MDR Organisms in Holy Family Hospital Rawalpindi An Antibiogram Pathology Department Holy Family Hospital Rawalpindi Medical College

Antimicrobial resistance is the ability of microorganisms that cause disease to withstand attack by antimicrobial agents. From drugs used to treat common bacterial infections, to the complex combinations, resistance is increasingly being detected and is spreading rapidly.

Antibiotic-resistant bacteria with the potential to cause untreatable infections pose "a catastrophic threat" to the population.

Antibiotic resistance evolves naturally via natural selection through random mutation, but it could also be engineered by applying an evolutionary stress on a population.

Once such a gene is generated, bacteria can then transfer the genetic information in a horizontal fashion (between individuals) by plasmid exchange. If a bacterium carries several resistance genes, it is called multi resistant or, informally, a superbug.

While a new infectious disease has been discovered nearly every year over the past 30 years, there have been very few new antibiotics developed leaving our armour nearly empty as diseases evolve and become resistant to existing drugs. ICU has highest rate of infection.

Case I of multidrug resistant SUPERBUG isolated from MICU HFH, Rawalpindi

Sensitive to POLYMYXIN Resistant to Augmentin Ceftazidime Ceftriaxone Specimen I ETT tip C/S Report : Coliform Spp Sensitive to IMIPENEM Resistant to Augmentin Ceftazidime Ceftriaxone Ciprofloxacin Tazocin Sulzone Gentamicin Specimen II C/S Report: Coliform Spp. Sensitive to POLYMYXIN Resistant to Augmentin Ceftazidime Ceftriaxone Ciprofloxacin Imipenem Tazocin Sulzone Gentamicin

Case II Sensitive Resistant Polymyxin Imipenem Sulzone Aztreonam Wound C/S received from Burn Unit C/S Report: Pseudomonas aeruginosa, heavy growth Sensitive Polymyxin Resistant Imipenem Sulzone Aztreonam Ceftazidime Tazocin Gentamicin Ciprofloxacin Cefepime

Case III Sensitive Resistant Nitrofurantoin Methicillin Vancomycin Urine C/S received from MICU C/S Report: Staphylococcus aureus. >105 cfu/ml Sensitive Nitrofurantoin Vancomycin Teicoplanin Resistant Methicillin Clarithromycin Penicillin Ciprofloxacin Gentamicin Co-Trimoxazole

HOLY FAMILY HOSPITAL RAWALPINDI 4 MONTH ANTIBIOGRAM. 1. 12. 2014 TO 31

Percentage of Sensitivity Coliforms Spp n=436 Percentage of Sensitivity Antibiotic Medical Surgical ICU OPD AMIKACIN 46 74 70 88 AMPICILLIN 07 9 - 16 CEFTAZIDIME 10 23 31 CEFTRIXONE 13 08 35 CIPROFLOXACIN 21 36 37 TAZOCIN 41 54 34 80 CO-TRIMAXAZOLE 27 17 SULZONE 33 61 44 76 IMIPENEM 81 83 73 94 CEFEPIME 58 42 57 NITROFURANTOIN 100 MEROPENEM 92 66 89 GENTAMICIN 60

Pseudomonas aeruginosa n=172 Percentage of Sensitivity Antibiotic Medical Surgical ICU OPD POLYMYXIN 97 100 AMIKACIN 28 41 67 65 CEFTAZIDIME 05 07 - 06 CEFTRIXONE 04 14 33 CARBENCILLIN 09 11 CIPROFLOXACIN 49 25 40 63 TAZOCIN 35 39 55 71 SULZONE 24 08 IMIPENEM 62 69 57 74 GENTAMICIN 12 50 CEFEPIME 43

Staphylococcus aureus (Including MRSA) n=91 Percentage of Sensitivity Antibiotic Medical Surgical ICU OPD METHICILLIN 20 55 15 TEICOPLANIN 100 VANCOMYCIN CHLORAMPHENICOL 90 - GENTAMICIN 27 25 63 CIPROFLOXACIN 11 38 14 COTRIMOXAZOLE 40 33 LINEZOLID

Staphylococcus spp (Coagulase Negative) n=57 Percentage of Sensitivity Antibiotic Medical Surgical ICU OPD METHICILLIN 50 52 TEICOPLANIN 100 VANCOMYCIN CHLORAMPHENICOL 48 - 75 GENTAMICIN 65 08 30 CIPROFLOXACIN 36 LINEZOLID

Acinetobacter Spp (n = 63) percentage of sensitivity Antibiotic Medical Surgical ICU OPD AMPICILLIN POLYMYXIN 100 AMIKACIN 05 20 CEFTAZIDIME CEFTRIXONE CIPROFLOXACIN 27 COTRIMOXAZOLE 12 06 TAZOCIN SULZONE 02 33 IMIPENEM 30 67 CEFEPIME - GENTAMICIN 40

EMPIRICAL ANTIBIOTICS FOR SEPSIS/ SEPTIC SHOCK Gram positive coverage: Vancomycin/ Teicoplanin Gram negative: Tazocin/ Imipenem/ Polymyxin

DE-ESCALATION OF BROAD SPECTRUM ANTIBIOTIC THERAPY De-escalation: the practice of changing the antibiotic prescribed from initial, empiric broad-spectrum agent to one with a narrower and more focused spectrum once the pathogen has been isolated.

Uncomplicated UTI Nitrofurantoin

Chloramphenicol Staphylococcus aureus Enterococci Acinetobacter Coliforms

AVOID UNNECESSARY ANTIBIOTICS