Antibiotic Susceptibility Surveillance in the Punjab Province of Pakistan: Findings and Implications
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Inclusion and Exclusion Criteria
2.3. Processing of the Samples and Susceptibility Testing
2.4. Statistical Analysis
2.5. Ethical Consideration and Patient’s Consent
3. Results
3.1. Identification of Clinical Pathogens
3.2. Antimicrobial Resistance
3.3. Antimicrobial Susceptibility Profile
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Isolates | Resistant to 1 Antibiotic Class n (%) | Resistant to 2 Antibiotic Classes n (%) | Resistant to 3 Antibiotic Classes n (%) | Resistant to 4 Antibiotic Classes n (%) | Resistant to 5 Antibiotic Classes n (%) | Resistant to 6 Antibiotic Classes n (%) | Resistant to 7 Antibiotic Classes n (%) | Total No. of Isolates |
---|---|---|---|---|---|---|---|---|
E. coli | 81 (9.95) | 108 (13.26) | 221 (27.14) | 174 (21.37) | 127 (15.60) | 61 (7.49) | 6 (0.73) | 814 |
P. aeruginosa | 42 (9.25) | 76 (16.74) | 122 (26.87) | 86 (18.94) | 57 (12.55) | 23 (5.06) | 6 (1.32) | 454 |
K. pneumoniae | 30 (11.15) | 38 (14.12) | 72 (26.76) | 51 (18.95) | 39 (14.49) | 23 (8.55) | 5 (1.85) | 269 |
Proteus spp. | 6 (8.57) | 5 (7.14) | 21 (30) | 16 (22.85) | 12 (17.14) | 6 (8.57) | 0 (0) | 70 |
A. baumannii | 3 (6) | 6 (12) | 8 (16) | 9 (18) | 8 (16) | 16 (32) | 0 (0) | 50 |
S. aureus | 180 (20.78) | 202 (23.32) | 190 (21.93) | 115 (13.27) | 50 (5.77) | 40 (4.61) | 7 (0.80) | 866 |
Total | 342 | 435 | 634 | 451 | 293 | 169 | 24 | 2523 |
Antibiotics | ATC Classification 1 | AWaRe Classification 2 | A. baumannii | E. coli | K. pneumoniae | Proteus spp. | P. aeruginosa | S. aureus | Total |
---|---|---|---|---|---|---|---|---|---|
Penicillins | |||||||||
Penicillin | J01CE01 | Access | NA * | NA | NA | NA | NA | 153/511 (29.9) | 153/579 (26.39%) |
Ampicillin | J01CA01 | Access | NA | 54/543 (9.9%) | NA | 5/53 (9.4) | NA | NA | 129/1112 (11.61%) |
Oxacillin | J01CF04 | Access | NA | NA | NA | NA | NA | 23/53 (43.4) | 23/53 (43.4) |
Beta-lactam inhibitors | |||||||||
Amoxicillin-clavulanate | J01CR02 | Access | NA | 51/198 (25.8) | 23/81 (28.4) | 14/44 (31.8) | NA | 27/48 (56.3) | 115/371 (31.00%) |
Ampicillin–Sulbactam | J01CR01 | Access | NA | 31/93 (33.3) | 4/16 (25.0) | 0/1 (0) | NA | 14/38 (36.8) | 49/148 (33.11%) |
Piperacillin–Tazobactam | J01CR05 | Watch | 10/28 (35.7) | 415/573 (72.4) | 173/231 (74.9) | 54/60 (90.0) | 241/360 (66.9) | 25/47 (53.2) | 918/1299 (70.70%) |
Cephalosporins | |||||||||
Cephalexin | J01DB01 | Access | NA | 7/145 (4.8) | 3/37 (8.1) | 0/3 (0.0) | NA | 60/138 (43.5) | 70/323 (21.67%) |
Cefazolin | J01DB04 | Access | NA | 3/44 (6.8) | 2/19 (10.5) | 1/2 (50.0) | NA | 35/67 (52.2) | 41/132 (31.06%) |
Cephradine | J01DB09 | Access | NA | NA | NA | NA | NA | 14/42 (33.3) | 14/42 (33.3) |
Cefoxitin | J01DC01 | Watch | NA | NA | NA | NA | NA | 243/336 (72.3) | 279/400 (69.75%) |
