Characterisation of ESKAPE Pathogens with Special Reference to Multidrug Resistance and Biofilm Production in a Nepalese Hospital

Figures & data

Table 1 Distribution of ESKAPE pathogens in Various Specimens

Specimens	Wards	E. faecium (N)	S. aureus (N)	K. pneumoniae (N)	Acinetobacter baumannii (N)	P. aeruginosa (N)	E. aerogenes (N)	Total (N)	Percentage
Urine	Medical	16	46	78	9	22	2	225	49.9%
	Surgical	4	11	16	–	2	–
	ICU	3	3	7	–	6	–
Pus	Medical	1	10	3	–	2	0	101	22.3%
	Surgical	–	52	10	2	17	–
	ICU	–	3	–	–	1	–
Sputum	Medical	1	6	23	22	27	2	97	21.5%
	Surgical	–	–	1	–	–	–
	ICU	–	2	5	3	5	–
Blood	Medical	0	3	–	–	0	0	12	2.7%
	Surgical	–	6	1	–	–	–
	ICU	–	–	1	1	-	-
Semen	Medical	0	-	1	0	0	0	6	1.3%
	Surgical	–	5	–	–	–	–
	ICU	–	–	–	–	–	–
High vaginal swab	Medical	0	2	1	0	0	0	3	0.7%
	Surgical	–	–	–	–	–	–
	ICU	–	–	–	–	–	–
Wound swab	Medical	0	–	–	0	0	0	2	0.4%
	Surgical	–	1	1	–	–	–
	ICU	–	–	–	–	–	–
Endotracheal tube	Medical	0	0	0	–	–	0	2	0.4%
	Surgical	–	–	–	–	–	–
	ICU	–	–	–	1	1	–
Ear swab	Medical	0	1	0	0	0	0	1	0.2%
	Surgical	–	–	–	–	–	–
	ICU	–	–	–	–	–	–
Broncho alveolar lavage	Medical	0	0	1	0	0	0	1	0.2%
	Surgical	–	–	–	–	–	–
	ICU	–	–	–	–	–	–
Suction tip	Medical	0	0	0	1	–	0	1	0.2%
	Surgical	–	–	–	–	–	–
	ICU	–	–	–	–	–	–
Oral swab	Medical	0	0	0	0	1	0	1	0.2%
	Surgical	–	–	–	–	–	–
	ICU	–	–	–	–	–	–
Total		25	151	149	39	84	4	452	100%

Table 2 Antimicrobial Resistance Pattern of Gram-Positive Isolates of ESKAPE Pathogens

Antimicrobials	Enterococcus faecium (N=25)		Staphylococcus aureus (N=151)
	N	%	N	%
Linezolid	0	0	0	0
Teicoplanin	3	12	0	0
Vancomycin	5	20	0	0
Nitrofurantoin	10	43.5	5	8.3
Tetracycline	12	48	3	1.32
Doxycycline	-	-	3	1.98
Tigecycline	12	48	0	0
High-Level Gentamicin	13	52	-	-
Amikacin	-	-	33	21.9
Ciprofloxacin	23	92	88	58.3
Meropenem	25	100	-	-
Ampicillin	25	100	-	-
Chloramphenicol	-	-	2	1.32
Trimethoprim Sulphomethoxazole	-	-	83	55
Cefoxitin	-	-	88	57.6
Clindamycin	-	-	51	60.7
Erythromycin	-	-	63	75

Notes: Nitrofurantoin= For urine isolates only; Meropenem= Intrinsic resistance in E. faecium (tested for species identification); Vancomycin= E-test for vancomycin; Cefoxitin= Screening of MRSA; Clindamycin/Erythromycin= For other than urinary isolates.

Table 3 Antimicrobial Resistance Pattern of Gram-Negative Isolates of ESKAPE Pathogens

Antimicrobials	Klebsiella pneumoniae (N = 149)	Acinetobacter baumannii (N = 39)	Pseudomonas aeruginosa (N = 89)	Enterobacter aerogenes (N = 4)
	N %	N %	N %	N %
Amikacin	37 (24.8)	19 (48.7)	15 (17.9)	-
Nitrofurantoin	31 (64.58)	0 (0)	-	2 (100%)
Trimethoprim-Sulfametoxazole	50 (33.6)	25 (64.1)	-	2 (50%)
Ciprofloxacin	48 (32.2)	21 (53.8)	43 (48.31)	-
Levofloxacin	-	20 (51.3)	-	-
Amoxicillin-Clavulanic Acid	61 (40.9)	-	-	-
Ampicillin- Sulbactam	-	14 (35.9)	-	-
Cefixime	73 (49)	-	-	4 (100%)
Ceftazidime	-	25 (64.1)	25 (29.8)	-
Cefepime	-	23 (59)	24 (28.6)	-
Piperacillin Tazobactam	32 (21.5)	18 (46.2)	7 (8.3)	-
Chloramphenicol	17 (11.4)	-	-	-
Meropenem	26 (17.4)	20 (51.3)	13 (15.5)	-
Tigecycline	7 (4.7)	-	-	-
Colistin	0 (0)	0 (0)	0 (0)
Polymyxin B	0 (0)	0 (0)	0 (0)	-
Doxycycline	20 (13.4)	19 (48.7)	-	-

Note: Nitrofurantoin= For urine isolates only.

Table 4 Frequency of ESBL, MBL, MDR and XDR Among ESKAPE Pathogens

Organism	MDR		XDR		ESBL		MBL
	N	%	N	%	N	%	N	%
E.faecium	20	80	5	20	–	–	–	–
S.aureus	102	67.5	1	0.6	–	–	–	–
K. pneumoniae	48	32.2	19	12.8	24	16.1	12	8.1
A. baumannii	12	30.76	12	30.76	4	10.3	4	10.3
P. aeruginosa	12	14.3	6	7.1	9	10.7	7	8.3
E. aerogenes	2	50	0	0	0	0	0	0

Abbreviations: ESBL, extended-spectrum β-lactamase; MBL, Metallo-β-lactamase; MDR, multi-drug resistant; XDR, extensively-drug resistant.

Figure 1 Gel Electrophoresis of PCR amplification of Van A gene. Lane 1 indicates DNA Ladder (1 Kbp), Lane 2: Blank (Negative Control), Lane 3: Positive Control, Lane 4,5,6,7,8 VRE clinical isolate positive with van A gene.

Table 5 Biofilm Producing ESKAPE Pathogens

Organisms	Producers		Non- Producers		P- value
	N	%	N	%
Enterococcus faecium	8	32	17	68	0.484
Multidrug-resistant	8	-	17	-
Non-multidrug-resistant	0	-	0
Staphylococcus aureus	41	27.1	110	72.9	0.424
Multidrug-resistant	30	-	73	-
Non-multidrug-resistant	11	-	37	-
Klebsiella pneumoniae	79	53.03	70	46.97	0.050
Multidrug-resistant	42		26	-
Non-multidrug-resistant	37		44	-
Acinetobacter baumannii	22	56.4	17	43.6	0.102
Multidrug-resistant	16	-	8	-
Non-multidrug-resistant	6	-	9
Pseudomonas aeruginosa	39	46.4	45	53.6	0.732
Multidrug-resistant	9	-	9	-
Non-multidrug-resistant	30	-	36	-
Enterobacter aerogenes	2	50	2	50	1.00
Multidrug-resistant	1	-	1	-
Non-multidrug-resistant	1	-	1	-