Antibiotic Resistance of Isolated Gram Negative Bacilli from Different Clinical Sample in a Central Teaching Hospital of Pediatric in Baghdad

The number of infections caused by microorganisms is increasing significantly over the last few years. A total of 140 patients admitted to the central teaching hospital of pediatrics from the 1st of Jun 2017 to 31 October 2017. The Clinical samples was processed from culture and sensitivity testing. Antibiotic discs used for gram negative isolates. The most prevalent gram negative isolates included Escherichia coli 63 (45.0 %), Pseudomonas spp. 21 (15.0 %), Klebsiella spp. 19 (13.6 %) predominantly. Escherichia coli were the most prevalent isolates from urine 45 (71.4 %), Klebsiella spp. 11 (57.9 %) and Enterobacter spp. 11 (68.8 %) followed by Escherichia coli 10 (15.9 %) predominant from blood. 68 (48.6 %) of specimens were urine, 47 (33.6 %) were blood and 25 (17.8 %) were from other origins. Resistance to CTR was 42 (51.2 %) in Escherichia coli, 15 (18.3 %) in Pseudomonas spp. 9 (11.0 %) in Klebsiella spp. and similarly AMC showed 41 (62.1) resistance among Escherichia coli, 8 (12.1 %) among Pseudomonas spp. and Klebsiella spp. and also GEN showed 27 (57.4 %) resistance among Escherichia coli, 7 (14.9 %) among Pseudomonas spp. and 6 (12.8 %) in Klebsiella spp.


INTRODUCTION
Number of infections caused by microorganisms is increasing significantly over the last few years; one of the reasons for this increase is development of microbial resistance to drugs used to treat these infections 1 . The infection due to gram negative bacteria increasing problem in recent years 2 . Most common reasons responsible for these infections are multidrug resistant gram negative bacilli particularly members of the family Enterobacteriaceae and non-fermenting gram negative rods 3 . Enterobacteriaceae family had shown high rates of antibiotic resistance [4][5][6] . Resistance gram negative bacteria are a serious global public health concern especially in developing countries [7][8][9][10] . Gram negative bacilli are common cause of intra-abdominal infections, urinary tract infections, nosocomial pneumonia and bacteremia 11 . Most infections may be related to unbalanced microbiota and host defenses mechanisms but undoubtly hospital environments are great source of potentially pathogenic microorganisms 12 . A number of factors have been reported that were related to infection with resistant microorganisms, including previous use of antibiotics, corticosteroid therapy, mechanical ventilation, length of hospital stay and use of invasive device such as catheters 13 . The prevalence of resistant gram negative bacteria can vary at local, regional, national and international levels 14 . The mortality is increasing every day because of global changing of antimicrobial resistance patterns 16 .

MATERIALS AND METHODS
A total of 140 children admitted to the central teaching hospital of pediatrics from the 1 st of Jun 2017 to 31 October 2017. Gram-negative isolates from clinical samples were included in the study. The Clinical samples included urine, blood, wound secretions, pus, ear, endotracheal, doubluma, peritoneal. The sample was processed from culture and sensitivity testing. Antimicrobial susceptibility was evaluated by the Kirby-Bauer disk diffusion method in guide lines of clinical and laboratory standards Institute. The sample was processed from culture and sensitivity testing. Specimens inoculated onto agar plates according to the type of sample and incubated aerobically at 37°C over night. The cultured plates were examined after 24 hours and organisms identified by their colonial morphology, Gram staining and API 20 E kits biochemical tests using standard techniques.

Statistical Analysis
The suitable statistical methods were used in order to analyze and assess the results, they include the followings: Descriptive statistics: Statistical tables including observed frequencies with their percentages.
Inferential statistics: These were used to accept or reject the statistical hypotheses, Persons Chi-Square test (χ2) at level of significance 0.05. P value < 0.05 level of significance was considered statistically significant.

DISCUSSION
The Microbial Pathogens as well as their antibiotic sensitivity patterns may change from place to place and from time to time 18 . In present study show in Table (     most common in study which was isolated from urine and this agree with Javeed et al. 19 , Saravanan et al. 20 and Vipin et al. 21 . Showed significant differences (P < 0.05) in Table (2). Urine samples were 68 (48.6 %) and blood samples were 47 (33.6 %) and other origins 25 (17.8 %) this agreement with Sharif et al. 22 . Showed significant differences (P < 0.05) in Table (3). Resistance emerges from over utilization of antibiotics trying to sterilize the environment and also the inappropriate use of the antibiotics for treatment, uncontrolled antibiotics resistance surveillance 23 Table (3) with significant differences (P < 0.05).