Fluoroquinolone Resistance in the Clinical Isolates of Kashmir Valley and In-Vitro Efficacy of Fosfomycin in Multiple Infections

摘要

BACKGROUND: Antibacterial resistance is a major concern in healthcare associated infections. Longer hospital stay, empirical treatment without antimicrobial stewardship policy and ineffective infection control practices are making it difficult to treat infections. Kashmir valley lacks surveillance data and awareness about antibiotic resistance among clinicians, thus complicating patient care. The aim of this study was to investigate the prevalence of antibacterial resistance among various clinical isolates. METHODS: The study was conducted between February 2013 and April 2014 in the Srinagar city. Samples of urine, pus, and other body fluids (N=500) were examined for clinically important pathogens. Standard laboratory protocols were followed for the isolation, identification and susceptibility tests. Recent CLSI guidelines for antimicrobial susceptibility were followed using Kirby-Bauer method. RESULTS: Predominant pathogens identified in urine cultures were Escherichia coli (42.1%), Klebsiella pneumoniae (31.57%), Proteus species (7.8%), Pseudomonas aeruginosa (13.1%) and Enterococcus faecalis (5.26%). Methicillin resistant Staphylocoocus aureus (14.8%) and Methicillin sensitive Staphylococcus aureus (22.2%) were common isolates found in pus. Other frequent clinical isolates found in pus cultures were Proteus species (28.1%), Enterococcus faecalis (18.5%) and Pseudomonas aeruginosa (14.8%). Klebsiella pneumoniae and Staphylococcus aureus were prevalent isolates in semen cultures. All clinical isolates screened in this study were resistant to quinolones, aminoglycosides, cephalosporins, carbepenems and sulphonamides. Glycopeptide resistance was observed in one of the urinary isolates. All clinical isolates were sensitive to fosfomycin. CONCLUSION: We found high quinolone resistance in pathogens isolated from community acquired urinary tract infection (UTI) and nosocomial infections. Fosfomycin can be a good alternative choice in the treatment of urinary tract infection with greater efficacy & lesser antibiotic resistance. The drug has not been so far prescribed in routine clinical practice in the valley.