Afaq R. Afridi, Tanveer Ahmad, Arshad Hussain and Abdul Samad. SPUTUM CULTURE ISOLATES AND THEIR ANTIBIOTIC SUSCEPTIBILITY PATTERNS IN NORTHWEST GENERAL HOSPITAL & RESEARCH CENTRE, PESHAWAR. Afaq R. Afridi, Tanveer Ahmad, Arshad Hussain and Abdul Samad.

Introduction Antimicrobial resistance Significant contribution Morbidity Mortality Global economic burden. The antimicrobial resistance has increased worldwide in the past few years. Inappropriate use of antibiotics (esp. broad spectrum) is thought to be the leading contributory factor in developing resistance. Many studies have been performed on antibiotic susceptibility worldwide. There is a profound lack of similar studies in Pakistan. Significant contribution -Canton R. Antibiotic resistance genes from the environment: A perspective through newly identified antibiotic resistance mechanisms in the clinical setting. Clin Microbiol Infect. 2009;15(Suppl 1):20-25. doi: 10.1111/j.1469-0691.2008.02679.x. -Zafar A. Prevalent nosocomial gram negative aerobic bacilli and their antimicrobial susceptibility pattern in intensive care unit. J Pak Med Assoc. 1999;49(7):169-172.

Rationale To document the frequency of different types of isolates. To assess antibiotic sensitivity and resistance patterns. To compare sensitivity patterns between two groups Afghanistan nationals vs Pakistan nationals

Methodology Cross sectional, descriptive study Consecutive sampling All patients with RTI , both in- and out-patients, Positive growth were included in this study. Sputum cultures that yielded no growth or had grown respiratory commensals were ultimately excluded. Data entered and analyzed in EXCEL 2013 The Sputum samples were received and processed as per standard protocol.

Methodology Sputum sample acquired according to standard protocol Samples were incubated for 24hours in 37oC. Blood agar, chocolate agar and MacConkey’s agar were used. Growth identified. Sensitivity checked via Kirby Bauer disc diffusion method according to CLSI† guidelines † Clinical & laboratory standards institute.

Results Sample size  615 Mean Age Gender distribution 354 (57.56%) yielded positive growth. Mean Age 49.87 ± 21.44 Gender distribution Male 219 (61.86%) Female 135 (38.14%) Nationality distribution Afghanistan 163 (46.05%) Pakistan 191 (53.95%)

Results Growth No. %age Acinetobacter Spp. 47 13.28% Candida Spp. 11 3.11% Chryseobacterium indologenes 1 0.28% E.coli Spp. 60 16.95% Enterobacter Spp. 15 4.24% Klebsiella Spp. 3 0.85% Moraxella Spp. 54 15.25% MRSA 17 4.80% Proteus mirabilis (cephalosporinase producer) 2 0.56% Providencia Spp. 4 1.13% Pseudomonas Spp. 71 20.06% Serratia Spp. 8 2.26% Staph. Aureus (MSSA) Streptococcus Spp. 58 16.38%

Results Growth in AF No. %age Acinetobacter Spp. 20 12.27% Candida Spp. 5 3.07% Chryseobacterium indologenes 1 0.61% E.coli Spp. 33 20.25% Enterobacter Spp. 11 6.75% Klebsiella Spp. 0.00% Moraxella Spp. 21 12.88% MRSA Proteus mirabilis (cephalosporinase producer) Providencia Spp. 3 1.84% Pseudomonas Spp. 28 17.18% Serratia Spp. 4 2.45% Staph. aureus Streptococcus Spp. Growth in PK No. %age Acinetobacter Spp. 27 14.14% Candida Spp. 6 3.14% Chryseobacterium indologenes 0.00% E.coli Spp. Enterobacter Spp. 4 2.09% Klebsiella Spp. 3 1.57% Moraxella Spp. 33 17.28% MRSA 12 6.28% Proteus mirabilis (cephalosporinase producer) 1 0.52% Providencia Spp. Pseudomonas Spp. 43 22.51% Serratia Spp. Staph. aureus Streptococcus Spp. 30 15.71%

Results

Results Amikacin 92.96% (AF 89.29%, PK 95.35%) Meropenem 91.55% (AF 82.14%, PK 97.67%) Cefoperazone + Sulbactam 16.90% (AF 14.29%, PK 18.60%). Meropenem 98.33% (AF 100%, PK 96.30%) Amikacin 98.31% (AF 96.97%, PK 100%) Amoxicillin/Clavulanic Acid, Piperacillin + Tazobactam, Cefotaxime and Ceftazidime 5% (AF 0%, PK 11.11%)

Results Doxycycline 100% (AF 100%, PK 100%) Amoxicillin/Clavulanic Acid 93.10% (AF 92.86%, PK 96.67%) Erythromycin 1.72% (AF 0% PK 3.33%) Complete resistance to Trimethoprim 0% (AF 0%, PK0%) Amoxicillin/Clavulanic Acid 98.15% (AF 95.24%, PK 100%) Doxycycline 96.23% (AF 90.48%, PK 100%) Penicillin-G 3.70% (AF 0%, PK 6.06%) Completely resistant to Trimethoprim 0% (AF 0%, PK 0%)

Results Amikacin 59.57% (AF 60%, PK 59.26%) Gentamicin 12.77% (AF 5%, PK 18.52%) Ciprofloxacin 2.13% (AF 5%, PK 0%) Completely resistant to Amoxicillin/Clavulanic Acid, Piperacillin + Tazobactam, Ceftazidime, Cefotaxime and Trimethoprim + Sulfamethoxazole 0% (AF 0%, PK 0%).

Conclusion Pseudomonas was the commonest isolated organism. In both AF and PK nationals. Lesser sensitivity to commonly used anti-pseudomonal drugs. There is a significantly higher resistance to commonly used antibiotics in the AF population as compared to the PK population. The most resistant organism isolated was Acinetobacter Spp.