Printer Friendly

Current status of uropathogens with special reference to enterococcus.

INTRODUCTION: The urinary tract is one of the most common sites of bacterial infection, particularly in females; 10-20% of women have recurrent Urinary Tract Infection (UTI) at sometime in their life. (1), (3) UTI in males is less common and primarily occurs after 50 yrs of age. Although the majority of infections are acute and short lived, they contribute to a significant amount of morbidity in the population.

Klebsiella, Enterobacter and Pseudomonas aeruginosa are more frequently found in nosocomial UTI. Among the Gram positive cocci, Staphylococcus saprophyticus causes UTI in young sexually active women. Staphylococcus epidermidis and Enterococcus species are more often associated with nosocomial UTIs. (1) The other causes of UTI include Candida species, Histoplasma capsulatum, Trichomonas vaginalis and Schistosoma haematobium. (1)

Enterococci, an indigenous flora of the intestinal tract, oral cavity and genitourinary tract of humans and animals, are known to be relatively avirulent in healthy individuals, but have become important opportunistic pathogens, especially in hospitalized patients. (5)

Recent years have witnessed increased interest in enterococci not only because of their ability to cause serious infections like endocarditis, bacteremia, intra-abdominal and urinary tract infection (UTI), but also because of their increasing resistance to many antimicrobial agents. Enterococcus is considered an important nosocomial pathogen because of its intrinsic as well as acquired antibiotic resistance. It also has the potential of transferring vancomycin resistance to other organisms such as Listeria monocytogens and Staphylococcus aureus. (5) Its acquired high-level resistance (HLR) to aminoglycoside as well as vancomycin resistance are causes of concern. This resistance contributes to failure of combination therapy of aminoglycoside and [beta]-lactam antibiotics used for severe enterococcal infection. (4) This emphasizes the need for the identification of such enterococci, as also of other group D streptococci, which are generally more sensitive to antimicrobial agents, from clinical specimens. In a CDC survey of nosocomial infection, enterococci accounted for 13.9% of urinary tract infection, second only to Escherichia coli as a sole agent of nosocomial urinary tract infections. (2)

Despite the widespread availability of antibiotics, UTI remains the most common bacterial infection in the human population. Antibiotics are usually given empirically before the laboratory results of urine culture are available. To ensure appropriate therapy, current knowledge of the organisms that cause UTIs and their antibiotic susceptibility is mandatory. (4) Antibiotic resistance among uropathogens also constitute a major deciding factor in the establishment and eradication of the disease.

AIMS AND OBJECTIVE: The present study aimed to isolate and identify various uropathogens and the emergence of antibiotic resistance among Enterococcus species and other Gram negative bacilli.

MATERIAL AND METHODS:

SAMPLE COLLECTION: A total of 1632 urine samples from clinically suspected patients of UTI were collected between April 2011 to March 2012 from both the inpatient as well as the outpatient department of a medical college hospital, in Eastern Bihar. Out of the 1632 patients of UTI, 388 were indoor patients and 1244 were from outdoor patient department. Out of 388 indoor patients 190 were male and 198 were female. Out of 1244 outdoor patients 374 were male and 870 were female. Majority of the samples were midstream urine specimens, and others included catheterized urine samples on supra pubic aspirates. Proper instructions were given to the patients regarding collection of urine. (8)

MICROSCOPIC EXAMINATION: Microscopy was performed on all samples. 3ml of well mixed urine sample was centrifuged at 3000 rpm for 10 min. The supernatant was discarded and the deposit was examined microscopically under 40X objective for pus cell, RBCs, epithelial cells and any other abnormal findings. (3)

