Antimicrobial Drug Resistance Trends of Bacteria Causing Bloodstream Infections in a Diagnostic Centre in Lahore: Antimicrobial Drug Resistance Trends of Bacteria

Sara  Minahil; Kiran  Nazeer; Muhammad Faisal ` Bashir; Amina  Asif; Saba  Riaz

doi:10.54393/pbmj.v6i08.922

Authors

Sara Minahil Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
Kiran Nazeer Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
Muhammad Faisal ` Bashir Citilab and Research Centre, Lahore, Pakistan
Amina Asif Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
Saba Riaz Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pbmj.v6i08.922

Keywords:

Bacteraemia, Multidrug Resistance, Staphylococcus epidermidis, Staphylococcus aureus, Salmonella typhi

Abstract

Bacteraemia due to multidrug-resistant (MDR) bacteria, particularly those producing carbapenemase or extended-spectrum beta-lactamase (ESBL), causes a significant threat to patients and associated morbidity and mortality. The global rise in the incidence of bacteremia necessitates the rapid and accurate identification of pathogens to ensure effective patient health management. Objective: To investigate antimicrobial drug resistance trends among bacteria causing bloodstream infections from a diagnostic centre in Lahore. Methods: This research was conducted at the Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore and Citilab and Research Centre, Lahore, from January 2020 to December 2022. A total of 2919 blood samples were cultured to screen the bacteremia patients. Following standard protocols, four hundred twenty isolates proceeded for gram-staining, biochemical characterization, and antimicrobial susceptibility testing (AST). The AST results of each strain calculated multiple antibiotic resistance (MAR). Results: Of 420 bacterial isolates, Gram-negative and Gram-positive isolates accounted for 48.57% and 51.43%, respectively. The predominant pathogens were Staphylococcus epidermidis (48.10%) and Salmonella typhi (27.14%), with other significant pathogens including Klebsiella spp., Pseudomonas spp., Enterobacter, Acinetobacter spp., Escherichia coli, Staphylococcus aureus, Enterococcus spp., Citrobacter, Morganella morganii, and Proteus mirabilis. AST revealed high resistance to Cephalosporins, Nitrofurantoin, Fosfomycin, and Quinolones. In contrast, Carbapenems demonstrated notable sensitivity. Salmonella typhi and Staphylococcus epidermidis exhibit the highest MAR values. Conclusions: The study highlights the prevalence of multidrug resistance bacteremia-causing pathogens, with a concerning trend towards decreasing antibiotic efficacy.

Author Biographies

Kiran Nazeer, Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan

Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore

Muhammad Faisal ` Bashir, Citilab and Research Centre, Lahore, Pakistan

Citilab and Research Centre, Lahore

Amina Asif, Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan

Ameer ud Din MedicalCollege, General Hospital, Lahore, Pakistan.

Saba Riaz, Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan

*Corresponding author

Dr. Saba Riaz

Associate Profesor

Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan.

Citilab and Research Centre, 525-A Faisal Town, Lahore, Pakistan.

References

Santella B, Folliero V, Pirofalo GM, Serretiello E, Zannella C, Moccia G, et al. Sepsis—a retrospective cohort study of bloodstream infections. Antibiotics. 2020 Nov; 9(12): 851. doi: 10.3390/antibiotics9120851. DOI: https://doi.org/10.3390/antibiotics9120851

Jin L, Zhao C, Li H, Wang R, Wang Q, Wang H. Clinical profile, prognostic factors, and outcome prediction in hospitalized patients with bloodstream infection: results from a 10-year prospective multicenter study. Frontiers in Medicine. 2021 May; 8: 629671. doi: 10.3389/fmed.2021.629671. DOI: https://doi.org/10.3389/fmed.2021.629671

Kuo KC, Yeh YC, Chiu IM, Tang KS, Su CM, Huang YH. The clinical features and therapy of community-acquired gram negative bacteremia in children less than three years old. Pediatrics & Neonatology. 2020 Feb; 61(1): 51-7. doi: 10.1016/j.pedneo.2019.05.009. DOI: https://doi.org/10.1016/j.pedneo.2019.05.009

Bonten M, Johnson JR, van den Biggelaar AH, Georgalis L, Geurtsen J, de Palacios PI, et al. Epidemiology of Escherichia coli bacteremia: a systematic literature review. Clinical Infectious Diseases. 2021 Apr; 72(7): 1211-9. DOI: https://doi.org/10.1093/cid/ciaa210

