Prakash H. Ravichandra et al.

/ JPBMS, 2012, 14 (05)

Available online at www.jpbms.info

Research article

ISSN NO- 2230 7885

CODEN JPBSCT

JPBMS
JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES

Antimicrobial susceptibility pattern of Pseudomonas aeruginosa strains isolated from

clinical sources.
H.RavichandraPrakash1. Rashmi Belodu2, Neena Karangate3, Suresh Sonth4, Anitha.M.R5, Vijayanath.V6
1Associate

Professor, Department of Microbiology, Basaveshwara Medical College and Hospital , Chitradurga 577502, India.

2Assistant

Professor, Department of Microbiology, Basaveshwara Medical College and Hospital, Chitradurga 577502, India.

3Professor

and Head Department of Microbiology, Basaveshwara Medical College and Hospital Chitradurga 577502, India.

4Assistant professor,
5Assistant
6Associate

Department of Microbiology, S.N Medical College, Navanagar, Bagalkot 587102 . India.

Professor, Department of Anatomy, VMKV Medical College and Hospital, Salem. Tamil Nadu, India.

Professor, Department of Forensic Medicine & Toxicology, VMKV Medical College & Hospital, Salem. Tamil Nadu,
India.

Abstract: Objective: Currently antibiotic resistance in bacterial populations is one of the greatest challenges to the

effective management of infections. Constant bacteriological monitoring of pathogens in the hospital in general and
specialized units is necessary to provide accurate data on the prevalence and antibiotic resistance pattern of specific
pathogens. Pseudomonas aeruginosa is one of the most common gram-negative microorganisms identified in the clinical
specimens of hospital admitted patients. The present study was undertaken to assess antibiotic resistance in clinical
isolates of Pseudomonas aeruginosa in our hospital, and to obtain baseline information on the presence of this important
pathogen.
Methods & Results: A total of 486 Pseudomonas aeruginosa were isolated of which 340 (70.0%) were from indoor and
146 (30.0%) were from outdoor patients. Of the 486 isolates 292 (60.0%) were from males and 194 (40.0%) from females.
From the study population 223 (45.88%) patients were aged between 21-40 years, while 149 (30.65%) were below 20
years. In present studies the resistance against ofloxacin and ciprofloxacin was observed between 70 98%. The
aminoglycoside group of antibiotics - amikacin - demonstrated maximum sensitivity against Pseudomonas species.
Conclusion: Therefore, use of amikacin should be restricted to severe nosocomial infections, in order to avoid rapid
emergence of resistant strains. Periodic susceptibility testing should be carried out over a period of two to three years, to
detect the resistance trends. Also, a rational strategy on the limited and prudent use of anti-Pseudomonal agents is
urgently required.

Keywords: Pseudomonas aeruginosa, Antimicrobial resistance, Sensitivity, Disk diffusion technique, Reserve drugs.
Introduction:

The Pseudomonads are a diverse bacterial group of

established and emergent pathogens [1-3]. Members of the
genus are major agents of nosocomial and community
acquired infections, being widely distributed in the
hospital environment where they are particularly difficult
to eradicate. Pseudomonas aeruginosa, although not an
obligate parasite, is the species amongst the
Pseudomonads most commonly associated with human
diseases. [3] It needs minimal nutritional requirements for
growth. It is a commensal in healthy people. This rate of
commensalism increases gradually with the increased
duration of hospital stay [4].

Pseudomonas aeruginosa is primarily an opportunistic

pathogen that causes infections in hospitalized patients
particularly in burns patients where the skin host defenses
is destroyed, orthopedic related infection, respiratory
diseases, immunosuppressed and catheterized patients. It
1

may be the cause of the chronic debilitating pulmonary

infection, which is one major cause of death in-patients
with cystic fibrosis [5]. Generally it contributes substantially
to wound related morbidity and mortality worldwide [6].
Pseudomonas aeruginosa is usually inherently resistant to
many antimicrobial agents, treatment of pseudomonal
infections is usually difficult, and mortality is usually high
[7,8]. This intrinsic resistance is mainly a result of the
diffusion barrier of the bacterial outer membrane; aminoacid substitution in the target molecules, such as Gyr A
and/or Par C, via point mutation in each genetic
determinant; and antimicrobial inactivating enzymes. In
most hospital environments, this inherent resistance is
further complicated by mutations mediated via
chromosomes and the acquisition of resistant genes from
plasmids and transposons [9].

Pseudomonas aeruginosa demonstrates resistance to

multiple antibiotics, thereby jeopardizing the selection of
appropriate treatment [10] and over a period of time, we

Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 14, Issue 14

Prakash H. Ravichandra et al. / JPBMS, 2012, 14 (05)

observed an increase in number of Pseudomonas

aeruginosa among our laboratory isolates. So, we decided
to carry out a retrospective study to see infections caused
by Pseudomonas aeruginosa and susceptibility pattern of
the organisms isolated from different clinical specimens at
our hospital.

Materials and Methods:

from outdoor patients. Of the 486 isolates 292 (60.0%)

were from males and 194 (40.0%) from females. From the
study population 223 (45.88%) patients were aged
between 21-40 years, while 149 (30.65%) were below 20
years. (Table 1)

Table 1: Age distribution of cases

Age (in years)
Number of isolates

The study was conducted in a tertiary care hospital from

January 2010 to December 2010. The cases were from both
inpatient and outpatient departments.