CULTURE: Urine samples were processed within an hour of collection. If delay of more than one hour was unavoidable the samples were refrigerated at 4[degrees]C. The bacterial counts in the urine samples were determined by semi quantitative method using 4 mm (24 SWG) internal diameter standard loop. The samples were inoculated on MacConkey and blood agar plates. After overnight incubation at 37[degrees]C culture plates yielding bacterial counts of [greater than or equal to] [10.sup.5] CFU/ml were considered as significant, while counts ranging between [10.sup.4]-[10.sup.5] CFU/ml were considered to be of doubtful significance and counts below [10.sup.4] CFU/ml were taken as insignificant. However, antibiotic susceptibility test were performed for all those samples showing counts [greater than or equal to] [10.sup.4] CFU/ml with a special note regarding possibility of contamination and advice to repeat culture with another sample to the attending physician when the colony counts were in between [10.sup.4]-[10.sup.5] CFU/ml. (3)

IDENTIFICATION: Uropathogens were identified on the basis of Gram's reaction, colony morphology and standard biochemical tests. (3)

ANTIBIOTIC SUSCEPTIBILITY OF ISOLATES: Antimicrobial susceptibility tests were performed on Muller Hinton agar by modified Kirby Bauer disc diffusion method. (3) Commercial discs from Hi-Media Laboratories were used. The concentration of each antimicrobial agent (in [micro]g) tested per disc was

(a) For GNB

gentamicin (10), amikacin (30), tetracycline (30), piperacillin (100), amoxicillin (20), cefoperazone (75), cefoperazone-sulbactam (75/10), ciprofloxacin (5), levofloxacin (5), aztreonam (30), imipenem (10), meropenem (10), co-trimoxazole (25), ceftazidime (30), amoxyclav (20/10)

(b) For Enterococcus species

gentamicin (10), amikacin (30), ciprofloxacin (5), ampicillin (10), tetracycline (30), ampicillin-sulbactam (10/10), vancomycin (30), rifampicin (5), teicoplanin (30), piperacillin (100)

(c) For Pseudomonas species

gentamicin (10), amikacin (30), ceftazidime (30), cefotaxime (30), piperacillin (100), cefoperazone (75), cefoperazone-sulbactam (75/10), ciprofloxacin (5), levofloxacin (5), aztreonam (30), imipenem (10), meropenem (10), piperacillin-tazobactam (100/10).

RESULTS:

MICROSCOPIC FINDINGS: Out of 1632 samples, 524 samples showed growth of microorganisms and 1108 were either sterile or showed insignificant bacteriuria. On the basis of microscopic findings it was seen that out of the 490 samples that showed pus cells (++) and bacterium (+++) on microscopy, 453 (92.45%) showed significant bacteriuria and 37 (7.55%) showed bacteriuria of doubtful significance. 16 samples showed pus cells (+) and bacteria (++) on microscopy. Out of these, 9 samples (56.25%) showed significant bacteriuria. 55 samples showed pus cells (+) and few bacteria, none of these samples showed significant bacteriuria. 47 were sterile and only 08 (14.5%) showed bacteriuria of doubtful significance.

Majority of the samples (1071) showed occasional pus cells and few bacteria. Only 10 (0.93%) of these samples showed bacteriuria of doubtful significance and the rest were sterile. The details of the microscopic findings from these samples have been depicted in Table-1.

CULTURE FINDINGS: Out of 1632 samples, 462 (28.3%) samples were found to showed significant bacteriuria, 62 (3.86%) showed colony counts ranging from [10.sup.4]-[10.sup.5] CFU/ml and 1108 (67.89%) showed no growth or insignificant bacteriuria. Out of 524 samples, 460 were positive for unimicrobial and 64 were positive for polymicrobial growth. Out of 524 positive samples, 386 were from OPD and 138 from IPD patients (Table-2).

A total of 588 organisms were isolated (433 from OPD and 155 from IPD), out of which Gram negative bacilli were predominant 324 (55.10%), followed by 212 (36.05%) Gram positive cocci, and 52 (8.84%) Candida species. Out of the 433 isolates from OPD samples, Gram negative bacilli [233 (53.81%)], were predominant followed by 171 (39.49%) Gram positive cocci, and 29 (6.69%) Candida species. Out of the 155 isolates from IPD samples, Gram negative bacilli were predominant 91 (58.70%), followed by 41 (26.45%) Gram positive cocci, and 23 (14.83%) Candida species (Table-3).

