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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
A Five-year Antimicrobial Susceptibility Trend among Bacterial Isolates from Blood Culture at a Tertiary Health Care Facility: A Retrospective Study
Correspondence Address :
Dr. Satabdi Sahu,
Senior Resident, Department of Pharmacology, Administrative Block, MKCG Medical College and Hospital, NH-59, Berhampur-760004, Odisha, India.
E-mail: sahusatabdi735@gmail.com
Introduction: Antimicrobial Agents (AMA) frequently used to treat Bloodstream Infections (BSI) when inappropriately used give rise to Antimicrobial Drug Resistance (AMR). Monitoring blood culture isolates with Antimicrobial Susceptibility Testing (AST) determines pattern of antibiotic resistance can help to promote its rational use.
Aim: To estimate clinicodemographic associates and trend of Antimicrobial Susceptibility among bacterial blood culture isolates over five-years (2019-2024).
Materials and Methods: This study was a retrospective record-based design done in the Department of Pharmacology in collaboration with the Department of Microbiology in Maharaja Krushna Chandra Gajapati, Medical College and Hospital, Berhampur, Odisha, India. All consecutive laboratory confirmed cases reported for blood culture AST using Clinical and Laboratory Standards Institute (CLSI) guidelines from December 2022 to December 2024 over five-year 2019-2024 were analysed for resistance and sensitivity pattern. All consecutive samples were taken and 1572 cases adhering to inclusion criteria were included. Percentage of AMA resistant and sensitive to different clinico-demographic associates was computed using Jamovi version 2.7.14.
Results: There was a rising trend of Antimicrobial Resistance (AMR) from 12.5% to 14.5% from 2019-2024. Statistically significant association p<0.05 were obtained for AMR patterns Ampicillin-Sulbactam-Cefepime-Ceftriaxone-Cefexime-Piperacillin-Tazobactam (AMS-CEP-CTR-CIX-PIT) with different clinicodemographic associates with A.baumannii being the predominant bacterial isolate in neonatal sepsis with a male gender preponderance. Association of sensitivity to Cotrimoxazole-Gentamycin-levofloxacin-linezolid-meropenem-teicoplanin-vancomycin (COT-GEN-LEV-LIN-MER-TEI-VAN) to different associates was also found to be statistically significant p<0.05.
Conclusion: Multidrug Resistance (MDR) being a potential matter of concern can be overcome with rational use of antibiotics and standardised timely susceptibility surveillance. Hence, AMAs which are sensitive in bacterial isolates have to be utilised judiciously to prevent further development of AMR to the existing antibiotics in future.
Antimicrobial agents, Antimicrobial resistance, Multidrug resistance
The AMR has been recognised as a major global health threat. According to the World Health Organisation (WHO), mutations in microorganisms resulting in AMR, which consequently render drugs ineffective with infections persisting and increasing the disease burden. Estimated annual burden due to AMR resulting from resistant infections indicate mortality exceeds 25000 annually (1). A systematic review on AMR published in 2016 showing estimates of disease burden across European countries proposed a mortality around 10 million annually by 2050 (2). Available data in 2008 at a national scale indicates rising AMR rates across multiple pathogens of clinical importance are MRSA- 29% has risen to 45% by 2014 (3). Extended Spectrum Beta-lactamase (ESBL) producing strains of Enterobacteriaceae is a challenge in both hospital and community settings out of which 61% E. Coli . In a multicentric study in seven tertiary care hospitals 51% Klebsiella sp. are carbapenem resistant, 65% Pseudomonas are ceftazidime resistant, 42% are imipenem resistant (3).
The Government of India has developed a National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017-2021 (4). Major gaps in AMR surveillance led urgent need for global collaboration which includes development of integrated and standard tool for population-based AMR surveillance, collaboration between AMR surveillance networks and centres to create, coordinated regional and global strategy and public health action to contain AMR (4).
Acinetobacter baumannii was the most resistant organism and showed 70% non-susceptibility to most of the antibiotics tested except colistin. Among carbapenems, non-susceptibility to imipenem was higher (82.2%) than meropenem (78.3%) (5),(6).
