ISSN: 2320-5407 Int. J. Adv. Res.

9(12), 161-168

Journal Homepage: - www.journalijar.com

Article DOI: 10.21474/IJAR01/13888

DOI URL: http://dx.doi.org/10.21474/IJAR01/13888

RESEARCH ARTICLE
STUDY OF ANTIBIOTIC-RESISTANCE AND SENSITIVITY PATTERN IN A TERTIARY CARE
TEACHING HOSPITAL

Dr. Sailajapriyadarsini Parlapalli1, Dr. V.V Padmavathy2 and Dr. Gunapati Rama Mohan Reddy1
1. Postgraduate, Associate Professor, Postgraduate.
2. Associate professor, Siddhartha Medical College, Vijayawada.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Introduction: Antibiotics are helpful in bacterial infection control and
Received: 05 October 2021 management. Irrational antibiotic use leads to resistance, which puts
Final Accepted: 10 November 2021 modern medicine’s achievements at risk. This study aims to know
Published: December 2021 antibiotic resistance and sensitivity patterns and to assess possible
factors that favor the development of antibiotic resistance.
Key words:-
Antibiotic Sensitivity Patterns, Methods: It is a retrospective observational study. Data collected from
Antibiotic Resistance Patterns, Culture June 2019 to May 2020 from the culture & sensitivity records of
Sensitivity, Antibiotics various clinical isolates at the Microbiology department of SMC,
Vijayawada, and analyzed by descriptive statistics.
Results: Total samples collected 2905. Only746 samples showed
significant growth. Most commonly, isolated organisms were from Pus
and Body fluids Staphylococcus aureus (31.16%), Klebsiella (23.02%),
from blood samples Staphylococcus aureus (44%,) Klebsiella (32%),
from urine samples Escherichia coli (27.31%),Staphylococcus aureus
(16.66%). Bacteria isolated from, Blood and Pus & body fluid samples
showed more resistance to Amoxicillin + Clavulanic acid, 60%
&58.60%, and urine samples showed more resistance to
Norfloxacin69.44%.
Conclusion: In this study, bacteria isolated from, blood, pus, and body
fluid samples showed more resistance to Amoxicillin + Clavulanic
acid, from urine samples showed more resistance to Norfloxacin.
Parenterally used drugs like aminoglycosides and vancomycin have
retained their sensitivity but bacteria also showed resistance to
Imipenem, Vancomycin, new combinations like Cefoperazone +
Sulbactam. A culture & sensitivity test and following antibiotic
stewardship guidelines before prescribing antibiotics will give good
results to prevent antibiotic resistance.

Copy Right, IJAR, 2021,. All rights reserved.

……………………………………………………………………………………………………....
Introduction:-
Antimicrobial agents were viewed as a miracle cure when first introduced into the clinical practice but the
development of resistance dims the luster of a miracle. Inappropriate use of antibiotics favors the emergence and
spread of antibiotic resistance which is putting the advancements of modern medicine at risk. Antibiotic resistance
refers to the ability of microorganisms to withstand the effect of the antibiotic. Antibiotic-resistant leads to longer
hospital stays, higher medical costs, and increased mortality.Many infections such as pneumonia, tuberculosis,

Corresponding Author:- Dr. V.V Padmavathy 161

Address:- Associate professor, Siddhartha Medical College, Vijayawada.
ISSN: 2320-5407 Int. J. Adv. Res. 9(12), 161-168

gonorrhea, and foodborne diseases are becoming difficult and sometimes impossible because of antibiotic resistance.
World Health Organization (WHO) has declared AMR a public health threat and has urged different countries to
develop an action plan to combat the problem.

Themajor factors associated with the emergence of antibioticresistance:

Evolution & clinical/environmental practices

Intrinsic factors:
Reduced entry of antibiotic into a pathogen,Enhanced export of antibiotics by efflux pumps,Release of microbial
enzymes that alter or destroy the antibiotic,Alteration of target proteins, Development of alternative pathways to
those inhibited by the antibiotic

Social factors:
Demographic changes,Deficient hygienic practices,Irrational use of antibiotics,Overcrowding, geographical
variations

Due to the geographical variations in antibiotic resistance and sensitivity that have been reported by manystudies,
this study was undertaken with the following objectives in a tertiary care teaching hospital in Vijayawada:
1)To identify the group of organisms isolated
2) To know resistance and sensitivity patterns to various antibiotics
3)To assess the possible factors that can favor the development of antimicrobial resistance

Methodology:-
This is a retrospective observational study conducted at the Dept of Pharmacology SMC Vijayawada. Approval
from the Institutional Ethics and Researchcommittee was obtained before the commencement of the study.
Dataregarding culture and sensitivity of the organisms isolated from different samples such as urine, blood, pus, and
body fluids were collected from June 2019 to May 2020 from culture and sensitivity records of dept of
Microbiology of SMC, Vijayawada. The obtained data were subjected to descriptive statistics.

