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\def\citeauthor{~Yesu~Deevena~Thiriveedhula,
              ~Sukeerthi~Valluru,
              ~Sai~Iswarya~Guduru,
              ~Prasanna~Kumar~T~J,
              ~Pragna~Malavika~B}
\def\citetitle{\textbf{Antimicrobial Susceptibility Patterns of Detected Bacterial Isolates in a Tertiary Care Teaching Hospital: A Cross Sectional Study}}
\def\copyrightstmt{This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial- ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.}
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\begin{document}


\def\RunningAuthor{Yesu Deevena Thiriveedhula et al.}
\firstPage{18}
\articleType{Original Article}
\receivedDate{05 Jan 2022}
\acceptedDate{28 Jan 2022}
\revisedDate{25 Jan 2022}
\journalVolume{2}
\journalIssue{1}
\copyrightYear{2022}
\eISSN{2583-0953}
\journalDoi{10.26452/ijcpms.v2i1.261}
\def\authorCount{5}
\def\affCount{2}

\def\journalTitle{International Journal of Clinical Pharmacokinetics and Medical Sciences}

\title{\textbf{Antimicrobial Susceptibility Patterns of Detected Bacterial Isolates in a Tertiary Care Teaching Hospital: A Cross Sectional Study}}
\author{Yesu~Deevena~Thiriveedhula\textsuperscript{*}\textsuperscript{1}\textsuperscript{\href{https://orcid.org/0000-0002-2859-7414}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}},  
            Sukeerthi~Valluru\textsuperscript{1}\textsuperscript{\href{https://orcid.org/0000-0002-7146-190X}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}},  
            Sai~Iswarya~Guduru\textsuperscript{1}\textsuperscript{\href{https://orcid.org/0000-0002-7879-8871}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}},  
            Prasanna~Kumar~T~J\textsuperscript{2}, 
            Pragna~Malavika~B\textsuperscript{1}~\\[5pt]{\textsuperscript{1}Nova College of Pharmaceutical Education and Research, Jupudi-521456, Andhra Pradesh, India}~\\{\textsuperscript{2}NRI General Hospital, Chinakakani, Mangalgiri-522503, Andhra Pradesh, India}}

\begin{abstract}
Antibiotics are the most widely prescribed medications and are regularly used to treat a wide range of illnesses. According to national ambulatory medical care, they are the second most commonly prescribed medications. They are sometimes referred to as miracle drugs. Our sole purpose is to determine the potential effectiveness of specific antibiotics on the bacteria and/or to determine if the bacteria have developed resistance to certain antibiotics to help select the drug(s) that will likely be most effective in treating an infection. This study was conducted to ascertain the current scenario of bacterial susceptibility in all infections to optimize empiric therapy among people of all groups of ages in our hospital. Out of the 219 various specimens analyzed, pathogens were identified in 211 (96.3\%) specimens. Sputum indicated almost more than 50\% positive cultured result whereas lung abscess indicated least number of pathogens (i.e., 2\%). The commonly found bacteria were Escherichia coli, Klebsiella pneumoniae followed by Streptococcus pneumoniae. Highest no. of E. coli isolates i.e., 16 were found in pus. E. coli  shows 100\% resistance to Macrolides and 100\% sensitivity to Polypeptides followed by Carbapenems i.e., 95.9\%. Highest no. of K. pneumoniae  isolates i.e., 24 were found in sputum. K. pneumoniae  shows 100\% to Macrolides \& Lincosamides and 100\% sensitivity to Polypeptides \& 95.9\% sensitivity to Carbapen E. Highest no. of S. pneumoniae  isolates i.e., 19 were found in sputum. S. pneumoniae  showed 100\% resistance to Lincosamides and 100\% sensitivity to Carbapenems, Aminoglycosides \& Sulfonamides. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Antibiotics,\newline Resistance,\newline Sensitivity,\newline Cultured Tests,\newline Bacterial Susceptibility
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright{\Large$^\ast$}Corresponding Author\par Name:\ Yesu~Deevena~Thiriveedhula~\\ Phone:\ +91 9618637996~\\  Email:\ deevenablessy15@gmail.com
        \par}\vspace*{-13pt}\hrulefill~\\{\fontsize{12}{14}\selectfont\ifx\@eISSN\@empty\else eISSN: \@eISSN\fi\ifx\@pISSN\@empty\else\hfill pISSN: \@pISSN\fi}\par% 
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        \makeatother
        
