ANTIBIOTIC SUSCEPTIBILITY PATTERN OF PSEUDOMONAS AERUGINOSA ISOLATED FROM CLINICAL SPECIMENS

ABSTRACT

This study investigated the antibiotic susceptibility pattern of Pseudomonas aeruginosa isolated from clinical specimens, from in-patient, out-patient and intensive care unit of Abia State specialist hospital. Clinical specimens which include wound, urine, sputum, were analyzed for Pseudomonas aeruginosa. Forty eight isolates of Pseudomonas aeruginosa were isolated using  standard bacteriological procedure. The isolated pathogen showed resistance to Ciprofloxacin (33.33%), Streptomycin (83.33%), and showed susceptibility to Levoflaxocin (87.50%), Ceftriaxone (81.25%) Gentamycin (79.16%). From the result obtained, Pseudomonas aeruginosa isolates from in-patient and out patient, intensive care unit of Abia state specialist hospital were highly susceptible to Levofloxacin (87.50%) and Gentamycin (79.16%) than other antibiotics. Hence, the use of antibiotics should be monitored among the group to avoid further drug resistance.

TABLE OF CONTENT

Title page i

Cover page ii

Certification iii

Dedication iv

Acknowledgement v

Abstract vi

Table of content vii

List of table viii

CHAPTER ONE

 INTRODUCTION

1.0 Background of the Study 1

1.1  Statement of Problem 3

1.2 Significance of Study 4

1.3    Limitations of the Study 4

CHAPTER TWO

2.1  Literature Review 7

2.2 Clinical Manifestation 8

2.3 Antibiotic Resistance 11

2.4 Theoretical Framework 13   

2.5 Current Therapeutic Options 14

CHAPTER THREE

METHODOLOGY

3.0 Materials and Method 20

3.1 Setting 20

3.2 Specimen Collection and Processing 20

3.3 Media Preparation 22

3.4 Biochemical Test 22

3.5 Susceptibility Test 24

CHAPTER FOUR

4.0 Result 25

4.1 Patients and Specimen Data 25

CHAPTER FIVE

5.1 Discussion 30

5.2 Conclusion and Recommendation 31

REFERENCES 32

LIST OF TABLE

Table 4.1: Age and Sex Distribution of Patients Infected with

Pseudomonas aeruginosa 26

Table 4.2: Distribution of Specimens from where Pseudomonas 

aeruginosa was Isolated 27

Table 4.3: Bacterial isolated from patients in various wards 28

Table 4.4: Antibiotic Susceptibility Pattern of Pseudomonas

 aeruginosa from Clinical Specimens. 29

 CHAPTER ONE

INTRODUCTION

1.0 BACKGROUND OF THE STUDY

Pseudomonas   aeruginosa is a gram negative, aerobic non spore forming, straight or slightly curved rod -shaped bacterium that occurs as single bacterium or in pairs and occasionally in short chains. Pseudomonas aeruginosa is an epitome of opportunistic nosocomial pathogen, which causes a wide spectrum of infection and leads to substantial morbidity in immuno- compromised patient .despite the therapy, the mortality due to nosocomial pseudomonal pneumonia is average. Unfortunately, pseudomonas aeruginosa demonstrate resistance to multiple antibiotics, thereby jeopardizing the selection of appropriate treatment. Therefore the present study was undertaken to find out the antibiotics susceptibility pattern of pseudomonas aeruginosa isolated from clinical specimens. It is widely distributed in nature including soil, water and various types of vegetation throughout the world. Besides that it has also revealed its presence in disinfectants, respiratory, equipment, sinks, taps and mops within the hospital as a bioflim. This organism found its entry into the hospital environment either through visitors and patients or goods that enter the hospital. Contact transmission is common mode of transmission in hospital (Arora and Romit et al., 2011). 

Pseudomonas aeruginosa is an opportunistic nosocomial pathogen. It is a major threat to hospitalized and immuno-compromised patient. Particularly those who are deliberated or immuno comprised. Also those with diseases such as cancer, burns. The high mortality associated with these infections is due to the combination of weak host defense system bacteria resistance to antibiotics. Pseudmonas  aeruginosa infection can develop in many anatomic sites  including skin, bones  ,ears , eyes , urinary  tract ,.  The site may vary with the portal of entry and the patient vulnerability. In hospitalized patients, the first sign may be overwhelming gram negative sepsis. (Doern, et al., 2005).

Today Pseudmonas  aeruginosa is  feared as dangerous  opportunistic  bacterium responsible for frequently  lethal  nosocomia  infections , it is resistant  to many  disinfecting  agents and highly resistant against  most  antibiotics (Aloush and Seigman-Igray et al., 2006).

Multiple  antibiotic  resistance  in bacteria  population is a pervasive  and growing  chemical problem , which is recognized as a threat  to public  health . The development of resistance to all available antibiotic in some organism may  preclude  the effectiveness of any antibiotic regimen (2.3).  infections caused by  Pseudmonas  aeruginosa  are  frequently  life  threatening and difficult to treat as it exhibits  intrinsically  high  resistance  to many  antimicrobials  and the development of increased , particularly  multi-drug  resistance  in heath care  setting .Mechanism  that cause  antimicrobial  drug  resistance  and multi drug  resistance  in Pseudmonas  aeruginosa  are due to acquisition of resistance  genes (example  those encoding  beta- lactamase  and  amino-glycoside  modifying  enzymes via  horizontal gene  transfer  and mutation of chromosomal genes (target ) site,  efflux  mutations ) are  the target  of the floroguinolones  particular  ciprofloxacin.

