Antibiogram profiles of bacteria isolated from different clinical samples among patients admitted to a teaching hospital in Andhra Pradesh: A cross-sectional study.

Dr Anand  Acharya; Dr.  Rao   Nageswara; Dr. Siddharth  Pimpalkar

doi:10.51168/sjhrafrica.v6i12.2338

Authors

Dr. Anand Acharya Dean and Professor, Department of Pharmacology, Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh, India
Dr. Nageswara Rao T Associate Professor, Department of Pharmacology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
Dr. Siddharth Pimpalkar Professor, Department of Microbiology, Shri Shankaracharya Institute of Medical Sciences, Durg (Bhilai), Chhattisgarh, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2338

Keywords:

Antibiogram, Antimicrobial resistance, Empirical therapy, Gram-negative bacilli, multidrug resistance

Abstract

Background:
This study evaluated the cumulative antibiogram profiles of bacterial isolates recovered from diverse clinical specimens among hospitalized patients at a tertiary-care teaching hospital in Andhra Pradesh, India.

Methods:
A cross-sectional, laboratory-based study was conducted from January 2024 to September 2024 in the Department of Pharmacology, in collaboration with the Department of Microbiology, Konaseema Institute of Medical Sciences and Research Foundation (KIMS & RF), Amalapuram. A total of 5,747 clinical specimens, including blood, urine, respiratory samples, pus, and body fluids, were processed. Significant bacterial growth was observed in 2,170 samples (37.7%). Isolates were identified using standard biochemical methods and confirmed with an automated system (VITEK-2). Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion technique and interpreted according to CLSI M100 (2024) guidelines. Cumulative antibiograms were prepared in accordance with CLSI M39 recommendations.

Results:
Gram-negative bacilli constituted 72% of isolates, with Escherichia coli and Klebsiella pneumoniae being predominant. Non-fermenting Gram-negative organisms, notably Pseudomonas aeruginosa and Acinetobacter baumannii, were frequently isolated. Gram-positive cocci accounted for 28%, mainly Staphylococcus aureus and Enterococcus species. Among Gram-negative isolates, carbapenems (75–85%), piperacillin–tazobactam (60–70%), and amikacin (≈70%) demonstrated the highest susceptibility. Methicillin-resistant Staphylococcus aureus prevalence was 40%. All Gram-positive isolates remained uniformly susceptible to vancomycin (100%) and highly susceptible to linezolid (98%). Multidrug resistance was observed in approximately 35–45% of isolates.

Conclusion:
The findings reveal a predominance of Gram-negative pathogens with a considerable burden of multidrug resistance among inpatients. While carbapenems, β-lactam/β-lactamase inhibitor combinations, and amikacin remain effective against Gram-negative organisms, glycopeptides and oxazolidinones continue to be reliable options for Gram-positive infections.

Recommendations:
Regular updating of hospital antibiograms, strict adherence to antimicrobial stewardship principles, reinforcement of infection prevention and control practices, and judicious use of reserve antibiotics are strongly recommended to limit resistance progression and improve clinical outcomes.

Author Biographies

Dr. Anand Acharya, Dean and Professor, Department of Pharmacology, Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh, India

MBBS, MD (Pharmacology), currently serves as Dean and Professor, Department of Pharmacology, at the Konaseema Institute of Medical Sciences & Research Foundation (KIMS&RF), Amalapuram, Andhra Pradesh, India. A distinguished academician, researcher, and medical education leader, he has been pivotal in transforming KIMS&RF from its formative phase into a premier medical institution with over 200 undergraduate and 100 postgraduate seats.

With more than 18 years of teaching and administrative experience, Dr. Acharya has held several leadership positions, including Vice Principal, Principal, Chief Warden, Member Secretary of Institutional Ethics and Animal Ethics Committees, and is an approved PhD Guide under Dr. NTR University of Health Sciences, Vijayawada. His visionary leadership has significantly enhanced the institution’s academic quality, clinical exposure, research infrastructure, and postgraduate training standards.

