Bacterial resistance to antibiotics in the Hospital San Juan de Dios, 1995-1999
DOI:
https://doi.org/10.51481/amc.v43i3.66Keywords:
antibiotics, antibiotic resistance, bacterial infections , beta-lactam resistance, vancomycin resistance, pneumo-coccus drug resistance, broad spectrum ?-lactamasesAbstract
Background and aim: Antimicrobial resistance results in increased morbidity, mortality and costs of health care. Therefore, surveillance of antimicrobial resistance in hospitals must be part of infection control programs.The Hospital San Juan de Dios is a tertiary health care center in Costa Rica with 700 beds for adults. Since 1995, an automatized system (VITEK®) is used in our bacteriology labo-ratory allowing an adequate control of the resistance patterns of bacterias isolated from different sites.The aim of this report is to descr ibe the susce ptibility to some antibi otics found in bacterias isolated from different sites from 1995 to 1999 and to dete rmine their changes in resi sta nce.
Materials and Methods: Were reviewed. The files of the bacteriology laboratory of the hospital was done. We analized bacterial strains from 1995 to 1999. Data from 1996 were incomplete and were not studied. All isolates were analized in the automatized system VITEK®. Streptococcus pneumoniae strains from blood or sputum were studied by the E-test method and their sensitivity ranges met the NCCLS criteria.
Results: We studied 2817 Gram positive cocci (GPC) strains and 7626 isolates of Gram negative bacteria (GNB). Staphylococcus aureus was the most frequently GPC specie found and Escherichia coli was the most common GNB.More than 90% of staphylococcal species produced β-lactamase and were resistant to penicillin.Resi sta nce to oxacillin (methicillin) in Staphylococcus aureus increased from 35% to 52% in this period. In coagula-se negative staphylococci the resistance to this antibiotic was very high (70-77%).Susceptibility to cephalotin and clindamycin in Staphylococcus aureus was similarly high (50-60%) in the years studied and in coagulase negative staphylococci (Staphylococcus epidermidis) the resistance stayed in high levels (65-70%). There were not resistance to vancomycin in the staphylococci analyzed.Ninety eight percent of the 61 isolates of Streptococcus pneumoniae were susceptible to penicillin.Susceptibility to penicillin was observed in 80% of 483 isola-tes of Enterococcus faecalis. Fifty percent of the enterococci showed synergism between gentamicin and cellwall active agents. Only a few isolates of Enterococcus faecuim were analized and no resistance to vancomycin was found. Resistance to Resistencia bacteriana a antibióticos/ Boza R y Barrantes Eaminoglycosides was demonstrated in 50% of enterococci isolates.Regarding enterobacterias, Escherichia coli strains presented high resistance to ampicillin (60%), sulfa trimetoprin (60%) and a decrease in the susceptibility to ceftazidime from 90% in 1995 to 65% in 1999, to cefotaxime from 95% to 88%, from 67% to 57% to cephalotin and from 100% to 85% to amikacin in the same period. Resistance to ciprofloxacin was 10% in 1995 and 20% in 1999.Regarding Klebsiella pneumoniae, resistance to amikacin increase from 20% to 32%, to ceftazidime from 0% to 52%, to cefotaxime from 5% to 24% but susceptibility to ciprofloxacin was high in the period (80-90%). Resistance to ampicillin was present in more than 90% of the K.pneumoniaeisolates and to cephalotin in more than 50% of this bacteria.Enterobacter cloacae showed high resistance patterns to ampicillin (>95%),cephalotin (> 90%) and ceftazidime (25-50%).In non-fermenting Gram negative bacilli, resi sta nce to amikacin (20%-72%) ceftazidime (42%-61%) and cipr ofl oxacin (58%) was documented in Acineto bacter calcoa ceticus. In Pseudomonas aeruginosa an increase in the resi sta nce to amikacin (15%-30%) and cipr ofl oxacin(20%-37%) were noted.In all BGN strains studied, a high susceptibility pattern to imipenem (from 88% in Ps. aeruginosa and 95% in Ac.calcoaceticus to 100% in enterobacterias) were observed.
Discussion: We analized these findings and compared them with those found in the medical literature. High resistance patterns to penicillin and oxacillin in staphylococci strains were documented. High resistance in GNB to ampicillin, cephalotin, ceftazidime and ciprofloxacin was observed. High susceptibility patterns to imipenem in GNB were found
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