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