Results:-
Data were collected from June 2019 to May 2020. Total samples collected 2905. Among 2905samples, 1347
samples are Pus and Body fluids, 632 Samples are blood, 926 samples areurine. Among these only 746 (25.67%)
samples showed significant growth and the remaining samples didn’t show growth(Table-1).

Table 1:-
Type of samples sterile Growth seen Total
Pus and Body fluids 917 430 1347
Blood 532 100 632
Urine 710 216 926
Total 2159 746 2905

Isolated organisms
Pus and Body Fluids:
Among 1347 samples of Pus and Body fluids only 31.9% (n=430) samples showed significant growth, remaining
68.07% (n=917) samples were sterile. Most common isolated organisms were Staphylococcus aureus
31.16%(n=134), Klebsiella 23.02%(n=99), Pseudomonas 14.65% (n=63), Escherichia coli 8.83% (n=38), Proteus
spp5.58%(n=24), Methicillin Resistant Staphylococcus Aureus (MRSA) 4.65%(n=20), Coagulase Negative
Staphylococcus (CONS) 4.65%(n=20), Methicillin Sensitive Staphylococcus aureus (MSSA) 3.95%(n=17),
Acinetobacter spp.2.09%(n=9), Streptococcus spp. 0.93%(n=4), Enterococcus spp. 0.46% (n=2) respectively
(Figure-1).

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ORGANISMS ISOLATED FROM VARIOUS SAMPLES

FIGURE-1

Pus and Body fluids Blood urine

134
140
NO OF ORGANISMS

120 99
100
80 59 63
60 44
40
36 3236 38
22 24 20 20 20 20 17
8 9
20 2 0 3 5 3 3 5 2 4 4 0 4 2 0 7 1
0

Blood:
Among 632 samples of blood, only 15.82%(n=100) samples showed significant growth, the remaining 84.17%
(n=532) samples are didn’t show any growth.Most common isolated organisms are Staphylococcus aureus
44%(n=44), Klebsiella 32%(n=32), Pseudomonas 8%(n=08), followed byMRSA (Methicillin-Resistant
Staphylococcus Aureus) 5%(n=05), CNSA (Coagulase Negative Staphylococcus Aureus) 3%(n=03) MSSA
(Methicillin Sensitive Staphylococcus Aureus) 3%(n=03), Acinetobacter 2%(n=02), E. coli 2%(n=02), Salmonella
1% (01) respectively (Figure-1)

Urine:
Among 926 urine samples only 23.32%(n=216) samples had shown significant growth remaining 76.67%(n=710)
samples were culture sterile. Most common isolated organisms were Escherichia coli 27.31%
(n=59),Staphylococcus aureus 16.66% (n=36), Klebsiella spp.16.66% (n=36), Pseudomonas spp10.18%(n=22),
followed by Methicillin Resistant Staphylococcus Aureus (MRSA)9.25% (n=20), Coagulase Negative
Staphylococcus (CONS)9.25%(n=20), Methicillin Sensitive Staphylococcus aureus (MSSA)2.31%(n=05),
Acinetobacter spp.1.85%(n=04), Citrobacter spp.1.85%(n=04), Proteus spp.1.38%(n=03). (Figure-1)

Resistance and Sensitivity Patterns

Pus and Body Fluids:
In this study,bacteria isolated from pus and body fluid samples showed resistance and sensitivity patternsto
Amoxicillin + Clavulanic acid58.60%&41.39%(n=252&178), Co-trimoxazole 53.02%&46.97% (n=228 &202),
Ciprofloxacin 51.16%&48.85% (n=220&210), Ceftriaxone48.85%&51.16%%(n=210&220), Cefotaxime
43.72%&56.27%% (n=188&212), Cefepime 42.79%&57.20% (n=184&226) followed by
Ceftazidime31.16%&68.85% (n=134&296), Piperacillin +Tazobactam31.16%&68.85%(n=134&296),
Cefoperazone16.74%& 83.25% (n=72&358), Amikacin15.34%&86.65%(n=66&364), Cefixime12.55%&87.44%
(n=54&376), Levofloxacin12.55&87.44% (n=54&376&43%), Gentamicin5.81% &88.37%(n=27&26),
Cefoperazone+Sulbactam 8.83%&91.16%(n=54&376), Imipenem 5.11%&94.88%%(n=22&408), Vancomycin
2.79%& 97.20%(n=12&418) Linezolid2.32%&97.67%%(n=10&420) respectively. No resistance seen with
Ceftazidime + Clavulanic acid and sensitivity is 100%. (Figure-2