    
\section{Introduction}
50\% of hospital Staphylococcus aureus isolates will be resistant to penicillin after seven years. Enzyme inactivation, changed receptors, and altered antibiotic transport are all mechanisms of bacterial resistance to antimicrobial drugs. Staphylococcus aureus is one of the most prevalent human diseases, capable of infecting a wide spectrum of people \unskip~\cite{1418035:24978044,1418035:24978052}. In the anteriornares, around 20-40\% of individuals are carriers of S. aureus. Invasive infections have increased as a result of the advent of community-acquired and hospital-acquired methicillin-resistant S. aureus (MRSA). The hospital antibiogram is a summary of local bacterial isolates' antibiotic susceptibilities reported to the hospital's clinical microbiology laboratory on a regular basis \unskip~\cite{1418035:24978048}. Antibiograms can also be used to compare susceptibility rates and follow resistance trends among institutions. When bacteria and fungi are unable to thrive in the presence of one or more antimicrobial medications, this is referred to as antimicrobial resistance syndrome (AMS) \unskip~\cite{1418035:24978054}.

\textbf{Time Taken for Testing}


  
  \begin{enumerate}
  \item \relax To develop the pathogen and get a pure culture for subsequent testing, bacterial cultures normally take 24-48 hours.
  \item \relax Fungus and tuberculosis cultures may take considerably longer {\textemdash} up to 6 to 8 weeks {\textemdash} since these microorganisms develop at a slower rate.
  \item \relax Traditional susceptibility testing takes 18-24 hours to complete; however, more fast assays are becoming available, with findings in as little as 24 hours \unskip~\cite{1418035:24978042,1418035:24978047}.
  \end{enumerate}
  \textbf{How is Antimicrobial Susceptibility Used?  }

Point-of-care testing with C-reactive protein (CRP) or communication training resulted to a significant reduction in antibiotic administration for acute respiratory tract infection in primary care in a multicenter study in six European countries \unskip~\cite{1418035:24978043,1418035:24978051}. However, combining these strategies had the greatest impact, resulting in a 62 percent reduction in antibiotic prescriptions. Antibiotics are essential to how we practice contemporary medicine, and we must acknowledge this as a culture  \unskip~\cite{1418035:24978049,1418035:24978040}. We must give them the respect they deserve \unskip~\cite{1418035:24978050,1418035:24978228,1418035:24978227}.

If the cultures are positive, narrower-spectrum antimicrobials should be used wherever feasible. Patients who use a long course of broad-spectrum antibiotics are more likely to develop infections caused by resistant pathogens later on \unskip~\cite{1418035:24978044,1418035:24978048,1418035:24978046}.

Along with this, we should work on minimizing antibiotic usage, lowering resistance-enhancing drug pressure through better antibiotic targeting, and removing antibiotic use for agricultural growth promotion. National surveillance of antibiotic resistance and antibiotic use{\textemdash}better data to underpin decisions on standard treatment guidelines, education, and other actions, as well as to track changes over time; increasing the use of diagnostic tests, which necessitates behavioral changes and improvements in microbiology laboratory capacity \unskip~\cite{1418035:24978045,1418035:24978053}.

\textbf{Aim and Objectives}


  
  \begin{enumerate}
  \item \relax This study aims to check the Antibiotic Susceptibility Pattern for commonly detected bacteria.
  \item \relax The primary objective is to identify the spectrum of organisms responsible for infection in our hospital.
  \item \relax The secondary objective is to evaluate the pattern of antibiotic susceptibility of those organisms.
  \end{enumerate}
  \textbf{Need of Study}
  
  \begin{enumerate}
  \item \relax To determine the potential effectiveness of specific antibiotics on the bacteria and/or to determine if the bacteria have developed resistance to certain antibiotics.
  \item \relax To help select the drug(s) that will likely be most effective in treating an infection.
  \end{enumerate}
  
    
\section{METHODOLOGY}
The plan of the study is shown in Chart~\ref{f-3d43a4cc243a}.