Generating AMR related evidence from a large number of hospitals is critical for informed decision making and moreover, the results of the culture tests are mainly available for treatment purposes but are not systematically analysed on a routine basis. A comprehensive analysis of blood specimen culture results could provide further evidence and guidance for the development of AMR control policy at the hospital and elsewhere (7).
The Indian Network for Surveillance of Antimicrobial Resistance (INSAR) was a study conducted in 15 tertiary care centres using S.aureus isolates reported an overall prevalence rate 47% showing high rates of resistance to ciprofloxacin (37.9%), nalidixic acid (96.7%), azithromycin (7.3%) and MDR in 3.4% isolates (8).
Pertaining to variations in AMAs prescribing practices within different clinical settings and geographical alterations of bacterial isolate susceptibility to AMAs and no similar study was undertaken in the concerned healthcare settings, the present study was undertaken. The present study was pursued to identify trends of antimicrobial susceptibility over a five-year period from 2019-2024 from case records of the Department of Microbiology in a tertiary care health facility of Southern Odisha.
The aim of the study was to analyse the prevalence of antimicrobial susceptibility patterns from AST reports for isolates identified in blood culture over a period of five-years (2019-2024) to understand the local priorities that can be applied to local policies and practices.
The objectives of the study are to enumerate the various species in blood culture specimens and to determine the clinico-demographic associates of antimicrobial drug susceptibility over a period of Five-years (2019-2024). The secondary objectives of the study were to plot a changing trend of antimicrobial drug susceptibility over a period of five-years (2019-2024).
The study was a retrospective record-based design done in the Department of Pharmacology in collaboration with the Department of Microbiology MKCG MCH Berhampur, data was collected from December 2022 to December 2024 from the bacteriology section of the Department of Microbiology, Maharaja Krushna Chandra Gajapati, Medical College and Hospital, Berhampur, Odisha, India from records of five-year 2019-2024. Data analysis was done from January 2025 to June 2025.
Inclusion criteria: All consecutive case reports with a provisional diagnosis of BSI associated with a bacterial isolate from blood culture susceptibility test were evaluated. The detailed clinico-demographic profile with respect to age, gender, provisional diagnosis and concerned Departments from where patients were sent for AST were documented on appropriate time and date in manually scripted and maintained records. The reports showing positive test results to AST having sensitivity to one or more AMAs selected using purposive sampling were considered as cases included.
Exclusion criteria: Those with inconclusive diagnosis, demographic details or without any isolates along with cases with ambiguous test results were excluded. Any cases with viral, tubercular or parasitic origin incongruent to isolate or susceptibility patterns to AMAs recorded were also excluded from the study to avoid data discrepancy.
All consecutive cases with a provisional diagnosis of BSI reporting for AST which was done according to Clinical and Laboratory Standards Institute (CLSI) guidelines at the Department of Microbiology were taken as defined study population. Data collection was done by the Principal Investigator from bacteriological blood culture susceptibility case records over a period of fi ve years (2019-2024). Patient confi dentiality was maintained by coding name initials thus obscuring identity. Details of case data were accessible only to the principal investigator and corresponding author. Study was approved and waiver of consent is sought from Institutional Ethics Committee (IEC) no.1362/Chairman-IEC, MKCG MCH Berhampur for the study period December 2022- December 2023.
Sample size: A total of 3078 consecutive cases were encountered from case records.
The CLSI 2025 guidelines (9) that were used to define MIC breakpoints when a phenotypic disk interpretation is provided. Two categories of susceptibility were used:
1. ‘Susceptible/Sensitive’ (S)
2. Non susceptible’ group includes isolates reported as ‘Intermediate Sensitive’ (I) and ‘Resistant’ (R) (9).
European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines for Antimicrobial Abbreviations 2025 was used in forming patterns of MDR and sensitivity of AMAs (10).
1. AMAs were abbreviated as their corresponding first three letters like AMP-AMPicillin, GEN-GENtamycin and so on.
2. For Beta-lactamase inhibitors like Amoxicillin-Clavulanate: two letters of first agent and first letter of second agent were used.
Multidrug Resistance (MDR): MDR is commonly defined as non susceptibility to at least one agent in three or more antimicrobial categories, and it is commonly defined as resistance to antimicrobial drugs from more than three classes (11).
