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Isolation of Shigella Species and Their Resistance Patterns to a Panel of Fifteen Antibiotics in Mid and Far Western Region of Nepal

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Isolation of Shigella Species and Their Resistance Patterns to a Panel of Fifteen Antibiotics in Mid and Far Western Region of Nepal Asian Pac J Trop Dis 2014; 4(1): 30-34 30 Contents lists available at ScienceDirect Asian Pacific Journal of Tropical Disease journal homepage: www.elsevier.com/locate/apjtd Document heading doi:10.1016/S2222-1808(14)60309-1 2014 by the Asian Pacific Journal of Tropical Disease. All rights reserved. 襃 Isolation of Shigella species and their resistance patterns to a panel of fifteen antibiotics in mid and far western region of Nepal 1* 2 3 4 Salman Khan , Priti Singh , Mukhtar Ansari , Ashish Asthana 1Department of Microbiology, Nepalgunj Medical College Affiliated to Kathmandu University, Nepal 2Department of Biochemistry, Nepalgunj Medical College Affiliated to Kathmandu University, Nepal 3Department of Pharmacology, National Medical College Affiliated to Tribhuvan University, Nepal 4Department of Microbiology, Neta ji Subhash Chandra bose subharti Medical College Affiliated to Swami Vivekanand Subharti University, India PEER REVIEW ABSTRACT Peer reviewer Objective: Shigella To determine the antimicrobial resistance patterns of species to the most Dr. Bharti bais, Professor& Head, commonlyMethods: used antibiotics in mid and far western part of Nepal. Department of Microbiology, S.S.R. Stool samples were collected from 458 patients who came from mid and far western Medical College, Mauritius. region of Nepal, attending OPD & IPD Departments of Nepalgunj Medical College, Nepal, between 00230 4912265 7135979 2011 2013 Tel: - / the periods of September Shigella to March . Standard microbiological procedures were used for E-mail: [email protected] isolation and identification of species while the disc diffusion test was used to determine Comments theResults: antimicrobial resistance patterns of the recoveredShigella isolates. Shigella flexneri, Shigella 65 dysenteriae,A totalShigella of boydii isolates were Shigella identified sonnei as species. 43 07% 27 69% The work is very good in which the and Shigella were accounted respectively for . , . , % % ( %) authorsShigella evaluated the distribution of 21.53 and 7.69 of the total number of isolated. Resistances to nalidixic acid 95.38 , species and their antibiotic ampicillin (84.62%), co-trimoxazole (81.54%) and ciprofloxacin (46.15%) were observed. Greater (38 46%) 1 10 resistance pattern that were found to number of Pisolates . was recovered from those aged - years. This was statistically ( 0 05) be different between isolates. Overall significantConclusions: < . , compared to the other age groups. Shigella flexneri the work done can add additive The study revealed the endemicity of shigellosis with as the support to treat the shigellosis. predominant serogroup. Children were at a higher risk of severe shigellosis. The results also Details on Page 33 suggest that nalidixic acid, ampicillin, co-trimoxazole and ciprofloxacin should not be used empirically as the first line drugs in the treatment of shigellosis. Periodic analysis of resistance patterns is necessary for the appropriate selection of empirical antimicrobial therapy. KEYWORDS Shigella , Dysentery/diarrhea, Antimicrobial resistance, Mid & far western region of Nepal 1. Introduction viz. Shigella dysenteriae S. ( dysenteriaeO antigen groups, groupShigella A as flexneri S. flexneri ) ( ) Shigella, group boydii B asS. boydii Shigella sonnie, group Shigellosis remains a public-health problem in most C as ( ) and [4]. It developing countries where communities are ravaged is a major cause of dysentery/diarrhea in children and by poverty, war, poor sanitation, personal hygiene, and others. Many of them are hospitalized immediately after water supplies[1]. Epidemiologic reports show that about the onset of the disease. Though, oral rehydration is the 140 million people suffer from shigellosis with estimated principal means of management, as the enteroinvasiveness 600 000 deaths per year worldwide[2,3]. There are four major antibacterial treatment may be necessary[5]. The *Corresponding author: Mr. Salman Khan, assistant professor, Department of Article history: Microbiology, Nepalgunj Medical College, Chisapani, Banke, Nepal. Received 6 Oct 2013 Tel: 009779848354981 Received in revised form 15 Oct, 2nd revised form 22 Oct, 3rd revised form 25 Oct 2013 E-mail: [email protected] Accepted 20 Dec 2013 Foundation Project: Supported by Nepalgunj Medical college and teaching hospital Available online 28 Feb 2014 Nepal [Grant No. 2(16)OTA-II/12]. Salman Khan et al./Asian Pac J Trop Dis 2014; 4(1): 30-34 31 ° ) emergence of antimicrobial resistance to members of the ShigellaPvt Ltd. The plates were incubated at 37 C for 24 h. The Enterobacteriaceae family is