\textbf{Study Design}

Cross-sectional, observational study.

\textbf{Study Duration}

November 2020 to April 2021

\textbf{Study Site}

NRI general hospital, Chinnakakani, Mangalagiri

\textbf{Sample Size}

219 Subjects.

\textbf{Study Data}

Patient data relevant to the study will be obtained from the case sheets in form of computerized patient profile forms.

\textbf{Eligibility Criteria}

\textbf{Inclusion Criteria}


  
  \begin{enumerate}
  \item \relax Patients aged between 18 and 70.
  \item \relax Patients with bacteriological proven infection with lab data showing positive reports against micro-organisms.
  \item \relax Patients receiving one or more antibiotics.
  \end{enumerate}
  \textbf{Exclusion Criteria}


  
  \begin{enumerate}
  \item \relax Out-patient samples.
  \item \relax Duplicate samples with differing sensitivities.
  \item \relax Positive reports with multiple pathogens.
  \item \relax Positive reports of pediatrics, pregnant women \& lactating females.
  \end{enumerate}
  
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\makeatother 
\caption{\boldmath {Plan of the Study}}
\label{f-3d43a4cc243a}
\end{chart*}
\egroup

    
\section{RESULTS}
In the current study, 219 subjects were included out of which 70\% were males and 30\% were females depicted in Figure~\ref{f-b32ac8a89b58}. Age categorization of the study population was done and depicted in Figure~\ref{f-640647107f7d}. 