Study Procedure
Cases reported and recorded with antimicrobial susceptibility details were collected for sensitivity to different AMAs using manually designed structured case record form validated by pharmacologists and microbiologists of respective departments. Clinico-demographic associates of all cases estimated include age, gender, Department, ward type, provisional diagnosis and bacterial isolates.
STATISTICAL ANALYSIS
Percentage denoting prevalence of sensitivity to different AMAs were computed and respective charts furnished using MS Excel. Commonly encountered sensitivity patterns of different AMAs were conglomerated in alphabetical order using European Committee on Antimicrobial Susceptibility Testing 9 (EUCAST) guideline for AMAs Abbreviation. An example is as follows: Sensitivity pattern of linezolid, teicoplanin, and vancomycin were similarly presented as LIN-TEI-VAN. Presence or absence of statistical significant association were established using Chi-square and corresponding p-value <0.05 using Jamovi version 2.7.14.
A five-year trend analysis of antimicrobial susceptibility showed rise in resistance pattern of AMS-CEP-CTR-CIX-PIT from 7/56, 12.5% to 55/378,14.5% from 2019 to 2024. Sensitivity pattern of COT-GEN-LEV-LIN-MER-TEI-VAN remained 7/56,12.5% in 2019 progressive to 52/378,13.7% with better therapeutic outcome. Similarly, the antimicrobial pattern CLI-COT-GEN- LEV-LIN-VAN had greater sensitivity trend from 2/56,3.5% in 2019 to 42/378,11.1% in 2024 (Table/Fig 1),(Table/Fig 2).
A.baumannii had highest resistance rates 532/915, 58.1% to AMS-CEP-CTR-CIX-PIT patterns but was 383/915,41.9% sensitive to COT-GEN-LEV-LIN-MER-TEI-VAN pattern. E.coli was 168/192, 87.5% resistant to AMS-CEP-CTR-CIX-PIT and 24/192,12.5% sensitive to COT-GEN-LEV-LIN-MER-TEI-VAN. 60/98, 61.1% of Klebsiella sp. and 73/86, 84.4% Pseudomonas aeruginosa were resistant to AMS-CEP-CTR-CIX-PIT. 66.7% S.aureus and 97.4% MRSA were sensitive to CLI-COT-GEN-LEV-LIN-VAN (Table/Fig 3).
Among 378 osteomyelitis cases, 184/378, 48.9% were resistant to AMS-CEP-CTR-CIX-PIT and 39/378, 10.4% were resistant to AMP-GEN-LEV while 84/378, 22.2% and 71/378, 18.7% were sensitive to COT-GEN-LEV-LIN-MER-TEI-VAN and CLI-COT-GEN-LEV-LIN-VAN. Among 372 neonatal sepsis cases, 191/372, 51.3% were sensitive to COT-GEN-LEV-LIN-MER-TEI-VAN and 181/372,48.6% were resistant to AMS-CEP-CTR-CIX-PIT. 312/500, 62.4% were sensitive to CLI-COT-GEN-LEV-LIN-VAN but all cases of POWD, diabetic foot ulcer and burn injury cases were resistant to AMP-GEN-LEV (Table/Fig 4).
Highest AMR rates to AMS-CEP-CTR-CIX-PIT were found from Paediatrics department 174/548, 31.8% but 259/548, 47.2% were sensitive to COT-GEN-LEV-LIN-MER-TEI-VAN. Among cases from Orthopaedics Department and general medicine, 143/392, 36.5% and 308/376, 81.9% were resistant to AMS-CEP-CTR-CIX-PIT. All POWD cases of General Surgery department were resistant to AMP-GEN-LEV (Table/Fig 5).
Majority AMR burden was documented from paediatrics age group 0-20 years to AMS-CEP-CTR-CIX-PIT and remained sensitive to CLI-COT-GEN-LEV-LIN-VAN. Similarly, there was a male gender preponderance observed in overall cases as well as AMR prevalence (Table/Fig 6).
