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Incidence of Cephalosporin Resistance Among Clinical Isolates of Pseudomonas Aeruginosa in Ibadan, South- Western Nigeria

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Incidence of Cephalosporin Resistance Among Clinical Isolates of Pseudomonas Aeruginosa in Ibadan, South- Western Nigeria International Journal of Medicine and Biomedical Research Volume 4 Issue 3 September – December 2015 www.ijmbr.com © Oladipo et al. ; licensee Michael Joanna Publications Original Article Open Access Incidence of cephalosporin resistance among clinical isolates of Pseudomonas aeruginosa in Ibadan, South- Western Nigeria Oladipo E.K*, Oloke J.K, Omomowo I.O., Oyeniran A.O, Awoyelu E.H, Ogundele S.O Department of Pure and Applied Biology (Microbiology Unit), Ladoke Akintola University of Technology, P.M.B. 4000, Ogbomoso, Oyo State, Nigeria. *Corresponding author: [email protected] Received: 17.09.15; Accepted: 04.12.15; Published: 12.12.15 ABSTRACT Background: The emergence of beta-lactam resistance in Pseudomonas aeruginosa is a major global challenge, particularly, the rise in the resistance to 3rd and 4th generation cephalosporins. Aim: This study was carried out to determine the resistance pattern of Pseudomonas aeruginosa to different generations of cephalosporins. Methods: A total number of one hundred clinical isolates of Pseudomonas aeruginosa were collected from June to November 2014 at University Teaching Hospital Ibadan, Oyo State. These were tested for their sensitivity to antibiotics by means of disc diffusion method using prepared antibiotics disc containing different µ of antibiotics; Ce fotaxine (30µ), Cefaclor (30µ), Cefamandole (30µ), Cefixime (5µ), Cefepime (30µ), Cefpodoxime (30µ) and Ceftazidime (30µ). Results: Pseudomonas aeruginosa showed absolute resistance to all antibiotics used except Ceftazidime, and Cefepime which are third a nd fourth generation of cephalosporin respectively. Ceftazidime had minimal resistant of 21% and higher susceptibility rate of 76%, Cefepime had the highest susceptibility rate of 90% and minimal resistance of 6%. Cefotaxime and Cefpodoxime had minimal int ermediate of 1%, Ceftazidime of 3% and Cefepime of 4%. Conclusion: The result from this study provided more evidence that among third generation of cephalosporins used, some are more active than the other while fourth generation is still the most effective of all other generations. Knowledge on the distribution of cephalosporin-resistant organisms is of ultimate importance as a guide in empirical therapy, taking note of preventive strategies as well as control measures against the spread of resistant microorganisms. Key words: Cephalosporins, resistance, susceptibility, Pseudomonas aeruginosa, antibiotics, organism INTRODUCTION diseases. Emergence and dissemination of β- lactam resistance in nosocomial Resistance of pathogenic organisms has Enterobacteriaceae, Pseudomonas become a worldwide problem with serious aeruginosa and Acinetobacter baumanni have consequence on the treatment of infectious pose a serious problem worldwide, especially the increasing resistance to different This is an Open Access article distributed under the terms of the creative commons Attribution 4.0 licence (http://creativecommons.org/licenses/by/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Oladipo et al .: Cephalosporin resistance among clinical isolates of Pseudomonas aeruginosa generations of Cephalosporins.[1] Infections isolates to different generations of due to gram-negative organisms, cephalosporin. Pseudomonas aeruginosa being the most common, continue to be one of the leading METHODOLOGY causes of health care-acquired infections as well as morbidity and mortality in the Study area [2,3] healthcare system. Pseudomonas This research was carried out in Ibadan, Oyo aeruginosa , a gram-negative bacterium, is State, South Western part of Nigeria, in order found in healthcare-associated infections to determine the resistance pattern of clinical especially in patients who have been isolates of Pseudomonas aeruginosa to hospitalized more than a week and is reported different generations of cephalosporin among in different outbreaks of infections such as the patients at University Teaching Hospital pneumonia, bacteremia, urinary tract infection, Ibadan, Oyo state, Nigeria over a period of five and endocarditis, which are often complicated months (June to November 2014). [4,5] and potentially life-threatening. Wound infections have been the leading reservoir for Bacterial isolates [6] the bacterium as well as burn patients. A total number of one hundred (100) clinical Cephalosporins are used to treat a wide isolates of Pseudomonas aeruginosa from variety of bacterial infections caused by different clinical sites including burns, wounds Pseudomonas aeruginosa not limited to and ear were used for this study. These respiratory tract infections, otitis media, samples were obtained from University gonorrhoea, skin infections, urinary tract Teaching Hospital Ibadan. [7] infections and sexually transmitted diseases. [2,3] [1] According to Oladipo et al ., Eyo et al ., and Processing of samples [8] Ramalingam et al ., the fundamental Media were prepared according to the mechanism of Pseudomonas aeruginosa manufacturer’s instructions and sterilized at resistance to cephalosporin involves the 121 0C for 15min at 15 lb pressure. The production of enzymes, extended spectrum β- inoculum were standardized using the lactamases (ESBLs) that aids in the bacterium MacFarland standard.