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\makeatother 
\caption{\boldmath {Gender Wise Distribution}}
\label{f-b32ac8a89b58}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/d2e7faa5-07ec-48fe-8b19-b15e86a5ec11-upicture3.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/d2e7faa5-07ec-48fe-8b19-b15e86a5ec11-upicture3.png}{\includegraphics{images/d2e7faa5-07ec-48fe-8b19-b15e86a5ec11-upicture3.png}}{}
\makeatother 
\caption{\boldmath {Age Wise Distribution}}
\label{f-640647107f7d}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/b2507579-d961-4cd0-bbb7-38bd0a1bb63c-upicture4.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/b2507579-d961-4cd0-bbb7-38bd0a1bb63c-upicture4.png}{\includegraphics{images/b2507579-d961-4cd0-bbb7-38bd0a1bb63c-upicture4.png}}{}
\makeatother 
\caption{\boldmath {Isolated Gram Positive Bacteria}}
\label{f-520d9a1d16c8}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/f7e2e847-794b-4b1a-b58d-b93adddf5757-upicture5.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/f7e2e847-794b-4b1a-b58d-b93adddf5757-upicture5.png}{\includegraphics{images/f7e2e847-794b-4b1a-b58d-b93adddf5757-upicture5.png}}{}
\makeatother 
\caption{\boldmath {Isolated Gram Positive Bacteria}}
\label{f-f2f84ad33837}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/031d0168-9094-4e10-9c99-a5a8559d8e17-upicture6.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/031d0168-9094-4e10-9c99-a5a8559d8e17-upicture6.png}{\includegraphics{images/031d0168-9094-4e10-9c99-a5a8559d8e17-upicture6.png}}{}
\makeatother 
\caption{\boldmath {Antibiotic Sensitivity Pattern of \textit{Escherichia coli}}}
\label{f-10acfe75acf0}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/071f8d1a-c12c-4322-a54a-41927536657a-upicture7.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/071f8d1a-c12c-4322-a54a-41927536657a-upicture7.png}{\includegraphics{images/071f8d1a-c12c-4322-a54a-41927536657a-upicture7.png}}{}
\makeatother 
\caption{\boldmath {Susceptibility Pattern of \textit{Klebsiella pneumoniae}}}
\label{f-75b07d798e75}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/738dcdae-b410-4289-a21e-06bdd212da53-upicture8.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/738dcdae-b410-4289-a21e-06bdd212da53-upicture8.png}{\includegraphics{images/738dcdae-b410-4289-a21e-06bdd212da53-upicture8.png}}{}
\makeatother 
\caption{\boldmath {Antibiotic Sensitivity Pattern of \textit{Streptococcus pneumonia}}}
\label{f-6fbfb025ff27}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/919fcbcf-09a1-4f77-b479-ce317b9c0f96-upicture9.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/919fcbcf-09a1-4f77-b479-ce317b9c0f96-upicture9.png}{\includegraphics{images/919fcbcf-09a1-4f77-b479-ce317b9c0f96-upicture9.png}}{}
\makeatother 
\caption{\boldmath {Susceptibility Pattern of \textit{Pseudomonas aeruginosa}}}
\label{f-29893d289b35}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/45c8f49e-489f-48ef-b24a-974176e2d706-upicture10.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/45c8f49e-489f-48ef-b24a-974176e2d706-upicture10.png}{\includegraphics{images/45c8f49e-489f-48ef-b24a-974176e2d706-upicture10.png}}{}
\makeatother 
\caption{\boldmath {Antibiotic Sensitivity Pattern of \textit{Acinetobacter baumannii}}}
\label{f-3f55310f548e}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/a4a3d05a-c340-4e03-900b-057f8dba62be-upicture11.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/a4a3d05a-c340-4e03-900b-057f8dba62be-upicture11.png}{\includegraphics{images/a4a3d05a-c340-4e03-900b-057f8dba62be-upicture11.png}}{}
\makeatother 
\caption{\boldmath {Susceptibility Pattern of \textit{Enterobacter aerogenes}}}
\label{f-18ba154fc10e}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/eb267103-8c96-4ed0-b06d-97ec3937d998-upicture12.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/eb267103-8c96-4ed0-b06d-97ec3937d998-upicture12.png}{\includegraphics{images/eb267103-8c96-4ed0-b06d-97ec3937d998-upicture12.png}}{}
\makeatother 
\caption{\boldmath {Susceptibility Pattern of \textit{Staphylococcus aureus}}}
\label{f-d9023e27be93}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/e7bef81c-aa93-462c-8253-8c28d9e925a7-upicture13.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/e7bef81c-aa93-462c-8253-8c28d9e925a7-upicture13.png}{\includegraphics{images/e7bef81c-aa93-462c-8253-8c28d9e925a7-upicture13.png}}{}
\makeatother 
\caption{\boldmath {Susceptibility Pattern of \textit{Staphylococcus haemolyticus}}}
\label{f-96cda23838fa}
\end{figure}
\egroup
In this study, 219 specimens were collected out of which 28 (13\%) are blood specimens, 92 (42\%) are sputum, 19 (8\%) are wound swab, 16 (7\%) are endotracheal secretion, 28 (13\%) are pus, 32 (15\%) are urine and 4 (2\%) are lung abscess. In the current study, 219 specimens were cultured out of which 52 (24\%) are gram positive organisms, 131 (60\%) are gram negative organisms, 28 (13\%) are fungi and 8 (3\%) are sterile.

The above Figure~\ref{f-520d9a1d16c8}  reported that the most isolated gram-positive organism is \textit{S. pnuemoniae} (20\%) and the least isolated gram-positive organisms are Bacillus species (4\%). The Figure~\ref{f-f2f84ad33837}  reported that the most isolated gram-negative bacteria are \textit{E. coli } (40) \& \textit{K. pneumoniae} (40) and the least isolated organism is \textit{S. maltophilia } (4).

The Figure~\ref{f-10acfe75acf0}  reported that the most sensitive antibiotic for \textit{E.coli} is Imipenem + Cilastatin and Colistin and the most resistant antibiotics are Ampicillin, Carbenicillin, Cephalexin, Azithromycin, Moxifloxacin and Gemifloxacin. The Figure~\ref{f-75b07d798e75}  reported that the most sensitive antibiotics are Meropenem, Imipenem + Cilastatin, Gentamicin, Clarithromycin, Co-trimoxazole and the most resistant antibiotics are Amoxicillin, Canbenicillin, Cephalexin, Lincomycin, Enrofloxacin \& Gemifloxacin.

