive isolates revealed maximum sensitivity to Vancomycin, Teicoplanin and Linezolid, whereas among gram negative isolates Imepenem, Piperacillin-tazobactam, and Amikacin were found to be most sensitive.Conclusion: The rate of SSI observed in this study was comparable to other similar studies, however we observed a higher degree of antimicrobial resistance. Adherence to strict infection control measures, maintenance of proper hand hygiene and optimal preoperative, intraoperative and postoperative patient care will surely reduce the incidence of SSIs.

Background:A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. SSIs previously called Post-operative wound infection result from bacterial contamination during or after a surgical procedure.Surgical Site Infection (SSI) by definition refers to an infection which occurs within 30 days after the surgery or within 1 year when an implant is left in place after the surgery and involving the incision or deep tissues at the operated site or infections involving organ or body space other than the incision, which was opened or manipulated during an operation. Surgical site infections (SSI) constitute a major public health problem worldwide and are the second most frequently reported nosocomial infections. They are responsible for increasing the treatment cost, length of hospital stays and significant morbidity and mortality. A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. This study is an attempt to know the pre-operative, Operative and post-operative factors predisposing to Surgical site infections and the bacteriological profile of those infection so as to establish Antibiotic guidelines in our tertiary care centre.
Materials and Methods: All adult male and female patients of age more than 18 yrs undergoing abdominal surgeries for various reasons were included in the study. This prospective study was conducted in the department of general surgery in SVS Medical College between 1-6-2020 to 6-5-2021.
Results: This study included 100 patients who underwent abdominal surgery, out of which 30 patients developed Surgical site infections. So the incidence is 30%. Incidence of SSI among males was 29.3 % whereas incidence of infection among females was 33.3 %. Clean wounds had least SSI (6.7%) and the Dirty wounds had the highest SSI (50%). Using drain was associated with increased incidence of SSI (44%) and mesh usage was not associated with SSI. SSI was most commonly detected on Post op day (POD) 4 (20 out of 45 cases). The SSI rate increased with increasing age and it also increased significantly with the increasing duration of pre-operative hospitalization. The SSI rate was significantly higher in emergency surgeries as compared to the elective surgeries. The infection rate was significantly higher as the duration of the surgery increased. The most commonly isolated organism from surgical site infections were Enterococci (22.2%) and staphylococcus aureus (22.2%) and other bacteria. Most of the organisms which were isolated were multidrug resistant. The high rate of resistance to many antibiotics underscored the need for a policy that could promote more rational use of antibiotics.
Conclusion: The rate of SSI observed in this study was comparable to other similar studies, however we observed a higher degree of antimicrobial resistance. Adherence to strict infection control measures, maintenance of proper hand hygiene and optimal preoperative, intraoperative and postoperative patient care will surely reduce the incidence of SSIs.

Staphylococcus aureus is an important infectious pathogen in health sector and communities. S. aureus was first described by the Scottish surgeon Alexander Ogaston in surgical abscess in 1881. It causes various infections ranged between simple to life threating infections. Owing potent toxins and other virulence factors enabled the bacteria to be very virulent. Additionally, acquisition of antimicrobial resistant genes increased the challenge in treating the infections caused by bacteria especially methicillin resistant S. aureus strains (MRSA) that are often multidrug resistant strains. The circulation of MRSA between health settings and communities resulted in changing even the genetic map for the strains in both places. Vancomycin was used for years and still acts as the drug of choice for treating MRSA infections but recently the resistance to vancomycin has risen and vancomycin resistant S. aureus were recorded. Consequently, different regimes were used like combination of antibiotics to reduce the resistance rate to antibiotics if they were used as a single drug and practiced the control measures at health settings to reduce the spread of MRSA strains. At last, global health organizations call for research and finding new antibiotics agents and put MRSA on the top list of infectious agents that need more antibiotics.

Cesarean section is the most frequent surgical procedure in obstetrics. This study was carried out to isolating and identifying bacteria causing cesarean section inflammation from patients and antimicrobial susceptibility test to bacterial isolates; 30 samples were collected from patients with different aged of women that had suffering from Post-Cesarean section Infection in Bent-Al-Huda & Al-Habboubi hospital in in Thi-Qar province. The isolates were identified on the bases of their morphological characteristics, the Gram stain reaction, biochemical tests and confirmed by the Api 20 E test. The results revealed that the rate of bacterial isolates in patients with Post-Cesarean section Infection was (76.6%). out of these (34.8 %) were E .coli, (30.4%) were Pseudomonas aeroginosa, (13%) of Staphylococcus aurous, (8.6%) isolates of Acintobacter and Bacillus. Antimicrobial susceptibility testing to 23 bacterial isolates showed variable sensitivity to antibiotic, they were more sensitive to chloramphenicol and Imipenem also the results appeared increasing prevalence of multidrug resistant between isolates.

Antibiotics resistance are increasing. Public health officials are alarmed by the increasing frequency of antimicrobial- resistant microorganisms that have been remerged in the hospitals. There is sufficient tales to remind us that antibiotics might lose all the potency against invading bacteria. The development of resistance from the evolution of the elegant resistance mechanisms that create superbugs, which is spread by exchange resistance traits with other microorganisms. The Centre for Disease Control and Prevention estimates that more than 2 million people annually are sicken from the drug-resistance bacteria. The antibiotic resistance is particularly destructive in hospitals, where such infections strike the patients with chronic disease and weak immune systems. High risk groups includes individuals who have undergone recent surgery, the cancer patients, diabetics etc.Selection intensity is the major contributor to the resistance which can be determined by the volume of drugs consumption by human and agricultural industry. Cost to fitness of the microorganism is associated by acquired or De novo resistance. Therefore it is assume that reduction of the prevalence of resistance can be carried out by reducing the volume of drug use

Background: To assess prevalence of P. aeruginosa and antibiotic sensitivity from respiratory samples.
Materials and Methods: One hundred twenty respiratory samples of both genders were taken for study.
All samples were processed and Pseudomonas aeruginosa was identified by various biochemical test. Antimicrobial susceptibility testing was done by disk diffusion method as per CLSI.
Results: Out of 120 patients, males were 70 (58.3%) and females were 50 (41.7%). Out of 120 respiratory samples, 30 (25%) had P. aeruginosa. Antibiotic sensitivity pattern of Pseudomonas isolates was seen 74% to Ciprofloxacin, 86% to Ofloxacin, 57% to Ceftriaxone, 65% to Ceftazidime, 84% to Amikacin, 85% to Meropenem and 63% to Imipenem. The difference was significant (P< 0.05).
Conclusion: There is high prevalence of Pseudomonas aeruginosa in respiratory samples.  Increasing resistance of Pseudomonas aeruginosa needs constant surveillance of antimicrobial resistance trends and administration of appropriate antibiotics.