[2,3] resistance, that is, bacterial resistance to beta- lactam antibiotics is due to the enzymatic Susceptibility test inactivation of antibiotics, that is, the The susceptibility test was conducted using production of enzyme β-lactamase which the Kirby- Bauer method of sensitivity hydrolyses the β-lactam ring of the antibiotics determination.[2,3] Petri – dishes of Mueller rendering them inactive. Extensive use and Hinton agar were prepared according to the misuse of antibiotics of the public alongside manufacturer’s instruction. 0.1ml of inappropriate practices of unskilled health Pseudomonas aeruginosa equivalent to 0.5 workers and practitioners have led to the McFarland standard was seeded into each of increasing resistance of nosocomial the Petri-dishes containing Mueller-Hinton microorganisms. agar using sterile swabs. [2] These were allowed to stand for 45min to enable the Different generations of cephalosporin, first, inoculated organisms to pre-diffusion. [3] The second, third and fourth generations, are antibiotics discs of Cefadroxil (30µg; Oxoid, broad spectrum antimicrobial agents with UK), Cefotaxim (30µg; Oxoid, UK), enhanced activity against both gram-positive Cefamandole (30µg; Oxoid, UK), Cefador [3] and gram-negative organisms. They have (30µg; Oxoid, UK), Cefpodoxime (10µg; Oxoid, been assured successful in the treatment of UK), Cefixime (5µg; Oxoid, UK) and Cefepime severe and multi-drug resistant infections, (30µg; Oxoid, UK) were aseptically placed on however, increased prevalence of nosocomial the surfaces of the sensitivity agar plates. [2,3] strains of Pseudomonas aeruginosa resistance These were incubated aerobically for 18–24 to cephalosporin among clinical isolates has hours at 37ºC and the radial zone of inhibitions [9] been reported. Knowledge on the distribution were taken. [2,3] The results were expressed as of cephalosporin-resistant organisms is susceptible, intermediate or resistant important for guide in empirical therapy, taking according to criteria developed by Clinical note of preventive strategies as well as control Laboratory Standard Institute.[10,11] measures against the spread of resistant microorganisms. This study therefore is Statistical analysis designed to determine the antimicrobial Susceptibility rates were analyzed using susceptibility pattern of selected clinical ANOVA at significant level of P≤0.05. All interval estimates are 95% confidence Int J Med Biomed R es 2015;4 (3): 13 5-141 136 Oladipo et al .: Cephalosporin resistance among clinical isolates of Pseudomonas aeruginosa intervals. SPSS program for Windows (version remaining 10(21.3%) were resistant. 16.0; SPSS, Inc., Chicago, IL) was used. 42(89.4%) of the isolate were susceptible to Cefepime, 2(4.3%) showed intermediate effect RESULTS and 3(6.4%) were resistant. All the Pseudomonas aeruginosa isolates from this Distribution of Pseudomonas aeruginosa site were resistant to Cefotaxime, from different sites Cefamandole, Cefador and Cefixime. Figure 1 shows the distribution of the clinical isolates of Pseudomonas aeruginosa from the Summarily, the susceptibility rate of different sites. Ear swab was 23, burns was 30 Pseudomonas aeruginosa to Cefotaxime was while wound swabs was 47. 0% sensitive, 1% intermediate and 99.0% resistant. Cefamandole was 0% sensitive, 0% Resistance pattern of Pseudomonas intermediate and 100% resistant. Cefador was aeruginosa to different generations of 0% sensitive, 0% intermediate and 100% Cephalosporin resistant. Cefpodoxime was 0% sensitive, 1% From table 1, out of 23 Pseudomonas intermediate and 99.0% resistant. Cefixime aeruginosa isolated from ear swab, 17(73.9%) was 0% sensitive, 0% intermediate and 100% were susceptible to Ceftazidime while the resistant. Ceftazidime was 76% sensitive, remaining 6(26.1%) were resistant. 19(89.2%) 3.0% intermediate and 21% resistant. of the isolates were susceptible to Cefepime Cefepime was 90% sensitive, 4% intermediate while 2(8.9%) showed intermediate effect. All and 6.0% resistant. The overall resistant the isolates were resistant to Cefotaxime, pattern of Pseudomonas aeruginosa to Cefamandole, Cefador, Cefpodoxime and different generations of cephalosporin was Cefixime. 23% sensitive, 1.3% intermediate and 75.0%
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