Antimicrobial susceptibility in various clinico-demographic associates: The prevalence of A.baumannii was found to be predominant pathogen which was contrary to Sisay A et al., where E.coli was more prevalent, 22.8% bacterial isolate having 88.1% AMP monoresistance and 39% sensitivity towards CTR. The present study highlights A.baumannii showing highest resistance to AMA pattern AMS-CEP-CTR-CIX-PIT (58.1%) and sensitivity as 41.9% to AMA pattern COT-GEN-LEV-LZ-MRP-TEI-VAN. This may be explained in line with WHO priority list pathogens 2017 wherein A. baumannii is a critical pathogen with high resistance potential and beta-lactams group of antibiotics were the most used antibiotics of choice in both empirical as well as definitive treatment modalities. With regards to demographic details of cases, Sisay A et al., and the present study were similar in having male gender preponderance as prevalence 59.9% and 99.7%, respectively which can be attributed to male gender dominance in epidemiology of case load and disease burden. The median age of the population among middle age groups were similar at 36 years and 34 years, respectively but the present study had AMR prevalence as 32.9% highest among paediatric age groups (below 18 years) upon subgroup analysis which went on to rise 2022 onwards (12).
According to Tsalidou M et al., highest antibiotic resistance rates were observed with Amoxicillin-Clavulanate (AMC) (58%), Fluoroquinolones, Levofloxacin (LEV) (66.7%) and Ciprofloxacin (CIP) (30%) monoresistance pattern. This was different from the present study findings where highest AMR prevalence of beta lactamase inhibitor with different beta-lactam antibiotics AMS-CEP-CTR-CIX-PIT (13). It shows frequent use of these drugs in most of the infections as provisional diagnosis encountered which culminated into AMR over the period of time. This present retro-prospective study analysed the data from 2019-2024 found A. baumannii had 41.9% sensitivity towards COT-GEN-LEV-LIN-MER-TEI-VAN. But Tsalidou M. et al., conducted during the same time period which depicted A. baumannii was only sensitive to colistin whereas exhibited pan-drug resistance to penicillin, cephalosporins and carbapenemns (13). This may be due to geographical variation in microbial susceptibility to AMAs and different prescription practices and AMAs usage patterns. In the present study, 55.4% overall sensitivity rate with prevalence of resistance to COT-GEN-LEV-LIN-MER-TEI-VAN was recorded which was the same pattern in the same species Enterococcus sp. i.e., 57.7% in the above study. This explains development of AMR may also be affected by host factors and topographical factors rather than just being influenced by clinico-demographic factors and acquired or transmitted genetic mutations of the microbial agents. The present study result showed overall AMR rates 31.8% highest from paediatrics department. An upsurge of AMR burden among neonatal sepsis 372 cases were reported and of these 48.6% were resistant to AMS-CEP-CTR-CIX-PIT and 51.4% sensitive to COT-GEN-LEV-LIN-MER-TEI-VAN. Hence, the present study predicted a shift of AMR burden from adult middle aged surgery cases towards paediatric neonatal sepsis cases over the study period. But the study conducted by Tsalidou M et al., found higher AMR rates from the general medicine department as 21.4% that differed from us which may be due to different study setting (13).
Delving deeper into the rise in AMR in paediatric neonatal sepsis cases, the present study had a purview of increasing cases taken for AST reporting and subsequent analysis of this study. This was opposite in another study, Fang P et al., which found Klebsiella sp. as predominant Gram- negative pathogen having 79.3% AMR prevalence in neonatal sepsis late-onset type to imipenem and meropenem and MDR trend declined from 2019 to 2022 which they attributed to restricted acceptance of patient referrals and less patient hospital admission (14).
AMR scenario of year-2020 in the present study, A. baumannii isolates in endocarditis cases from the medicine ward were resistant to AMS-CEP-CTR-CIX-PIT (3rd and 4th generation cephalosporins). It might explain Hospital Acquired Infections (HAIs) being a substantial source of infective pathogens. These pathogens may be having suboptimal drug exposure due to incomplete treatment regimens or inadvertently used empirical broad spectrum antibiotics giving rise to AMR. This microorganism may have acquired resistance due to nosocomial infections which is common in clinical settings having huge patient load, improper sanitation and prolonged hospital stay duration. This simulated study Kindu M et al., performing profiling MDR of gram negative bacteria in ICU patients. It found carbapenemase producing A. baumannii 88.2% resistant to ceftazidime and 94.1% resistant to cefuroxime and also showed higher resistance rates to other groups of antibiotics which exhibited MDR (15).