Out of 324 the Gram negative bacilli, Escherichia coli (69.13%) was the predominant isolate, followed by Klebsiella pneumoniae (8.95%), Pseudomonas aeruginosa (8.64%), Proteus mirabilis (4.32%), Proteus vulgaris (3.70%), Klebsiella oxytoca (3.39%), Citrobacter freundii (0.92%), Morganella morganii (0.61%) and Citrobacter koseri. Out of 212 Gram positive cocci, Enterococcus species was the predominant isolates (43.39%), followed by Coagulase negative staphylococcus (33.96%) and S. aureus (22.64%).

Among all isolates (including Gram negative bacilli, Gram positive cocci and candida species), Enterococcus sp ecies was the 2nd most common isolates (15.64% after E. coli (38.09%). E. faecium was the predominant species (73.91%) followed by E. faecalis (17.39%) and E. casseliflavus (8.69%) (Table-4).

Out of the 233 the Gram negative bacilli isolated from OPD samples, Escherichia coli (77.68%) was the predominant isolate, followed by Klebsiella pneumoniae (7.72%), Pseudomonas aeruginosa (6.16%), Proteus mirabilis (3.43%), Proteus vulgaris (2.14%), Klebsiella oxytoca (1.71%) and Citrobacter freundii (0.42%) (Table-5).

Out of the 91 the Gram negative bacilli isolated from IPD samples, Escherichia coli (47.25%) was the predominant isolate, followed by Klebsiella pneumoniae (12.08%), Pseudomonas aeruginosa (13.18%), Proteus vulgaris (7.69%), Klebsiella oxytoca (7.69%), Proteus mirabilis (6.59%) and Citrobacter freundii (0.42%) (Table-5).

Out of 212 Gram positive cocci, 171 isolated from OPD samples and 41 from IPD samples. Out of 171 Gram positive cocci from OPD, Enterococcus species was the predominant (41.52%) followed by CONS (37.42%) and COPS (21.05%). Out of 41 Gram positive cocci from IPD, Enterococcus species was the predominant (51.21%) followed by CONS (19.51%) and COPS (29.26%). (Table-5)

Enterococcus species was the second most common isolates after E. coli among OPD as well as IPD isolates.

The details of the Culture findings have been depicted in Table-2, 3, 4 and 5.

ANTIBIOTIC SENSITIVITY TEST FINDINGS: E. coli isolated from OPD was highly sensitive to

imipenem (99.23%) followed by meropenem (91.03%), piperacillin-tazobactam (82.54%), amikacin (87.67%) and gentamicin (76.78). E. coli strains showed maximum resistance to piperacillin and Nalidixic acid.

E. coli isolated from IPD also was highly sensitive to imipenem (96.49%), followed by meropenem (85.05%), piperacillin-tazobactam (76.32%), amikacin (66.67%) and cefoperazone-sulbactam (61.07). E. coli strains showed maximum resistance to ciprofloxacin and Nalidixic acid

Overall, E. coli was highly sensitive to imipenem (97.86%), followed by meropenem (88.04%), piperacillin-tazobactam (79.43%) and Amikacin (77.17%). E. coli strains showed maximum resistance to piperacillin (78.04%) (Table-6).

Enterococcus species from OPD sample were highly sensitive to rifampicin (100%), teicoplanin (100%) and vancomycin (100%), followed by amikacin (72.25%), ampicillin-sulbactam (68.40%) and tetracycline (66.70%) (Table-7).

Enterococcus species from IPD samples also were highly sensitive to rifampicin (100%) and teicoplanin (100%), followed by vancomycin (92%), ampicillin-sulbactam (57.60%) and tetracycline (57.30%). 8% strains were found to be resistant to vancomycin (Table-7).

