High prevalence of extended-spectrum β-lactamase-producing pathogens: results of a surveillance study in two hospitals in Ujjain, India

Figures & data

Table 1 Demographic characteristics of the 901 pediatric and 1667 adult patients from whom 716 pathogenic bacteria were isolated in Ujjain, India

Patient characteristics	Pediatrics (0–12 years)	Adults	Total (%)
	n = 901 (35%)	n = 1667 (65%)	n = 2568 (100%)
Gender
Male	569 (63)	868 (52)	1437 (56)
Female	332 (37)	799 (48)	1131 (44)
Family size
≤4	356 (40)	742 (44)	1098 (43)
5–10	502 (55)	778 (47)	1280 (50)
>10	43 (5)	147 (9)	190 (7)
Hospital
Nonteaching	552 (58)	608 (36)	1130 (44)
Teaching	379 (42)	1059 (64)	1438 (56)
Hospital ward
Pediatrics	686 (76)	–	686 (27)
Medicine	–	243 (14)	243 (9)
Obstetrics and gynecology	14 (2)	378 (23)	392 (15)
Surgery	38 (4)	661 (40)	699 (27)
Orthopedics	10 (1)	37 (2)	47 (2)
ENT	69 (8)	150 (9)	219 (7.5)
Chest medicine	7 (0.7)	103 (6)	110 (4)
NICU	62 (7)	–	62 (2)
PICU	12 (1)	–	12 (0.5)
ICU	–	46 (3)	46 (2)
Others	3 (0.3)	49	52 (2)
Source of infection
Abscesses	151 (17)	770 (46)	921 (36)
Pneumonia	480 (53)	257 (15)	737 (29)
UTI	75 (8)	331 (20)	406 (16)
BSI	182 (20)	72 (4)	254 (10)
Vaginal infections	13 (1)	237 (14)	250 (10)
Gram-negative bacteria grown	88 (53)	359 (65)	447 (62)
Gram-positive bacteria grown	77 (47)	192 (35)	269 (38)

Abbreviations: ENT, ear nose and throat; NICU, neonatal intensive care unit; PICU, pediatric intensive care unit; ICU, intensive cardiac care unit; UTI, urinary tract infection; BSI, blood stream infection.

Table 2 Distribution of commonest four pathogens per site of infection in surveillance study in two hospitals, Ujjain, India

Site of infection	n	% of total	Rank
Abscessa
Staphylococcus aureus	185	47	1
Pseudomonas aeruginosa	84	21	2
Klebsiella pneumoniae	44	11	3
Escherichia coli	43	11	4
Others	37	10	–
Total	393	100
UTIb
Escherichia coli	61	60	1
Klebsiella pneumoniae	25	24	2
Pseudomonas aeruginosa	6	5	3
Bacillus spp.	3	3	4
Others	8	8	–
Total	103	100
BSIc
Salmonella typhi	21	28	1
CoNS	20	27	2
Staphylococcus aureus	10	13	3
Pseudomonas aeruginosa	6	8	4
Others (Escherichia coli, 8 isolates)	18	24	–
Total	75	100
Pneumoniad
Pseudomonas aeruginosa	22	30	1
Klebsiella pneumoniae	21	28	2
Staphylococcus aureus	10	14	3
Escherichia coli	8	8	4
Others	15	20	–
Total	74	100
Vaginal infectionse
Escherichia coli	32	45	1
Staphylococcus aureus	14	20	2
Klebsiella pneumoniae	12	17	3
Pseudomonas aeruginosa	9	13	4
Others	4	5	–
Total	71	100

Notes:

a Including pus/secretions and swabs from skin and soft tissue infections, postsurgery or traumatic wounds, burns, ear discharge (clinically confirmed otitis media), empyema, breast abscess and intra-abdominal abscess (See Figure 1 for details);

b UTI urinary tract infection; most (91%) samples were mid-stream clean catch and the rest urine from catheter;

c BSI blood stream infections; samples sent in cases of clinical sepsis;

d pneumonia samples were induced sputum and bronchioalveolar lavage;

e vaginal infection samples were high-vaginal swabs.

