ANTIBIOGRAM PATTERN OF STREPTOCOCCUS PNEUMONIA AMONG SYMPTOMATIC AND ASYMPTOMATIC INDIVIDUAL ATTENDING YUSUF DANTSOHO MEMORIAL HOSPITAL, 44 ARMY REFERENCE HOSPITAL AND SHALLOM HOSPITAL
ANTIBIOGRAM PATTERN OF STREPTOCOCCUS
PNEUMONIA AMONG SYMPTOMATIC AND ASYMPTOMATIC INDIVIDUAL ATTENDING YUSUF
DANTSOHO MEMORIAL HOSPITAL, 44 ARMY REFERENCE HOSPITAL AND SHALLOM HOSPITAL
CHAPTER ONE
1.0 Introduction
Streptococcus pneumoniae (pneumococcus) remains a common pathogen and a leading cause
of morbidity and mortality worldwide. In Canada, population based surveillance
studies for invasive pneumococcal disease revealed an overall incidence between
11.8 - 16.1 cases per 100,000 people between 1991 - 1993 (Mastro, et al., 2003).
In the United State, each year,
there' are 2 to 4 cases of community acquired pneumonia with half a million
hospitalizations and 5,000 death resulting in an annual associated cost of 20 billion
dollars.(Kertesz,et al, 1999).Of all
the organisms that can be readily cultured, S.
pneumonia is by far the most common cause of community acquired pneumonia
(15 - 60%) followed by Haemophilus influenza (3-10%), gram negative
bacteria including Klaebsiella pneumonia and
Pseudomonas aeruginosae (3 -10%), Staphylococcus aureus (3-5%) and Moraxellacatarhalis (l-20%) .(Jorgensen,et al,,1999 ).
In the United Kingdom, Pneumococcus
is responsible for 30 - 50% of community acquired and 80% of nosocomial
pneumonia and it may be the cause of most cases of pneumonia with no identified
causative organism (Bulter et al., 1993).
In Africa, the attack rate of
pneumococcal disease is very high, particularly in children. It is estimated to
cause 60 - 90% of lower respiratory tract infections in Gambian children
younger than 5years and as many as 100 cases per 1000 population in adult.
South Africans living in crowded mining communities (Chong, et al., 1995).
An estimate indicate that 18% of S. pneumonia strains from the USA have intermediate
susceptibility to penicillin (Mic 0.12 - l.0mg/l) and 33% have high - level
penicillin resistance (Mic>2mg/l) Clinical Laboratory Standards Institute,
(2005). Some other estimates have placed the increase in high - level
penicillin resistance among Streptococcus
pneumoniae at 60 fold over the past years. Outside the USA, resistance to
penicillin is even 15 times higher, with Spain, Hungary and South Africa
reporting rates of intermediate and high - level resistance between 40 and 70%
(Marton et al., 2001).
In recent times, pneumococcal strains
that are resistance to penicillin have~ emerged and these strains have also
shown resistance to other antibiotic such as the cephalosporin, tetracycline,
sulfonamides, erythromycin, chloramphenicol and clindamycin. (Klugman, et,al,1990) Resistance of Streptococcus pneumoniae to antimicrobial
agents varies with geographical location, which implies a growing need to
monitor their presence in various localities (Orret, 2005).
The increase in penicillin non-susceptibility
is usually associated 'with resistance to other antibiotic and poses a well -
demonstrated risk of therapeutic failure for pneumococcal infections as well as
a potential danger for other respiratory tract infections (Feikin and Klugnan,
2002).
Documented information on
pneumococcal disease in Africa and particularly Nigeria has been few. Little or
no information exist on the antimicrobial susceptibility patterns in this
region in the face of worldwide reports of antibiotic resistance among Streptococcus pneumoniae strains.
(Feikin and Klugnan, 2002).
There are over 80 serotypes of Streptococcus. pneumoniae in circulation
worldwide and these vary in their geographical distribution and pathogenesis (Platt,
et al.,2001). These are information
needed to plan effective interventions against various pneumococcal diseases in
the region. Hence, this study set out to determine the involvement in clinical
conditions, specifically in pneumonia cases, serotype distribution and
antimicrobial susceptibility patterns of S. pneumonia strains in Kaduna,
Northern part of Nigeria.
