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MDR Organisms in
Holy Family Hospital Rawalpindi
An Antibiogram
Pathology DepartmentHoly Family HospitalRawalpindi Medical College
Antimicrobial resistance is the ability of microorganisms that cause disease to withstand attack by antimicrobial agents.
From drugs used to treat common bacterial infections, to the complex combinations, resistance is increasingly being detected and is spreading rapidly.
Antibiotic-resistant bacteria with the potential to cause untreatable infections pose
"a catastrophic threat"
to the population.
Antibiotic resistance evolves naturally via natural selection through random mutation, but it could also be engineered by applying an evolutionary stress on a population.
Once such a gene is generated, bacteria can then transfer the genetic information in a horizontal fashion (between individuals) by plasmid exchange.
If a bacterium carries several resistance genes, it is called multi resistant or, informally,
a superbug.
While a new infectious disease has been discovered nearly every year over the past 30 years, there have been very few new antibiotics developed leaving our armour nearly empty as diseases evolve and become resistant to existing drugs.
ICU has highest rate of infection.
Case I of multidrug resistant SUPERBUG isolated from
MICU HFH, Rawalpindi
Specimen I ETT tip C/S Report : Coliform Spp Sensitive to IMIPENEM Resistant to Augmentin Ceftazidime Ceftriaxone Ciprofloxacin Tazocin Sulzone Gentamicin
Specimen II C/S Report: Coliform Spp.Sensitive to POLYMYXINResistant to AugmentinCeftazidimeCeftriaxoneCiprofloxacinImipenemTazocinSulzone Gentamicin
Case IIWound C/S received from Burn Unit
C/S Report: Pseudomonas aeruginosa, heavy growth
Sensitive
Polymyxin
Resistant
ImipenemSulzoneAztreonamCeftazidimeTazocinGentamicinCiprofloxacinCefepime
Case IIIUrine C/S received from MICUC/S Report: Staphylococcus aureus. >105 cfu/ml
Sensitive
NitrofurantoinVancomycinTeicoplanin
Resistant
MethicillinClarithromycinPenicillinCiprofloxacinGentamicinCo-Trimoxazole
HOLY FAMILY HOSPITAL RAWALPINDI4 MONTH ANTIBIOGRAM.
1.12.2014 TO 31.3. 2015
Acinetobacter Staphylococcus Coliforms Pseudomonas Enterococcus0
10
20
30
40
50
60
7
18
53
21
1
Commonly Isolated Organisms
perc
enta
ge o
f org
anis
ms
Antibiotic Medical Surgical ICU OPD
AMIKACIN 46 74 70 88
AMPICILLIN 07 9 - 16
CEFTAZIDIME 10 23 - 31
CEFTRIXONE 13 23 08 35
CIPROFLOXACIN 21 36 13 37
TAZOCIN 41 54 34 80
CO-TRIMAXAZOLE 27 17 27 27
SULZONE 33 61 44 76
IMIPENEM 81 83 73 94
CEFEPIME 58 42 - 57
NITROFURANTOIN 100 100 100 83
MEROPENEM 92 66 100 89
GENTAMICIN 41 100 60 57
Coliforms Spp n=436Percentage of Sensitivity
Antibiotic Medical Surgical ICU OPD
POLYMYXIN 97 100 100 100
AMIKACIN 28 41 67 65
CEFTAZIDIME 05 07 - 06
CEFTRIXONE 04 14 - 33
CARBENCILLIN 09 06 - 11
CIPROFLOXACIN 49 25 40 63
TAZOCIN 35 39 55 71
SULZONE 24 08 40 55
IMIPENEM 62 69 57 74
GENTAMICIN 12 - 50 12
CEFEPIME 06 43 40 33
Pseudomonas aeruginosa n=172 Percentage of Sensitivity
Antibiotic Medical Surgical ICU OPD
METHICILLIN 20 55 15 55
TEICOPLANIN 100 100 100 100
VANCOMYCIN 100 100 100 100
CHLORAMPHENICOL 100 90 - 100
GENTAMICIN 27 55 25 63
CIPROFLOXACIN 11 38 14 38
COTRIMOXAZOLE 25 40 0 33
LINEZOLID 100 100 100 100
Staphylococcus aureus (Including MRSA) n=91Percentage of Sensitivity
Antibiotic Medical Surgical ICU OPD
METHICILLIN 50 52 0 50
TEICOPLANIN 100 100 100 100
VANCOMYCIN 100 100 100 100
CHLORAMPHENICOL 48 - 75 -
GENTAMICIN 75 65 08 30
CIPROFLOXACIN 30 36 0 30
LINEZOLID 100 100 100 100
Staphylococcus spp (Coagulase Negative) n=57
Percentage of Sensitivity
Antibiotic Medical Surgical ICU OPD
AMPICILLIN 0 0 0 0
POLYMYXIN 100 100 100 100
AMIKACIN 0 0 05 20
CEFTAZIDIME 0 0 0 0
CEFTRIXONE 0 0 0 0
CIPROFLOXACIN 27 0 0 20
COTRIMOXAZOLE 12 0 05 06
TAZOCIN 0 0 05 20
SULZONE 0 0 02 33
IMIPENEM 0 0 30 67
CEFEPIME - 0 - -
GENTAMICIN - - 0 40
Acinetobacter Spp (n = 63) percentage of sensitivity
Gram positive coverage: Vancomycin/ Teicoplanin
Gram negative: Tazocin/ Imipenem/ Polymyxin
EMPIRICAL ANTIBIOTICS FOR SEPSIS/ SEPTIC SHOCK
De-escalation: the practice of changing the
antibiotic prescribed from initial, empiric broad-
spectrum agent to one with a narrower and more
focused spectrum once the pathogen has been
isolated.
DE-ESCALATION OF BROAD SPECTRUM ANTIBIOTIC THERAPY
Nitrofurantoin
Uncomplicated UTI
Staphylococcus aureus
Enterococci
Acinetobacter
Coliforms
Chloramphenicol
AVOID UNNECESSARY ANTIBIOTICS