In the last decade, along with the problem of nosocomial infections,multidrug-resistant bacteria in community and hospitals have soared. Highfrequencies of multidrug-resistant bacteria have been grouped under the acronymESKAPE: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.
The ESKAPE pathogensare responsible for the majority of nosocomial infections and capable of ‘escaping’the biocidal action of antimicrobial agents. Enterococciare opportunistic bacteria which cause severe infectious diseases. Enterococcus faecium can cause severalinfections including septicaemia, urinary tract infections, endocarditis, bacteraemia,wound infections, meningitis, and neonatal sepsis.
Acinetobacter are gram-negative coccobacilli that may causenosocomial infections in critically ill or debilitated patients’ particularlyventilator-associated pneumonia and infections of the bloodstream, urinarytract, and wounds. Klebsiellapneumoniae is a Gram-negative, nonmotile, rod-shaped bacterium .Klebsiella infections are seen mostly in people witha weakened immunesystem. The most common condition caused by Klebsiella bacteriais pneumonia.
In additionto pneumonia, Klebsiella can also cause infections inthe urinary tract, lower biliary tract, and surgical wound sites. Enterobacter isa genus of common Gram-negative, rod-shaped bacteria. These bacteria are pathogenic and cause opportunisticinfections in immunocompromised patients. The urinary and respiratory tracts are the most common sites of infection .Pseudomonasis an opportunistic pathogen for humans lead to a broad spectrum of diseasesuch as urinary, burn, respiratory infections, and septicaemia. It is theprimary cause of ventilated, associated pneumonia in the intensive care unit This study is to consider the clinical importance of emerging of ESKAPEpathogens in nosocomial infections to prepare feasible data about tracing andtreatment of infection related to ESKAPE pathogens that may be beneficial toclinicians at the bed head. The awareness of residential antimicrobialresistance can support selecting a convenient empirical therapeutic diet indiseases due to ESKAPE pathogens.
Objectives· To observe and analyzethe carriers of the ESKAPE pathogens in the ICU workers · To develop innovativetherapeutic strategies. · Study the environmentalfactors leading to nosocomial infections in humans. Methodology Various organisms isolated from the nasal swabs will be tested forESKAPE pathogens along with their sensitivity pattern Studydesign and sample size This will be a cross sectional study ,which will be carried out in twomonths in the Department of Microbiology, in Sri Lakshmi Narayana Institute ofMedical Science ,Pondicherry .
Clearance from the Institutional ethicalcommittee will be obtained . Nasal swabs will be collected from 80 healthworkers from ICU after obtained informed consent. The health workers were nottaking any antibodies for last 2 weeks and were not admitted in hospital forthe last one year. Demographic details like age, occupation, sex, history ofunderlying disease will be obtainedCollectionand transport of sample Nasal swabs will be collected from both the anterior nose by swabbingwith a sterile swab, pre-moistened with sterile normal saline solution. Then theseswabs will be sending to the laboratory for culturing and testing theantibiotic susceptibility. Antimicrobial susceptibility testing will be done onMuller Hinton agar.
Processingof sample Afterreceiving the sample in the laboratory, the swabs immediately inoculated onBlood agar, chocolate agar, and macconkey agar. Then swabs are incubated at 37°Cfor 24 hrs. Nextday, after overnight incubation, growths of bacterial colonies in all theculture plates were noted. Identification of organisms was carried out usingstandard microbiological methods, including Gram stain and other biochemicalreactions. In Blood agar, the type of haemolysis was noted. In MacConkey Agar,Lactose fermentation was noted. By utilizing the lactose available in themedium, Lac positive bacteria such as, Enterobacterand Klebsiella will produce acid,which lowers the pH of the agar below 6.8 and results in the appearance of pinkcolonies .
Non lactose fermenting organisms such as,Pseudomonas aeruginosa produce mucoidcolonies which appear very moist and sticky. This phenomenon happens becausethe organism is producing a capsule, which is predominantly made from thelactose sugar in the agar. Theisolated colonies were Gram stained. After making out the gram reaction of theorganisms, appropriate biochemical tests were carried out to identify theisolated organisms. Antimicrobialsusceptibility testing were done on Muller Hinton agar by Kirby Bauer disc diffusion method asemi-quantitative way based on diffusion ; small discs containing differentantibiotics, or impregnated paper discs, are dropped in different zones of theculture on an agar plate, which is a nutrient-rich environment in whichbacteria can grow. The antibiotic will diffuse in the area surrounding eachtablet, and a disc of bacterial lyses will become visible.
.Their susceptibilitiesto antimicrobials will be recorded.Implication Treatment of nosocomial infectionscan be challenging due to the high level of antibiotic resistance of nosocomialpathogens and the frequent immune depression of the host.
We will use theseknowledge gathered on both microbial factors and host responses to developnovel therapeutic strategies to prevent or fight nosocomial infections