Tamizhazhagan 1
Tamizhazhagan 1
Tamizhazhagan 1
Research Article
STUDIES ON BACTERIAL POPULATION IN INTENSIVE CARE UNIT OF THANJAVUR MEDICAL
COLLEGE
INTRODUCTION organisms. Several attempts were directed to find out the causal
agent of wound and their eradication by antibiotic therapy in man
The widespread use of antibiotics both inside and outside of [13, 14]. Specific causal agents of other infectious diseases of
medicine is playing a significant role in the emergence of resistant humans were diagnosed. Penicillin was the first antibiotic
bacteria [6]. Although there were low levels of preexisting discovered for the treatment of bacterial infection and its
antibiotic-resistant bacteria before the widespread use of antibiotics indiscriminate use causes emergence of resistant organisms.
Caldwell and Lindberg (2011) [2]. Evolutionary pressure from their Currently some important organisms are developing resistance
use has played a role in the development of multidrug resistance rapidly, including those that cause skin and bloodstream infections,
varieties and the spread of resistance between bacterial species S. aureus [15].
Hawkey and Jones (2009) [7]. In some countries, antibiotics are sold
over the counter without a prescription, which also leads to the In recent years most of the organisms get resistant power against
creation of resistant strains. In human medicine, the major problem most of the antibiotics. World health organization recently reported
of the emergence of resistant bacteria is due to misuse and overuse the nosocomial infection is mainly causing most of the disease.
of antibiotics by doctors as well as patients WHO (2002) [22]. Other Recently Mycobacterium tuberculosis bacterial strains get resistant
practices contributing towards resistance include the addition of power against antibiotics. So in the present investigation justifiably
antibiotics to livestock feed [5]. Household use of antibacterial in planned with following objectives:
soaps and other products, although not clearly contributing to
resistance, is also discouraged (as not being effective at infection Clinical sample were collected from ICU / ICCU Thanjavur Medical
control) [3]. Also unsound practices in the pharmaceutical College Hospital (TMCH), Thanjavur, Isolation and identification of
manufacturing industry can contribute towards the likelihood of bacteria from the open plate method and to study the antibiotic
sensitivity test against isolated organism by using Kirby Bauer
creating antibiotic-resistant strains [4].
method.
Certain antibiotic classes are highly associated with colonization
MATERIALS AND METHODS
with "superbugs" (highly antibiotic resistant bacteria) compared to
other antibiotic classes. The risk for colonization increases if there is Sample collection
a lack of sensitivity (resistance) of the superbugs to the antibiotic
used and high tissue penetration, as well as broad-spectrum activity In the present study isolate and identify the bacterial population in
against "good bacteria". In the case of MRSA, increased rates of Intensive Care Unit / Intensive Critical Care Unit. To study the
MRSA infections are seen with glycopeptides, cephalosporin and bacterial population the samples were collected from Thanjavur
especially quinolones[15]. In the case of colonization with Medical College Hospital (TMCH). For the sample collection nutrient
Clostridium difficile the high risk antibiotics include cephalosporins agar plates were used by open plate method at different time
and in particular quinolones and clindamycin [17]. intervals in Intensive Care Unit / Intensive Critical Care Unit. The
transport media also used to collect the sample by swab the internal
The volume of antibiotic prescribed is the major factor in increasing things like equipments and patient beds, bed seat etc. After sample
rates of bacterial resistance rather than compliance with collection the samples were brought to the laboratory immediately
antibiotics[13]. A single dose of antibiotics leads to a greater risk of and kept in 37 C for further analysis.
resistant organisms to that antibiotic in the person for up to a year [4].
Isolation of bacteria
Inappropriate prescribing of antibiotics has been attributed to a
number of causes, including: people who insist on antibiotics, For bacteriological analysis, samples were pipette out in the 1st test
physicians simply prescribe them as they feel they do not have time tube containing 9 ml sterile distilled water from transport media.
to explain why they are not necessary, physicians who do not know The 1 ml of diluted sample was serially diluted to the following
when to prescribe antibiotics or else are overly cautious for medical dilution factors such as 10-6, and 10-7. The 0.1 ml of diluted sample
legal reasons. For example, a third of people believe that antibiotics was taken from each dilution factor the 1 ml of diluted sample was
are effective for the common cold [11, 12]. taken from each dilution factor (10-6 and 10-7). The aerobic
heterotrophic bacteria were enumerated in nutrient agar by serial
Antibiotic sensitivity study is prime important in clinical dilution of the sample, followed by the conventional spread plate
management of ailing cases caused by various pathogenic method of Saha et al., 1995[14]. Aeromonas sp. and Pseudomonas sp.
Ashok et al.
