Evaluation of Antimicrobial Resistance Pattern of Nosocomial and Community Bacterial Pathogens at a Teaching Hospital in Tehran, Iran

  • Samin Zamani Department of Microbiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Mohammad Javad Nasiri Department of Microbiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Behshad Noorazar Khoshgnab Department of Microbiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Abbas Ashrafi Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
  • Alireza Abdollahi Mail Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Antimicrobial resistance, Bacterial Pathogen, Nosocomial, Community

Abstract

Antimicrobial resistance in pathogens not only in hospitals but also in the community has become an important public health problem. The aim of this study was to determine the antimicrobial resistance patterns of predominant pathogens from hospitalized and outpatients in a university hospital in Tehran, Iran. A total of 820 samples of common Gram-negative and Gram-positive bacteria were collected from a major referral and teaching hospital affiliated to Tehran University of Medical Sciences in Iran during April 2010 to February 2011. The pattern of antibiotic resistance was determined by disk diffusion test as recommended by the Clinical Laboratory and Standards Institute (CLSI). Gram-negative bacilli were the most isolated pathogens. Acinetobacter spp. and Pseudomonas aeruginosa (P. aeruginosa) was the most antibiotic-resistant pathogens. Imipenem and piperacillin/tazobactam were the most active antimicrobials against gram-negative bacilli whereas vancomycin was the antimicrobial agent most consistently active against the Gram-positive cocci. Community-acquired organisms were more susceptible to antimicrobial drugs tested than nosocomial isolates. The rates of antibiotic resistance among isolated pathogens in this study were approximately similar to other studies. However, high rates of antibiotic resistance among Acinetobacter spp and P. aeruginosa, the most isolated pathogens, indicating that antibiotic policy is urgently needed to prevent the resistance development ago.

References

Alberti C, Brun-Buisson C, Burchardi H, et al. Epidemiology of sepsis and infection in ICU patients from an international multicenter cohort study. Intensive Care Med 2002;28(2):108-21.

Trilla A. Epidemiology of nosocomial infections in adult intensive care units. Intensive Care Med 1994;20(Suppl3):S1-4.

NNIS System. Intensive Care Antimicrobial Resistance Epidemiology (ICARE) surveillance report data summary from January 1996 through December 1997: a report from the National Nosocomial Infections Surveillance (NNIS) system. Am J Infect Control 1999:27(3):279-84.

Bradley JS, Guidos R, Baragona S, et al. Anti-infectives research and development problems, challenges and solutions:the clinical practitioner perspective. Lancet Infect Dis 2007;7(1):68-78.

Felmingham D. The need for antimicrobial resistance surveillance. J Antimicrob Chemother 2002;50(SupplS1):1-7.

Nugent R, Back E, Beith A, editors. The Race against Drug Resistance. Washington, DC: Center for Global Development; 2010: p. 116.

Fagon JY, Novara A, Stephan F, et al. Mortality attributable to nosocomial infections in the ICU. Infect Control Hosp Epidemiol 1994;15:428-34.

Davey P, Brown E, Fenelon L, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2005;(4):CD003543.

Shlaes DM, Gerding DN, John JF Jr, et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America joint committee on the prevention of antimicrobial resistance:Guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis 1997;25(3):584-99.

Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections. In:Olmsted RN, editor. APIC infection control and applied epidemiology:principles and practice. 1st ed. St. Louis: Mosby; 1996: p. A1-20.

Clinical and Laboratory Standards Institute, editor. Performance standards for antimicrobial susceptibility testing. 19th ed. Wayne, Pennsylvania: Clinical and Laboratory Standards Institute Publiction; 2009: p. 100-19.

Khalili H, Soltani R, Safhami S, Dashti-Khavidaki S, et al. Antimicrobial resistance pattern of Gram-negative bacteria of nosocomial origin at a teaching hospital in the Islamic Republic of Iran. East Mediterr Health J 2012;18(2):172-7.

Vessal GH, Afhami SH, Gholami KH, et al. Evaluation of antimicrobial resistance among Gram- negative isolates collected from intensive care units and reliability of routine disc susceptibility tests at a teaching hospital in Tehran. Iranian J Pharm Res 2006;5(2):89-100.

Lockhart SR, Abramson MA, Beekmann SE, et al. Antimicrobial resistance among Gram-negative bacilli causing infections in intensive care unit patients in the United States between 1993 and 2004. J Clin Microbiol 2007;45(10):3352-9.

