Resistance Trends and in vitro Activity of Tigecycline Against Bacterial Pathogens Isolated from ICU Departments of European-Gaza Hospital

Qudaih, Nasser Rateb (2016) Resistance Trends and in vitro Activity of Tigecycline Against Bacterial Pathogens Isolated from ICU Departments of European-Gaza Hospital. Masters thesis, Al Azhar University Gaza.

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Abstract

Background: Emergence and spread of antimicrobial resistance among bacterial pathogens has increased to worrying levels in recent years. Multi-drug resistant (MDR) bacteria are known to cause life threatening infections especially in Intensive Care Unit (ICU). Tigecycline is a newer glycycline antibiotic considered as therapeutic option with promising broad spectrum of activity against Gram positive and Gram negative bacteria. Objective: The main objective was to study the resistance trends and to evaluate the in vitro activity of tigecycline against the isolated bacterial pathogens from the ICU departments of the European Gaza Hospital. Material and method: Prospective cross-sectional study was performed on the patients who were admitted to the ICU departments of the European Gaza Hospital for nine months from May, 2015 to January, 2016. All the isolated bacterial pathogens were diagnosed phenotypically and biochemically, tested against tigecycline and most common used antibiotics by disc diffusion method according to the Clinical and Laboratory Standards Institute guidelines. Resistant isolates to tigecycline were further confirmed using E-test according to the US Food and Drug Administration (FDA) breakpoints and manufacturer's instructions respectively. Results: A total of 90 clinically significant isolates obtained from various clinical specimens from ICU patients were included in the study. The isolated organisms include methicillin resistant Staphylococcus aureus (MRSA) (n=11), XIV Streptococcus spp. (n=4), Klebsiella pneumoniae (n=24), Acinetobacter baumannii (n=21), Klebsiella oxytoca (n=2), Pseudomonas aeruginosa (n=16), E. coli (n=4), Morganella morganii (n=2), Proteus mirabilis (n=2), Enterobacter cloacae (n=2), Alcaligenes spp. (n=1) and Serratia spp. (n=1). Most of the isolated pathogens were MDR and the overall susceptibility to tigecycline were observed in 57(63.3%) isolates, while 5(5.6%) isolates were intermediate and 28(31.1%) were resistant. Tigecycline exhibited 100% activity against all gram-positive isolates including MRSA. Besides tigecycline, the most effective agents against MRSA were meropenem (81.8%) and amikacin (72.7%). In addition, tigecycline was also very effective against most members of the Enterobacteriaceae, while E. coli isolates were 100% susceptible to tigecycline, along with amikacin and pipracillin/tazobactam. K. pneumoniae isolates were 80% susceptible to tigecycline, amikacin and pipracillin/tazobactam, while meropenem was less active (62.5%). Yet, the two K. oxytoca isolates were susceptible to tigecycline, meropenem and amikacin. Surprisingly, high resistance rate against tigecycline was observed among P. aeruginosa and A. baumannii isolates with resistance rate reach 81.3% and 33.3% respectively. However, amikacin and meropenem were found to be the most effective drugs agents P. aeruginosa. On the other hand, A. baumannii isolates exhibited high resistance to common used antimicrobial agents, including the carbapenem drug, meropenem were more than half found to be resistant (52.3%). Finally, Alcaligenes spp. and P. mirabilis were 100% resistant to tigecycline, Morganella morganii and Enterobacter cloacae were 50% susceptible to tigecycline and Serratia spp. was 100% susceptible to tigecycline. CONCLUSION: Tigecycline was active against all Gram positive isolates and to a lesser degree against Gram negative. Most of Enterobacteriaceae members and other Gram negative were MDR. A high resistance rate to tigecycline was XV observed among P. aeruginosa and A. baumannii isolates. This new antibiotic is a promising agent which may have an important role in the therapy of infections caused by MDR Gram-positive and Gram-negative bacteria isolated in ICU departments of European Gaza Hospital. Keywords: Tigecycline, European Gaza Hospital, ICU departments, MDR, Antimicrobial resistance, Gaza strip

Item Type: Thesis (Masters)
Subjects: Q Science > Q Science (General)
Depositing User: أ. طارق زياد عبد حنونة
Date Deposited: 18 Aug 2020 08:32
Last Modified: 18 Aug 2020 08:32
URI: http://scholar.alaqsa.edu.ps/id/eprint/1990

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