Int J Curr Pharm Res, Vol 6, Issue 4, 55-57
were similarly enumerated on Aeromonas Isolation Medium Base Table 3: Antibiotic sensitivity test by using Penicillin G
and Pseudomonas Isolation Agar, respectively. All the bacteriological
media were used Himedia aboratories Ltd product. After S. No. Organisms Zone of inhibition in mm
inoculation, the Petri dishes containing the culture media were 1 Klebsiella pneumonia 20
incubated at 37for 48 hrs. The populations of bacteria were 2 Escherichia coli, 14
expressed in terms of cfus/ml (colony forming units) in water, 3 Staphylococcus aureus 26
Arithmetical means from three Petri dishes for each dilution were 4 Serratiamarcensis 5
used in the study. 5 Pseudomonas aeruginosa 14
Transport media
Weighed Peptone 3 g, NaCl 2 5g , and then dissolved in 1000 ml of Table 4: Antibiotic sensitivity test by using Streptomycin
distilled water. Adjust the pH of the medium 7.0 (using 1 N NaOH or
S. No. Organisms Zone of inhibition in mm
1% HCl sterilized medium) by autoclave at 121C, 15 lbs pressure for
1 Klebsiella pneumonia 17
15 minutes [18, 21].
2 Escherichia coli, 22
Identification of bacteria 3 Staphylococcus aureus 25
4 Serratiamarcensis 35
The isolated organisms were subjected into various physiological 5 Pseudomonas aeruginosa 17
and biochemical test. The isolated organisms were characterized by
Gram staining technique and the organisms were confirmed by
Joseph et al., 1996 [8] and the biochemical tests were carried out
according to the method of Koneman et. al., 2005 [17].
Antibiotic sensitivity test by disc diffusion method
50
The above identified bacterial colonies were study the antibiotic
40
sensitivity test. The strains are following commercially available
antibiotic discs used for the Antimicrobial sensitivity studies. The 30
test was carried out by disc diffusion method on Muller Hinton Agar
medium (MHA) following the method of NCCLS, 1999[16]. 20
RESULT AND DISCUSSION 10
Isolation and identification of bacteria
0
In the present study the following bacterial species were isolated
and identified from Intensive Care Unit / Intensive Critical Care Unit
of Thanjavur Medical College Hospital (TMCH), Thanjavur. Totally
five species of bacteria were isolated and identified based on colony Fig. 1: Antibiotic sensitivity test
morphology, gram staining and Biochemical studies. The identified
bacteria namely Klebsiella pneumoniae, Pseudomonas aeruginosa,
Escherichia coli,Staphylococcus aureus and Serratiamarcensis spp., Antibiotic sensitivity test
(Table-1).
After incubation period, the plates were examined, and the results
Aerobic Gram negative bacilli are common in mixed infections with were observed as zone of inhibition in mm. In antibiotic sensitivity
Proteus sp., Escherichia coli, Klebsiella and Enterobacter sp., being test, three commercially available common antibiotic discs like
isolated most often. It was found to be true in this study also and the Ciproflaxacin, Penicillin G and Streptomycin were used. Most of the
mixed growth was noticed in 5 cultures (12.1%). Klebsiella and organisms were sensitive like Klebsiella pneumonia, Escherichia coli,
Escherichia coli and Pseudomonas and Klebsiella showed mixed Staphylococcus aureus Serratiam arcensis and Pseudomonas
growth. However, the common inhabitant of the pus, proteus sp., was aeruginosaare sensitive to all three antibiotics and clear zone was
absent among the isolates. Mixed growth was obtained rarely, only formed respectively 14-20 mm, 14-29 mm, 25-42 mm, 5-35 mm and
in 5 cultures among the eight positive samples, this was found to be 14-35 mm (Table-2, 3, 4 and Fig. 1). Comparable activities were also
a deviation from the earlier works, in which mixed growth was observed in Ashok and Jayaprash, 2012 [23]
frequently present and more often than single incidence[10]. Similar
studies were observed by [7,9,1]. In these cases, the implementation of standard principles for
preventing hospital acquired infections will result in the prompt
eradication of the outbreak. In other hospitals, infections have
become endemic, and the clinical and microbiological epidemiology
Table 1: Isolation and identification of bacteria from sample
of these infections remain obscure [19, 18, 20, 22]
S. No. Organisms
CONCLUSION
1 Klebsiella pneumonia
2 Escherichia coli, These studies will be very much helpful in designing many novel
3 Staphylococcus aureus drugs for the beneficial values of human lives.
4 Serratiamarcensis
5 Pseudomonas aeruginosa REFERENCE
1. Bal A. Dairy animals Foot: magnitude of the problem. J Indian
Med Assoc 2002. p. 155-7.
Table 2: Antibiotic sensitivity test by using Ciprofloxacin 2. Roy C, Lindberg, David. Understanding Evolution Mutations
arerandom University of California Museum of Paleontology.
S. No. Organisms Zone of inhibition in mm BMJ 2011;4:3-6.
1 Klebsiella pneumonia 14 3. CDC. Antibiotic Resistance Questions & Answers [Are
2 Escherichia coli, 29 antibacterial-containing products (soaps, household cleaners)
3 Staphylococcus aureus 42 better for preventing the spread of infection? Does their use
4 Serratiamarcensis 37 add to the problem of resistance?]". Atlanta, Georgia, USA:
5 Pseudomonas aeruginosa 35 Centers for Disease Control and Prevention; 2009.
56
Ashok et al.