The Figure~\ref{f-6fbfb025ff27}  reported that the most sensitive antibiotics are Meropenem, Imipenem + Cilastatin, Gentamicin, Clarithromycin, Co-trimoxazole and the most resistant antibiotics are Amoxicillin, Carbenicillin, Cephalexin. Enrofloxacin \& Gemifloxacin. The Figure~\ref{f-29893d289b35}  reported that the most sensitive antibiotics are Meropenem, Ertapenem, Imipenem + Cilastatin, Colistin and the most resistant antibiotics are Cephalexin, Ciprofloxacin \& Co-trimoxazole.

The above Figure~\ref{f-3f55310f548e}  reported that the most sensitive antibiotics are Ampicillin + Sulbactam, Co-trimoxazole, Polymyxin-B and the most resistant antibiotics are Piperacillin + Tazobactam, Ceftazidime, Ceftriaxone, Cefepime, Meropenem, Imipenem, Amikacin, Gentamicin, Ciprofloxacin and Levofloxacin. The Figure~\ref{f-18ba154fc10e}  reported that the most sensitive antibiotic is Nitrofurantoin and the most resistant antibiotics are Penicillin, Cephalexin, Ceftazidime, Ceftriaxone, Cefixime, Ceftazidime + Tazobactum, Clarithromycin, Ciprofloxacin and Co-trimoxazole.

The Figure~\ref{f-d9023e27be93} reported that the most sensitive antibiotics are Cefazolin, Ceftriaxone, Tigecycline, Linezolid, Vancomycin, Fusidic acid and the most resistant antibiotics are Ampicillin \& Penicillin. The Figure~\ref{f-96cda23838fa}  reported that the most sensitive antibiotics are Co-trimoxazole, Vancomycin, Fusidic acid, Rifampin, Quinupristin + Dalfopristin and the most resistant antibiotics are all Penicillins, Cephalosporins, Aminoglycosides, Macrolides, Fluoroquinolones, Lincosamides, Oxazolidinediones, Phosphonic acid derivatives.
    
\section{CONCLUSION}
This study was carried out in our hospital to determine the present state of bacterial susceptibility in all illnesses in order to maximize empiric therapy among persons of all ages. Out of the 219 various specimens analyzed, pathogens were identified in 211 (96.3\%) specimens. Sputum indicated almost more than 50\% positive cultured result whereas lung abscess indicated least number of pathogens (i.e., 2\%). The big three bacteria found were Escherichia coli, Klebsiella pneumoniae  followed by Streptococcus pneumoniae. Highest no. of E. coli  isolates i.e., 16 were found in pus. E. coli  shows 100\% resistance to Macrolides and 100\% sensitivity to Polypeptides followed by Carbapenems i.e., 95.9\%. Highest no. of K. pneumoniae  isolates i.e., 24 were found in sputum. K. pneumoniae  shows 100\% to Macrolides \& Lincosamides and 100\% sensitivity to Polypeptides \& 95.9\% sensitivity to CarbapenE. Highest no. of S. pneumoniae  isolates i.e., 19 were found in sputum. S. pneumoniae  shows 100\% resistance to Lincosamides and 100\% sensitivity to Carbapenems, Aminoglycosides \& Sulfonamides. Infections are a big issue in underdeveloped nations like India, where cleanliness and sanitation standards are much below international standards. A lack of microbiological and antimicrobial data is also a difficulty in directing physicians in treating patients with infections before using the most effective medication. For both patients and healthcare personnel, resistance is a terrifying condition. In order to reduce excessive antibiotic usage, health care clinicians, hospital managers, and policymakers must collaborate to focus on and execute an intervention strategy. The Indian government should reassess its policy on antibiotic usage and prohibit the over-the-counter selling of medicines. Medical equipment's hygiene and sterility should never be jeopardized. As a result, antibiotics with a poor susceptibility profile should not be administered or distributed (in empiric therapy); additionally, manufacture should be halted for a sufficient amount of time to restore susceptibility. Antibiotics having a favourable susceptibility profile, on the other hand, should be preferred by the physician.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that there is no conflict of interest.
    
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