1.1 Aim and Objectives
1.
The
study is aimed at to determine the antibiotic susceptibility pattern of Streptococcus pneumoniae among symptomatic
and asymptomatic individual in Kaduna state Nigeria.
2.
The
aim of this study was to determine the antibiotic resistance pattern and
measurement of minimum inhibitory concentration (MIC) in S. pneumoniae strains isolated from clinical specimens.
3.
To
determine the drug resistance of the antibiotic susceptibility patterns of Streptococcus pneumonia among symptomatic
and asymptomatic individual.
4.
To
determine the spread of Streptococcus
pneumoniae strains and the antibiotic sensitivity pattern.
5.
To
determine drug resistance pattern that are similar in both carriage strains.
1.2 Justification
Antibiotic are substance produce by
microorganisms that kill or inhibit the growth of other microorganism. Antibiotic
are used routinely in medicine to treat patient with infectious disease. The
use of carrying out antibiotic susceptibility testing is very important. For
this reason, the need to determine the spread of Streptococcus pneumoniae stains and drug resistance pattern in very
necessary.
CHAPTER TWO
2.0
LITERATURE REVIEW
Streptococcus pneumoniae (pneumococcus) is a type of bacterium that comes in chains
and shaped like a lancet a surgical knife with a short wide two edged blade.
Pneumococcus is the leading cause of bacterial pneumonia and important
contribution to bacterial, meningitis, pneumococcal infection are most common
invasive bacterial infection in children in united states, causing about 1,400
cases of meningitis, 17,000 cases of blood stream infection and 7,000 cases of
pneumonia every year in children under 5 years of age. (Reinert, et al, 2002).
The formal name of the bacterium is
currently streptococcus pneumonia. (The "Strepto" meaning twisted and
the coccus comes from the Greek "kokkos" meaning berry).(Koh,et,al,1998) and because of its coming in
pairs, it has also been called Diplococcus
pneumoniae. Vaccine now exists for those individual at high risk of
infection with this bacterium.(Levine,et
al,1998) Streptococcus pneumoniae
belong to the following classification:
Domain Bacteria
Phylum Firmicutes
Class
Bacilli
Order Lactobacillales
Family Streptococciceae
Specie Streptococcus pneumoniae
Binomial name Streptococcus
Pneumoniae. (Doern, et al., 2000 )
Streptococcus pneumoniae or pneumococcus is a gram positive, alphahemolytic
falcutative anaerobic member of genus streptococcus.
A significant human pathogenic bacterium, Streptococcus
pneumoniae was recognized as a major cause of pneumonia in the late 19th
century, and is the subject of many humoral immunity studies. (Doern,et al., 2000 )
Streptococcus pneumonia resides asymptomatically in the nasopharynx of healthy carriers.
The respiratory tract, sinuses, and nasal cavity are the pairs of host body
that are usually infected, however, in susceptible, individuals, such as
elderly and immunocompromised people and children, the bacterium may become
pathogenic spread to other locations and cause disease. Streptococcus pneumoniae is the main cause of community acquired
pneumonia and meningitis in children and the elderly and of septicemia in (HIV)
infected persons. The methods of transmission include sneezing, coughing and
direct contact with an infected person.
Despite the name, the organism causes
many types of pneumococcal disease which include meningitis, bacteremia,
sepsis, osteomyelitis, septic arthritis, endocarditis, peritonitis,
pericarditis, cellulitis, and brain abscess. (Hsueh, et al., 1999).
Streptococcus pneumoniae is one of the most common cause of bacteria meningitis in
adults and young adult along with (Neisseria meningitides) and is the leading
cause of bacterial meningitis in adult in the USA. (Orrett, (2005).