Isolation, characterization and identification:

The various clinical specimens included wound swab,

urine, pus, ear discharge, etc. were cultured. Pseudomonas
aeruginosa isolates were characterized and identified using
a combination of colonial morphology, Gram stain
characteristics, motility test, oxidative- fermentation test,
catalase, citrate and oxidase tests and pyocyanin
production.

Antibiotic susceptibility testing:

The antibiotic susceptibility pattern of the Pseudomonas

aeruginosa isolates was determined using the disk
diffusion method according to the modified Kirby-Bauer
technique [11]. All the clinical isolates and a standard strain
Pseudomonas aeruginosa ATCC 27853 were tested for their
sensitivity against a panel of anti-pseudomomal
antimicrobials including: tobramycin (TOB), gatifloxacin
(GAT), ciprofloxacin (CIP), nalidixic acid (NA), ceftazidime
(CAZ), ceftriaxone (CTR), cefixime (CFX), doxycycline (DO),
gentamycin (GEN), amikacin (AK), ofloxacin (OF),
piperacillin-tazobactum (PIT), and azithromycin (AT) of
standard strengths.

Results:

A total of 486 Pseudomonas aeruginosa were isolated of

which 340 (70.0%) were from indoor and 146 (30.0%)

0 20

177

36.42

>60

25

5.14

21 40

211

41 60

Pus
Urine
Ear discharge
Blood culture
Sputum
Others

Discussion:

TOTAL

15.02

486

100

Wound swab, urine, pus and ear discharge constituted

about 95.2% of the total samples. Of the 486 isolates of
Pseudomonas aeruginosa, 232 (47.7.0%) were isolated
from wound swab only, followed by pus 133 (27.4%),
urine 59 (12.1%) and ear discharge 39 (8%). (Table 2)
Table 2: Isolation of Pseudomonas aeruginosa from different clinical
specimens
Specimen
No of isolates
Percentage
Wound swab

232

47.7

Ear discharge

39

8.0

Pus

133

Urine

27.4

59

Blood culture

12.1

Sputum

Others

1.5

11

Total

2.3

486

100

The Pseudomonas aeruginosa isolated from different

specimens varied in resistance rate to different
antimicrobials. The isolates with least amount of resistance
were
to
amikacin,
piperacillin-tazobactum
and
azithromicin. Greater resistance was shown to
ciprofloxacin, ofloxacin, gentamycin, cefixime and less
resistance was shown to tobramicin, ceftazidime,
gatifloxacin, nalidixic acid and doxycycline. (Table 3).
GEN

AK

OF

PIT

AT

66.37

32.32

87.93

64.65

73.27

74.13

84.48

88.36

78.44

21.55

87.93

58.18

13.36

59.32

55.93

93.22

67.79

71.18

62.71

79.66

77.96

84.74

8.47

77.86

66.10

11.86

92.30

23.07

74.35

84.61

100

48.71

87.17

56.41

76.92

15.38

87.17

38.46

23.07

80

40

80

80

80

100

100

60

60

20

80

40

20

85.71

71.42

85.71

71.42

42.85

57.14

85.71

28.57

71.42

14.28

100

42.85

28.57

81.81

36.36

90.90

63.63

45.45

72.72

72.72

45.45

90.90

09.09

90.90

27.27

09.09

78.19

48.87

98.49

57.89

58.64

Pseudomonas aeruginosa emerged as an important

pathogen and responsible for the nosocomial infections
that is one of the important causes of morbidity and
2

43.42

73

Table 3: Resistance rate of Pseudomonas aeruginosa isolated from different clinical samples
SPECIMEN
TOB
GAT
CIP
NA
CAZ
CTR
CFX
DO
Wound swab

Percentage

68.42

91.72

67.66

94.73

18.79

98.49

46.61

19.54

mortality among hospital patients. More over Pseudomonas

aeruginosa infection is dependent on age and duration of
the stay in hospital. The infection was more common in
young and middle age group then elderly people. Duration
of stay is directly proportional as infection was much

Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 14, Issue 14

Prakash H. Ravichandra et al. / JPBMS, 2012, 14 (05)

higher in indoor patients than the outdoor patients. This

might be due to the prolonged stay in hospital following an
operation resulting in colonization and subsequent
infection [12- 14].
In our study the resistance against ofloxacin and
ciprofloxacin was observed between 70 98%. The
quinolone resistant Pseudomonas aeruginosa showed the
presence of new outer membrane protein in the range of
51-54 KDa. These proteins apparently actively transport
quinolone out of the cell [15]. The resistance pattern against
gentamycin tobramycin, ceftazidim, amikacin, doxycicline,
ceftriaxone was observed to be less as compared to other
drugs in this study. These finding are in good agreement
with the other similar studies [16]. The least resistance was
seen
with
amikacin,
azithromycin,
and
piperacillin/tazobactam. Among all the drugs amikacin
showed the highest sensitivity against Pseudomonas
aeruginosa (Table 3), which is in corroboration with an
earlier report published from India[17]. Amikacin was
designed as a poor substrate for the enzymes that bring
about inactivation by phosphorylation, adenylation or
acetylation, but some organisms have developed enzymes
that inactivate this agent as well.
Amikacin seems to be a promising therapy for
Pseudomonal infection. Hence, its use should be restricted

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Conflict of Interest: - None

Source of funding: - Not declared

*Corresponding author:

Dr. H.Ravichandra Prakash. MD.,

Associate Professor, Department of Microbiology
Basaveshwara Medical College and Hospital
Chitradurga 577502 ,India.
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