Cefuroxime | J01DC02 | Watch | NA | 74/474 (15.6) | 50/201 (24.9) | 10/53 (18.9) | NA | 69/134 (51.4) | 203/862 (23.56%) |
Cefaclor | J01DC04 | Watch | NA | 31/222 (14) | 32/91 (35.2) | 1/14 (7.1) | NA | 35/85 (41.2) | 99/412 (24.03%) |
Cefotaxime | J01DD01 | Watch | 0/1 (0.0) | 38/171 (22.2) | 9/34 (26.5) | 0/1 (0.0) | NA | 23/72 (31.9) | 70/279 (25.09%) |
Ceftazidime | J01DD02 | Watch | 0/22 (0.0) | 122/336 (36.3) | 67/156 (42.9) | 14/25 (56) | 122/271 (45.0) | 28/86 (32.6) | 353/896 (39.42%) |
Ceftriaxone | J01DD04 | Watch | 1/38 (2.6) | 95/412 (23.1) | 20/86 (23.3) | 9/34 (26.5) | NA | 111/210 (52.9) | 236/780 (30.26%) |
Cefixime | J01DD08 | Watch | NA | 94/437 (21.5) | 56/169 (33.1) | 11/38 (28.9) | NA | 30/86 (34.9) | 191/730 (26.16%) |
Cefoprazone | J01DD12 | Watch | NA | NA | NA | NA | NA | 40/64 (62.5) | 40/64 (62.5) |
Cefoperazone–Sulbactam | J01DD62 | Watch | NA | NA | NA | NA | NA | 12/29 (41.4) | 31/62 (50.0%) |
Cefepime | J01DE01 | Watch | 4/34 (11.8) | 56/244 (23.0) | 22/56 (39.3) | 8/19 (42.1) | 48/107 (44.9) | 20/69 (29.0) | 37/117 (31.7) |
Carbapenems | |||||||||
Imipenem | J01DH51 | Watch | 10/28 (35.7) | 373/427 (87.4) | 92/108 (85.2) | 25/36 (69.4) | 105/149 (70.5) | 98/143 (68.5) | 703/891 (78.9) |
Meropenem | J01DH02 | Watch | 17/48 (35.4) | 542/639 (84.8) | 142/203 (70) | 48/57 (84.2) | 228/346 (65.9) | 148/244 (60.7) | 1125/1537 (73.12%) |
Etrapenem | J01DH03 | Watch | NA | 96/123 (78.0) | 27/42 (64.3) | 14/19 (73.7) | NA | 2/4 (50.0) | 156/225 (69.3) |
Macrolides | |||||||||
Erythromycin | J01FA01 | Watch | NA | NA | NA | NA | NA | 296/559 (53) | 296/559 (53) |
Clarithromycin | J01FA09 | Watch | NA | NA | NA | NA | NA | 122/255 (47.8) | 122/255 (47.8) |
Azithromycin | J01FA10 | Watch | NA | NA | NA | NA | NA | 36/128 (28.1) | 36/128 (28.1) |
Clindamycin | J01FF01 | Access | NA | NA | NA | NA | NA | 412/665 (62.0) | 412/665 (62.0) |
Aminoglycosides | |||||||||
Gentamicin | J01GB03 | Access | 7/38 (18.4) | 291/518 (56.2) | 75/149 (50.3) | 22/48 (45.8) | 120/225 (53.3) | 331/495 (66.9) | 846/1473 (57.4) |
Amikacin | J01GB06 | Access | 16/41 (39) | 498/631(78.9) | 141/211 (66.8) | 40/58 (69) | 247/356 (69.4) | NA | 942/1297 (72.63%) |
Tobramycin | J01GB01 | Watch | 8/23 (34.8) | 107/233 (45.9) | 61/111 (55) | 14/23 (60) | 137/227 (60) | NA | 327/617 (52.97%) |
Fluoroquinolones | |||||||||
Ciprofloxacin | J01MA02 | Watch | 7/32 (21.9) | 164/555 (29.5) | 81/164 (49.4) | 27/47 (57.4) | 150/288 (52.1) | 250/580 (43.1) | 679/1666 (40.8) |
Levofloxacin | J01MA12 | Watch | 11/23 (47.8) | 143/374 (38.2) | 59/152 (38.8) | 20/39 (51.3) | 117/215 (54.4) | 134/245 (54.7) | 484/1048 (46.2) |
Norfloxacin | J01MA06 | Watch | NA | 90/344 (26.2) | 46/118 (39.0) | 11/23 (47.8) | 73/182 (40.1) | 33/116 (28.4) | 253/783 (32.36%) |
Ofloxacin | J01MA01 | Watch | NA | 62/256 (24.2) | 50/83 (60.2) | 1/9 (11.1) | 56/133 (42.1) | 25/68 (36.8) | 194/549 (35.34%) |