Holmes CL, Anderson MT, Mobley HL, Bachman MA. Pathogenesis of Gram-negative bacteremia. Clinical Microbiology Reviews. 2021 Jun; 34(2): 10-128. DOI: https://doi.org/10.1128/CMR.00234-20

Tsai CM, Lin CH, Zhang H, Chiu IM, Cheng CY, Yu HR, et al. Using machine learning to predict bacteremia in febrile children presented to the emergency department. Diagnostics. 2020 May; 10(5): 307. DOI: https://doi.org/10.3390/diagnostics10050307

Emamie A, Zolfaghari P, Zarei A, Ghorbani M. Prevalence and antibiotic resistance of ESKAPE pathogens isolated from patients with bacteremia in Tehran, Iran. Indian Journal of Medical Specialities. 2023 Apr; 14(2): 97. DOI: https://doi.org/10.4103/injms.injms_12_23

Sabé N, Maristany M, Tuells M, Favà A, Melilli E, Tubau F, et al. Risk factors and outcomes of acute graft pyelonephritis with bacteremia due to multidrug-resistant gram-negative Bacilli among kidney transplant recipients. Journal of Clinical Medicine. 2022 Jun; 11(11): 3165. DOI: https://doi.org/10.3390/jcm11113165

Aliabadi S, Anyanwu P, Beech E, Jauneikaite E, Wilson P, Hope R, et al. Effect of antibiotic stewardship interventions in primary care on antimicrobial resistance of Escherichia coli bacteraemia in England (2013–18): a quasi-experimental, ecological, data linkage study. The Lancet Infectious Diseases. 2021 Dec; 21(12): 1689-700. DOI: https://doi.org/10.1016/S1473-3099(21)00069-4

Di Domenico EG, Marchesi F, Cavallo I, Toma L, Sivori F, Papa E, et al. The impact of bacterial biofilms on end-organ disease and mortality in patients with hematologic malignancies developing a bloodstream infection. Microbiology spectrum. 2021 Aug; 9(1): 10-128. DOI: https://doi.org/10.1128/Spectrum.00550-21

Islas-Muñoz B, Volkow-Fernández P, Ibanes-Gutiérrez C, Villamar-Ramírez A, Vilar-Compte D, Cornejo-Juárez P. Bloodstream infections in cancer patients. Risk factors associated with mortality. International Journal of Infectious Diseases. 2018 Jun; 71: 59-64. DOI: https://doi.org/10.1016/j.ijid.2018.03.022

Singh N, Puri S, Kumar S, Pahuja H, Kalia R, Arora R, et al. Risk Factors and Outcome Analysis of Gram-Positive Bacteremia in Critically Ill Patients. Cureus. 2023 Mar; 15(3): e38585. DOI: https://doi.org/10.7759/cureus.36585

Droz N, Hsia Y, Ellis S, Dramowski A, Sharland M, Basmaci R. Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low-and middle-income countries: a systematic review and meta-analysis. Antimicrobial Resistance & Infection Control. 2019 Dec; 8(1): 1-2. DOI: https://doi.org/10.1186/s13756-019-0673-5

Qamar FN, Batool R, Qureshi S, Ali M, Sadaf T, Mehmood J, et al. Strategies to improve coverage of typhoid conjugate vaccine (TCV) immunization campaign in Karachi, Pakistan. Vaccines. 2020 Nov; 8(4): 697. DOI: https://doi.org/10.3390/vaccines8040697

Bhatti JM, Raza SA, Alam AF, Khan YN, Mala A, Batool I, et al. Antibiotic choices among healthcare professionals for enterococcal bacteremia with patterns of resistance and risk factors of mortality, in settings of poor antibiotic stewardship program—a five-year retrospective cohort study. BMC Infectious Diseases. 2023 Dec; 23(1): 1-1. DOI: https://doi.org/10.1186/s12879-023-08498-0

Morelli MK, Veve MP, Shorman MA. Maternal bacteremia caused by Staphylococcus aureus with a focus on infective endocarditis. InOpen Forum Infectious Diseases. US: Oxford University Press. 2020 Aug: 7(8): 239. DOI: https://doi.org/10.1093/ofid/ofaa239

