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Increasing Antibiotic Resistance Among Isolates of Escherichia coli Recovered From Inpatients and Outpatients in a Saudi Arabian Hospital

Published online by Cambridge University Press:  21 June 2016

Jaffar A. Al-Tawfiq
Jaffar A. Al-Tawfiq*
Affiliation:
Internal Medicine Specialty Services Division, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Saudi Arabia
*
PO Box 76, Room A-420B, Building 61, Dhahran Health Center, Saudi Aramco, Dhahran 31311, Saudi Arabia (jaffar.tawfiq@aramco.com)
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Abstract

Objective.

To study the pattern of antibiotic resistance among Escherichia coli and the trend in resistance during a 6-year period in a Saudi Arabian hospital.

Design.

Retrospective in vitro surveillance study of the antibiotic susceptibility pattern among E. coli isolates recovered from outpatients and from inpatients.

Setting.

A general hospital in Saudi Arabia.

Patients.

All patients with a culture positive for E. coli during a 6-year study period.

Results.

A statistically significant increase in antibiotic resistance was observed among outpatient and inpatient isolates of E, coli. Inpatient isolates were more likely to be resistant to antimicrobial agents. Among isolates from outpatients, 50% were resistant to ampicillin, 33% were resistant to trimethoprim-sulfamethoxazole (TMP-SMZ), and 14% were resistant to ciprofloxacin. Among isolates from inpatients, 63% were resistant to ampicillin, 44% were resistant to TMP-SMZ, and 33% were resistant to ciprofloxacin. There was a low rate of resistance to imipenem (0.3% of isolates), amikacin (2%), and nitrofurantoin (2.4%-6.5%). Resistance to ceftazidime was detected in 9% of outpatient isolates and 17% of inpatient isolates. Multidrug resistance was defined as resistance to 2 or more classes of antibiotics. Multidrug resistance was detected in 2.0%-28.1% of outpatient isolates and 7.4%-39.6% of inpatient isolates, depending on the combination of antimicrobials tested. More isolates were resistant to ampicillin plus TMP-SMZ than to any other combination of antimicrobials.

Conclusion.