Overall, Enterococcus species were highly sensitive to rifampicin (100%) and teicoplanin (100%) followed by vancomycin (92%), ampicillin-sulbactam (63%) and tetracycline (60%). 4% strains were found to be resistant to vancomycin (Table-7).

Pseudomonas aeruginosa was highly sensitive to imipenem and piperacillin-tazobactam (90.90%) followed by meropenem (81.81%) and gentamicin & amikacin (72.72% each). Maximum resistance was seen with Aztreonam (72.72%) followed by piperacillin (63.63%) and cefotaxime (37.5%) (Table-6).

The antibiotic sensitivity test results have been summarised in Tables-6 & 7.

DISCUSSION: This study highlights the isolation pattern of various uropathogens and their antibiogram in a rural setting in eastern Bihar. Out of the 1632 samples collected during the study period, 28.3% showed significant bacteriuria, 3.86% showed bacteriuria of doubtful significance and 67.89% showed no growth in culture. E. coli (69.13%) was the predominant isolate among all Gram negative bacilli, followed by Klebsiella pneumoniae (8.95%). Enterococcus was the predominant isolate (43.39%) amongst Gram Positive isolates. Surprisingly, Enterococcus was the second most common cause (15.64%) of UTI after E. coli (38.09%). In the year 1997 and 1998, E. coli was associated with more than 40% and 35% of clinically suspected cases of UTI respectably (3). According to the author Streptococcus fecalis was isolated in only 0.8% and 0.5% of cases in 1997 and 1998 respectively (3). This highlights the fact that Enterococcus species is emerging as a major pathogen.

A study from Mumbai in the year 2001 however reported isolation rates of 8.9% for various Enterococcus species. (2) Another study from Chandigarh in 2002 reported the isolation rate of Enterococcus faecalis as 4.0% and 6.4% from outdoor and indoor patients respectively. The isolation rate of E. coli was 64.0% and 46.5% from outdoor and indoor patients respectively (Table 2). (4)

When urinary microscopic findings were correlated with culture findings it was found that majority of samples (92.44%) showing pyuria (pus cells ++) in urine sediment showed significant bacteriuria, only 7.55% of these samples showed bacteriuria of doubtful significance. On the other hand only 0.93% of samples with occasional pus cells in urine sediment showed bacteriuria of doubtful significance. This could have been due to overgrowth of normal flora during transit of specimen or delay in processing of samples. In such cases a repeat culture of midstream urine sample is indicated.

Gram negative bacilli was found to be sensitive to imipenem (97.86%) followed by meropenem (88.04%). Other antibiotics to which the organism was relatively sensitive was piperacillin-tazobactam and amikacin. Sensitivity to fluoroquinolones, co-trimoxazole, 3rd generation cephalosporins, amoxicillin and aztreonam was low (Table-6). This scenario is similar to the one reported from Ludhiana in the year 1997-98 (3), the only difference being that antibiotics like imipenem, meropenem and piperacillin-tazobactam were not tested as they were probably not in extensive use at that time as it is used now.

Enterococcus species were sensitive to rifampicin and teicoplanin (100%) and vancomycin (96%). Though all strains were sensitive to rifampicin this antibiotic would have restricted use as it cannot be given as a monotherapy. 4% of strains were found to be sensitive to teicoplanin but resistant to vancomycin which could be due to presence of the VAN-C (genotype amongst these isolates which constitutively show low levels of resistance to vancomycin but not to teicoplanin. (7) Therefore, determination of MICs in such cases is very important. Sensitivity to ampicillin, piperacillin, ciprofloxacin and gentamicin was fairly low (Table-7).