He has successfully completed prestigious national faculty development programs such as the Revised Basic Course Workshop (rBCW), Advanced Course in Medical Education (ACME), and National Teacher Training Course (NTTC, JIPMER, Puducherry). He also serves as Coordinator for Pharmacovigilance and Materiovigilance Programs under IPC–PvPI and MoHFW, Government of India, contributing actively to national drug safety and regulatory initiatives.

A prolific academician, Dr. Acharya has authored and co-authored more than 100 scientific publications in reputed national and international indexed journals. His wide-ranging research covers toxicology, pharmacovigilance, antimicrobial resistance, endocrinology, neuropharmacology, and clinical pharmacology. His recent studies include long-term analyses of pyrethroid, paraquat, and chlorpyrifos poisoning, investigations into antimicrobial resistance trends, and predictive models for treatment outcomes in dermatological and toxicological emergencies.

Dr. Acharya’s professional interests include clinical pharmacology, toxicovigilance, rational drug use, pharmacovigilance systems, and innovations in medical education technologies. He continues to mentor numerous postgraduate and undergraduate researchers while playing an integral role in curriculum reform, ethics governance, and institutional academic advancement.ORCID iD: https://orcid.org/0009-0000-7967-9092

Dr. Nageswara Rao T, Associate Professor, Department of Pharmacology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India

is currently serving as an Associate Professor of Pharmacology at Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, East Godavari District, Andhra Pradesh, India. He holds a doctoral degree in Medical Pharmacology from the prestigious Index Medical College and Research Institute, Madhya Pradesh. With over 16 years of teaching experience in various medical institutions, Dr. Nageswararao has made significant contributions to the field of pharmacology. His academic work includes nine research publications in reputed national and international journals, including one article indexed in PubMed. His dedication to research and education continues to enrich the academic and clinical landscape of medical pharmacology.T.Nageswararao:https://orcid.org/0009-0005-1638-6897

Dr. Siddharth Pimpalkar, Professor, Department of Microbiology, Shri Shankaracharya Institute of Medical Sciences, Durg (Bhilai), Chhattisgarh, India

is a Professor in the Department of Microbiology at Shri Shankaracharya Institute of Medical Sciences, Durg (Bhilai), Chhattisgarh, India. He has extensive experience in medical microbiology, with academic and clinical expertise spanning bacteriology, antimicrobial resistance, and hospital infection control. His professional interests include diagnostic microbiology, antibiogram development, and antimicrobial stewardship, with active involvement in teaching, research, and mentoring undergraduate and postgraduate medical students.

References

Okeke IN, de Kraker MEA, Van Boeckel TP, Kumar CK, Schmitt H, Gales AC, Bertagnolio S, Sharland M, Laxminarayan R. The scope of the antimicrobial resistance challenge. Lancet. 2024 Jun 1;403(10442):2426-2438. doi: 10.1016/S0140-6736(24)00876-6. Epub 2024 May 23. Erratum in: The Lancet. 2024 Sep 14;404(10457):1018. doi: 10.1016/S0140-6736(24)01879-8. PMID: 38797176.

Laxminarayan R, Chaudhury RR. Antibiotic Resistance in India: Drivers and Opportunities for Action. PLoS Med. 2016 Mar 2;13(3):e1001974. doi: 10.1371/journal.pmed.1001974. PMID: 26934098; PMCID: PMC4775002.

Mittal N, Goel P, Goel K, Sharma R, Nath B, Singh S, Thangaraju P, Mittal R, Kahkasha K, Mithra P, Sahu R, Priyadarshini RP, Sharma N, Pala S, Rohilla SK, Kaushal J, Sah S, Rustagi S, Sah R, Barboza JJ. Awareness Regarding Antimicrobial Resistance and Antibiotic Prescribing Behavior among Physicians: Results from a Nationwide Cross-Sectional Survey in India. Antibiotics (Basel). 2023 Sep 29;12(10):1496. doi: 10.3390/antibiotics12101496. PMID: 37887197; PMCID: PMC10604884.