It is also one of the evidence of top two isolates found in ear
infection, otitis media pneumococcal pneumonia is more common in the very young
and the very old. Its also a major bacterium for invasive disease like
pneumonia and meningitis in South Asian children (12 years of age), though the
evidence is of low quality and scarce, Streptococcus
viridians, some of which are also alpha hemolytic, using an optochin test,
as Streptococcus pneumoniae is optochin sensitive. S. pneumonia can also be distinguished based on it sensitivity to
lysis by bile, the so-called 'bile solubility test', the encapsulated, gram
positive coccoid bacteria have a distinctive morphology on gram stain, lancet
shaped diplococcic. They have a polysaccharide capsule that act as a virulence
factory for the organism, more than 90 different serotypes are known prevalence
and extent of the drug resistance. (Paul, et
al., 2000 ).
2.1
History of S. pneumoniae
In 1881, the organism, known as the
pneumococcus for its role as an (etiologic agent) of pneumonia, was first
isolated simultaneously and independently by the US army physician (George
Starnberg and the French chemist Louis Pasteur). The 'organism was termed Diplococcus pneumoniae from 1920 because
of its characteristics appearance in gram stained sputum. It was Streptococcus pneumoniae in 1974 because
of its growth in chains in liquid growth media. (Maugein,et al., 2003).
Streptococcus pneumoniae played a central role in demonstrating genetic material of
DNA, in 1928, Fredrick Griffith demonstrated transformation of life, turning
harmless pneumococci. In 1944 Oswald Avery, Colin Macleod, and Medyn Mccarly
demonstrated the transforming factors in Griffiths experiment was DNA, not
protein, as was widely marked the birth of the molecular era of genetics.
(Maugein,et al., 2003).
2.2 Genetics
of S. pneumoniae
The genome of S. pneumoniae is a closed, circular DNA, structure that contained
between 2.0 and 2.1 million base pairs, depending on the strain. It has a
concentration set of 1553 genes, Pius 154 genes with virulence, which
contribute to virulence, and 176 genes that maintain a non invasive
phenotype. Genetic information can vary
up to 10% between strains. (Ohene,
2001).
Natural bacterial transformation
involves the transfer of DNA. from one bacterium to another through the
surrounding medium. Transformation, it takes up and recombine exogenous DNA
into its chromosome and it must enter a special physiological state, called
competence. (Ohene, 2001).
Competence in S. pneumoniae is induced by DNA damaging agent such as mutomycin c,
a DNA interstrand across liking agent and the fluorogunolone antibiotic
norfloxacin, lerofloxacin and moxifloxacin, topoisomerase inhibitors that
causes double strand breaks.
2.3 Infection
of S. pneumoniae
Pneumococcal infection is a part of
the normal upper respiratory tract flora, it can become pathogenic under the
right conditions, like if the immune system of the host is suppressed invasive
such as pnemolysim,which is an anti-phagocytic capsule, various adhesine and
immunogenic cell components are all major virulence.
2.3.1 Transmission of S. pneumoniae
Pneumococcus is spread through
contact with people who are ill or who carry the bacteria in their throat, pneumonia
can be transmitted from respiratory droplets from the nose or mouth of an infected
person. It is common for people, especially children to carry the bacteria in
their throats without being sick.
2.3.2 Symptoms of S. pneumonia
Pneumococcus pneumonia may- begin
suddenly; one may first have a severe shaking chill which is usually followed
by
High fever
Cough
Shortness of breath
Rapid breathing
Chest pain and other symptoms may
include,
Nausea
Vomiting
Headache
Tiredness
Muscle aches.
2.3.3 Causes of S. pneumonia
Pneumococcus pneumonia can be caused by a variety of viruses, bacteria and
sometimes fungi, pneumococcus pneumonia is
caused by bacteria called Streptococcus
pneumoniae .
2.3.4 Diagnosis of S. pneumoniae
Health care provider can diagnosis
pneumococcal based on its symptoms, physical examination, laboratory test and
chest x-ray.
Diagnosis is generally made based on
clinical suspicious along with a positive culture from a sample for virtually
any place in the body. An asotive of 200 units is significant, Streptococcus pneumoniae is in general,
optochin sensitive, although optochin resistances has been observed.
