J. Commun. Dis. 45(3&4) 2013 : 225-234 Proteus Infections in North Indian Tertiary Care Hospital Singhal Ritu,* Mohanty Srujana,** Sood Seema,*** Dhawan Benu,*** Das Bimal Kumar,*** Kapil Arti*** (Received for publication Dec 2012) Abstract Present prospective study was carried out to study the isolation and susceptibility pattern of tribe Proteus from different clinical samples. Demographic data, relevant clinical details & antimicrobial resistance were noted for all patients having infection due to tribe Proteus during Jan-Dec 2007. Antimicrobial susceptibility was performed by discdiffusion method according to CLSI guidelines. Proteus isolated were Proteus mirabilis, Proteus vulgaris, Proteus penneri, Providencia rettgeri, Providencia stuartii and Morganella morganii in 47 (47.9%), 35 (35.7%), 2 (2%), 7 (7.1%), (6.1%) and 1 (1%) patients respectively. Commonest sample of isolation was urogenital tract (38 ) followed by respiratory tract (27), pus (19), blood cultures (8) and sterile body fluids (6). Infection was nosocomialy acquired in 79 (80.6%) cases whereas 19 (19.4%) were community-acquired. Seventy nine patients had underlying illnesses. P. mirabilis was most multi-drug resistant species (51.1%) with 72.3% of isolates producing beta lactamases. Proteus was found to be most sensitive to piperacillin-tazobactum (96.9%). The study highlights the increasing drug resistance among Proteus in India especially among patients with underlying diseases. It necessitates the need for continuous surveillance of infections due to Proteus and practice of good hospital infection control procedures. Key words : Proteus, infection, antimicrobial resistance, nosocomial * Deptt of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, Aurobindo Marg, New Delhi-110030 ** Deptt of Microbiology, All India Institute of Medical Sciences, Bhuvaneshwar, Odisha, India *** Deptt of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India Correspondence to : Dr Arti Kapil, Professor, Dept. of Microbiology, All India Institute of Medical Sciences, New Delhi 110029. Phone : (O) 91-11-26594237, 91-11-26864851 ext. 4237, Fax: 91-11-26862663 E-mail : ritugo@hotmail.com
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228 Singhal Ritu et al Table 1 : Species distribution of Proteus among different samples Samples P. mirabilis P. vulgaris P. penneri M. morganii P. rettgeri P. stuartii n = 47 n = 35 n = 2 n = 1 n = 7 n = 6 Urine 12 14 1 1 7 3 n=38 Respiratory* 19 7 1 0 0 0 n=27 Pus 10 8 0 0 0 1 n=15 Blood 5 3 0 0 0 0 n=8 Sterile fluids # 1 3 0 0 0 3 n=6 * Respiratory samples include bronchoalveolar lavage (2), tracheal aspirate (25) # Sterile fluids include cerebrospinal fluid (2), pancreatic aspirate (1), ascitic fluid (1), pleural fluid (1), and peritoneal fluid (1)
Proteus Infections in North Indian Tertiary Care Hospital 229 Table 2 : Isolation of Proteus from various samples of patients with and without underlying conditions Underlying Urine Respiratory Pus Blood Fluids Total Conditions Samples Sterile Neurology á 8 20 1 3 1 33 Trauma â 7 6 0 0 1 14 Urogenital tract ã 6 0 0 0 1 7 Gastrointestinal pathology ä 1 0 4 1 3 9 Malignancy æ 2 0 2 2 0 6 Paediatric Surgery è 1 0 2 0 0 3 Renal Transplant 1 0 1 0 0 2 Cardio-thoracic 0 0 0 1 0 1 Diabetes mellitus 0 0 1 0 0 1 Skin Lesions å 0 0 1 1 0 2 Pneumonia 0 1 0 0 0 1 None 12 0 7 0 0 19 Total 38 27 19 8 6 98 á â ã ä æ è å Includes brain tumors (12 patients), paralytic conditions (6 patients), autoimmune neural diseases (4 patients), vascular malformations (3 patients), coma (2 patients), myasthenia gravis (1 patient), neurocysticercosis (1 patient), meningomyelocele (1 patient), hydrocephalous (1 patient), cerebral palsy (1 patient), epilepsy (1 patient) Includes head injury (9 patients), traumatic paraplegia (4 patients), gun shot injury (1 patient) Includes stricture urethra (3 patients), vesico-urethral reflux (1 patient), nephritic syndrome (1 patient), renal lump (1 patient), benign prostatic hypertrophy (1 patient) Includes perforation peritonitis (1 patient), pancreatitis (1 patient), idiopathic bowel disease (1 patient), whipple's disease (1 patient), hemicolitis (1 patient), abdominal resection (1 patient), cholecystectomy (1 patient) Includes carcinoma cervix (3 patients), non-hodgkins lymphoma (1 patient), leukemia (1 patient), multiple myeloma (1 patient) Includes TSARP with anorectal fistula (2 patients), hirshsprung disease (1 patient) Includes pemphigus vulgaris (1 patient), exomphalus major (1 patient)
230 Singhal Ritu et al Table 3 : Resistance rates of different species of Proteus to various antimicrobials Anti- P. P. P. Mor- P. P. Total microbial mirabilis vulgaris pennari ganella stuartii rettgeri n=47 n=35 n=2 n=1 n=6 n=7 n=98 n(%) n(%) n(%) n(%) n(%) n(%) n(%) Amikacin 25 (53.2) 9(25.7) 1 (50) 0 2(33) 3 (42.9) 40 (40.8) Aztreonam 13 (27.7) 8 (22.9) 0 0 1 (16.7) 2 (28.6) 24 (24.5) Cefoperazone/ 1 (2.1) 3 (8.6) 0 0 1 (16.7) 1 (14.3) 6 (6.1) sulbactum Cefotaxime 34 (72.3) 23 (65.7) 1 (50) 1 (100) 2 (33.3) 4 (57.1) 65 (66.3) Ceftazidime 34 (72.3) 23 (65.7) 1 (50) 1 (100) 2 (33.3) 4 (57.1) 65 (66.3) Ciprofloxacin 34 (72.3) 23 (65.7) 0 1 (100) 6(100) 6 (85.7) 70 (71.4) Imipenem 2 (4.3) 3 (8.6) 0 0 2 (33) 0 7(7.1) Meropenem 2 (4.3) 3 (8.6) 0 0 2 (33) 0 7(7.1) Nitrofurantoin** 8/12 8/14 1/1(100) 1/1(100) 1/3 1/7 20/38 (66.7) (57.1) (33.3) (14.3) (52.6) Piperacillin 19 (40.4) 13 (37.1) 1 (50) 1 (100) 1 (16.7) 4 (57.1) 39 (39.8) Piperacillin/ 1 (2.1) 1 (2.9) 0 0 1 (16.7) 0 3 (3.1) tazobactam Ticaracillin/ 5 (10.6) 5 (14.3) 1 (50) 0 2 (33.3) 2 (28.6) 15 (15.3) clavulanic Acid ** Susceptibility to Nitrofurantoin is determined for urinary isolates only
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