Determination of multidrug resistance profile of isolated Gram-positive and Gram-negative bacteria from clinical pus samples in Bangladesh
Authors: Nobel Fahim , Ahammad Hasib , Saha Sumita , Asaduzzaman Mohammad , Nashra Aanan , Jebin Ruksana , Zahan Yeasmin , Kamruzzaman Mohammad , Babu Golap , Islam Mohammod 
Published: January 2024

Introduction: Antimicrobial resistance (AMR) has been a very concerning issue with consistent rise on a global scale. The rapid spread of drug-resistant pathogenic bacteria is a serious public health concern in both developed and developing countries, including Bangladesh. This study aimed to determine the prevalence of antibiotic resistant pathogenic bacteria in pus samples and their multidrug resistance (MDR) rate. Methods: A total of 891 pus positive samples were collected from the Lab Zone and Hormone center in Tangail, Bangladesh between January 2018 to March 2022. The standard microbiology cultural method such as Nutrient agar, Blood sheep agar, and MacConkey agar media plates were used to process the samples following aseptic techniques and the resulting bacterial isolates were confirmed by biochemical tests and gram staining to classify bacterial species into two large groups. Antimicrobial susceptibility tests were performed for the identified bacterial isolates using the disk diffusion method. Results: Among the Gram-negative bacterial isolates, Pseudomonas spp. was the most predominant (n=368, 58.69%), followed by Proteus spp. (n=95, 15.15%), E. coli (n=93, 14.83%), Klebsiella spp. (n=64, 10.21%), Acinetobacter spp. (n=6, 0.96%) and Enterobacter (n=1, 0.16%). On the other hand, in Gram-positive bacterial isolates, Enterococcus faecalis constitutes 39.02% of the total (n=103) which is the majority followed by Staphylococcus aureus (n=81, 30.68%), Staphylococcus spp. (n=77, 29.16%) and Streptococcus spp. (n=3, 1.14%).
In this study, an examination of the multidrug resistance (MDR) pattern among Gram-negative bacteria revealed notable findings. Escherichia coli exhibited the highest resistance level, with 98.92% (n = 92) of isolates demonstrating resistance. Following closely, Pseudomonas displayed a substantial resistance pattern at 92.66% (n = 341), Proteus at 91.58% (n = 87), Klebsiella at 87.5% (n = 56), and Acinetobacter exhibiting complete resistance of 100% (n =6). The cumulative MDR trend for Gram-negative bacteria was significant, reaching 92.98% (n = 583). Conversely, Gram-positive bacteria demonstrated a robust resistance pattern as well. Streptococcus spp. displayed resistance in 66.66% (n = 2) of cases, and Enterococcus faecalis exhibited resistance in 92.23% (n = 95) of instances. While, Staphylococcus aureus showed a high resistance level with 95.06% (n = 77) of isolates. The overall drug-resistant pattern for Gram-positive bacteria was substantial, reaching 87.5% (n = 231).
Conclusion: As per the findings of this study, bacteria frequently encountered demonstrate a concerning prevalence of multidrug resistance (MDR), posing a significant challenge to public health. The outcomes of this research may contribute valuable insights for formulating evidence-based treatment strategies and underscore the critical need for early identification of drug-resistant bacteria. This imperative step holds the potential to mitigate the disease burden effectively.