Kaur J, Singh H, Sethi T. Emerging trends in antimicrobial resistance in bloodstream infections: multicentric longitudinal study in India (2017-2022). Lancet Reg Health Southeast Asia. 2024 May 9;26:100412. doi: 10.1016/j.lansea.2024.100412. PMID: 38757091; PMCID: PMC11097075.

Salam MA, Al-Amin MY, Salam MT, Pawar JS, Akhter N, Rabaan AA, Alqumber MAA. Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare (Basel). 2023 Jul 5;11(13):1946. doi: 10.3390/healthcare11131946. PMID: 37444780; PMCID: PMC10340576.

Humphries R, Bobenchik AM, Hindler JA, Schuetz AN. Overview of Changes to the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, M100, 31st Edition. J Clin Microbiol. 2021 Nov 18;59(12):e0021321. doi: 10.1128/JCM.00213-21. Epub 2021 Sep 22. PMID: 34550809; PMCID: PMC8601225.

Simner PJ, Hindler JA, Bhowmick T, Das S, Johnson JK, Lubers BV, Redell MA, Stelling J, Erdman SM. What's New in Antibiograms? Updating CLSI M39 Guidance with Current Trends. J Clin Microbiol. 2022 Oct 19;60(10):e0221021. doi: 10.1128/jcm.02210-21. Epub 2022 Aug 2. PMID: 35916520; PMCID: PMC9580356.

Dakorah MP, Agyare E, Acolatse JEE, Akafity G, Stelling J, Chalker VJ, Spiller OB, Aidoo NB, Kumi-Ansah F, Azumah D, Laryea S, Incoom R, Ngyedu EK. Utilising cumulative antibiogram data to enhance antibiotic stewardship capacity in the Cape Coast Teaching Hospital, Ghana. Antimicrob Resist Infect Control. 2022 Oct 3;11(1):122. doi: 10.1186/s13756-022-01160-5. PMID: 36192790; PMCID: PMC9528876.

Adamkova V, Matouskova M, Adamkova VG, Huptych M, Fontana M. The Role of Stratified Cumulative Antibiograms in the (Choice of Appropriate Antibiotics in Urinary Tract Infection) Management of Urinary Tract Infections. Pathogens. 2025 Feb 3;14(2):141. doi: 10.3390/pathogens14020141. PMID: 40005518; PMCID: PMC11858224.

Burbick CR, Fajt VR, Frey E, Fritz H, Goodman LB, Lorenz C, Lubbers BV, Marshall E, Rankin SC, Silva M. Benefits and challenges of creating veterinary antibiograms for empiric antimicrobial selection in support of antimicrobial stewardship and advancement of one-health goals. Am J Vet Res. 2023 Jun 19;84(9):ajvr.23.05.0086. doi: 10.2460/ajvr.23.05.0086. PMID: 37315936.

Lakshmi V, Ashok R, Susmita J, Shailaja VV. Changing trends in the antibiograms of Salmonella isolates at a tertiary care hospital in Hyderabad. Indian J Med Microbiol. 2006 Jan;24(1):45-8. doi: 10.4103/0255-0857.19894. PMID: 16505555.

Tiwari DK, Golia S, K T S, C L V. A study on the bacteriological profile and antibiogram of bacteremia in children below 10 years in a tertiary care hospital in Bangalore, India. J Clin Diagn Res. 2013 Dec;7(12):2732-5. doi: 10.7860/JCDR/2013/6682.3701. Epub 2013 Dec 15. PMID: 24551625; PMCID: PMC3919345.