Thomson JM, Bonomo RA. The threat of antibiotic resistance in gram-negative pathogenic bacteria:betalactams in peril! Curr Opin Microbiol 2005;8(5):518-24.

Jain R, Danziger LH. Multidrug-resistant Acinetobacter infections:an emerging challenge to clinicians. Ann Pharmacother 2004;38(9):1449-59.

Iglesias de Sena H, Miron Canelo JA, Fresnadillo Martinez MJ, et al. Epidemiological study and effect on antimicrobial use in the genus Acinetobacter in a university hospital. Rev Esp Quimioter 2004;17(2):177-83.

Rhomberg PR, Jones RN, Sader HS, et al. Antimicrobial resistance rates and clonality results from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) programme:report of year five (2003). Diagn Microbiol Infect Dis 2004;49(4):273-81.

Shamsuzzaman AK, Sirajee A, Rahman M, et al. Pattern of aerobic bacteria with their drug susceptibility of surgical inpatients. Mymensingh Med J 2003;12(2):98-103.

Hadadi A, Rasoulinejad M, Maleki Z, et al. Antimicrobial resistance pattern of Gramnegative bacilli of nosocomial origin at 2 university hospitals in Iran. Diagn Microbiol Infect Dis 2008;60(3):301-5.

Guembe M, Cercenado E, Alcala L, et al. Evolution of antimicrobial susceptibility patterns of aerobic and facultative gram-negative bacilli causing intra-abdominal infections:results from the SMART studies 2003-2007. Rev Esp Quimioter 2008;21(3):166-73.

Al-Lawati AM, Crouch ND, Elhag KM. Antibiotic consumption and development of resistance among gram negative bacilli in intensive care units in Oman. Ann Saudi Med 2000;20(3-4):324-7.

Streit JM, Jones RN, Sader HS, et al. Assessment of pathogen occurrences and resistance profiles among infected patients in the intensive care unit:report from the SENTRY Antimicrobial Surveillance Program (North America, 2001). Int J Antimicrob Agents 2004;24(2):111-8.

Bronzwaer SL, Cars O, Buchholz U, et al. A European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis 2002;8(3):278-82.

Beekmann SE, Heilmann KP, Richter SS, et al. Antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and group A beta-Haemolytic streptococci in 2002-2003. Results of the multinational GRASP surveillance program. Int J Antimicrob Agents 2005;25(2):148-56.

Hanumanthappa AR, Chandrappa NR, Rajasekharappa MG. Prevalence of methicillin resistant Staphylococcusaureus in Karanataka. Indian J Pathol Microbiol 2003;46(1):129-32.

Tahnkiwale SS, Roy S, Jalgankar SV. Methicillin resistance among isolates of Staphylococcus aureus;antibiotic sensitivity pattern and phage typing. Indian J Med Sci 2002;56(7):330-4.

Bukharie HA, Abdelhadi MS. The epidemiology of methicillin-resistant Staphylococcus aureus at a Saudi University Hospital. Microb Drug Resist 2001;7(4):413-6.

Zaman R, Dibb WL. Methicillin resistant Staphylococcus aureus isolated in Saudi Arabia:Epidemiology and antimicrobial resistance patterns. J Hosp Infect 1994;26(4):297-300.

Sturenburg E, Mack D. Extended-spectrum betalactamases: implications for the clinical microbiology laboratory, therapy, and infection control. J Infect 2003;47(4):273-95.

Rodríguez-Baño J, Navarro MD, Romero L, et al. Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamaseproducing Escherichia coli in nonhospitalized patients. J Clin Microbiol 2004;42(3):1089-94.

Borer A, Gilad J, Menashe G, et al. Extended-spectrum beta-lactamase-producing Enterobacteriaceae strains in community-acquired bacteremia in Southern Israel. Med Sci Monit 2002;8(1):CR44-7.

Valverde A, Coque TM, Sánchez-Moreno MP, et al. Dramatic increase in prevalence of fecal carriage ofextended-spectrum beta-lactamase-producing Enterobacteriaceae during nonoutbreak situations in Spain. J Clin Microbiol 2004;42(10):4769-75.

How to Cite
1.
Zamani S, Nasiri MJ, Khoshgnab BN, Ashrafi A, Abdollahi A. Evaluation of Antimicrobial Resistance Pattern of Nosocomial and Community Bacterial Pathogens at a Teaching Hospital in Tehran, Iran. Acta Med Iran. 52(3):182-186.
Section
Articles