Prevalence and antibiotic resistance of bacterial pathogens in respiratory tract samples of geriatric patients

Year 2021, , 472 - 477, 01.05.2021

Meryem Çolak , Elçin Kal Çakmaklıoğulları

https://doi.org/10.28982/josam.915141

Abstract

Background/Aim: The frequency and severity of respiratory tract infections increase with aging. The aim of this study was to determine the bacterial profile of respiratory tract samples in geriatric patients and evaluate the antibiotic susceptibility patterns of the pathogens.
Methods: In this cross-sectional study, a total of 509 clinical samples which were obtained from 302 geriatric patients over 65 years of age and sent to the microbiology laboratory between June 2019-January 2021 were investigated retrospectively. The identification and antibiotic susceptibilities of strains were evaluated with BD-Phoenix-100 fully automated microbiology system.
Results: Of the 302 geriatric patients, 166 (%55) were males and 136 (%45) were females. The most isolated pathogens were Klebsiella pneumoniae (25.3%) Pseudomonas aeruginosa (22.5%) and Acinetobacter baumannii (10.2%), Corynebacterium striatum (7.3%), Escherichia coli (6.4%), Staphylococcus aureus (6.4%) and coagulase-negative staphylococci (4.2%). The production of ESBL in Klebsiella pneumoniae strains (52.3%) was higher than in Escherichia coli (41%) strains. All Corynebacterium striatum samples were resistant to ciprofloxacin, tetracycline, rifampin, and penicillin. Methicillin resistance among Staphylococcus aureus (MRSA) isolates was 22.7% and they were 100% susceptible to vancomycin and teicoplanin. Above 90% of K. pneumoniae, P. aeruginosa and A. baumannii positive patients were hospitalized in intensive care units (P<0.05). The tobramycin-resistant E. coli and colistin-resistant A. baumannii rates were highest between 85-99 years of age (P<0.05).
Conclusion: K. pneumoniae, P. aeruginosa and A. baumannii were the most common pathogens in respiratory tract samples in geriatric patients, especially those hospitalized in the intensive care units. The antimicrobial resistance rates were higher in patients aged ≥85 years. Vancomycin and teicoplanin were the most effective antibiotics against MRSA. It is thought that the results will be useful in the preparation of treatment protocols and guiding physicians about the correct use of antibiotics.

