Anti-Microbial Resistance in Global Perspective by Louise Ackers & Gavin Ackers-Johnson & Joanne Welsh & Daniel Kibombo & Samuel Opio

Anti-Microbial Resistance in Global Perspective by Louise Ackers & Gavin Ackers-Johnson & Joanne Welsh & Daniel Kibombo & Samuel Opio

Author:Louise Ackers & Gavin Ackers-Johnson & Joanne Welsh & Daniel Kibombo & Samuel Opio
Language: eng
Format: epub
ISBN: 9783030626624
Publisher: Springer International Publishing


Table 5.7Antibiotic resistance patterns of Staphylococcus aureus isolated from PNG ward

Staphylococcus aureus (n = 15)

Antibiotic agent

Susceptible

Intermediate

Resistant

Resistant (%)

Chloramphenicol

14

0

1

7

Gentamicin

14

0

1

7

Cefoxitin (n = 13)

11

0

2

15

Trimethoprim/sulfame

9

1

5

33

Ciprofloxacin (n = 14)

11

0

3

21

Clindamycin

15

0

0

0

Erythromycin (n = 13)

6

1

6

46

Source FPRRH Laboratory

The antibiotic susceptibility of isolates was tested utilising the disk diffusion technique against a specific panel of antibiotics to best determine its resistance potential. The two antibiotics most commonly prescribed in the PNG ward: ceftriaxone and metronidazole, are not specifically mentioned in the tables below. These antibiotics are often prescribed together prophylactically prior to any laboratory testing. Metronidazole is commonly used to treat anaerobic bacteria (Smith 2018; Shafquat et al. 2019) and as such testing for this antibiotic requires laboratories capable of simulating anaerobic conditions. This is not possible at FPRRH. Ceftriaxone, on the other hand, is a member of the cephalosporin group of antibiotics. In this case, other members of the same family (such as cefepime or cefotaxime) with similar mechanisms of action can be used to infer resistance.

Table 5.5 evidences an alarmingly high level of resistance across all antibiotics tested against the 17 Acinetobacter isolates with the exception of doxycycline and amikacin (5 and 1 resistant isolates, respectively). That there were no isolates susceptible to cefepime or cefotaxime, fourth- and third-generation cephalosporins, respectively, is cause for concern. Not only are these some of the most recent iterations of antibiotics, but the fact that the primary antibiotic of choice on the ward is ceftriaxone shows Acinetobacter infections could leave people vulnerable. Equally, once an infection is present, few other antibiotics are shown to be effective.

The most prevalent bacterial species identified from the tests was E. coli. Table 5.6 shows that E. coli displays mixed levels of resistance, leaning towards being either highly susceptible or highly resistant depending on the antibiotic of choice. Again, there is high resistance to cefotaxime (20/26) as well as cefuroxime (21/26), a second-generation cephalosporin, which adds to the concern that ceftriaxone is losing its effectiveness. Thankfully, imipenem8 has been shown to be 100% effective against the isolates tested, promoting its use as a secondary option.

The third most prevalent isolate was S. aureus. (Table 5.7) which showed minimal resistance to all antibiotics with the exception of erythromycin and trimethoprim/sulfame. Additionally, clindamycin was shown to be 100% effective against the isolates tested. Of particular note is cefoxitin which performed strongly with 11 susceptible and 2 resistant isolates. Cefoxitin is a second-generation cephalosporin and acts as an indicator for MRSA (methicillin-resistant S. aureus), a key metric for AMR.



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