90.9% of strains of Pseudomonas aeruginosa were sensitive to imipenem and piperacillin-tazobactam. Only 72.7% of strains were sensitive to gentamicin and amikacin. Sensitivity to aztreonam, piperacillin and cefotaxime was very low. On the whole, sensitivity to third generation cephalosporins was very low for both pseudomonas and other Gram negative bacilli which are probably due to extensive misuse of these drugs. Resistance as high as 77.0% for piperacillin, 73.5% for ceftazidime and 71.0% for ciprofloxacin have been reported. (5) There appears to be a change in the scenario of isolation pattern of different organisms. Though E. coli is still the most important cause of UTI, Enterococcus species are on the rise. Antibiotic resistance amongst Enterococcal species is also on the rise showing substantial resistance to oral antibiotics as well as many injectable antibiotics. Antibiotic resistance is also a cause of concern in both Gram negative bacilli and Pseudomonas species with more than 50% strains showing resistance to 3rd generation cephalosporins. It would indeed be very sad if we are unable to treat cases of UTI because of this menace of drug resistance.

REFERENCES:

(1.) Mims C, Dockrell HM, Goering RV et al. (eds.) Urinary tract infections. In: Medical Microbiology. 3rd ed. Elsevier Mosby, Philadelphia. 2006; 241-244.

(2.) Desai PJ, Pandit D, Mathur Male et al. Prevalence, identification and distribution of various species of enterococci isolated from clinical specimens with special reference to urinary tract infection in catheterized patients. Indian International Journal. 2001; 19 (3): 132-137.

(3.) Ram S, Gupta R and Gaheer M. Emerging antibiotic resistance among uropathogens. Indian Journal of Medical Science. 2000; 54 (9): 388-394.

(4.) Gupta V, Yadav A and Joshi RM. Antibiotic resistance pattern in uropathogens. Indian Journal Medical Microbiology. 2002; 20 (2): 96-98.

(5.) Shinde Rupali S, Koppikar Geeta V, Oomen Seema. Characterization and antimicrobial susceptibility pattern of clinical isolates of Enterococci at a tertiary care hospital in Mumbai, India. ANNALS OF Tropical Medicine and Public Health. 2012; 5(2):85-88.

(6.) Jackson E. Fower, Mary Lee, Anthony A. Caldamone. Infected renal calculi. In: Urinary tract infection and inflammation. Year Book Medical Publishers INC. Chicago. 1989; 173.

(7.) Reynolds PE and Courvalin P. Vancomycin resistance in enterococci due to synthesis of precursors terminating in D-Alanine-D-Serine. Antimicrobial agents and chemotherapy. 2005; 49 (1): 21-25.

(8.) Elmer W. Koneman et al. Urinary Tract Infection. In: Color Atlas and Textbook of Diagnostic Microbiology. 5th ed. Lippincott, Philadelphia. 1997; 136-141.

Dhananjay Kumar, Sangeeta Dey Krishan Nandan, Aninda Sen, Udayan Ganguly.

[1.] Assistant professor, Department of Microbiology, Katihar Medical College, Katihar, Bihar, India.

[2.] Professor, Department of Microbiology, Katihar Medical College, Katihar, Bihar, India.

[3.] Assistant professor, Department of Microbiology, Katihar Medical College, Katihar, Bihar, India.

[4.] Professor, Department of Microbiology, Katihar Medical College, Katihar, Bihar, India.

[5.] Professor, Department of Microbiology, Katihar Medical College, Katihar, Bihar, India.

CORRESPONDING AUTHOR:

Dhananjay Kumar, Assistant Professor, Department of Microbiology, Katihar Medical College, Karim Bagh, Katihar--854105, India.

E-mail: dhananjay2microbiology@gmail.com
TABLE: 1. Correlation between microscopic and culture findings.

