ANTIBIOTIC SENSITIVITY PATTERN OF BACTERIAL ISOLATES FROM CLINICAL SPECIMENS OF PATIENTS ADMITTED IN INTENSIVE CARE UNIT

1* 2 Khilasa Pokharel , Bishwa Raj Dawadi Khilasa P et al Received : 27 July, 2021 Accepted : 22 December, 2021 Published : 21 February, 2022 ISSN: 2542-2758 (Print) 2542-2804 (Online) 1601 Birat Journal of Health Sciences Vol.6/No.3/Issue 16/Sep.-Dec., 2021 Original Research Ar cle 1602 ISSN: 2542-2758 (Print) 2542-2804 (Online) Birat Journal of Health Sciences Vol.6/No.3/Issue 16/Sep.-Dec., 202


Introduc on
An bio cs resistance is increasing nowadays. Factor to an bio c resistance is its misuse. There is no na onal guideline for use of an bio cs.

Objec ve
Study was conducted to determine bacteriological profile, and the bacterial an bio c sensi vity pa ern of the pathogens isolated from pa ents in intensive care unit.

Methodology st th
Study was conducted between 1 October 2020and 30 March 2021. The samples collected from Intensive care units pa ents were processed in Microbiology Laboratory following Clinical and Laboratory Standard Ins tute guideline. Organisms were iden fied morphologically and biochemically and an bio c sensi vity pa ern was determined by disc diffusion methods.

Result
Out of total 397 samples, only 46 were found to be culture posi ve, of which 32 (69.56%) were gram nega ve organisms and 14 (30.43%) were gram posi ve organisms. Out of gram nega ve organisms Klebsiellapecies 10 (21.73%) were predominant which is more sensi ve to colis n, polymyxin B and gecycline. Among gram posi ve organisms Staphycoccus aureus 12 (85.71%) was found more sensi ve to Vancomycin than others.

Conclusion
It is concluded that Klebsiella species and Staphylococcus aureus were predominant pathogens isolated from the pa ents. Regular surveillance of an bio c sensi vity pa ern and stewardship program will beuseful in trea ng pa ents in Intensive care unit. 1 Microbes are the organism that causes infec ons. The major cause of mortality worldwide is infec on which 2 targeted low and lower middle countries. Infec on is common among hospitalized pa ents of intensive care 3,4 unit.

INTRODUCTION
Intensive care unit (ICU) is a confined se ng where 5 an bio cs are extremely used. Rather than other hospital pa ents, Intensive care unit pa ents are 5-10 mes more 6 likely of acquiring hospital infec on. Health care associated infec on is high risk factor with cri cally ill pa ents in Intensive Care Unit which occurs due to various factors like decreased host defences, use of devices and due to cross 7,8 transmission of infec on among pa ents and staffs. Health care associated infec on and an bio c resistance are prime 9 treats among pa ents in ICU. Therapeu c drugs are constantly found to be ineffec ve in infec on, which is 10 decreasing the success of rou ne treatment. One study conducted in 2007 with ICU pa ents, from 75 different countries, reported that pa ents with longer ICU stay got higher rate of infec on especially due to resistant Staphylococci, Acinetobacter, Pseudomonas species and 11 Candida species. ICU pa ents acquiring infec ons are 12 mostly associated with invasive devices and ven lators. The major consequences of the problem is increase in pa ents morbidity, mortality which is the result of the 13,14 treatment failure. Infec ons caused by gram nega ve bacteria in ICU has increased with which lack of treatment op ons against mul drug resistant (MDR) strains is in doubt. Infec on that is caused by MDR gram nega ve organisms brings high morbidity and mortality. So, infec on control guideline should be followed to improve pa ent 15 outcome and decrease cost for treatment. An microbial Stewardship programs can op mize the proper use of available an microbial agent which can improve infec ons caused by organisms. The results from this study can help in building up strategies for proper use of prophylac c and ampiric an bio c therapy among ICU pa ents in developing countries like ours. The aim of the study was to reduce the advance consequence of an microbial use.

METHODOLOGY
This is a descrip ve cross sec onal study conducted at st Kathmandu Medical College and Teaching Hospital from 1 th October 2020 to 30 March 2021. Ethical approval was taken from Ins tu onal review board (IRC) Reference no: 170920205. Clinical specimens collected from ICU pa ents were included in this study. Specimens a er been collected in the Microbiology laboratory were further been processed for Grams staining and culture. A er isola ng the organisms from the culture they were further characterized by conven onal biochemical test to iden fy the specific microorganism. An bio c suscep bility test of the bacterial isolates were done by Kirby Bauer disc diffusion method on Mueller Hinton Agar (MHA) as per Clinical Laboratory Standard Ins tute (CLSI) guideline. With a sterile loop four or five colonies of the isolated cultured organisms were mixed with 2ml of sterile saline and was vortexed to create a suspension. Turbidity of the solu on was adjusted to 0.5 Mc Farland standard. A sterile swab s ck was then dipped into the formed suspension, firmly pressed to remove excess fluid and then lawn culture was performed on Muller Hinton agar (MHA). An bio c discs were then applied to MHA plates and was included at 37ºC for 18-24 hours. Zone of inhibi on was measured and interpreted using standard chart and organisms were reported suscep ble, intermediate or resistant accordingly. Himedia, Mumbai, India and MAST diagnos cs, Merseyside, England an bio c discs were 16 obtained. An bio cs of following concentra ons used were: Amikacin (30µg), Gentamycin (10µg), Ciprofloxacin
(   We have also focused on using sterile techniques while inser ng devices, use of sterile gloves and gowns in ICU and most importantly hand hygiene to prevent nosocomial infec ons and be er pa ent response. We have analyzed the spectrum of pathogens and the an bio c treatment.

CONCLUSION
Klebsiellaspecies, Pseudomonas aeruginosa and Acinetobacter species are the gram nega ve mul resistant organisms isolated. Most of the strains of these organism were resistant to cefriaxone, cotrimoxazole, ciprofloxacin, chloramphenicol, ce azidime and were more sensi ve to colis n and polymyxin B. Among gram posi ve organisms Staphylococcus aureus was the pathogen prevalent in ICU and the strains were found to be more sensi ve to vancomycin. Appropriate an bio c u liza on in ICU is required for which stewardship program is useful in ICU.

LIMITATIONS OF STUDY
An bio c sensi vity test, its use in the hospital and hospital infec on control vary from hospital to hospital. The limita on of this study is that we would have conducted study in large size but we conducted this study in only one hospital site and could not compare it with other hospital se ng.

ACKNOWLEDGEMENT
Thankful to all the staff of Microbiology Department working in our hospital for their support and ac ve par cipa on in this ar cle.