Int J Curr Pharm Res, Vol 6, Issue 4, 55-57
4. Ceire C, Chris M, Andrew L, Alastair D. "Effect of antibiotic 17. Koneman WK, Allen SD, Janda WM, Schreckenberger PC,
prescribing in primary care on antimicrobial resistance in Propcop GW, Woodsand GL, et al. Philadelphia Color Atlas and
individual patients: systematic review and meta-analysis". BMJ Textbook of Diagnostic Microbiology, 6th ed. Lippincott-Raven
2010. p. 17-8. Publisher; 2005. p. 624-62.
5. Ferber D."Livestock Feed Ban Preserves Drugs Power". Sci 18. Chakraborty SP, Kar Mahapatra S, Somenath Roy BM. Isolation
2002;5552:278. and Identification of Vancomycin Resistant Staphylococcus
6. Goossens H, Ferech M, Vander Stichele R, Elseviers aureus from Post Operative Pus Sample. Al Ameen J Med Sci
M.Outpatient antibiotic use in Europe and association with 2011a:4:152-68.
resistance: a cross-national database study". Lancet 19. Cisneros JM, Rodriguez-Bano J, Nosocomial bacteremia due to
2005;9459:57987. Acinetobacter baumanii: epidemiology, clinical features and
7. Hawkey PM, Jones AM. "The changing epidemiology of treatment. Clin Microbiol Infect 2002;8(11):687-91.
resistance". J Antimicrobial Chemotherapy 2009;64 Suppl 1:i3 20. Bayuga S, Zeana C, Sahni J, Della-Latta P, el-Sadr W, Larson E.
10. Prevalence and antimicrobial patterns of Acinetobacter
8. Joseph WS, Kosinki MA. Prophylaxis in lower extremity baumanii on hands and nares of hospital personnel
infectious diseases. Clin Poadiatr Med Sur 1996;13(4):647-60. andpatients: the iceberg phenomena again. Heart Lung
9. Kamal K, Powelt RJ, Sumpio BE. The pathobiology of Dairy 2002;31(5):382-90.
animals. Implication for surgeons. J AM Coll Surg 21. Corbella X, Montero A, Pujol M. Emergence and rapid spread of
1996;183(3):271-89. carbapanem resistance during a large and sustained hospital
10. Kamal MM, Parveen N, Saha S, Amin MM. Bacteriological study putbreak of multiresistant Acinetobacter baumanii. J Clin
on uterine discharge in repeat breeder cows. Banglodesh Vet J Microbiol 2000;38(11):4086-95.
2001;35:49-52. 22. WHO. World Health Report: Reducing risks, Promoting Healthy
11. McNulty CA, Nichols BP, Clappison P, Davey P. "The public's Life. Geneva: World Health Organization; 2002.
attitudes to and compliance with antibiotics". J Antimicrob 23. Ashok K, Jayaprakash P. Screening of active phytocompounds
Chemother 2007;60:i638. by GC-MS study and antimicrobial activity in the stem of
12. Nelson William R, Darwin then. Now: The Most Amazing Story Santalum album 2012;4(3):43-4.
in the History of Science I Universe; 2009. p. 294. 24. Cisneros JM, Rodriguez-Bano J. Nosocomial bacteremia due to
13. Pechre JC. "Patients' interviews and misuse of antibiotics". Acinetobacter baumanii: epidemiology, clinical features and
Clin Infect Dis 2001;3:S1703. treatment. Clin Microbiol Infect 2002;8(11):687-91.
14. Saha SC, Zaman MA, Khan MR, Ali SMK. Common aerobic 25. NCCLS. Performance Standards forAntimicrobial Susceptibility
bacteria in post operative wound infection and their sensitivity Testing: Ninth Info Suppl 1999;19(1):68.
pattern. Bangladesh Med Res Coun Bull 1995;21:32-7. 26. Bayuga S, Zeana C, Sahni J, Della-Latta P, el-Sadr W, Larson E.
15. Tacconelli E, De Angelis G, Cataldo MA, Pozzi E, Cauda R. "Does Prevalence and antimicrobial patterns of Acinetobacter baumanii
antibiotic exposure increase the risk of methicillin-resistant on hands and nares of hospital personnel andpatients: the iceberg
Staphylococcus aureus (MRSA) isolation: A systematic review phenomena again. Heart Lung 2002;31(5):382-90.
and meta-analysis". J Antimicrob Chemother 2008;61(1):26 27. Corbella X, Montero A, Pujol M. Emergence and rapid spread of
38. carbapanem resistance during a large and sustained hospital
16. NCCLS, Performance Standards for Antimicrobial Susceptibility putbreak of multiresistant Acinetobacter baumanii. J Clin
Testing: Ninth Inf Suppl 1999;19(1):68. Microbiol 2000;38(11):4086-95.
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