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

2. 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.

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

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

5. 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.

6. 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.

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

8. 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

9. 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

10. 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

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

14. 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

15. 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

16. 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

17. 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

18. 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

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

20. 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.

21. Uncomplicated UTI
Nitrofurantoin

22. Chloramphenicol Staphylococcus aureus Enterococci Acinetobacter
Coliforms

23. AVOID UNNECESSARY ANTIBIOTICS