The prevalence of antibiotic resistance among outpatient and inpatient E. coli isolates increased during the study period. The rates of antibiotic resistance were statistically significantly higher among inpatient isolates, compared with outpatient isolates. These findings call for wiser use of antibiotics and continued surveillance of antibiotic resistance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 7 , July 2006 , pp. 748 - 753
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1. US Congress, Office of Technology Assessment. Impacts of Antibiotic-Resistant Bacteria. Washington, DC: US Government Printing Office; 1995. Publication OTA-H-629.Google Scholar
2. Friedland, I, Stinson, L, Ikaiddi, M, Harm, S, Woods, GL. Resistance in Enterobacteriaceae: results of a multicenter surveillance study, 1995-2000. Infect Control Hosp Epidemiol 2003; 24:607–612.CrossRefGoogle ScholarPubMed
3. Oteo, S, Campos, J, Baquero, F, and Spanish members of the European Antimicrobial Resistance Surveillance System. Antibiotic resistance in 1962 invasive isolates of Escherichia coli in 27 Spanish hospitals participating in the European Antimicrobial Resistance Surveillance System (2001). J Antimicrob Chemother 2002; 50:945–952.CrossRefGoogle ScholarPubMed
4. Garau, J, Xercavins, M, Rodriguez-Carballeira, M, et al. Emergence and dissemination of quinolone-resistant Escherichia coli in the community. Antimicrob Agents Chemother 1999; 43:2736–2741.CrossRefGoogle ScholarPubMed
5. Bukharie, HA, Saeed, IM. Antimicrobial resistance among pathogens causing acute uncomplicated UTIs. Infect Med 2001; 18:358–362.Google Scholar
6. Al-Ghamdi, MS, El-Morsy, F, Al-Mustafa, ZH, Al-Ramadhan, M, Hanif, M. Antibiotic resistance of Escherichia coli isolated from poultry workers, patients and chicken in the eastern province of Saudi Arabia. Trop Med Int Health 1999; 4:278–283.CrossRefGoogle ScholarPubMed
7. Kader, AA, Nassimuzzaman, M, Dass, SM. Antimicrobial resistance pattern of microorganisms isolated from blood cultures in a Saudi Arabian hospital. BMJ (Middle East) 2000; 7:6–7 Google Scholar
8. National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Disk Susceptibility Test. 8th ed. Approved Standard A6 and M7-A4. Villanova, PA: NCCLS; 1998.Google Scholar
9. Raveh, D, Rudensky, B, Huerta, M, Aviv, Y, Yinnon, AM. Use of time-trend analysis in the design of empirical antimicrobial treatment of urinary tract infection. Eur J Clin Microbiol Infect Dis 2003; 22:158–164.CrossRefGoogle ScholarPubMed
10. Raveh, D, Rudensky, B, Schlesinger, Y, Benenson, S, Yinnon, AM. Susceptibility trends in bacteraemias: analyses of 7544 patient-unique bacteraemic episodes spanning 11 years (1990-2000). J Hosp Infect 2003; 55: 196–203.CrossRefGoogle ScholarPubMed
11. Abussaud, MJ. Incidence of wound infection in three different departments and the antibiotic sensitivity pattern of the isolates in a Saudi Arabian hospital. Acta Microbiol Immunol Hung 1996; 43:301–305.Google Scholar
12. Akbar, DH. Urinary tract infection: diabetics and non-diabetic patients. Saudi Med J 2001; 22:326–329.Google ScholarPubMed
13. Rafay, AM, Nsanze, HN. Multi-drug resistance of Escherichia coli from the urinary tract. Saudi Med J 2003; 24:261–264.Google ScholarPubMed
14. Gupta, K, Scholes, D, Stamm, WE. Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA 1999; 281:736–738.CrossRefGoogle ScholarPubMed
15. Ena, J, Lopez-Perezagua, MM, Martínez-Peinado, C, Cia-Barrio, MA, Ruiz-Lopez, I. Emergence of ciprofloxacin resistance in Escherichia coli isolates after widespread use of fluoroquinolones. Diagn Microbiol Infect Dis 1998; 30:103–107.CrossRefGoogle ScholarPubMed
16. Singh, AK, Sen, MR, Anupurba, S, Bhattacharya, P. Antibiotic sensitivity pattern of the bacteria isolated from nosocomial infections in ICU. J Commun Dis 2002; 34:257–253.Google ScholarPubMed
17. Chaniotaki, S, Giakouppi, P, Tzouvelekis, LS, et al. Quinolone resistance among Escherichia coli strains from community-acquired urinary tract infections in Greece. WHONET Study Group. Clin Microbiol Infection 2004; 10:75–78.CrossRefGoogle ScholarPubMed
18. Al-Lawati, AM, Crouch, ND, Elhag, KM. Antibiotic consumption and development of resistance among gram-negative bacilli in intensive care units in Oman. Ann Saudi Med 2000; 20:324–327.CrossRefGoogle ScholarPubMed
19. Fadel, R, Dakdouki, GK, Kanafani, ZA, Araj, GF, Kanj, SS. Clinical and microbiological profile of urinary tract infection at a tertiary-care center in Lebanon. Infect Control Hosp Epidemiol 2004; 25:82–85.CrossRefGoogle Scholar
20. Tohme, A, Karam-Sarkis, D, El-Rassi, R, Chelala, D, Ghayad, E. Agents and consequences of nosocomial infections in a Lebanese university hospital: retrospective study over a two-year period. Ann Med Interne (Paris) 2001; 152:77–83.Google Scholar
21. Quentin, C, Arpin, C, Dubois, V, et al. Antibiotic resistance rates and phenotypes among isolates of Enterobacteriaceae in French extra-hospital practice. Eur J Clin Microbiol Infect Dis 2004; 23:185–193.Google ScholarPubMed
22. El-Karsh, T, Tawfik, AF, Al-Shammary, F, Al-Salah, S, Kambal, AM, Shibl, AM. Antimicrobial resistance and prevalence of extended spectrum beta-lactamase among clinical isolates of gram-negative bacteria in Riyadh. J Chemother 1995; 7:509–514.CrossRefGoogle ScholarPubMed
23. Kader, AA, Nassimuzzaman, M. Antimicrobial resistance patterns of gram-negative bacteria isolated from urine cultures in Almana General Hospital. Ann Saudi Med 2001; 21:110–112.CrossRefGoogle ScholarPubMed
24. Sörberg, M, Farra, A, Ransjö, U, et al. Different trends in antibiotic resistance rates at a university teaching hospital. Clin Microbiol Infect 2003; 9:388–396.CrossRefGoogle ScholarPubMed
25. Lautenbach, E, Strom, BL, Nachamkin, I, et al. Longitudinal trends in fluoroquinolone resistance among Enterobacteriaceae isolates from inpatients and outpatients, 1989-2000: differences in the emergence and epidemiology of resistance across organisms. Clin Infect Dis 2004; 38:655–662.CrossRefGoogle ScholarPubMed
26. Zervos, MJ, Hershberger, E, Nicolau, DP, et al. Relationship between fluoroquinolone use and changes in susceptibility to fluoroquinolones of selected pathogens in 10 United States teaching hospitals, 1991-2000. Clin Infect Dis 2003; 37:1643–1648.CrossRefGoogle ScholarPubMed
27. Mehr, S, Powell, CV, Curtis, N. Cephalosporin resistant urinary tract infections in young children. J Paediatr Child Health 2004; 40:48–52.CrossRefGoogle ScholarPubMed