Mohammed NB, Cherukuri RC, Pendyala J, K. Parameswari. Antibiogram of uropathogens from cases of urinary tract infections in a tertiary care hospital: A cross-sectional study. SJHR-Africa [Internet]. 2025Jun.30 [cited 2025Dec.30];6(6):9.

Bhatia R. Environmental aspects of antimicrobial resistance in India: Current progress & way forward. Indian J Med Res. 2024 Jan 1;159(1):10-15. doi: 10.4103/ijmr.ijmr_2104_23. Epub 2024 Mar 4. PMID: 38376372; PMCID: PMC10954102.

Suresh K, Pillai D, Soman M, Sreenivas A, Paul R. Isolation and identification of antimicrobial susceptibility, biofilm formation, efflux pump activity, and virulence determinants in multi-drug resistant Pseudomonas aeruginosa isolated from freshwater fishes. J Water Health. 2023 Dec;21(12):1858-1870. doi: 10.2166/wh.2023.206. PMID: 38153717.

Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007 Jan 15;44(2):159-77. doi: 10.1086/510393. Epub 2006 Dec 13. PMID: 17173212.

Kadam A, Mamulwar M, Bhambure G, Bembalkar S, Bapat S, Mane A, Rajure S, Mathaiyan J, Shafiq N, Prinja S, Ramanathan Y, Mehendale SM, Deotale VS, Khadanga S, Bhattacharya S, Gogoi G, Walia K, Panda S, Gangakhedkar R, Attal R, Mandal J, Ramanathan V, Ray P, Chatterjee S. Incremental cost of treating antimicrobial-resistant infections among hospitalised patients in India: a cohort study. BMJ Open. 2024 Dec 22;14(12):e086505. doi: 10.1136/bmjopen-2024-086505. PMID: 39806697; PMCID: PMC11664386.

Ajulo S, Awosile B. Global antimicrobial resistance and use surveillance system (GLASS 2022): Investigating the relationship between antimicrobial resistance and antimicrobial consumption data across the participating countries. PLoS One. 2024 Feb 5;19(2):e0297921. doi: 10.1371/journal.pone.0297921. PMID: 38315668; PMCID: PMC10843100.

Fernández J, Vázquez F. The Importance of Cumulative Antibiograms in Diagnostic Stewardship. Clin Infect Dis. 2019 Aug 30;69(6):1086-1087. doi: 10.1093/cid/ciz082. PMID: 30715204.

Kohlmann R, Gatermann SG. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data--The Influence of Different Parameters in a Routine Clinical Microbiology Laboratory. PLoS One. 2016 Jan 27;11(1):e0147965. doi: 10.1371/journal.pone.0147965. PMID: 26814675; PMCID: PMC4729434.

Forbes, Betty A et al. Bailey & Scott’s Diagnostic Microbiology. 12th ed. St. Louis, Mo: Elsevier Mosby, 2007. Print.

Schuetz AN, Ferrell A, Hindler JA, Humphries R, Bobenchik AM. Overview of changes in the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing: M100 32nd and 33rd editions. J Clin Microbiol. 2025 Sep 10;63(9):e0162323. doi: 10.1128/jcm.01623-23. Epub 2025 Aug 7. PMID: 40772786; PMCID: PMC12421849.

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012 Mar;18(3):268-81. doi: 10.1111/j.1469-0691.2011.03570.x. Epub 2011 Jul 27. PMID: 21793988.

Jorgensen, James H, and issuing body National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically : Approved Standard. Third edition. Villanova, PA: National Committee for Clinical Laboratory Standards, 1993. Print.

Tornimbene B, Eremin S, Escher M, Griskeviciene J, Manglani S, Pessoa-Silva CL. WHO Global Antimicrobial Resistance Surveillance System early implementation 2016-17. Lancet Infect Dis. 2018 Mar;18(3):241-242. doi: 10.1016/S1473-3099(18)30060-4. Epub 2018 Jan 29. PMID: 29396007.