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BLOOD (N=100)
FIGURE-3
120.00%
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%

Resistance sensitivity

PUS AND BODY FLUIDS, N=430

FIGURE-2
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%

Resistantce Sensitivity

Blood:
In this study bacteria isolated blood samples showed resistance and sensitivity to Amoxicillin + Clavulanic acid
60%&40% (n=60&40), Cefoperazone54%&46% (n=54%&46%),Cefepime 52%&48(n=52%48%),
Cefotaxime40%&60%(n=40&60), Ceftazidime32%&68%(n=32&68), Ceftriaxone28%&72% (n=28&72) ,
Ciprofloxacin 22%&78%%(n=22&78),Cotrimoxazole20%&80%(n=20&80), Gentamicin20%&80% (n=20&80),
Piperacillin +Tazobactam18%&82% (n=18&82),Amikacin16%&84(n=16&84), Levofloxacin16&84%(n=16&84),
Azithromycin14%&86%(n=14&86), followed by Cefixime12%&82%(n=12&82),Vancomycin8%&96
(N=08&96),Linezolid 3%&97%(N=3&97), Cefoperazone +Sulbactam 2%&98%(n=02&98), Imipenem
1%&99%(n=1&99) respectively and Ceftazidime + Clavulanic acid didn’t show any resistance.(Figure-3).

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Urine:

Urine (n=216)
Figure-4
120.00%
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%

Resissatnce Sensitivity

In this study, bacteria isolated from urine samples showed resistance & sensitivity to Nalidixic acid
82.87%&17.21%(n=179 &37),Norfloxacin69.44%&30.55%(n=150&66),Ceftriaxone 66.66%&32.87%
(n=145&71),Cefotaxime61.11%&32.87%(n=13&84), Amoxicillin+ Clavulanic acid59.72%&40.27%(n=129&87)
,Ceftazidime 53.24%&46.75%(n=115&101), Nitrofurantoin 51.85%&48.14% (n=112&48.14%),Cefixime
51.85%&48.14% (n=112&104), Cefoperazone 49.50%&50.46%(n=107&109),Co-trimoxazole 46.29% &53.70%(n-
100&106 Levofloxacin 46.29%&53.70%(n=100&106), Ciprofloxacin 44.09&55.09% (n=97&119),
Cefepime27.77%&72.22%(n=60 &156), Amikacin 21.29%& 77.70%(n=48&168),
Vancomycin1.85%&98.14%(n=04&212), Linezolid 1.38& %98.61 (n=03&213), Ceftazidime + Clavulanic acid
0.92%&99.07% (n=02&214),Imipenem 0.46% &99.53%(n=01&21),No resistance is observed for Cefoperazone +
Sulbactam(Figure-4).

Discussion:-
Antibiotic resistance is one of the most common problems in the health care sector which is a challenging issue for
healthcare professionals to combat infectious diseases and complications. This study is a retrospective observational
study, collected data from microbiology department records from June 2019 to May 2020. The totalnumber of
samples collected was2905.Tested samples were from Pus& Body fluids, Blood, and urine. Out of 2905 samples,
only 25.67%(N=746) samples showed culture positivity which corresponds with studies conducted byVijayalaxmi
V. Mogasale et al.(19%), Revathy Saravanan etal.(12.5%)

Among 1347 Pus and Body fluids samples, only 31.9% (n=430) of culture positivity, remaining 68.07% (n=917)
samples were culture negative. Astudy conducted by S. Ambwani et al.in pus samples showed 46.75% culture
positivity. Another study conducted by Haritha Madigubba in sterile body fluids showed 29.9% culture
positivity.The most common isolated organisms were Staphylococcus aureus 31.16%(n=134/430) which correlates
with the study conducted byPerween N et al. Next most isolated organism is Klebsiella 23.02%(n=99),
Pseudomonas 14.65% (n=63). Bacteria isolated from pus and body fluid samples were highly resistant to
Amoxicillin + Clavulanic acid 58.60% and showed high sensitivity to Ceftazidime + Clavulanic acid (100%),
Linezolid 97.67%%(n=420), Vancomycin 97.20%(n=418),Imipenem94.88%(n=408).