Antromentin and leucoelone posses anti bacterial activity inhibiting, the
enzyme enoyacyl carrier protein reductase, essential for the biosynthesis of
fatty acid in Streptococcus pneumoniae.(Parray
et al, 2000).s
2.3.5 Treatment of S. Pneumoniae
The health care provider usually-will
prescribe antibiotics to tract this disease. The symptoms of pneumococcal
pneumonia usually go away within 12 to 36 hours after you start taking
medicine. Some bacteria such as Streptococcus
pneumoniae, however are now capable of resisting and fighting off
antibiotics such antibiotic resistance is increasing world wide because these
medicines have been over used or misused. Therefore if you are at risk of
getting pneumococcal pneumonia, you should talk to your health care provider
about what you can do to prevent it.(Centers for disease control and prevention
1997).
2.3.6 Prevention of S. pneumoniae
Acting the pneumococcal vaccine is
the main way you can reduce your chance
of getting pneumococcal. Pneumonia vaccines are available for children and
adult.
The centress for disease control and
prevention (CDC) recommends that you get the pneumococcal pneumonia vaccine if
you are in any of the following groups,
1.
You
are 65yrs old or older.
2.
You
have a serious long-term health problem such as health disease, sickle cell
disease, alcoholism, ling disease (not including asthma) diabetes, or liver
cirrhosis.
3.
Your
resistance to infection is lowered due to
·
HIV/AIDS
·
Lymphonai,
Leukemia, or other cancers.
·
Cancers
treatment with long term steroid medicine
·
Bone
marrow or organ transplant.(bulter et al,
1993)s
2.4 Pneumococcal
Vaccine
Interaction with haemophilus influenzae, both haemophilus
influenzae (H. influenzae and Streptococcus pneumoniae can be found in
the human upper respiratory system. A study of completion in vitro recorded Streptococcus pnemomiae overpowered
Influenzae by attacking it with hydrogen peroxide. When both are placed
together into the nasal cavity of a (mouse) with two (2) weeks, only H. influenzae survives.
When both are placed separately into a nasal cavity each one survive
upon. (Ndinya-Achola,et al., 2002).
2.4.1
Complication
In about 30 percent of people with
pneumococcal pneumonia, the bacteria invade the blood stream from the lungs,
this causes bacteremia a very serious complication of pneumococcal pneumonia
that also can cause other lung problems and certain heart problems. (Orrett, 2005).
2.4.2 Who Is At Risk
Pneumococcal disease occurs around
the world travelers may be at higher risk of spending time in crowded settings
or in close contact. (Rahav et al,
1997).
2.4.3 Antibiotic Sensitivity Testing
Antibiotic sensitivity assay involves
testing selected antibiotics against a pathogen isolated from a diseased
individual. The assay is carried out by inoculating a standard suspension
pathogen in broth containing various concentration of an antibiotic. The lowest
concentration that will inhibit the pathogen from reproducing in the broth can
be measured by determining the turbidity of the broth after an incubation
period. Inoculated broth tubes containing inhibitory concentration of the
antibiotic being tested will remains clear. Those tubes containing non
inhibitory levels of antibiotics will become turbid ,reflecting microbial
growth. The efficiency of the antibiotic can then be determined by the lowest
concentration of that antibiotic that will kill or inhibit the pathogen. This
procedure for determining the effectiveness of an antibiotic, called the
minimum inhibitory concentration (MIC) procedure, is very popular in clinical laboratories
because it yields reliable result ad is well suited to automation. The
dispensing of culture media, dilution of the various antibiotics, inoculation
of microorganisms, and measuring of turbidity can all be preprogrammed and
computerized.(Bogaerts et al, 1993).
Another reliable procedure for
determining the effectiveness of a drug, or the degree of sensitivity or
resistance of a pathogen to various antibiotics is the Kirby-Bauer method. The
test, introduced by William Kirby and Alfred Bauer in 1966, consists of
exposing a newly-seeded lawn of the bacterium to be tested, growing on a
nutrient medium (Mucller-Hinton agar), to filter paper disks impregnated with
various antibiotics. The culture is in batedrs for 16 to18 hours and then
examined for growth. If the organism is inhibited by one of the growth. If the
organism is in habited by one of antibiotics, there will be a zone of
inhibition around the disk represeareaa the area in which the microorganism was
inhibited by that antibiotic.(Inostroza et
al, 2001).