Keywords

Antibiotic resistance, Geriatric patients, Respiratory tract samples

References

• 1. World Health Organisation. Definition of an older or elderly person. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health Accessed: April 5, 2021.
• 2. Cagatay AA, Tufan F, Hindilerden F, Aydin S, Elcioglu OC, Karadeniz A, et al. The causes of acute fever requiring hospitalization in geriatric patients: comparison of infectious and noninfectious etiology. J Aging Res. 2010;380892.
• 3. Kurtaran B, Kuscu F, Korkmaz P, Ozdemir B, Inan D, Oztoprak, et al. A snapshot of geriatric infections in Turkey: ratio of geriatric inpatients in hospitals and evaluation of their infectious diseases: A multicenter point prevalence study. Int J Infect Dis. 2020;100:337-42.
• 4. Ieven M, Coenen S, Loens K, Lammens C, Coenjaerts F, Vanderstraeten A, et al. Aetiology of lower respiratory tract infection in adults in primary care: a prospective study in 11 European countries. Clin Microbiol Infect. 2018;24(11):1158-63.
• 5. Troeger C, Forouzanfar M, Rao PC, Khalil I, Brown A, Swartz S, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017;17(11):1133-61.
• 6. Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial resistant pathogens associated with health care associated infections: Summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013;34(1):1-14.
• 7. Tacconelli E, Pezzani MD. Public health burden of antimicrobial resistance in Europe. Lancet Infect Dis. 2019;19(1):4-6.
• 8. EUCAST European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 6.0-10.1. http://www.eucast.org/ast_of_bacteria/previous_versions_of_documents/ Accessed: Feb 20, 2021.
• 9. Premalatha E, Sharavanan TKV, Jayalakshmi GA. Study on bacterial profile of lower respiratory tract infections in geriatric population. Int J Pure App Biosci. 2014;2(4):161-5.
• 10. Khattab A, Said A, Raafat H, Osman N. Study of the pattern of respiratory infections in elderly patients at Ain Shams University hospitals. Egypt J Bronchol. 2010;4(2):111-23.
• 11. Weiner-Lastinger LM, Abner S, Edwards JR, Kallen AJ, Karlsson M, Magill S, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: summary of data reported to the National Healthcare Safety Network, 2015–2017. Infect Control Hosp Epidemiol. 2020;41(1):1-18.
• 12. Mu XL, He LX, Zhou ZY, Zhou CM, Jia ML, Nı CM, et al. Surveillance of Lower Respiratory Tract Infection of ESBL-producing Strains and Analysis of Risk Factors for Acquisition. Chin J Nosocomiol. 2002:2.
• 13. Lin, HC, Lai LA, Wu JY, Su YM, Chang SP, Hsueh YM. Risk factors for acquiring extended‐spectrum β‐lactamase‐producing Enterobacteriaceae in geriatric patients with multiple comorbidities in respiratory care wards. Geriatr Gerontol Int. 2013;13(3):663-71.
• 14. Rossi F, Baquero F, Hsueh PR, Paterson DL, Bochicchio GV, Snyder TA, et al. In vitro susceptibilities of aerobic and facultatively anaerobic Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: 2004 results from SMART. J Antimicrob Chemother. 2006;58:205-10.
• 15. Hawser SP, Bouchillon SK, Hoban DJ, Badal RE. In vitro susceptibilities of aerobic and facultative anaerobic Gram-negative bacilli from patients with intra-abdominal infections worldwide from 2005–2007: results from the SMART study. Int J Antimicrob Agents. 2009;34:585-8.
• 16. Apisarnthanarak A, Kiratisin P, Saifon P, Kitphati R, Dej-sirilert S, Mundy LM. Risk factors for and outcomes of healthcare-associated infection due to extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumoniae in Thailand. Infect Control Hosp Epidemiol. 2007;28:873-6.
• 17. UAMDSS (Ulusal Antimikrobiyal Direnç Surveyans Sistemi), 2016, Public Health Institution, Ministry of Health, Ankara. http://uamdss.thsk.gov.tr Accessed: April 10, 2021.
• 18. Kocak AA, Yayla B, Guclu AU, Mirza HC, Istar EH, Alıskan HE et al. Adana’da Evaluation of Respiratory Pathogens Isolated in a University Hospital in Adana and Their Antibiotic Resistance Profiles. Turk Mikrob Cem Derg. 2019;49(4):226-32.
• 19. Suh JW, Ju Y, Lee CK, Sohn JW, Kim MJ, Yoon YK. Molecular epidemiology and clinical significance of Corynebacterium striatum isolated from clinical specimens. Infect Drug Resist. 2019;4:161-71.
• 20. Asgin N, Otlu B. Antimicrobial Resistance and Molecular Epidemiology of Corynebacterium striatum Isolated in a Tertiary Hospital in Turkey. Pathogens. 2020;9(2):136.
• 21. Founou RC, Founou LL, Essack SY. Clinical and economic impact of antibiotic resistance in developing countries: a systematic review and meta-analysis. PLoS One. 2017;12:e0189621.
• 22. Antimicrobial resistance in Europe 2016. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2017.
• 23. Akgun S, Sayiner HS. Using multiplex PCR as a diagnostic tool to detect methicillin resistant Staphylococcus aureus. J Surg Med. 2018;2(3):215-7.
• 24. Cecchini M, Langer J, Slawomirski L Antimicrobial Resistance in G7 Countries and Beyond: economic issues, policies and options for action, 2015. Available from: https://www.oecd.org/els/healthsystems/Antimicrobial-Resistance-in-G7-Countries-and-Beyond.pdf. Accessed: April 6, 2021.
• 25. Denkinger CM, Grant AD, Denkinger M, Gautam S, D’Agataet EMC. Increased multi-drug resistance among the elderly on admission to the hospital a 12-year surveillance study. Arch Gerontol Geriat. 2013;56:227–30.
• 26. Adam HJ, Baxter MR, Davidson RJ, Rubinstein E, Fanella S, Karlowsky JA, et al. Comparison of pathogens and their antimicrobial resistance patterns in paediatric, adult and elderly patients in Canadian hospitals. J Antimicrob Chemother. 2013;68(1):31-7.