Moxifloxacin | J01MA14 | Watch | NA | NA | 6/34 (17.6) | NA | NA | 56/107 (52.3) | 62/141 (44.0%) |
Nalidixic acid | J01MB02 | NA | NA | 48/294 (16.3) | 24/104 (23.1) | 2/20 (10.0) | NA | NA | 74/418 (17.70%) |
Tetracyclines | |||||||||
Doxycycline | J01AA02 | Access | 1/11 (9.1) | 82/191 (42.9) | 9/20 (45.0) | 3/5 (60.0) | NA | 69/126 (54.8) | 164/353 (46.45) |
Tetracycline | J01AA07 | Access | 2/16 (12.5) | 77/258 (29.8) | 57/120 (47.5) | NA | NA | 194/399 (48.6) | 339/825 (36.63) |
Minocycline | J01AA08 | Watch | 21/30 (70.0) | 25/52 (48.1) | 12/19 (63.2) | 5/12 (41.7) | NA | 228/248 (91.9) | 291/361 (80.61%) |
Tigecycline | J01AA12 | Reserve | NA | 86/95 (90.5) | NA | NA | NA | 60/64 (93.8) | 146/159 (91.82%) |
Carb–Monobactams | |||||||||
Aztreonam | J01DF01 | Reserve | NA | 35/100 (35) | 1/3 (33.3) | NA | 14/42 (33.3) | 0/6 (0.0) | 50/151 (33.1) |
Glycopeptide | |||||||||
Vancomycin | A07AA09 | Watch | NA | NA | NA | NA | NA | 513/737 (69.6) | 513/737 (69.6) |
Tecoplanin | J01XA02 | Watch | NA | NA | NA | NA | NA | 73/125 (58.4) | 73/125 (58.4) |
Polymixin | |||||||||
Colistin | A07AA10 | Reserve | 28/35 (80.0) | 177/231 (76.6) | 94/99 (94.9) | NA | 179/209 (85.6) | 489/601 (81.36%) | |
Polymixin-B | A07AA05 | Reserve | 27/28 (96.4) | 80/87 (92.0) | 48/48 (100.0) | NA | 102/108 (94.4) | NA | 265/288 (92.01%) |
Phosphonic | |||||||||
Fosfomycin | J01XX01 | Watch | NA | 255/277 (92.1) | 25/32 (78.1) | NA | NA | NA | 280/309 (90.61%) |
Nitrofuran | |||||||||
Nitrofurantoin | J01XE01 | Access | 3/5 (60.0) | 171/205 (83.4) | 14/18 (77.8) | NA | 25/34 (73.5) | 222/283 (78.4) | |
Oxazolidinones | |||||||||
Linezolid | J01XX08 | Reserve | NA | NA | NA | NA | NA | 497/575 (86.4) | 497/575 (86.4) |
Sulphonamide | |||||||||
Trimethoprim–sulfamethoxazole | J01EE01 | Access | 1/32 (3.1) | 68/359 (18.9) | 28/92 (30.4) | 4/25 (16.0) | NA | 78/327 (23.8) | 179/835 (21.44%) |
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Saleem, Z.; Haseeb, A.; Abuhussain, S.S.A.; Moore, C.E.; Kamran, S.H.; Qamar, M.U.; Azmat, A.; Pichierri, G.; Raees, F.; Asghar, S.; et al. Antibiotic Susceptibility Surveillance in the Punjab Province of Pakistan: Findings and Implications. Medicina 2023, 59, 1215. https://doi.org/10.3390/medicina59071215
Saleem Z, Haseeb A, Abuhussain SSA, Moore CE, Kamran SH, Qamar MU, Azmat A, Pichierri G, Raees F, Asghar S, et al. Antibiotic Susceptibility Surveillance in the Punjab Province of Pakistan: Findings and Implications. Medicina. 2023; 59(7):1215. https://doi.org/10.3390/medicina59071215
Chicago/Turabian StyleSaleem, Zikria, Abdul Haseeb, Safa S. Almarzoky Abuhussain, Catrin E. Moore, Sairah Hafeez Kamran, Muhammad Usman Qamar, Aisha Azmat, Giuseppe Pichierri, Fahad Raees, Shahzad Asghar, and et al. 2023. "Antibiotic Susceptibility Surveillance in the Punjab Province of Pakistan: Findings and Implications" Medicina 59, no. 7: 1215. https://doi.org/10.3390/medicina59071215