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Abstract
There is a generalized assumption among clinicians that the hemodynamically unstable patients are mostly infected with the multidrug resistant organisms compared to the hemodynamically stable patients, and that is why the patients who are considered to be hemodynamically less stable, are empirically prescribed with the broad spectrum antibiotics. This hypothesis has not been supported by any valid evidenceyet .So the aim of ourstudy was to find the association of the hemodynamic status of patients with the drug resistance pattern of organisms and the prescribing pattern of antibiotics. In the present study it has been found that the MDR organisms were isolated more frequently from hemodynamically unstable patients compared to the stable patients (70% Vs 63.25%). However the difference is not statistically significant.Interestingly in case of bacteremia,significantly higher no. (p=0.001) of hemodynamically unstable patients have been infected with MDR organisms. Moreover another significant finding ofthe study is that thehemodynamically unstable patients have beenmostly prescribed with broad spectrum antibiotics like Colistin (p=0.031) and combination of multiple groups of antibiotics (p=0.004) than the stable ones. So the study may provide an important indication for the correlation of hemodynamic stability with multidrug resistance and antibiotic prescription pattern.
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References
- [1]. Basak S, Singh P, Rajurkar M. Multidrug Resistant and Extensively Drug Resistant Bacteria: A Study. Journal of pathogens. 2016.
- [2]. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson‐Liljequist B, Paterson DL. Multidrug‐resistant, extensively drug‐resistant and pandrug‐resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical microbiology and infection. 18(3), 2012 , 268-81
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- [4]. Rawat D, Nair D. Extended-spectrum β-lactamase in gram negative bacteria. J Glob Infect Dis. 2(3), 2010, 263-274
- [5]. Harris PN, Tambyah PA, Paterson DL. β-lactam and β-lactamase inhibitor combinations in the treatment of extended-spectrum β-lactamase producing Enterobacteriaceae: time for a reappraisal in the era of few antibiotic options?. The Lancet Infectious Diseases. 15(4), 2015, 475-85.
- [6]. Chow JW. Aminoglycoside resistance in enterococci. Clinical Infectious Diseases. 31(2), 2000, 586-9.
- [7]. Marothi YA, Agnihotri H, Dubey D. Review Article-ENTEROCOCCAL RESISTENCE-AN OVERVIEW. 2005
- [8]. Bailey J. Hemodynamic instability. 2003
- [9]. Herget-Rosenthal S, Saner F, Chawla LS. Approach to hemodynamic shock and vasopressors. Clinical Journal of the American Society of Nephrology. 3(2), 2008, 546-53.
- [10]. Prado A, Arias NL, Chávez M, Cabrera CE, Gómez RF. Phenotypic characterization of Acinetobacterbaumannii isolates in a high-complexity healthcare institution in the city of Cali. Biomedica. 34, 2014, 101-7.
- [11]. Anthony KB, Fishman NO, Linkin DR, Gasink LB, Edelstein PH, Lautenbach E. Clinical and microbiological outcomes of serious infections with multidrug-resistant gram-negative organisms treated with tigecycline. Clinical infectious diseases. 46(4), 2008 , 567-70.
- [12]. Rodríguez-Baño J, Navarro MD, Retamar P, Picón E, Pascual Á. β-Lactam/β-lactam inhibitor combinations for the treatment of bacteremia due to extended-spectrum β-lactamase–producing Escherichia coli: a post hoc analysis of prospective cohorts. Clinical Infectious Diseases. 54(2), 2012, 167-74.
References
[1]. Basak S, Singh P, Rajurkar M. Multidrug Resistant and Extensively Drug Resistant Bacteria: A Study. Journal of pathogens. 2016.
[2]. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson‐Liljequist B, Paterson DL. Multidrug‐resistant, extensively drug‐resistant and pandrug‐resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical microbiology and infection. 18(3), 2012 , 268-81
[3]. Wattal C, Goel N, Oberoi JK, Raveendran R, Datta S, Prasad KJ. Surveillance of multidrug resistant organisms in tertiary care hospital in Delhi, India. J Assoc Physicians India. 58, 2010, 32-6.
[4]. Rawat D, Nair D. Extended-spectrum β-lactamase in gram negative bacteria. J Glob Infect Dis. 2(3), 2010, 263-274
[5]. Harris PN, Tambyah PA, Paterson DL. β-lactam and β-lactamase inhibitor combinations in the treatment of extended-spectrum β-lactamase producing Enterobacteriaceae: time for a reappraisal in the era of few antibiotic options?. The Lancet Infectious Diseases. 15(4), 2015, 475-85.
[6]. Chow JW. Aminoglycoside resistance in enterococci. Clinical Infectious Diseases. 31(2), 2000, 586-9.
[7]. Marothi YA, Agnihotri H, Dubey D. Review Article-ENTEROCOCCAL RESISTENCE-AN OVERVIEW. 2005
[8]. Bailey J. Hemodynamic instability. 2003
[9]. Herget-Rosenthal S, Saner F, Chawla LS. Approach to hemodynamic shock and vasopressors. Clinical Journal of the American Society of Nephrology. 3(2), 2008, 546-53.
[10]. Prado A, Arias NL, Chávez M, Cabrera CE, Gómez RF. Phenotypic characterization of Acinetobacterbaumannii isolates in a high-complexity healthcare institution in the city of Cali. Biomedica. 34, 2014, 101-7.
[11]. Anthony KB, Fishman NO, Linkin DR, Gasink LB, Edelstein PH, Lautenbach E. Clinical and microbiological outcomes of serious infections with multidrug-resistant gram-negative organisms treated with tigecycline. Clinical infectious diseases. 46(4), 2008 , 567-70.
[12]. Rodríguez-Baño J, Navarro MD, Retamar P, Picón E, Pascual Á. β-Lactam/β-lactam inhibitor combinations for the treatment of bacteremia due to extended-spectrum β-lactamase–producing Escherichia coli: a post hoc analysis of prospective cohorts. Clinical Infectious Diseases. 54(2), 2012, 167-74.