                                                CULTURE FINDINGS

MICROSCOPIC                      NO. OF    GROWTH (%)
FINDING                          SAMPLES
                                           TOTAL         SIGNIFICANT
                                           GROWTH        BACTERIURIA

Pus: ++ Bacteria: +++            490       490 (100)     453 (92.44)
Pus: + Bacteria: +               16        16 (100)      09 (56.25)
Pus:+ Bacteria: Few              55        8 (14.54)     0 (0.00)
Pus: Occasional Bacteria: Few    1071      10 (0.93)     0 (0.00)
TOTAL                            1632      524 (32.10)   462 (28.30)

                                    CULTURE
                                   FINDINGS

MICROSCOPIC                        GROWTH (%)
FINDING
                                 BACTERIURIA OF   NO GROWTH
                                 DOUBTFUL         (%)
                                 SIGNIFICANCE

Pus: ++ Bacteria: +++            37 (7.55)        0 (0.00)
Pus: + Bacteria: +               07 (43.75)       0 (0.00)
Pus:+ Bacteria: Few              8 (100.00)       47 (85.45)
Pus: Occasional Bacteria: Few    10 (0.93)        1061 (99.06)
TOTAL                            62 (3.86)        1108 (67.89)

% is calculated horizontally

TABLE: 2. Details of samples collected from OPD and IPD patients.

Sample                 OPD
details

Sample from            Male      Female    Total
No.                    374       870       1244
(%)                    (30.06)   (69.93)   (76.25)

Sterile sample         261       597       858
(%)                                        (68.97)

Positive sample        113       273       386
(%)                                        (31.02)

Unimicrobial sample    105       241       346
(%)                                        (89.63)

Polymicrobial sample   8         32        40
(2 pathogens)
(%)                                        (10.36)

Sample                 IPD                            Total
details                                               No

Sample from            Male      Female    Total
No.                    190       198       388        1632
(%)                    (48.96)   (51.03)   (23.77%)

Sterile sample         112       138       250        1108
(%)                                                   (67.89)

Positive sample        86        52        138        524
(%)                                                   (32.10)

Unimicrobial sample    70        44        114        460
(%)                                                   (87.86)

Polymicrobial sample   16        8         24         64
(2 pathogens)
(%)                                                   (12.21)

TABLE: 3. Nature of uropathogens isolated from OPD and IPD patients.

Type of isolate      OPD       IPD        TOTAL(H)

GNB                  233       91         324
(V %)                (53.81)   (58.70)    (55.1%)

GPC                  171       41         212
(V %)                (39.49)   (26.45%)   (36.05%)

YEAST                29        23         52
(V %)                (6.69)    (14.83%)   (8.84%)

TOTAL ISOLATES (V)   433       155        588

V = vertical; H = Horizontal

TABLE: 4. Uropathogens isolated from patients

GNB isolated          % of total   % OF GNB
N = 324 (55.1%)       isolates     isolates

E. coli
N=224                 38.09        69.13

Klebsiella            4.93         8.95
pneumoniae
N = 29

Pseudomonas           4.7          8.64
aeruginosa
N = 28

Proteus               2.38         4.32
mirabilis
N = 14

Proteus               2.04         3.70
vulgaris
N = 12

Klebsiella            1.87         3.39
oxytoca
N = 11

Citrobacter           0.51         0.92
freundii
N = 3

M. morganii           0.34         0.61
N = 2

Citrobacter koserii   0.17         0.30
N = 1

GPC isolated          % of total   %  of GPC
N = 212               isolates     isolates
(36.05%)

Enterococcus
faecalis
N = 68                11.56        32.07

E. faecium            2.72         7.54
N = 16

E. casseliflavus      1.36         3.77
N = 8

CONS                  12.24        33.96
N = 72

S. aureus             8.16         22.64
N = 48

TABLE: 5. Distribution of organism isolated from OPD and IPD patients

GNB             From         From         Total No
                OPD          IPD          (H)

E. coli         181          43           224
(V %)           (77.68)      (47.25)

K. pneumonia    18           11           29
(V %)           (7.72)       (12.08)

P. aeruginosa   16           12           28
(V %)           (6.86)       (13.18)

P .mirabilis    8            6            14
(V %)           (3.43)       (6.59)