The diameter of the zone of
inhibition around an antibiotic disk is an indication of the sensitivity of the
sensitivity of the tested microorganism to that antibiotic. The diameter of the
zone, however, is also related to the rate of diffusion of the antibiotic in
the medium. This fact must be kept in mind when interpreting the zones of inhibition
of various antibiotics (Lyon et al,
2000).
CHAPTER THREE
3.1
METHODOLOGY
Study Area
The research study was carried out in
Yusuf Dantsoho Memorial Hospital tudun wada , 44 Army Reference Hospital
Governor Road, Shalom Hospital Gonin Gora within kaduna metropolis, kaduna
state. Kaduna state is located in the zone of Nigeria. Samples of streptococcus pneumouiae were collected
from Yusuf Dantsoho Memorial Hospital, at Tudun Wada, 44 Army Reference
Hospital at Governor Road and Shalom Hospital Gonin Gora respectively.
3.2 Samples Collection
A total of (30) thirty samples of streptococcus pneumoniae isolate were
obtained from (3) three hospitals, namely, Yusuf Dantsoho Memorial Hospital, 44
army reference hospital and shalom hospital respectively. All the specimen were
collected and cultured based on the guidelines governing the collection and
cultivation of microbiological samples.
Thirty (30) throat swab specimen (for
the evaluation of Pneumococcal carriage) was collected from all the healthy
individuals attending Yusuf Dantsoho hospital clinical laboratory, and those
attending shalom and 44 Army Reference Hospital using cotton tipped wooden swab
stick. The specimen was taken to the laboratory for microbiological analysis. The
biodata of each individual from whom specimen were collected include age and
sex as documented for the pneumonia cases, the sputum specimen here after was
referred to as clinical specimens and collected in a clean sterile wide mouth
container.
The specimen were inoculated into 5%
defibrinated sheep blood Agar and incubated at 37%c for 24hrs. Colonies
obtained on the blood Agar medium were examined for morphology (Small Greenish)
and alpha haemolysis characteristics of S.
pneumoniae. Their identity was confirmed by the bile solubility and
optochin sensitivity test.
3.3 Antibiotic susceptibility testing using
kirby bauer method
In this study, based on Kirby Bauer
method as describe by CLSI (Clinical Laboratory Standards Institute) and EUCAST
(European Committee on Antimicrobial Susceptibility Testing) was adopted for
each selected antibiotic. The inclusion criteria were based on CLSI and EUCAST
which referred to minimum inhibitory concentration of selected antibiotics
isolated strains were classified into susceptible, intermediate and
resistance.
3.4 Preparation of Culture Media
The selective culture medium was
Nutrient Agar it was prepared according to the manufacturer instructions and
sterilized in an autoclave at 1210c for 15 minutes and was allowed
to cool at 370c, 50ml of the blood sheep was then introduced
aseptically into the prepared Agar which in turn becomes blood sheep Agar.
3.5 Antimicrobial Agent
Antimicrobial agent used in this study
consist of Ampicillin (PN) (30 mcg) Ceporex (CEP) (lomcy), Septrin (SET) (30
mcg), Nalidixic acid NA (30mcg). Augmentin Au (30mcy) Gentamycin CN (10mcg), Ciproflox
Cpx (10mcg), Reflacine PSF (10mcg),
Ampiclox APX (20mcy), Erythromycin E (30mcg), Chloramphenicol CH (30mcy),
Norfloxacin NB (10mcg), Rifampicin RD (20mcg), Amoxil Aml (20Mcy).
3.6 Isolation of Streptococcus pneumoniae
The isolation of S. pneumonia is carried out based on clinical examination the
isolation was done after solidification of the prepared blood sheep Agar while the
inoculated samples and were kept for 24hrs in the incubator at 370c
for observation of the growth of the organism on the Agar.
3.7 Identification of Streptococcus pneumoniae
Is based on the physical and
microbiological analysis being carried out on the samples obtained on the blood
Agar medium,the colonies were examined for morphology (Small Greenish) and
analysis characterized through identification of S. pneumoniae. The identification was confirmed by bile solubility
and optochin sensitivity test.
CHAPTER FOUR
4.0 RESULT
Symptomatic Individual
4.1 Zone of Inhibition (Mm) of Twelve Tested
Antibiotics Against Streptococcus pneumoniae
TABLE 4.1: Zone of Inhibition of
Tested Antibiotics Against S. Pneumoniae
Isolates From Yusuf Dantsoho Memorial Hospital
|
Tested
isolates
|
CPX 10mcg
|
Au 30mcy
|
CN 10mcg
|
S (30mcg)
|
PN
(30mcy)
|
SXT
(30mcg)
|
NA
(30mcg)
|
OFX
(10mcg)
|
CH
(30mcg)
|
E (30mcg)
|
NB
(10mcg)
|
|
S. pneumonae
|
15
|
25
|
30
|
28
|
20
|
25
|
20
|
25
|
20
|
25
|
25
|
|
10
|
10
|
20
|
10
|
10
|
15
|
10
|
10
|
10
|
10
|
10
|
|
|
5
|
5
|
5
|
5
|
5
|
0
|
5
|
5
|
0
|
0
|
0
|
4.2 Zone
of Inhibition (Mm) of Twelve Antibiotic Against Streptococcus pneumoniae
TABLE 4.2: Zone of Inhibitions of
Tested Antibiotics against Streptococcus
pneumoniae Isolated From 44 Army
Reference Hospitals
|
Tested
isolates
|
CPX 10mcg
|
Au 30mcy
|
CN 10mcg
|
S (30mcg)
|
PEF
(10mcg)
|
PN
(30mcy)
|
SXT
(30mcg)
|
NA
(30mcg)
|
OFX
(10mcg)
|
CH
(30mcg)
|
E (30mcg)
|
NB
(10mcg)
|
|
S. pneumonae
|
20
|
30
|
20
|
20
|
20
|
28
|
28
|
20
|
15
|
25
|
25
|
20
|
|
10
|
20
|
10
|
10
|
10
|
15
|
15
|
10
|
10
|
10
|
10
|
10
|
|
|
5
|
5
|
5
|
5
|
5
|
5
|
0
|
5
|
5
|
0
|
0
|
0
|
4.3 Zone Of Inhibition (Mm) Of Twelve
Antibiotic Against Streptococcus
pneumoniae
TABLE 4.3: Zone of Inhibition of Tested Antibiotics
Against S. Pneumonae Isolated From
Shalom Hospital
|
Tested
isolates
|
CPX 10mcg
|
AU 30mcy
|
CN 10mcg
|
S (30mcg)
|
PEF
(10mcg)
|
PN
(30mcy)
|
SXT
(30mcg)
|
NA
(30mcg)
|
OFX
(10mcg)
|
CH
(30mcg)
|
E (30mcg)
|
NB
(10mcg)
|
|
Streptococcus pneumonia
|
20
|
30
|
20
|
25
|
20
|
25
|
20
|
20
|
20
|
25
|
20
|
25
|
|
10
|
20
|
10
|
15
|
10
|
15
|
10
|
10
|
10
|
10
|
10
|
10
|
|
|
5
|
5
|
5
|
5
|
5
|
5
|
0
|
5
|
5
|
0
|
0
|
0
|
Key:
CPX
– Ciproflox (10mcg)
AU
– Augmentin (30mcy)
CN
– Gentamiycin (10mcy)
S
– Streptomycin (30mcg)
PEF
– Reflaxin (10mcg)
PN
– Amplicillin (30mcg)
SXT
– Septrin (30mcg)
NA
– Nalidixic Acid (30mcg) OFX – Taravid
(10mcg)
CH
– Chloramphenicol (30mcg) E – Erythromycin
(30mcg)
NB
– Norfloxacin (10mcg)
4.4 Asymptomatic Individual
From the research carried out, All
the samples collected from Yusuf Dantsoho Memorial Hospital, 44 Army Reference
Hospital and Shalom Hospital respectively shows that all samples are negative
to Streptococcus pneumoniae which
means patient attending clinical laboratories in the hospital are not prone to Streptococcus pneumoniae saccording to the research carried out.