Abbreviations: BSI, blood stream infection; CoNS, coagulase-negative staphylococci; UTI, urinary tract infection.

Figure 1 Details of site of infection and proportion of different bacteria (n = 393) isolated from abscesses in two hospitals in Ujjain, India.

Table 3 Spectrum of activity of 20 antimicrobials against five most prevalent causes of Gram-negative infections in a surveillance study in two hospitals, Ujjain, India

Antimicrobial class/agent tested	Resistance by organism (number tested)
	R (%)
	E. coli (149)	P. aeruginosa (127)	K. pneumoniae (107)	S. typhi (21)	Proteus spp. (20)
Penicillin
Ampicillin	89		97	87	80
Amoxicillin/clavulanate	82		90		79
Piperacillin/tazobactam	15	17	21		12
Cephalosporins
Cefuroxime	80		93		76
Ceftriaxone	72		79	14	74
Cefixime	79				72
Cefpodoxime	79		75		75
Ceftazidime	73	87	82		74
Other β lactam
Imipenem	2	2	2	0	0
Quinolones
Nalidixic acid	92		93	83	82
Ciprofloxacin	83	63	65	69	71
Norfloxacin	85		74	–	70
Ofloxacin	80	55	55	72	68
Gatifloxacin	79	64	53		67
Sparfloxacin	80	61	51		72
Aminoglycosides
Gentamicin	59	69	69		33
Amikacin	33	38	32		20
Others
Chloramphenicol	33			2	50
Tetracycline	92				100
Cotrimoxazole	83		94	87	58
Nitrofurantoin	12	–	–	–	–

Abbreviation: R, resistance.

Table 4 Spectrum of activity of 25 antimicrobials against three most prevalent causes of Gram-positive infections in surveillance study in two hospitals, Ujjain, India

Antimicrobial class/agent tested	Activity by organism (number tested)
	MSSA (154)			MRSA (67)			CoNS (20)
	R (%)	IR (%)	S (%)	R (%)	IR (%)	S (%)	R (%)	IR (%)	S (%)
Penicillin
Oxacillin	–	–	100	100	–	–	89	–	11
Ampicillin	86	–	14	–	–	–	–	–	–
Amoxicillin/clavulanate	50	2	48	–	–	–	42	–	58
Cephalosporins
Cefoxitin	4	3	93	*	*	*	*	*	*
Ceftriaxone	3	3	94
Cefixime	32	3	65
Cefoperazone	49	8	43
Quinolone
Ciprofloxacin	49	3	48	81	1	18	58	3	49
Ofloxacin	34	2	64	63	6	31	–	–	–
Gatifloxacin	22	4	74	58	13	29	–	–	–
Sparfloxacin	30	3	67	60	3	37	–	–	–
Levofloxacin	29	6	65	60	6	34	60	2	48
Lomefloxacin	38	2	60	67	–	33	–	–	–
Macrolides-lincosamides
Erythromycin	9	10	81	28	16	56	68	2	32
Clarithromycin	–	–	100	9	–	91	–	–	–
Clindamycin	4	4	92	21	7	72	56	–	44
Glycopeptides
Vancomycin	–	–	100	2	–	98	–	–	100
Teicoplanin	–	–	100	–	–	100	–	–	100
Aminoglycosides
Gentamicin	8	1	91	34	2	64	–	–	–
Amikacin	6	2	92	24	2	74	38	–	62
Other classes
Lenezolid	–	–	100	–	–	100	50	–	50
Chloramphenicol	13	1	86	15	5	80	88	–	12
Tetracycline	21	4	75	30	4	66	76	–	24
Doxycycline	18	4	78	27	2	71	68	2	30
Cotrimoxazole	38	4	58	76	1	23	82	1	17

Notes: CoNS were considered only in the blood stream infections if the clinical condition of the patient merited it, Resistant (R) and susceptible (S) percentage as per CLSI criteria 2006.

* See the oxacillin results for rates of susceptibilty.

Abbreviations: IR, Intermediate resistant; MSSA, methicillin-sensitive Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; CLSI, Clinical and Laboratory Standards Institute; CoNS, coagulase-negative Staphylococcus aureus; R, resistance.