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World Applied Sciences Journal 30 (6): 778-781, 2014
ISSN 1818-4952
© IDOSI Publications, 2014
DOI: 10.5829/idosi.wasj.2014.30.06.82327
Antibiotic Resistance of Gram-Negative Bacteria to Ampicillin, Gentamicin and
Imipenem in Samples of the Patients Admitted to Shahidbeheshti Hospital in Kashan
1
Alireza Sharif, 2Mohammad Reza Sharif and 3Javad Alizargar
Department of Infectious Disease, Kashan University of Medical Sciences, Kashan, Iran
2
Department of Pediatrics, Kashan University of Medical Sciences, Kashan, Iran
3
Student Research Committee, Kashan University of Medical Sciences, Kashan, I.R. Iran
1
Abstract: Gram-negative bacteria (GNB) are among the commonest causes of infections. Lack of control on
antibiotics use made GNB resistant to different antibiotics so susceptibility of 205 GNB samples to ampicillin,
gentamicin and imipenem were evaluated. In our study there were 78% resistance rate of GNB to ampicillin,
26.3% resistance rate of GNB to gentamicin and 6.3% to imipenem. New strategies in controlling antibiotic
resistance seem to be necessary.
Key words: Antimicrobial
Bacteria
Resistance
Ampicillin
INTRODUCTION
Gentamicin
Imipenem
considerable costs. In most cases, antibiotic-resistant
infections require extended hospital stays, additional
doctor visits and healthcare use. The estimates of the
healthcare costs to the United States economy for
antibiotic-resistant infections have ranged as high as $20
billion [7].
High bacterial resistance in our hospital settings
[2, 5, 9, 10], as well as the presence of limited studies
regarding antibiotic resistance of GNB in Iran made us to
evaluate pattern of infection and bacterial susceptibility
of GNB of the patients with positive culture of GNB in
Shahidbeheshti Hospital in 2010-2011 for antibiotic
resistance.
Gram-negative bacteria (GNB) are common causes of
intra-abdominal infections, urinary tract infections,
nosocomial pneumonia and bacteremia [1]. Escherichia
coli, Klebsiella pneumoniae and Pseudomonas
aeruginosa are important pathogens in the hospital
setting, accounting for 27% of all pathogens and
70% of all Gram-negative pathogens causing
healthcare-associated infections [1].
Gram-negative bacteria are highly adaptive
pathogens that can develop resistance through several
mechanisms [2]. Resistant Gram-negative bacteria are a
serious global public health concern, especially in
developing countries such as Iran that there are reports of
high antibiotic resistance [3-6]. In the United States it has
been estimated that as many as 2 million patients each
year become infected with a bacterial infection that is
resistant to antibiotics, with an estimated 23,000
deaths associated
with
these infections [7].
The prevalence of resistant Gram-negative bacteria can
vary at local, regional, national and international levels
[8]. Antibiotic-resistant infections pose considerable
challenges to the health care system in relation to
diagnosis, treatment and infection control, as well as
MATERIALS AND METHODS
In this retrospective study, that has been approved
by Kashan University of Medical Sciences Ethical
Committee, by referring to the Shahidbeheshti Hospital
laboratory, cultures of Gram-negative bacteria isolated
from different samples of patients admitted to the hospital
from1st Jun 2010 to 1st December 2011, were identified
[11]. Susceptibility of every case to ampicillin, gentamicin
and imipenem has been added to checklists and all data
were analyzed with SPSS software version 11.5. Names of
Corresponding Author: Mohammad Reza Sharif, 5th Km-Qotb-e Ravandi Boulevard, P.O. Box: 87155.111, Kashan, Iran.
Tel: +98 913 5339790, Fax: +98 361 5579028.
