Characterisation of ESKAPE Pathogens with Special Reference to Multidrug Resistance and Biofilm Production in a Nepalese Hospital

Abstract

Background “ESKAPE” is an acronym for a group of life-threatening nosocomial pathogens, viz, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp. Global efforts on controlling multidrug-resistant (MDR) organisms have been hampered by their ability to escape antibacterial drugs. This study was undertaken to determine the prevalence of ESKAPE pathogens with prime focus on biofilm production and antibiotic resistance. Methods A total of 8756 clinical samples were processed for the isolation and identification of ESKAPE pathogens following standard microbiological procedures. These isolates were subjected to antimicrobial sensitivity test as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Test for MDR, extended-spectrum β-lactamase (ESBL), metallo-β-lactamase (MBL), methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) was done by the disk diffusion and E-test methods. In the case of VRE molecular detection was done for vanA and vanB genes. All the isolates were processed for biofilm detection by the tube adherence method. Results The percentage distribution of Enterococcus faecium was 5.5%, S. aureus 33.4%, K. pneumoniae 33.0%, A. baumannii 8.6%, P. aeruginosa 18.6%, and Enterobacter aerogenes 0.9%. MRSA was 57.6%, and vancomycin resistance among Enterococcus faecium was 20%. ESBL- and MBL-producing K. pneumoniae were 16.1%, and 8.1%, A. baumannii 10.3% each and P. aeruginosa 10.7% and 8.3%, respectively. A total of 42.3% of isolates were biofilm producers. Linezolid was the drug of choice for VRE. Ampicillin-sulbactam was most useful against A. baumannii apart from polymyxins, whereas piperacillin-tazobactam was effective against other Gram-negative bacteria. VanA gene was detected in all the VRE isolates. Conclusion This study estimates the burden of the ESKAPE organisms and their antimicrobial resistance pattern in a hospital setting. A high percentage of drug resistance and biofilm production was noted; hence antimicrobial resistance surveillance targeting ESKAPE pathogens should be incorporated in the infection control policy in Nepal.

Prevalence of Antibiotic Resistance Over Time in a Third-Level University Hospital

“…Moreover, considerations of resistance phenotypes, inference, inferring, and interpretative reading suggest that the VITEK system, as a unique system, is still questionable 40–46 and not uniformly used worldwide, for instance, in some Asian countries. 47 Therefore, future studies should measure resistance using more appropriate methods. Fourth, molecular mechanisms or genes underlying resistance have not been investigated.…”

Bacterial Antibiotic Resistance: The Most Critical Pathogens

“…Acinetobacter baumannii is an aerobic gram-negative bacillus that belongs to the group of pathogens grouped under the acronym "ESKAPE" (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumonia, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species), which refers to the ability of these bacteria to escape the effect of bactericidal activity of antibiotics [6,27]. A. baumannii is an opportunistic pathogen that causes hospital-acquired infections worldwide and can develop resistance to antibiotics by different mechanisms such as:…”

Exploring the Benefits of Metal Ions in Phage Cocktail for the Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Infection

“…S. aureus could colonize human skin and cause serious nosocomial infections. 41 Although vancomycin has been widely used to treat MRSA infections in hospital patients, the widespread occurrence of vancomycin-intermediate S. aureus led to the failure of antibiotic treatment. 7 , 42 Therefore, alternative strategies are urgently needed to overcome resistant S. aureus in hospitals.…”