Studies have found that contaminated fomites of the hospital environment not only harbour resistant pathogens leading to biofilm formation but also carry out person to person transmission of MDR difficult-to-treat pathogens (16),(17). Composed of structured entities like extracellular polymeric substances- polysaccharides, proteins, and extracellular Deoxyribonucleic Acid (DNA)-bacterial biofilms confer resistance through multiple mechanisms, including impeding the cell cycle, facilitating horizontal gene transfer, secreting enzymes that alter or bind antibiotics, and limiting antibiotic diffusion (18),(19).
Majority cases in the present study during year 2020 were from Orthopaedics Department, 61.1% Klebsiella sp. in osteomyelitis were resistant to AMS-CEP-CTR-CIX-PIT. ESKAPE (Enterococcus faecium, S. aureus, A. baumannii, K. pneumonia, Enterobacter species, and P. aeruginosa) pathogens were found to be the major cause of MDR sepsis, pathogens have shown noticeable resistance to β-lactam antibiotics. Moreover, Extended-spectrum beta lactamase (ESBL) production is far higher in Klebsiella sp. in cases of sepsis. Infections with Klebsiella sp., are a significant concern in ICU patients with MDR sepsis. Studies have identified an almost 51% incidence of infection in Intensive Care Unit (ICU) patients, with infection incidence density ranging from 13 to 20.3 episodes per thousand patient days (20),(21),(22). Hence, P. aeruginosa and Klebsiella sp. causes both acute and chronic hospital acquired and severe respiratory infections. Like A. baumannii, P. aeruginosa and Klebsiella sp. can produce β-lactamases. Moreover, this pathogen can confer resistance through gene mutation, resulting in overexpression of AmpC β-lactamases (23).
Doing a trans-analysis of AMR trend in present study, it was seen that in year 2022, 84.4% P. aeruginosa isolates were resistant to AMS-CEP-CTR CIX-PIT in endocarditis cases from general medicine department which had a majority AMR burden in that period. In 2022, where P. aeruginosa had 15.6% sensitivity towards COT-GEN-LEV-LIN-MER-TEI-VAN. This may explain there must be a presence of changing AMAs prescribing practices within the clinical settings depending upon different clinicopathological patient encounters. AST reports showing resistance and sensitivity to AMAs which were personalised and patient centric in a particular case scenario affects clinician’s choice of antibiotic. But rational use should be mandated to prevent AMR to antibiotics which were deemed initially sensitive in patients.
In the present study from the year 2021 onwards, 100% S.aureus and MRSA were resistant to AMS-CEP-CTR-CIX-PIT patterns in the majority of osteomyelitis cases. 66.7% S.aureus and 97.4% MRSA were sensitive to CLI-COT-GEN-LEV-LIN-VAN. Notably, there were no isolated Staphylococci strains that exhibited resistance to either vancomycin or linezolid. This pattern of Antimicrobial Susceptibility decreased in subsequent years (2022-23) but remained as higher in prevalence than other AMAs patterns. This was similar to the findings of Li K et al., that a comprehensive survey of blood culture-positive isolated specimens (2018 to 2021) yielded a total of 336 S. aureus and 117 Coagulase-negative Staphylococcus (CoNS) strains. The detection rates of MRSA were 39.3% (24). In cases where staphylococci induce BSIs, vancomycin or linezolid may be used. Vancomycin and linezolid are preferred options for treating patients with some antimicrobial gram-positive bacteria, such as MRSA, because of their effectiveness against these bacteria (25). S. aureus and MRSA, which cause mild and severe life-threatening skin and soft-tissue infections, pleuropulmonary, bacterial endocarditis, and device-related infections, have decades of AMR history (26).
The present study showed a peculiar trend of Enterococcus sp. as a causative pathogen of diabetic foot ulcer, burn injury, Pus or Wound Discharge (POWD) cases were 100% resistant to AMP-GEN-LEV in POWD cases from surgery and Orthopaedics Department. This again showed the isolate developed MDR to penicillins (AMP) and aminoglycosides (GEN) and fluroquinolones (LEV) which were sensitive in preceding years. This is in line with the evidence provided by Aslangul E et al., in-vitro analysis of selected mutants that exhibited increased gentamycin resistance suggested that impaired uptake of gentamycin can contribute directly to enhanced resistance (27).