P. vulgaris     5            7            12
(V %)           (2.14)       (7.69)

K. oxytoca      4            7            11
(V %)           (1.71)       (7.69)

C. freundii     1            2            3
(V %)           (0.42)       (2.19)

M. morganii     0            2            2
(V %)           (0.00)       (2.19)

C. koserii      0            1            1
(V %)           (0.00)       (1.09)

Total No. (V)   233          91           324

GPC             From         From         Total No
                OPD          IPD          (H)

E. faecalis     54 (31.57)   14 (34.14)   68
(V %)

E. faecium      11 (6.43)    5 (12.19)    16
(V %)

E.              6 (3.50)     2 (4.87)     8
casseliflavus
(V %)

CONS            64 (37.42)   8 (19.51)    72
(V %)

S. aureus       36 (21.05)   12 (29.26)   48
(V %)

Total No. (V)   171          41           212

V = vertical; H = Horizontal

TABLE: 6. Antibiotic Sensitivity Percentages of E. coli &
Pseudomonas aeruginosa

ANTIBIOTICS             E. coli          Pseudomonas aeruginosa

                 OPD     IPD     TOTAL   OPD      IPD      TOTAL

Imipenem         99.23   96.49   97.86   94.22    87.58    90.90
Meropenem        91.03   85.05   88.04   83.25    80.37    81.81
Piperacillin-    80.54   78.32   79.43   93.12    88.68    90.90
  tazobactam
Amikacin         87.67   66.67   77.17   75.27    69.17    72.72
Cefoperazone-    67.19   61.07   64.13   65.78    61.48    63.63
  sulbactam
Gentamicin       76.78   44.94   60.86   75.27    69.17    72.72
Levofloxacin     40.24   36.84   38.04   82.25    77.75    80.00
Cefotaxime       44.13   30.53   37.33   40.00    35.00    37.50
Cefoperazone     43.02   29.20   36.11   54.93    45.07    50.00
Co-trimoxazole   38.14   33.58   35.86   --       --       --
Tetracycline     40.11   31.61   35.86   --       --       --
Ciprofloxacin    56.23   11.15   33.69   67.35    59.91    63.63
Ceftazidime      36.31   27.69   32.00   72.22    70.62    71.42
Amoxy-clave      24.79   17.79   21.79   --       --       --
Aztreonam        22.52   16.60   19.56   27.27    0.00     27.27
Amoxycillin      21.89   15.05   18.47   --       --       --
Piperacillin     17.20   13.66   15.43   37.2 1   35.5 1   36.36
Nalidixic acid   12.80   11.10   11.95   --       --       --

TABLE: 7. Antibiotic Sensitivity Percentages of Enterococcus species

ANTIBIOTICS            OPD      IPD      TOTAL

Rifampicin             100.00   100.00   100.00
Teicoplanin            100.00   100.00   100.00
Vancomycin             100.00   92.00    96.00
Ampicillin-sulbactam   68.40    57.60    63.00
Tetracycline           66.70    57.30    62.00
Amikacin               72.25    47.75    60.00
Gentamicin             65.30    38.40    51.85
Ciprofloxacin          42.40    21.02    31.71
Piperacillin           33.60    17.40    25.00
Ampicillin             26.67    13.33    20.00
COPYRIGHT 2013 Akshantala Enterprises Private Limited
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2013 Gale, Cengage Learning. All rights reserved.

 
Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:ORIGINAL ARTICLE
Author:Kumar, Dhananjay; Dey, Sangeeta; Nandan, Krishan; Sen, Aninda; Ganguly., Udayan
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:May 20, 2013
Words:3734
Previous Article:A co-relative study of intra operative findings and post operative complications of laparoscopic cholecystectomy.
Next Article:Evaluation of mass drug administration campaign against Lymphatic Filariasis at Bidar district.
Topics:

Terms of use | Privacy policy | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters