Antimicrobial Resistance Dynamics of Pseudomonas Aeruginosa in a Tertiary Care Hospital in Delhi

Authors

  • Seema Gangar Department of Microbiology, Holy Family Hospital, Delhi, India
  • Nisha Goyal Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi University, Delhi, India
  • Nimisha Jain Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi University, Delhi, India
  • Hage Yaja Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi University, Delhi, India
  • Neha Sharma Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi University, Delhi, India
  • Shukla Das Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi University, Delhi, India

DOI:

https://doi.org/10.21276/apalm.3700

Keywords:

pseudomonas aeruginosa, antimicrobial resistance, hospital-acquired infections, icmr

Abstract

Background: Pseudomonas aeruginosa, non-fermenting gram-negative bacilli are a major cause of healthcare-associated infections. The rise in multidrug-resistant (MDR) strains globally has been associated with increased morbidity and mortality. In India, antimicrobial resistance (AMR) presents a significant challenge, necessitating effective policies and infection control measures. This study explores the resistance dynamics of P. aeruginosa in a tertiary care hospital, evaluating the findings in relation to the data from the Indian Council of Medical Research (ICMR).

Methods: A total of 1,536 P. aeruginosa isolates from 31997 clinical samples of pus, wound, and burn swabs, respiratory specimens and body fluids submitted for routine culture were analyzed. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Blood, urine, cerebrospinal fluid (CSF), and stool were excluded.

Results: P. aeruginosa accounted for 5th most frequent pathogen with prevalence declining from 15.7% (136/869) in 2020 to 7.7% (249/3236) in 2024. Among the isolates, 34.2% (525/1536) were susceptible to all tested antimicrobials, while 13.2% (203/1536) were MDR and 10.6% (163/1536) were extensively drug-resistant (XDR). Improved susceptibility was observed for piperacillin-tazobactam, carbapenems, aztreonam, and aminoglycosides, whereas, fluoroquinolones and monobactams showed persistently low susceptibility.

Conclusion: Continuous monitoring of MDR pathogens like P. aeruginosa and their resistance dynamics are crucial for guiding treatment strategies and infection control measures.

References

1. Farzin A, Mizanur Rahman Md, Ara Mollika F. Pseudomonas aeruginosa: The Alarming Pathogen of Hospital Acquired Infection in Pseudomonas aeruginosa—new perspectives and applications .IntechOpen; 2023 Available from: http://dx.doi.org/10.5772/intechopen.110249

2. Reynolds D, Kollef M. The epidemiology and pathogenesis and treatment of Pseudomonas aeruginosa infections: an update. Drugs. 2021 Dec;81(18):2117-31.

3. Pyle-Eilola AL. Guidelines for monitoring vancomycin, aminoglycosides, and other antibiotics." Therapeutic Drug Monitoring. Academic Press, 2024. 197-215.

4. Gin A, Dilay L, Karlowsky JA, Walkty A, Rubinstein E, Zhanel GG. Piperacillin–tazobactam: a β-lactam/β-lactamase inhibitor combination. Expert review of anti-infective therapy. 2007;5(3):365-83.

5. Bhatt S, Chatterjee S. Fluoroquinolone antibiotics: Occurrence, mode of action, resistance, environmental detection, and remediation–A comprehensive review. Environmental Pollution. 2022;315:120440.

6. Ji B, Ye W. Prevention and control of hospital-acquired infections with multidrug-resistant organism: A review. Medicine. 2024;103(4):e37018.

7. Bazghandi SA, Arzanlou M, Peeridogaheh H, Vaez H, Sahebkar A, Khademi F. Prevalence of virulence genes and drug resistance profiles of Pseudomonas aeruginosa isolated from clinical specimens. Jundishapur Journal of Microbiology. 2021;14(8).

8. Morehead MS, Scarbrough C. Emergence of global antibiotic resistance. Primary care: clinics in office practice. 2018;45(3):467-84.

9. Coppola N, Maraolo AE, Onorato L, Scotto R, Calò F, Atripaldi L et al. Epidemiology, mechanisms of resistance and treatment algorithm for infections due to carbapenem-resistant gram-negative bacteria: an expert panel opinion. Antibiotics. 2022;11(9):1263.

10. Melchiorri D, Rocke T, Alm RA, Cameron AM, Gigante V. Addressing urgent priorities in antibiotic development: insights from WHO 2023 antibacterial clinical pipeline analyses. The Lancet Microbe. 2024. Available from: https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00260-X/fulltext.

11. Le Terrier C, Nordmann P, Poirel L. In vitro activity of aztreonam in combination with newly developed β-lactamase inhibitors against MDR Enterobacterales and Pseudomonas aeruginosa producing metallo-β-lactamases. Journal of Antimicrobial Chemotherapy. 2023;78(1):101-7.

12. Nair M, Zeegers MP, Varghese GM, Burza S. India's national action plan on antimicrobial resistance: a critical perspective. Journal of Global Antimicrobial Resistance. 2021;27:236-8.

13. Ranjalkar J, Chandy SJ. India's National Action Plan for antimicrobial resistance–An overview of the context, status, and way ahead. Journal of family medicine and primary care. 2019;8(6):1828-34.

14. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical Microbiology and Infection. 2012;18(3):268–281.

15. CLSI. 2020. Performance standards for antimicrobial susceptibility testing, M100, 30th ed. Clinical and Laboratory Standards Institute, Wayne, PA.

16. CLSI. 2021. Performance standards for antimicrobial susceptibility testing, M100, 31st ed. Clinical and Laboratory Standards Institute, Wayne, PA.

17. CLSI. 2022. Performance standards for antimicrobial susceptibility testing, M100, 32nd ed. Clinical and Laboratory Standards Institute, Wayne, PA.

18. CLSI. 2023. Performance standards for antimicrobial susceptibility testing, M100, 33rd ed. Clinical and Laboratory Standards Institute, Wayne, PA.

19. CLSI. 2024. Performance standards for antimicrobial susceptibility testing, M100, 34th ed. Clinical and Laboratory Standards Institute, Wayne, PA.

20. Annual Report. AMR Surveillance Network, Indian Council of Medical Research, 2023. (Accessed on 20th December,2024) Available from: https://www.icmr.gov.in/icmrobject/uploads/Documents/1725536060_annual_report_2023.pdf.

21. Annual Reports. Indian Council of medical research. (Accessed on 20th December,2024). Available from: https://www.icmr.gov.in/annual-reports

22. Vincent JL, Sakr Y, Singer M, Martin-Loeches I, Machado FR, Marshall JC et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. Jama. 2020;323(15):1478-87.

23. Harris AD, Jackson SS, Robinson G, Pineles L, Leekha S, Thom KA et al. Pseudomonas aeruginosa colonization in the intensive care unit: prevalence, risk factors, and clinical outcomes. Infection control & hospital epidemiology. 2016;37(5):544-8.

24. CDC. Antibiotic Resistance Threats in the United States; Department of Health and Human Services, CDC: Atlanta, GA, USA, 2019; pp. 87–88. (Accessed on 28th December 2024). Available online: https://www.cdc.gov/antimicrobial-resistance/media/pdfs/2019-ar-threats-report-508.pdf

25. Sader HS, Castanheira M, Duncan LR, Flamm RK. Antimicrobial susceptibility of Enterobacteriaceae and Pseudomonas aeruginosa isolates from United States medical centers stratified by infection type: results from the International Network for Optimal Resistance Monitoring (INFORM) surveillance program, 2015–2016. Diagnostic microbiology and infectious disease. 2018;92(1):69-74.

26. Al-Orphaly M, Hadi HA, Eltayeb FK, Al-Hail H, Samuel BG, Sultan AA et al. Epidemiology of multidrug-resistant Pseudomonas aeruginosa in the Middle East and North Africa Region. Msphere. 2021;6(3):10-128.

27. Kaleem Ullah M, Malamardi S, Siddaiah JB, Prashant A, Vishwanath P, Riley LW et al. Trends in the bacterial prevalence and antibiotic resistance patterns in the acute exacerbation of chronic obstructive pulmonary disease in hospitalized patients in South India. Antibiotics. 2022;11(11):1577.

28. Saeli N, Jafari-Ramedani S, Ramazanzadeh R, Nazari M, Sahebkar A, Khademi F. Prevalence and mechanisms of aminoglycoside resistance among drug-resistant Pseudomonas aeruginosa clinical isolates in Iran. BMC Infectious Diseases. 2024;24(1):680.

29. Krovvidi S, Penmetcha U, Shaik N, Yarlagadda P, Sumana P. Antimicrobial resistance patterns of pathogens isolated in patients from a tertiary care hospital in Andhra Pradesh, South India. Journal of Dr. YSR University of Health Sciences. 2023;12(4):313-21.

30. Reddy SG, Bilolikar AK, Kakarla PL, Udayasree B. Prevalence and antibiogram of Pseudomonas aeruginosa isolated from various clinical samples in a tertiary care ICU setting. J Med Sci Res. 2018;6(2):44-8.

31. WHO Regional Office for Europe/European Centre for Disease Prevention and Control. Antimicrobial Resistance Surveillance in Europe 2022–2020 Data; WHO Regional Office for Europe: Copenhagen, Denmark, 2022. (Accessed on 29, December, 2024). Available online: https://www.ecdc.europa.eu/sites/default/files/documents/ECDC-WHO-AMR-report.pdf

32. Weiner-Lastinger LM, Abner S, Edwards JR, Kallen AJ, Karlsson M, Magill SS et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: summary of data reported to the National Healthcare Safety Network, 2015–2017. Infection Control & Hospital Epidemiology. 2020;41(1):1-8.

33. Tenover FC, Nicolau DP, Gill CM. Carbapenemase-producing Pseudomonas aeruginosa–an emerging challenge. Emerging microbes & infections. 2022;11(1):811-4.

34. Varaiya A, Gupta A, Siddiqui AH, Poojary A, Tarai B, et al. Antimicrobial Resistance and Susceptibility Patterns among Gram-negative Bacteria Isolated from ICU–An Indian Study. SSR Inst Int J Life Sci. 2024;10(4): 5847-5855.

Downloads

Published

05-01-2026

Issue

Section

Original Article

How to Cite

1.
Antimicrobial Resistance Dynamics of Pseudomonas Aeruginosa in a Tertiary Care Hospital in Delhi. Ann of Pathol and Lab Med [Internet]. 2026 Jan. 5 [cited 2026 Feb. 1];13(1):A33-A40. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/3700