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION
5.1 Discussion
. Antibiotics are substances
produced by micro organisms (certain fungi and bacteria) that kills or inhibits
the growth of other micro organisms. Antibiotics are used routinely in medicine
to treat patients with infectious diseases. A modern medicine takes advantage
on the many antibiotics that are commercially available to treat infectious
diseases. Not all antibiotics however are effective against all infectious
disease. Before these drugs are administered to a patient, it must first be
determine to ascertain which one to use, this is done by performing an antibiotic
sensitivity test on the pathogens.
Antibiotics sensitivity assays
involves testing selected antibiotics against a pathogen isolated from a
diseased individual. The assay is carried out by inoculating a standard
suspension of pathogen in various concentrations of an antibiotics. The lowest
concentration that will inhibit the pathogen from producing in the broth can be
measured by determining the turbidity of the broth after an incubation period. Inoculated
broth tubes containing inhibitory concentrations of the antibiotic being tested
will remain clear.
The reliable procedure to determine the effectiveness of a
drug or the degree of sensitivity or resistance of a pathogen to various
antibiotics, is the Kirby Bauer method. The test introduced by William Kirby
and Alfred Baver in 1966, consist of exposing a newly seeded lown of the bacterium
to be tested, growing on a nutrient medium (Mueller – Hinton Agar), to filter
paper disks impregnated with various antibiotics. The culture is inoculated for
24 to 48hours and then examined for growth. If the organism is inhibited by one
of the antibiotics, there will be zone of inhibition around the disk,
representing the area in which the microorganism was inhibited by that
antibiotics.
The diameter of the zone of
inhibition around an antibiotic disk is an indication of the sensitivity of the
tested micro organism to those antibiotics. The diameter of the zone, however,
is also related to the rate of diffusion of the antibiotics in the medium.
Based on the research carried out
which is the antibiogram pattern of Streptococcus
pneumoniae and to determine the antibiotics resistance of Streptococcus pneumoniae strains
isolated from clinical specimens.Table 4.1,4.2,and 4.3 above illustrate the
zone of inhibition of the bacteria isolate (Streptococcus
pneumoniae isolated from three different hospital in Kaduna metropolis).
Table 4.1 are result obtained from
Yusuf Dantsoho Memorial Hospital Tudun Wada Area of Kaduna State indicating the
susceptible, intermediate and resistance drugs based on zone of inhibition.
The 1st roll numbers
indicates that the antibiotics are susceptible to the Streptococcus pneumoniae isolates obtained from Yusuf Dantsoho
Memorial Hospital, 2nd roll shows the intermediate of the drugs
while the 3rd roll shows the resistance of the drugs to the isolated
strains.
The 1st roll which is the
susceptible, Gentamycin is more active on the isolate including other like
Streptomycin, Augmentin, Septrin, Reflexacin, Erythromycin and Norfloxacin
which are fairly active to the isolates. Gentamycin really shows actively on
the isolates from Yusuf Dantsoho Memorial Hospital because the resistance was
very low on the isolate and the intermediate was also close to the susceptible.
Septrin, Chloramphenicol, erythromycin and Norfloxacin shows total resistance
to the isolated strains.
Table 4.2 which represents result
obtained from 44 Army Reference Hospital, Governor Road,Kaduna shows that
Augmentin, Septrin and Ampicillin are very active drugs on the clinical
isolates obtained from 44 Army Reference Hospital Governor Road . Augmentin was
reactive in both the susceptible and intermediate. Norfloxacin, Erythromycin
and Chloramphenicol shows total resistance to the isolates obtained from the
hospital.
