A clinical study to examine the resistance pattern of culture isolates to Amoxicillin Clavulanic acid (AMC) in the sample sent to culture sensitivity: A teaching Hospital based study at north India

Abstract

Background: Concurrent administration of a β-lactamase inhibitor such as clavulanate or sulbactum markedly expands the spectrum of activity of acid resistant penicillins like ticarcillin and piperacillin. The dose as well as the incidence of toxicity were subsequently reduced with semi-synthetic penicillins like ticarcillin, which makes it the preferred ureidopenicillin against P. aeruginosa infections.Amoxicillin Clavulanic Acid (AMC) is a broad-spectrum antibacterial being used over 20 years. Emergence of resistant bacteria has complicated the empirical therapy of infections. Resistance to Amoxicillin is a matter of concern. Clavulanic acid, a β-lactamase inhibitor, is used to overcome resistance. But appearance of resistance to even this combination is a matter of even more concern. Hence an attempt is made to find out the proportion of resistance to AMC in a tertiary care setup.Aim: To examine the resistance pattern to Amoxicillin Clavulanic acid (AMC) amongorganisms isolated from pus sample collected for culture sensitivity. Material and Methods: This is the descriptive study, taken up to evaluate the resistance pattern of culture isolates of pus samples from various departments. Pus culture and sensitivity reports obtained by Kirby Bauer Disc diffusion method of pus samples during a period of 6 months was collected from Microbiology Department. Results: A total of 250 reports were analyzed. 250 reports included in the study, 76 (30%) were reported sensitive to AMC whereas 174 (70%) were reported resistant Of all the isolates, Citrobacter showed the highest rate of resistance to AMC (100%), followed by E.coli (87.75%), Klebsiella (79.31%), Proteus (75%), Pseudomonas (63.88%), Staphylococci (62.6%) and Enterobacter (50%). All the Streptococci that were isolated were sensitive to AMC. However, statistically significant resistance was identified highest in E. coli (87.75%, p=0.002), followed by Klebsiella (79.31%, p=0.047) and Staphylococci (62.6%, p=0.001) among the isolated organisms (Table 3). None of the streptococci and acetobacter species that were isolated was found to be resistant to AMC. All of the citrobacter species isolated showed resistance to AMC however it was not statistically significant (p=0.057). Staphylococci which was the most commonly isolated organism had a resistance of 62.6% (p=0.001), of sample culture isolates were found to be resistant to AMC. Conclusion: Our study concludes an encountered organism in pus samples to beStaphylococcus, followed by E.coli, Pseudomonas and Klebsiella. Nearly 70% of organisms causing purulent infections were resistant to AMC. Of the isolates, statistically significant resistance was shown by E.coli followed by Klebsiella and Staphylococcus.