Numerous cultures isolated from different sites of infections such as blood, cerebrospinal fluid (CSF), urine, pus, stool and many more are routinely measured through a microbial profile and antibiogram. The results of the microbial profile and antibiogram of these cultures isolated are applicable in diagnosing and monitoring the infection caused by particular microbes. Based on Jorgenson and Ferraro (2009), an important task of the clinical microbiology laboratory is the performance of antimicrobial sensitivity testing of significant bacterial isolates. The goals of testing are to detect possible drug resistance in common pathogen and to assure susceptibility to drugs of choice for particular infections. Therefore, the purpose of carrying out this study is to actuate the common pathogens found in each culture isolates obtained from various sites, antibiotics that show the highest susceptibility and resistivity towards the isolated pathogen.
The most common site of infection is via blood and the pathogens found here are known as bacteremia. Humans’ bloodstream is known to be aseptic but still, pathogens are able to penetrate through and give rise to a vast number of diseases; Septicemia is one of them. According to a study carried out by Pal and Sujatha (2016) in Kanpur, India, out of 121 patients, 24 patients (88.9%) are suspected to have septicemia. The majority of patients who were diagnosed with septicemia were adults, (>18 years) (37.0%) and neonates (25.9%). In positive isolates, the number of males was 16 (59.0%) and females were 11 (41.0%). Then, the most common pathogens found was E.coli (22.0%), K.pneumoniae (22.0%) followed by Coagulase Negative Staphylococcus (CoNS) spp. (15.0%), P.aeruginosa (11.0%), S.aureus (11.0%), K. oxytoca (4.0%), E.foecalis (4.0%). Candida spp. was mainly isolated in neonates (7% C.glabrata and 4% C.krusei). For the antibiotic sensitivity, gram-positive bacilli such as CoNS showed the highest sensitivity towards cefotaxime, ceftazidime, cefepime, erythromycin and co-trimoxazole (75%). S.aurues, on the other hand, showed the highest sensitivity towards co-trimoxazole (100%) and lower sensitivity towards ampicillin, oxacillin and cefoxitin (35%). For gram-negative bacilli, E.coli portray the highest sensitivity towards ampicillin (80%) followed by imipenem (65%). Ampicillin and imipenem were found to be the most sensitive antibiotics for K.pneumoniae (70%). Besides blood, a pathogen may invade other channels such as cerebrospinal fluid (CSF).
According to Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, it is a fluid that can be found in subarachnoid space, central canal of spinal cord and four ventricles of the brain, structured with a blood-cerebrospinal fluid barrier that prevents harmful substances including pathogenic organisms. A number of studies were carried out using a CSF sample as isolates for more accuracy in the detection of pathogen and one of it is by Kennedy et al., (2007). Based on his research carried out by the Department of Paediatrics of Loma Linda University, CSF polymerase chain reaction-enzyme immunoassay was more accurate than culture or latex agglutination in the detection of haemophilase influenzae type B (Hib) and S. pneumoniae in meningitis cases where the incidence were (74.0%) and (50.0%) respectively compared to culture.
Other than that, according to Benachinmardi et al. (2017) from Neuromicrobiology Department of National Institute of Mental Health and Neurosciences, her study showed from 1642 shunt CSF sample obtained, (14.79%) showed positive culture that yielded 254 isolates. It was recorded that (51.9%) were gram-negative bacilli, (46.46%) were gram-positive cocci and (1.57%) were candida albicans. From recorded results of gram-negative bacilli, non-fermented bacteria were most common that was followed by P.aeruginosa by (15.9%). From (46.46%) of gram-positive cocci, (88.13%%) coagulase-negative staphylococci (CoNS), (4.24%) Enterococcus spp., (5.08%) S.aureus and (2.54%) Streptococcus spp. were acknowledged and (43.26%) of CoNS were methicillin-resistant.Urine is considered to be one of the common sites for bacterial infection in both paediatrics and adults respectively and women are found to be more likely to be infected by urinary tract infections (UTI). This statement can be supported by a study conducted by Iqbal, et al., (2014) which was done in a community at PIMS Islamabad. Based on this study, out of 4 010 samples that were carried out on both males and females, around 20% of women having a single episode of urinary tract infection throughout their life and 3% of women have recurrent episode of urinary tract infection yearly. However, in children, about 5% of girls and 1% of boys have urinary tract infection by the age of 11. The study conducted showed the most prevalent bacteria species isolated from the urine culture was E.coli (58.5%).
Isolation of E.coli is usually resistant to Ampicillin, Co-trimoxazole, Nalidixic acid, Norfloxacin, Tetracycline, and Cefotaxime. Antibiotics like Imipenem (100%), Levofloxacin (41%), and Amikacin (8.7%) and other gram-negative microbes are effective to fight E.coli. There is more than 50% risk of female getting urinary tract infection.Apart from that, pus infection has been a major concern among healthcare practitioners due to its contribution to the increasing health issues these days. Therefore, a study was done due to the concern of the issue mentioned earlier. Based on Rai.S, et al., (2017) ‘s conducted study in a Tertiary Care Hospital in Kathmandu, Nepal, 450 pus/wound swab samples were collected for antimicrobial susceptibility testing. Out of the 450, 264 (59.0%) samples were cultured positive. The age group of less than 1 year (76.0%) were found to be more prone to bacterial infection via pus. Out of the 264 growth positive samples, 162 (61.0%) samples were gram-positive bacteria while 102 (39.0%) samples were gram-negative bacteria.
Furthermore, the most prominent gram-positive bacteria isolated was S. aureus (99.0%) while gram-negative bacteria was P.aeruginosa (44.0%). 90% of S.aurues were methicillin resistant (MIC) of oxacillin. A conducted study in Khyber Teaching Hospital (KTH), Peshawar, Pakistan by Khan, I et al., (2017) supports the precious research as they obtained quite similar results. Out of 200 clinical pus, drainage and wound swab, S.aureus was the most common pathogen isolated, 100 (50.0%) followed by E.coli 45 (22.5%) followed by P.aeruginosa 35 (17.5%). The similarity that can be observed between both study was the two most prominent pathogen found in pus isolate were S.aurues and P.aeruginosa. Then, bactericidal activity of amoxicillin was the highest for S.aurues 100, (82%). Out of the 100 S.aurues isolates, methicillin and vancomycin resistance was found to be (1.5%) and (2.0%) respectively whilst gram-negative isolates with the number of 100.
Among the 100, most of the isolates were resistant towards augmentin. Although an abundance of study has been conducted-having similar results for the same collected isolates, they were mostly done out of our country. Hence, our proposed study is to carry out a study regarding microbial profile and antibiogram of various culture isolates specifically in adults and paediatric patients in private hospital settings in Sarawak, Malaysia. We would like to witness the prevalence of the bacterial infection among Malaysians and compare our findings with the previous findings that were already conducted before.
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