Table 4.3 are result obtained from
Shalom Hospital, Gonin Gora. Augmentin was susceptible on the isolates obtained
from the hospital. Reflaxin, Chloramphenicol and Norfloxacin also shows fairly
active on the isolates, Augmentin, Streptomycin, Reflaxin are intermediate on
the isolates. Septrin, Chrloramphemicol, Erythromycin and Norfloxacin are all
resistance
on the isolated strains.
In this study, drug resistance
pattern were similar in both the three hospitals which were used as the area of study, in table 4.1,4.2, and 4.3
hospital clinical strains, From the research carried out, it shows that samples
from Yusuf Dantsoho Memorial Hospital were mostly susceptible to Gentamycin
while that of 44 Army Reference Hospital and Shalom Hospital shows susceptible
to Augmentin which means according to (Reinert et al., 2007) and other scientist who conducted research and
stated that pneumococcal drug resistance rate vary from region to region. Still
the research table 4.1 show that Gentamycin has the highest zone of inhibition
in intermediate and also Septrin which also has some amount of zone of
inhibitive on the table 4.1 clinical isolates.
Septrin, Chloramphenicol, Erythromycin
and Norfloxacin shows non effective total resistance to Yusuf Dantsoho Memorial
Hospital and Shalom Hospital clinical isolate. Chloramphenicol, Erythromycin
and Norfloxacin except Septrin also shows resistant to 44 Army Reference
Hospital clinical isolate.
Resistance of penumococcus to drugs
tested in this work is similar to the observations reported from other African
countries including Egypt, Ghana (Coheren, 1997, Kenya (Paul, et
al., 1996), Rwanda (Bogaest, et al., 1993), Senegal, Tunisia, Morocco
and Ivory Coast. Nevertheless, for most antibiotic tested in this work, the
magnitude of the problem differs from one area to the other.
Considerable variations of the
antibiotics resistance patterns have been observed in countries of the same
region (Appelbaum, 1992, Doem, et al., 1996), between regions in the same country
(Doem, et al., 1996) or even between
hospitals within a country (CDC, 1999). The difference observed antibiotics
policies, the low rate of resistance to Chloramphenicol, Erythromycin, Norfloxacin
and Septrin observed in this study may be explained by the fact that these
antibiotics are rarely used. This implies that chloramphenicol, Septrin,
Erthromycin, Norfloxacin, Gentamycin and Augmentin would be effective in the
treatment of pneumonia caused by Streptococcus
pneumoniae.
5.2 Conclusion
It is of public health interest that
pneumococcal strains encountered in this study are included in the available
pneumococcal vaccines, however, high rate of resistance to Chloramphenicol,
Erythromycin and Norfloxacin observed is a concern.Nevertheless, the continuous
monitoring of pneumococcus regarding drug resistance in Nigeria is needed to
assses the real issue regarding drug resistance, which will allow doctors to
adjust the empirical treatment In this research work carried out, the
antibiotic susceptibility testing of the drugs on the bacteria Streptococcus pneumoniae effective based on the region and area of where
the patient acquired the disease. Gentamycin shows effectively on the isolate
obtained from Yusuf Dantsoho memorial Hospital at Tudun Wada, while Augmentin shows
effective on the clinical isolate obtained from 44 Army Reference Hospital and
Shalom Hospital respectively.
5.3 Recommendations
Based on this project work, the
following recommendations were made:
1.
Before
the treatment of streptococcus pneumoniae
disease, a culture sensitivity testing must be carried out to determine the
antibiotic resistant of the drug on the disease.
2.
Self
medication should not be a first priority in any symptoms of disease, which
implies that the need to consult the doctor who will direct you to the
laboratory for further analysis.
3.
When
carrying out research on antibiotic resistance pattern on any isolate, when the
use of negative sensitivity disk shows all resistance to the antibiotic, it is
advisable to use the positive antibiotic disk because the antibiotic present in
the positive disk including the concentration of the drugs may not be present
in the negative disk.
4.
In
this research, it was observed that some antibiotics in the negative disk and
positive disk were all resistance to the drugs which implies that the patient
is on self medications of different antibiotic which there will be no result
without the proper analysis on the patient sample in the laboratory.
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