The current study is mainly focusing on to find out the resistant rate in the hospital using Antibiogram and to find out the common bacterial isolates, which are responsible for infectious disease in the hospital. Currently antimicrobial resistance in increasing and in this condition each hospital has to develop its own Antibiogram, which is useful for developing antibiotic policy and it, is one of the integral parts of antimicrobial stewardship program.
In our study period during six-month150 patients were enrolled according to the inclusion criteria.In general, the study results show there is high usage of third generation cephalosporin antibiotic in hospital and same antibiotic class found to most resistant during our study.
In gender wise distribution as 66.6% of total population was male and 33.3% of total population were female and similar study was conducted by Qadeer et al., 2016[12] where 56.6% were males and 43.3% were female patient were found. Therefore, study data shows that the male was most exposed population to the antibiotic than female.
Our study shows that ceftriaxone was found to most resistance antibiotics to most of the bacteria and clindamycin and Amikacin was found to most susceptible antibiotic in our study. One study was conducted by Thakur P, et al., 2012[13] they also found that amikacin was found to be most susceptible antibiotic in the study and found to be most effective and susceptible antibiotic. In another study conducted by Soman N et al [14] reported that increased cephalosporin prescribing practice, which may result in antibiotic resistance, and there is need of strict monitoring of cephalosporin antibiotic usage in hospital.
In our study for isolation and identification of bacteria, various samples were used in that most of the microorganism was isolated in urine, blood, pus, sputum, swab respectively. It was found that sample from urine (N = 65); blood (N = 23), pus (N = 53) and sputum (N-16) number of bacteria were isolated using various sample. In our study E. coli was mostly isolated in urine sample and Pseudomonas aeruginosa is most commonly found in pus and a similar study was conducted from Tripura shows the high rate of isolation of Pseudomonas aeruginosa from sputum (Debnat j. et al., 2019)[15]
E. coli is mostly responsible for the UTI and it is found to be mostly resistant to the ciprofloxacin as it the main antibiotic used in treatment of UTI. In our study, out of the total bacterial isolates, gram-negative bacteria were more prevalent than were gram-positive bacteria. This predominance of gram-negative bacteria is in concordance with the findings of the similar study conducted (Qadeer et al. 2016) [12] and result showed lower resistance in E. coli. According to Saravanan R. et al., 2013[16]E. coli was found to be the most common and highly resistant organism.
In our study E. coli was found to be the most common and resistant bacteria followed by pseudomonas aeruginosa, klebseillaspp and S. Aureus, Klebseilla pneumonia were isolated and found most resistant bacteria in our study. Various studies have reported varying range of E. coli isolation; while Gupta P et al., 2018[17], Eshwarappaet al., 2011[18] and Bencyet al., 2017[19] reported most common isolation of E. coli. Now currently there is increasing cases of E. coli resistance to fluoroquinolone antibiotic and in our study 50% cases of E. coli was found to be resistant to ciprofloxacin which is alarming feature so to use antibiotics very cautiously to prevent antibiotic resistance.
During our study, 20 antibiotics were prescribed to the study population and out of which 58% (138) time’s antibiotics came resistant to one of the bacteria and susceptible rate was found to be 42% (98). Ceftrixone was found to be most widely utilized antibiotic in our study. Bilal Bin Y. et al., 2015[20] reported the consumption of ceftriaxone was more and most prescribed antibiotics in medicine and surgery ward which is similar to our findings where ceftriaxone was had highest share of prescriptions which isabout 24 percentage. Baidya S. et al., 2017[21] reported Ceftriaxone (36.3%), Amoxicillin + clavulanic acid(13.5%) and amikacin (10.7%) were most frequently prescribed. The Kathmandu Valley study reported that cephalosporin’s were the most commonly prescribed antibiotic followed by penicillin’s. Among cephalosporin’s, ceftriaxone was frequently prescribed (Palikhe N. et al., 2004) [22].
The Tripura study reported that (Debnat j. et al., 2019) [15] Higher level of resistance was observed with Gentamicin (60.7%), Amikacin (42%), Ciprofloxacin (46%), Levofloxacin (42%) and Nitrofurantoin. In our study Ceftriaxone, meropenam, azithromycin, linezolid, amoxicillin + clavulanic acidwas found to be most resistant. Thakur P, et al., 2012[13] reported thatamikacin was found to showed the highest susceptibility of 96.25%followed by nitrofurantoin, gentamicin, cefotaxime and ceftazidime with 92.5%, 77.5%, 72.5% and 71.25% respectively. In our study Clindamycin (75%), amikacin (65%), piperacilline + tazobactum (62%), cefoperazone (48%), ciprofloxacin (44%) were found to be most susceptible.