While the present study projected E.coli AMA susceptibility trend as 87.5% resistance to AMS-CEP-CTR-CIX-PIT pattern and 12.5% sensitivity to COT-GEN-LEV-LIN-MER-TEI-VAN pattern. Hence, a rise in AMR to penicillin, cephalosporins were observed. Daneman et al., showed AMR following E.coli bacteraemia to 46.8% aminopenicillins and 26.5% to fluroquinolones (28).
In the present study, Micrococcus was a causative pathogen in bacterial endocarditis and peritonitis was 80.4% sensitive to COT-GEN-LEV-LIN-MER-TEI-VAN pattern. Minghui Z et al., suggested Micrococcus sp. BSI was present in immunocompromised patients or those with former invasive surgeries or with indwelling catheters. Isolates were less sensitive to erythromycin, gentamycin, cephalosporins, levofloxacin and carbapenems. Hence, the shift in choice of AMAs for empirical therapy to vancomycin and teicoplanin was observed (29).
Limitation(s)
Being a retrospective trend study, prevalence of overall antimicrobial susceptibility and a temporal variation over a five-year period was analysed which gives a snapshot of antimicrobial susceptibility pattern in this tertiary healthcare settings over the past five-years. It was unicentric study, a multicentric population based survey would be more predictive of antibiogram. The cases were evaluated from manually designed records which also has a probability of commission of errors. Some causative pathogen of Blood Stream Infections (BSIs) like Salmonella typhi, Group-B Streptococci, Haemophilus influenzae were not found and newer agents like daptomycin, colistin were not tested which could have contributed to the rationality of the study. Proper case history with co-morbidities or delineation of patients as from outpatient, inpatient or emergency were not done. A total of 99.7% males were reported. But as data were taken from case records any manual mistake upon data entry may be a limitation.
The present day AMR scenario is transitioning into the “Post-antibiotic era” where no new antibiotics developed and existing ones were simultaneously becoming resistant. This can lead to pan-drug resistance where Enterococcus faecium, Staphylococcus aureus, and Klebsiella pneumonia (ESKAPE) pathogens would be resistant to commonly used broad spectrum AMAs. The study was single centric tertiary healthcare facility-based trend analysis of antimicrobial susceptibility profiling. An antibiogram which is defined as a multicentric periodic profiling of AMAs, susceptibility patterns of pathogens to track the AMR patterns in broader geographical areas could be a potential guide for prescribers in selecting AMAs for empirical treatment of diseases. Antibiotic lock therapy by instillation of antibiotic solution in the lumen and allowing it to dwell for a specific time period to eradicate bacterial biofilms and prevent luminal colonisation in catheter related BSIs is a novel targeted drug delivery systems to lower chances of suboptimal antibiotics exposure thereby decreasing AMR.
A five-year antimicrobial susceptibility trend among bacterial isolates from blood culture AST reports encountered A.baumannii as predominant bacterial isolate from blood culture in BSIs. There was an increased prevalence of AMR and decreasing sensitivity of beta-lactamase inhibitors and beta lactam antibiotic pattern AMS-CEP-CTR-CIX-PIT with a rising trend from 2019 in osteomyelitis cases among 21-40 years age group to 2024 in neonatal sepsis with A.baumannii as predominant pathogen and a male gender preponderance. MDR being a potential matter of concern can be overcome with rational use of antibiotics and standardised timely susceptibility surveillance. Hence, AMAs which are sensitive in bacterial isolates have to be utilised judiciously to prevent further development of AMR to the existing antibiotics in future.
DOI: 10.7860/JCDR/2026/86099.24414
Date of Submission: Dec 27, 2025
Date of Peer Review: Mar 17, 2026
Date of Acceptance: Jun 15, 2026
Date of Publishing: Sep 01, 2026
Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 30, 2025
• Manual Googling: Jun 11, 2026
• iThenticate Software: Jun 13, 2026 (1%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com