Multidrug Resistant

and Extensively Drug

Resistant Bacteria: A
Study
Pembimbing :
dr. Desvita Sari, SpMK
dr. Mujahidah, SpMK

Residen : dr. Primasari

INTRODUCTION

 In 2011, WHO declared “combat drug resistance: no action

today, no cure tomorrow.”

 Antimicrobial resistance (AMR) poses a major threat to

patient’s treatment as it leads to increased morbidity and

mortality
Clinical Isolate

Pseudomonas
aeruginosa
Rapidly
Methicillin Resistant develop
Staphylococcus aureus antibiotic
(MRSA) resistance and
Enterococci, especially spread in the
Vancomycin Resistant hospital
environment
Enterococci(VRE) and
members of Family
Enterobacteriaceae:
Klebsiella pneumoniae,
E.coli, and Proteus sp.
 • acquired nonsusceptibility to at least
MDR one agent in three or more
antimicrobial categories

• nonsusceptibility to at least one agent in

XDR all but two or fewer antimicrobial
categories

• Nonsusceptibility to all agents in all

PDR antimicrobial categories.
The main purpose this study

to detect the incidence

of MDR, XDR, and PDR
bacterial isolates in a
tertiary care hospital of
Central India
 MATERIAL AND METHODS

 This short time  from 15th of April to 15th of July, 2014 

isolated from different clinical samples and were identified by

conventional methods  from indoor patient departments (IPD)

 Antibiotic susceptibility test of bacterial strains was done by Kirby

Bauer disc diffusion method as per Clinical Laboratory Standard

Institute (CLSI) guidelines

 Antibiotics
Antibiotics
used for
used for
Gram
Gram positive
cocci (GPC) Penicillin negative
bacilli (GNB) Amikacin
Erythromycin
Ceftazidime
Ciprofloxacin
Clavulanic acid
Tetracycline
Ciprofloxacin
Amikacin
Imipenem
Vancomycin
Colistin
Linezolid
Quality Control of
antibiotic
susceptibility test
MDR,XDR,
and PDR
strains were
detected as
S. aureus ATCC
per criteria
25923, E. coli ATCC described by
25922,and ECDC and
Pseudomonas CD
aeruginosa ATCC
27853
 Methicillin Resistant Staphylococcus aureus (MRSA) strains were
detected by mecA-mediated oxacillin resistance using cefoxitin disk
(30𝜇g) on Mueller Hinton (MH) agar

 Inhibition zone ≤21mm with cefoxitin disk was interpreted as

mecA positive according to CLSI guidelines

 Cefoxitin is used as a surrogate marker for mecA-mediated

oxacillin resistance
MUELLER HINTON (MH) AGAR
 S. aureus ATCC 43300 was used as Quality Control for mecA positive
strains

 Extended Spectrum 𝛽-lactamases (ESBL) producing strains were

detected by combined disk method using ceftazidime (30𝜇g) and
ceftazidime plus clavulanic acid (30𝜇g plus 10𝜇g)

 An increase in diameter of ≥5mm with ceftazidime plus clavulanic acid

as compared to ceftazidime disk alone was considered positive for
ESBL detection
OBSERVATION AND RESULT
138 ICU 698 single
bacterial
growth
880 clinical
sample 172 samples had 2
bacterial isolates
182 mixed
742 ward bacterial 4 samples had 3
growth bacterial isolates

6 samples had 1
bacterial isolate
along with Candida
Total number of 1060 bacterial
albicans
strains were studied.
 252 (80.3%) were 261 (35%) were E.
coagulase positive coli, followed by
staphylococci Pseudomonas
aeruginosa 212
(28.4%)

Total patients admitted were 9304 ( 7947

indoor patient department, 1357 ICU )
 DISCUSSION
 Barbara Soule, Joint Commission Resources Practice Leader, Infection
Prevention and Control Service  Patients who are infected with
MDROs often have an increased risk of prolonged illness and
mortality

 There are new 4 antibiotic class  linezolid, Streptogramins,

daptomycin (effective against MRSA and VRE ) and tigecycline
(effect on Gram negative bacilli)

 The problem is that the bacteria are developing resistance at a much

faster pace than the new drug development
 MDROs are described as superbugs having very limited treatment
 For some MDROs, only 1 or 2 antibiotics can be effective with toxic
side effects

 In 2009, Boucher et al. have reported ESKAPE ( E : Enterococcus

faecium, S : Staphylococcus aureus, K : Klebziella pneumoniae, A :
Acinetobacter baumannii, P : Pseudomonas aeruginosa, and E :
Enterobcter sp) organisms as “Bad Bugs”

 In 2009, Peterson report ESKAPE was change to ESCAPE  C :

Clostridium difficile and E : Enterobacteriaceae
 In the present study, Aly and Balkhy reported that most prevalent
MDRO in their study was E. coli followed by Klebsiella pneumoniae

 In another study,carried out in a tertiary care hospital in Riyadh, it

has been reported that most frequent MDR pathogens were
Pseudomonas aeruginosa followed by E. coli

 The percentage of MDR E. coli strains was more than Klebsiella

pneumoniae and even Pseudomonas aeruginosa in our study probably
because a total number of E. coli strains isolated (261) were also higher.
 CONCLUSION
 We here by conclude that early detection and close monitoring of
MDR, XDR, or even PDR bacterial strains must be started by all
clinical microbiology laboratories to reduce the menace of
antimicrobial resistance which is now a global problem