order to select the suitable antimicrobial agents, even in the case of assessing the resistance pattern of Pseudomonas aeruginosa isolated from diabetic foot ulcers. (This set of data corresponds to 2430-diabetic foot infection patients reported by 17-investigtors from various cities of India). Conclusions: 1. Routine microbiological analysis must include the testing for the presence of  biofilm-forming-bacterial strains. 2. All combinations of antibiotic agents/beta-lactamase-inhibitors  must be tried in carrying out the sensitivity tests, so that alternative antibiotic agents could be evaluated, in case of certain antimicrobial agents to  which the patients may develop some  allergic reactions. 3. In the Indian scenario of  Healthcare administration, modernization  of  the existing Clinical & Microbiological Laboratories, with regard to instrumentation and staffing-pattern, in  all the 683-District Hospitals in India, seems to be a viable solution for the generation of  local data-bank  on bacterial antibiotic  sensitivity patterns, so that therapeutic strategy could be suitably evolved in each geographical zone, with the purpose of protecting the public health of rural India, as an exercise as good as protecting the borders of the country!" /> Drug Resistance of <em>Pseudomonas aeruginosa</em> in Diabetic Foot Ulcers: A Comprehensive Analysis of Data in Indian Cities
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Int.J.Curr.Microbiol.App.Sci.2016.5(10): 724-742
DOI: http://dx.doi.org/10.20546/ijcmas.2016.510.079


Drug Resistance of Pseudomonas aeruginosa in Diabetic Foot Ulcers: A Comprehensive Analysis of Data in Indian Cities
C. Meenakshi Sundaram1*, Usha Anand Rao2, P. Rajendran3, Mohan4 and R. Vasudevan5
1Associate Professor, Department of Microbiology, Sri Venkateswara Medical College and Research Centre, Pondicherry-605 102, India
2Professor (Retired), Department of Microbiology, Dr. A. L. M. Post Graduate Institute of Basic Medical Sciences, Tharamani Campus, University of Madras,Chennai-600 013,India.
3Professor of Microbiology, Madha Medical College and Hospital, Chennai-600 112, India
4Director, 5Surgeon, Dr. Mohan’s Diabetes Specialties Research Centre, Gopalapuram, Chennai-600 028, India
*Corresponding author
Abstract:

Drug resistance pattern of Pseudomonas aeruginosa,in the treatment of diabetic foot ulcer, against 9-standard antibiotic agents  was tested, in a tertiary care hospital  in Chennai during 2005. In this retrospective study, the bacterial prevalence was: E.coli (22.2%), S.aureus (17.3%), P.aeruginosa (17.3%), Klebsiella spp. (10.6%), CONS(10.6%), Proteus spp.(9.6%), Streptococcus spp.(5.8%), Corynebacterium spp.(3.8%), and Enterococcus spp (2.9%).   The resistance pattern of Pseudomonas aeruginosa was revealed  as  5.5% to Imipenem, 11.0% to Piperacillin, 22.0% to Co-amoxyclav, 33.0% to Gentamicin,  33.0% to Ceftazidime, 44.0% to Ciprofloxacin, 44.0% to  Ceftriaxone, and 55.5% to Cefotaxime. This result on the effectiveness of various antimicrobial agents (AMAs) in Chennai was   compared with  similar data reported by various other investigators, for 9-other cities in Southern  India (Kelambakkam, Pondicherry, Karaikal, Salem, Coimbatore,  Bengaluru, Thiruvananthapuram, Manipal and Hyderabad), and for  7-cities in Northern  India (Mumbai, Karad, Ahmedabad, Chandigarh, Bathinda, New Delhi and Kolkata). The antimicrobial agents (AMAs) facing resistances in the workable range of 0.0% to 33.3% (susceptibility of 100.0% to 66.7%) were short-listed. Our studies in Chennai  evaluated Imipenem, Piperacillin, Co-amoxyclav, Ceftazidime and Gentamicin as  effective antimicrobial agents, against Pseudomonas aeruginosa isolated from diabetic foot ulcers, in the susceptibility range of 100.0% to 66.7%.. On comparison of this result with the  data reported by various other investigators from 16- other cities in India,  a new set of details has been revealed, according to which the following highlights may deserve consideration in future studies: i) Imipenem, Piperacillin, Piperacillin/ tazobactam, Cefoperazone/ sulbactam, Meropenem andAmikacin,  have been the most  effective AMAs  against Pseudomonas aeruginosa isolated from diabetic foot ulcers in a majority of the 17-cities, including Chennai. ii) Colistin, and Polymixin  B were 100.0% effective against Pseudomonas aeruginosa,  in one South Indian city (Kelambakkam, where the production of carbapenemase/ ESBL were recorded). iii) In Bathinda (North India) where ESBL and MBL production by Pseudomonas aeruginosa were produced, Piperacillin/ tazobactam was the only AMA which was effective against the pathogen, whereas many other AMAs failed, such as, Carbapenems, Aminoglycosides, Monobactam, Quinolones, and a few Cephalosporins. As a contrast to the resistance pattern of Pseudomonas aeruginosa isolated from diabetic foot ulcer, as reported above,  the data reported by GurungJ,et al., 2015, describing the  resistances exerted by Pseudomonas aeruginosa isolated from clinical (composite ) samples in Shillong were compared. It is learnt that the bio-film forming Pseudomonas aeruginosa isolated from clinical (composite) samples proved to be  pan-resistant, rejecting many AMAs tried, namely, Oflaxacin, Amikacin, Ciprofloxacin,Ceftriaxone, Cefoperazone and Ceftazidime. Therefore,  it is recommended that biofilm-forming-strains of Pseudomonas aeruginosa must be separately identified, in order to select the suitable antimicrobial agents, even in the case of assessing the resistance pattern of Pseudomonas aeruginosa isolated from diabetic foot ulcers. (This set of data corresponds to 2430-diabetic foot infection patients reported by 17-investigtors from various cities of India). Conclusions: 1. Routine microbiological analysis must include the testing for the presence of  biofilm-forming-bacterial strains. 2. All combinations of antibiotic agents/beta-lactamase-inhibitors  must be tried in carrying out the sensitivity tests, so that alternative antibiotic agents could be evaluated, in case of certain antimicrobial agents to  which the patients may develop some  allergic reactions. 3. In the Indian scenario of  Healthcare administration, modernization  of  the existing Clinical & Microbiological Laboratories, with regard to instrumentation and staffing-pattern, in  all the 683-District Hospitals in India, seems to be a viable solution for the generation of  local data-bank  on bacterial antibiotic  sensitivity patterns, so that therapeutic strategy could be suitably evolved in each geographical zone, with the purpose of protecting the public health of rural India, as an exercise as good as protecting the borders of the country!


Keywords: Pseudomonas aeruginosa-bacterial biofilm- local data bank on drug resistance - geographical zone.
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How to cite this article:

Meenakshi Sundaram, C., Usha Anand Rao, P. Rajendran, V. Mohan and Vasudevan, R. 2016. Drug Resistance of Pseudomonas aeruginosa in Diabetic Foot Ulcers: A Comprehensive Analysis of Data in Indian Cities.Int.J.Curr.Microbiol.App.Sci. 5(10): 724-742. doi: http://dx.doi.org/10.20546/ijcmas.2016.510.079