posing serious problems in isolates were speciated biochemically as outlined the treatment of outbreaks of infections. Since its first by Cowan and confirmed by the slide agglutination test using ( ) report in studies conducted in the 1950s,Shigella multiple-drug polyvalent and monovalent antisera Denka Seiken, Japan resistance transmitted by plasmids among species [29]. [6-8] has been reported from many countries . Moreover, an 2.3. Antibiotic susceptibility testing increase in resistance against many different drugs has been observed in the last two decades. In one study, a significant decrease was observed in the susceptibility of the species to Antimicrobial sensitivity testing was determined by the ampicillin and cotrimoxazole from 1988-89 to 1991-92[9]. In Kirby-Bauer disc diffusion method on Mueller Hinton anotherShigella report, it was shown that co-trimoxazole resistance agar using the antimicrobial agents including amikacin, of increased from 3% to 40% within ten years[10]. ampicillin, amoxyclav, cefotaxime, ceftazidime, ceftriaxone, AShigellanother study showed that the percentage of resistant chloramphenicol, ciprofloxacin, cotrimoxazole, doxycycline, ( ) % strains in Madrid Spain increased from 39.6 to gentamicin, imipenem, nalidixicacid, norfloxacin,° and 97.9% for ampicillin, from 34.4% to 96.9% for co-trimoxazole, ofloxacin[30]. The plates were incubated at 37 C for 24 h, % % % from 6.3 to 18.0 for tetracycline, and fromShigella 1.6 to 15.1% for and the diameters of zone of inhibition wereEscherichia compared withcoli chloramphenicol[11]. In Ethiopia, strains of that were recorded diameters of the reference isolate ( resistant to many commonly used drugs have been reported ATCC 25922) in order to determine susceptibility or resistance. [12-14] in differentet al parts of the country by several studies . 2.4. Statistical analysis Belay . have reported a strain that was resistant to eight [14] drugs out of Shigellathe nine antimicrobials they used . In India, Over 70% of isolates were resistant to two or more Data obtained were analyzed using the SPSS software drugs including ampicillin and co-trimoxazole during 2002 for windows version 18. Comparison of data in respect of [15] Shigella Chi to 2007 . Reports from Indonesia, Bangladesh, MShigellaalaysia, P, sex, and age-groups were performed by - and Nepal showed increasing frequency of square. <0.05 was consider to be statistically significant. with multiple resistance to ampicillin, trimethoprim- [16-19] sulphamethoxazole, tetracycline, and nalidixic acid . 3. Results Similar resistance profiles were reported from Africa[20], [21] [22-24] [25,26] Central America , Europe , and South AmericaShigella. Besides the temporal changes in the antibiogram of Shigella Of the 458 diarrheal/dysenteric stool samples screened, ( %) species, it Shigellais well known that antibiotic susceptibility strains were identified in 65 14.19 samples,Shigella 36 patterns in may differ between geographical areas. (55.38%) in male and 29 (44.62%) in female (Table 1). Such differences are never stable and may change rapidly, spp. were isolated from patientsn with ages ranging between 1 especially in places where antibiotics are used excessively to >60 years. Of these, 38.46% ( =25) were from children from ( )[27] particularly in developing countries . This warrants 1P-10 years age groups, which was statistically significant for frequent observation on the change in the pattern of ( <0.05) compared to the other age groups. However, antibiogram for this organism. To our best knowledge, no there was no significant difference in the overall Pnumber ( ) reportShigella exists regarding the antibiotic resistance pattern of S.of iflexnerisolates recovered in the study based on sex Shigella>0.05 . ( %) species in mid and far western region of Nepal. This strains were identifiedS. dysenteriae in 28 43.07 study was thus carriedShigella out to determine the antimicrobial positive S.cultures, boydii while S. sonnei accounted for 18 ( %) ( %) ( %) resistance patterns of species to the most commonly 27.69 , in 14 21.53 and S. flexneri in 5 7.69 of used antibiotics in mid and far western part of Nepal. the total number of isolates (Table 2). has been the predominant isolate during the period of the study. 2. Materials and methods Table 1 Shigella. Sex distribution of all positive cases in different species of 2.1. Study background and subjects Shigella Sex distribution of positive cases species Male Female Total No (%) S. flexneri T 458 16 12 28 (43.07) his was a prospective study conducted on patients S. dysenteriae of diarrhea/dysentery who come from mid and far western 9 9 18 (27.69) S. boydii region of Nepal, attending out-patients and in-patients of 8 6 14 (21.53) S. sonnei the Departments of Nepalgunj Medical college and teaching 3 2 5 (7.69) Hospital, Banke, Nepal, between the periods of September Total No. (%) 36 (55.38) 29 (44.62) 65
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