Prevalence of multidrug-resistant Gram-negative bacteria causing pyogenic infections at a tertiary care hospital in Haryana

Abstract

Background: The growing occurrence of antibiotic-resistant bacteria, especially those resistant to multiple drugs found in pyogenic infections, presents considerable challenges in effectively managing and curing these infections. Objective: This current research aimed to determine the prevalence of Gram-negative bacteria with multidrug resistance in cases of pyogenic infections treated at a tertiary care hospital located in Haryana, India. Materials and Methods: An observational cross-sectional investigation was conducted over 8 months, from June 2022 to January 2023, at a tertiary care hospital located in Haryana, India. Throughout the study, 376 samples of pus and wound swabs were gathered from patients visiting the outpatient and inpatient departments. Subsequently, specimens that exhibited noteworthy aerobic bacterial growth were identified following established bacterial testing procedures, and their antibiotic susceptibility profiles were determined using the Kirby-Bauer disc diffusion method. Results: Out of the total 376 collected pus and wound swab specimens (n = 376), significant aerobic bacterial growth was observed in 116 cases (30.9%), with 113 instances (97.4%) showing monomicrobial growth and the remaining three cases (2.6%) exhibiting polymicrobial growth. Consequently, a sum of 119 bacterial isolates was obtained, with 70 (58.8%) being Gram-negative bacilli (GNB) and 49 (41.2%) being Gram-positive cocci. Among the GNB isolates, 37 (52.9%) were identified as Gram-negative fermenters (belonging to the Enterobacteriaceae family), while the remainder were categorized as Gram-negative non-fermenters. The prevalent isolate was Pseudomonas aeruginosa, accounting for 42.9% of the cases, Escherichia coli at 25.7%, and Enterobacter species at 7.1%. Of these isolates, 31 (44.3%) were multidrug-resistant, 24 were Gram-negative fermenters, and seven were Gram-negative non-fermenters. Approximately three-quarters of the Enterobacteriaceae isolates showed potential for producing extended-spectrum β-lactamases, whereas a quarter exhibited potential for producing carbapenemases. Similarly, a quarter of the Gram-negative non-fermenters were identified as potential carbapenemase producers. Conclusion: The present study underscores the prevalence of multidrug-resistant strains within the pathogens, particularly among Enterobacteriaceae isolates responsible for pyogenic infections. Additionally, these findings will play a pivotal role in shaping a community-specific antimicrobial stewardship initiative, which stands as one of the most essential strategies for addressing the challenge of antimicrobial resistance.