778
World Appl. Sci. J., 30 (6): 778-781, 2014
Table 1: Susceptibility of different GNB to the three tested antibiotics
Antibiotic
Ampicillin
---------------------------------------S
I
R
Gentamicin
------------------------------------S
I
R
Imipenem
------------------------------------S
I
R
Sum
E. coli
Klebsiella
Pseudomonas
Enterobacter
Citrobacter
Proteus
Acinetobacter
Brucella
2
1
3
0
2
1
2
0
23
4
3
2
1
0
0
1
107
26
14
8
4
1
0
0
12
6
4
5
1
1
1
1
88
18
5
3
5
1
0
0
32
7
11
2
1
0
1
0
122
26
13
9
7
2
1
0
6
3
2
0
0
0
0
0
4
2
5
1
0
0
1
0
132
31
20
10
7
2
2
1
Total
11
34
160
31
120
54
181
11
13
205
Pseudomonas, Enterobacter, Citrobacter, Proteus,
Acinetobacter and Brucella to imipenem was 3, 6.4, 25,
10, 0, 0, 50 and 0% respectively.
Resistance of E. coli to ampicillin in Tadesse et al
[12] study was 24.1% that is way lesser than our 81%
result. In a study by Iqbal et al. [13] the resistance rate of
E. coli to ampicillin, gentamicin and imipenem was 76%,
37% and 0.3% respectively. Our results regarding
ampicillin and imipenem resistances are in accordance
with this study and regarding gentamicin, our 24% results
are less than 37% results of Iqbal et al. [13] study and
may show different profiles in the two study
environments of these three antibiotic use.
the patients remained unrevealed. Antimicrobial
susceptibility was evaluated by the Kirby-Bauer disk
diffusion method in guide lines of Clinical and Laboratory
Standards Institute [11].
RESULTS
From 205 samples that had been entered to
checklists 97 (47.3%) were from male patients and 108
(52.7%) were from female ones. different bacterial types
can be seen in figure 1 and the pattern of susceptibility
among samples of patients with GNB are shown in
figure 2.
Different bacterial resistance pattern can be seen in
table 1 and figure 3.
DISCUSSION
Antibiotics are critical in the fight against infectious
disease caused by bacteria. Antimicrobial chemotherapy
has been a leading cause for the dramatic rise of
average life expectancy in the Twentieth Century.
However, disease-causing
microbes that have
become resistant to drug therapy are an increasing
public health problem [10]. There are reports of
increasing in GNB resistance to different antibiotics
[8, 10].
In our study there was 78% resistance rate of GNB
to ampicillin. Resistance rate of E. coli, Klebsiella,
Pseudomonas, Enterobacter, Citrobacter, Proteus,
Acinetobacter and Brucella to ampicillin was 81, 84, 70,
80, 57, 50, 0 and 0% respectively. There was 26.3%
resistance rate of GNB to gentamicin. Resistance rate of
E. coli, Klebsiella, Pseudomonas, Enterobacter,
Citrobacter, Proteus, Acinetobacter and Brucella to
gentamicin was 24, 22.5, 55, 20, 14.2, 0, 50 and 0%
respectively; and there were 6.3% resistance rate of
GNB to imipenem. Resistance rate of E. coli, Klebsiella,
Fig 1: Distribution of bacterial types among patients with
GNB sample
Fig 2: Susceptibility pattern of ampicillin, gentamicin and
imipenem among patients with GNB
779
World Appl. Sci. J., 30 (6): 778-781, 2014
3.
4.
5.
Fig 3: Resistance rate of GNB to different antibiotics
Our results of ampicillin resistance is quite shocking
because this antibiotic with the high resistance, we
obtained,
is
practically
useless in medicine.
Karlowsky et al. [14] announced E. coli ampicillin
resistance from 1998 to 2001 range from 36% to 37.4
whereas our results are twice as much as those.
Gail et al. [15] investigated 7225 sample of E. coli
that showed the resistance rate of 30, 4 and 1% in 19901993 for ampicillin, gentamycin and imipenem. In this
study, ampicillin, gentamicin and imipenem resistance
rates were 38, 8 and 2% regarding Klebsiella; 76, 7 and
3% regarding Enterobacter and 98, 35 and 13% regarding
Pseudomonas respectively.
Our high results of ampicillin resistance shows that
it is not useful in treating most of GNB infections any
more. If we do not control the increasing trend of other
antibiotics such as gentamicin and imipenem, we will
soon lose their efficacy in treating such infections.
6.
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