 Biofilm  formation in Pseudmonas  aeruginosa,  particularly in the cause  of pulmonary infections in patient  with cystic  fibrosis , contribute  to its  resistance  to  antimicrobial  agents  hypermutable  (or mutator) strains of Pseudmonas  aeruginosa exhibiting  increase mutation rates are common in chronic  infections such as  those that occur in the lungs  of cystic  fibrosis  patient . Increase in the frequency of multi-drug resistance (MDR) stains of Pseudomonas aeruginosa has severally limited the availability of therapeutic options.

1.1 STATEMENT OF PROBLEM

  It is a  major  threat to hospitalized  and immune- compromised  patients  ,particularly  those with  disease such as  cancer  and burns . The high mortality associated with these infections is due to a combination of weak   host defense system and bacteria resistance to antibiotics. Resistance of this notorious bacterium to commonly  used  antimicrobial  agent  is becoming  an increasing  clinical problem  and a recognized public  health threat because there are limited number of  antimicrobial agents  including the an  un pseudomonas  penicillin’s,  cephalosporin’s , carabapenems ,aminoglycoside and fluoroguinoilones  with reliable  activity  against it . It has intrinsic resistance to many antimicrobial agents and only a few antimicrobial agents have potent antibacterial activity against its bacterium. (Thornton et al., 2004).

 The emergence of multidrug resistance (MDR) Pseudmonas aeruginosa  has become a serious problem. There are several mechanisms which may contribute to the microbial resistance among pseudomonas aeruginosa including the production of chromosomally encoded B-Lactamases. (Liverrmore, 2000).

Aim: to determine the prevalence and antibiogram of pseudomonas aeruginosa from clinical samples

Objectives

a) To isolate and identify Pseudomonas aeruginosa from clinical specimens..

b) To determine the pattern of antibiotic sensitivity of pseudomonas aeruginosa from such clinical specimens.

1.2 SIGNIFICANCE OF STUDY

Majority of isolates were recovered from patient on admission, this observation affirmed the significant role of this organism in nosocomical infection, similarly was the pattern in wound specimens. The unique feature of pseudomonas aeruginosa, isolates is the resistance of Varity of antibiotics, primarily attributed to low permeability of the cell wall, production of inducible cephaloporinase, active efflux and poor affinity for target (DNA gyrase). Aminoglycosides, especially gentamicin and streptomycin knowing frontline antibiotic in the treatment of bacteria. However, emerging reports showed increased prevalence of resistance to these drugs. Pseudomonas aeruginos has received the most attention. it is ubiquitous free living bacterium and is found in most moist environment..Although it seldom causes disease in healthy individuals, it is a major treat to hospitalized and immuno-compromised   patients, particularly those with serious under laying disease such cancer and burns. It also help in the investigating the pattern of antibiotic resistance to test antibiotics and help us in determining the role of combination therapy in its management. This study suggests the use of triple antimicrobial therapy( meropenam, sulzone and amikacin) can be a useful alternative treatment for multidrug resistant (MDR).            

1.3   LIMITATIONS OF THE STUDY

 Comparison of epidemiological  data  of bacterial  pathogens  as  in this study  might  be difficult  as there are other variables  that influences  the outcome  of  results  such as  clinical  specimens  received  for examination , studied  population , types of hospitals  and geographical  locations . However, the possibility  of  Pseudomonas aeruginosa  contamination of wounds  cannot be  ruled out , this is  possible  environment  whose strict  hand  washing  procedures  is not  strictly  adhered   to and  unhygienic  procedure especially  in wound  dressing   may be a  contributor  factors. ( Iregu et al., 2002).

Difference in the resistance pattern may be attributed to factors like exposure to antibiotics studied population, type of clinical specimen examined. the clinical implication  is that  there is  need for  evaluation of the efficacy  of cephalosporin in the treatment of  pseudomonal infection  in order to prevent  treatment  failure    a scenario  that often  common in management  of Pseudomonas  infections .Most  disturbing  pattern  observed in this study  was the  multidrug  resistance  exhibited   by most of the  isolates.

 The  multidrug  resistance  by   Pseudomonas aeruginosa  isolated  in this  management and infection control  approach  in hospital  environments  also the  high mortality  associated  with these  infections  is also due to  a combination of weakened  host  defenses  and production of extracellular  bacteria  enzymes and toxins.

Treatment of Pseudomonas aeruginosa is a challenge because resistance limits dramatically therapeutic options. antibiotics  resistant organisms appear to be biological  fit and are capable  of causing   serious life  threatening   infection that are  difficult  to management because  treatment  options are limited , this increases  in the prevalence  of  drug  resistant  pathogenesis  occurring  at a time  when the discovery  and development of  new  anti  infection agents  is showing  down  dramatically . In fact  the irrational and  inappropriate use of  antibiotics  is responsible  for the development  of  resistance  of Pseudomonas species  to antibiotics  immunotherapy  . hence  there is need to  emphasize  the rational use of antimicrobials and strictly  adhere  to the concept  of reverse  drugs  to minimize  the use of available  antimicrobials  . In addition regular antimicrobial surveillance is essential for the area wise (Humasuna, et al., 2004) monitoring of the resistance patterns. An effective national and state level antibiotics policy and draft guidelines should be introduced to preserve the effectiveness.

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