Among 632 blood samplesof blood only 15.82%(n=100) samples showed significant growth, remaining 84.17%
(n=532) samples are didn’t show any growth.Most frequently, isolated bacteria wereStaphylococcus aureus which is
a Gram-positivebacteria.Among Gram-negative bacteria,the most frequent isolate was Klebsiella SPs.and
Pseudomonas SPs.A Studyconducted in Vijayawada,Andhra Pradesh byDr. Tharangini Karicheti et al. and another
study conducted in Ethiopia showed the same results. Isolated bacteria showed high resistance to Amoxicillin +

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Clavulanic acid 60% (n=60) and showed high sensitivityCeftazidime + Clavulanic acid (100%). Imipenem
99%(n=99) Cefoperazone +Sulbactam 98%(n=98) Linezolid 97%(N=97).Bacteria isolated from blood, pus, and
body fluidsshowed high Amoxicillin + Clavulanic acid resistance. a study conducted by K. V. Ramanath et al
showed the same results

Among 926 urine samples, only 23.32%(n=216) samples had shown significant growth remaining 76.67%(n=710)
samples were culture negative.The most common isolated organisms were Escherichia coli 27.31% (n=59) which
corresponds with a studyconducted in Bangladesh by F. Tarannum Haque et al andin South India by Saligrama
Chikkannasetty Somashekara et al. Next most commonly isolated organisms are Staphylococcus aureus 16.66%
(n=36), Klebsiella spp.16.66% (n=36).Bacteria isolated from urine samples showed high resistanceto Nalidixic acid
82.87%(n=179), which is not used much in clinical practice.

Among frequently using antibiotics, uropathogens showed high resistance to Norfloxacin69.44%(n=150) a study
conducted in South India by Saligrama Chikkannasetty Somashekara et al. showed the same results. There is
increased resistance to Fluoroquinolones and similar observations were reported from the studies from other parts of
India. This may be due to the widespread use of fluoroquinolones as first-line empirical therapy for UTIs.Bacteria
isolated from urine samples sensitive to Cefoperazone + Sulbactam(100%),Imipenem 99.53%(n=21) Ceftazidime +
Clavulanic acid 99.07%(n=214), Linezolid98.61%(n=213),Vancomycin198.14%(n=212).

In this study after amoxicillin+ clavulanic acid, for 3 rd generation, Cefalosporins bacteria showed a considerable
amount of resistance. Considerable sensitivity is still retained to amikacin due to less use of these injectable
antibiotics. Imipenem, Linezolid, Vancomycin-resistant bacteria and Ceftazidime+Clavulanic acid,
Cefoperazone+Clavulanic acid-resistant bacteria also isolated, but very less number. This resistant pattern may be
due to the inadvertent prescription of antibacterial drugs.But sensitivity to these drugs is very high.

Conclusion:-
In this retrospective observational study, among 2905 samples, only 746 (25.67%) samples showed significant
growth. The most commonly isolated organisms were Staphylococcus aureus, Klebsiella, Pseudomonas from pus
and body fluids and blood samples, Escherichia coli,Staphylococcus aureus, Klebsiella were the most common
isolated organisms from Urine samples.

In this study, bacteria isolated from blood, pus, and body fluid samples showed more resistance to Amoxicillin +
Clavulanic acid. Among bacteria isolated from urine samples showed more resistance to Fluoroquinolones like
Norfloxacin and 3rd generation Cephalosporines like Ceftriaxone, Cefotaxime. Parenterally used drugs like
aminoglycosides (e.g.gentamicin and amikacin) and vancomycin have retained their sensitivity but bacteria also
showed resistance to Imipenem, Vancomycin, new combinations like Cefoperazone + Sulbactam From this study
understood that organisms also developed resistance to even reserve group antibiotics (4th generation
Cephalosporines, Linezolid).

Currently, we are in an antibiotic discovery void state, since 2007 there has been no new antibiotic intervention. So,
it is essential to use antibiotics conservatively to prevent antibiotic resistance by following 4Ds (Right Drug, Right
Dose, De-escalation to pathogen directed therapy, right Duration of therapy) and following antibiotic stewardship
policies and culture sensitivity tests before prescribing Every hospital should have an antibiotic policy. Regular
antibiotic audits are needed. By following the above policies can prevent antimicrobial overuse, misuse, and abuse
which helps to minimize the development of resistance at the hospital and community level. Not only do physicians,
veterinary, and agricultural personnel also need to participate in preventing misuse of antibiotics also need to be
controlled.

Acknowledgement:-
We sincerely thank the Dept.of Microbiology, Siddhartha Medical College, Vijayawada and for permitting to carry
out this study.

Financial Support And Sponsorship:

Nil.

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Conflicts Of Interest:
There are no conflicts of interest.

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