Ahmad S, Rahman H, Qasim M, Nawab J, Alzahrani KJ, Alsharif KF, et al. Staphylococcus epidermidis Pathogenesis: Interplay of icaADBC Operon and MSCRAMMs in Biofilm Formation of Isolates from Pediatric Bacteremia in Peshawar, Pakistan. Medicina. 2022 Oct 24;58(11):1510. DOI: https://doi.org/10.3390/medicina58111510

Huang L, Hu H, Xu C, Zhou M, Li Y, Li Y, et al. Characterization of NDM-5-producing Escherichia coli strains isolated from pediatric patients with bloodstream infections in a Chinese hospital. Genes. 2023 Feb; 14(2): 520. DOI: https://doi.org/10.3390/genes14020520

Ioannou P, Zacharioudaki M, Spentzouri D, Koutoulakou A, Kitsos-Kalyvianakis K, Chontos C, et al. A Retrospective Study of Staphylococcus aureus Bacteremia in a Tertiary Hospital and Factors Associated with Mortality. Diagnostics. 2023 Jun; 13(11): 1975. doi: 10.3390/diagnostics13111975. DOI: https://doi.org/10.3390/diagnostics13111975

Jabeen F, Khan Z, Sohail M, Tahir A, Tipu I, Murtaza Saleem HG. Antibiotic Resistance Pattern Of Acinetobacter Baumannii Isolated From Bacteremia Patients In Pakistan. Journal of Ayub Medical College Abbottabad-Pakistan. 2022 Jan; 34(1): 1-7. doi:

Sandhu R, Dahiya S, Sayal P. Evaluation of multiple antibiotic resistance (MAR) index and Doxycycline susceptibility of Acinetobacter species among inpatients. Indian Journal of Microbiology Research. 2016 Apr; 3(3): 299. doi: DOI: https://doi.org/10.5958/2394-5478.2016.00064.9

Abrar S, Hussain S, Khan RA, Ul Ain N, Haider H, Riaz S. Prevalence of extended-spectrum-β-lactamase-producing Enterobacteriaceae: first systematic meta-analysis report from Pakistan. Antimicrobial Resistance & Infection Control. 2018 Dec; 7(1): 1-1. doi: 10.1186/s13756-018-0309-1. DOI: https://doi.org/10.1186/s13756-018-0309-1

Javaid N, Sultana Q, Rasool K, Gandra S, Ahmad F, Chaudhary SU, et al. Trends in antimicrobial resistance amongst pathogens isolated from blood and cerebrospinal fluid cultures in Pakistan (2011-2015): A retrospective cross-sectional study. PLoS One. 2021 Apr; 16(4): e0250226. doi: 10.1371/journal.pone.0250226. DOI: https://doi.org/10.1371/journal.pone.0250226

Hussain A, Satti L, Hanif F, Zehra NM, Nadeem S, Bangash TM, et al. Typhoidal Salmonella strains in Pakistan: an impending threat of extensively drug-resistant Salmonella Typhi. European Journal of Clinical Microbiology & Infectious Diseases. 2019 Nov; 38: 2145-9. doi: 10.1007/s10096-019-03658-0. DOI: https://doi.org/10.1007/s10096-019-03658-0

Mintz A, Mor M, Klinger G, Scheuerman O, Pirogovsky A, Sokolover N, et al. Changing epidemiology and resistance patterns of pathogens causing neonatal bacteremia. European Journal of Clinical Microbiology & Infectious Diseases. 2020 Oct; 39: 1879-84. doi: 10.1007/s10096-020-03921-9. DOI: https://doi.org/10.1007/s10096-020-03921-9

Kim D, Yoon EJ, Hong JS, Choi MH, Kim HS, Kim YR, et al. Major bloodstream infection-causing bacterial pathogens and their antimicrobial resistance in South Korea, 2017–2019: Phase i report from kor-glass. Frontiers in Microbiology. 2022 Jan; 12: 799084. DOI: https://doi.org/10.3389/fmicb.2021.799084

Waseem H, Ali J, Sarwar F, Khan A, Rehman HS, Choudri M, et al. Assessment of knowledge and attitude trends towards antimicrobial resistance (AMR) among the community members, pharmacists/pharmacy owners and physicians in district Sialkot, Pakistan. Antimicrobial Resistance & Infection Control. 2019 Dec; 8(1): 1-7. doi: 10.1186/s13756-019-0517-3. DOI: https://doi.org/10.1186/s13756-019-0517-3