Oyekale OT, Ojo BO, Olajide AT, Oyekale OI. Bacteriological profile and antibiogram of blood culture isolates from bloodstream infections in a rural tertiary hospital in Nigeria. Afr J Lab Med. 2022 Aug 24;11(1):1807. doi: 10.4102/ajlm.v11i1.1807. PMID: 36091350; PMCID: PMC9453184.

Trojan R, Razdan L, Singh N. Antibiotic Susceptibility Patterns of Bacterial Isolates from Pus Samples in a Tertiary Care Hospital of Punjab, India. Int J Microbiol. 2016;2016:9302692. doi: 10.1155/2016/9302692. Epub 2016 Oct 30. PMID: 27872643; PMCID: PMC5107258.

Shetty SC, Shenoy S, Asha PKB, Sudhindra RM, Ankeeta MJ, Shetty AK, Veena Shetty A. 730. Emerging patterns of multidrug resistance in Gram-negative bacterial infections and their clinical outcome at a tertiary medical center. Open Forum Infect Dis. 2023 Nov 27;10(Suppl 2):ofad500.791. doi: 10.1093/ofid/ofad500.791. PMCID: PMC10678109.

Peters RP, van Agtmael MA, Danner SA, Savelkoul PH, Vandenbroucke-Grauls CM. New developments in the diagnosis of bloodstream infections. Lancet Infect Dis. 2004 Dec;4(12):751-60. doi: 10.1016/S1473-3099(04)01205-8. PMID: 15567125.

Gandra S, Alvarez-Uria G, Turner P, Joshi J, Limmathurotsakul D, van Doorn HR. Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries. Clin Microbiol Rev. 2020 Jun 10;33(3):e00048-19. doi: 10.1128/CMR.00048-19. PMID: 32522747; PMCID: PMC7289787.

Gagneja D, Goel N, Aggarwal R, Chaudhary U. Changing trend of antimicrobial resistance among gram-negative bacilli isolated from lower respiratory tract of ICU patients: A 5-year study. Indian J Crit Care Med. 2011 Jul;15(3):164-7. doi: 10.4103/0972-5229.84900. PMID: 22013308; PMCID: PMC3190467.

Kollef MH, Bassetti M, Francois B, Burnham J, Dimopoulos G, Garnacho-Montero J, Lipman J, Luyt CE, Nicolau DP, Postma MJ, Torres A, Welte T, Wunderink RG. The intensive care medicine research agenda on multidrug-resistant bacteria, antibiotics, and stewardship. Intensive Care Med. 2017 Sep;43(9):1187-1197. doi: 10.1007/s00134-017-4682-7. Epub 2017 Feb 4. PMID: 28160023; PMCID: PMC6204331.

Hope M, Kiggundu R, Byonanebye DM, Mayito J, Tabajjwa D, Lwigale F, Tumwine C, Mwanja H, Kambugu A, Kakooza F. Progress of Implementation of World Health Organization Global Antimicrobial Resistance Surveillance System Recommendations on Priority Pathogen-Antibiotic Sensitivity Testing in Africa: Protocol for a Scoping Review. JMIR Res Protoc. 2024 Nov 15;13:e58140. doi: 10.2196/58140. PMID: 39546786; PMCID: PMC11607573.

Vijay S, Ramasubramanian V, Bansal N, Ohri VC, Walia K. Hospital-based antimicrobial stewardship, India. Bull World Health Organ. 2023 Jan 1;101(1):20-27A. doi: 10.2471/BLT.22.288797. Epub 2022 Nov 9. PMID: 36593779; PMCID: PMC9795386.

Lessa FC, Sievert DM. Antibiotic Resistance: A Global Problem and the Need to Do More. Clin Infect Dis. 2023 Jul 5;77(Suppl 1): S1-S3. doi: 10.1093/cid/ciad226. PMID: 37406051; PMCID: PMC10877623.

Falagas ME, Karageorgopoulos DE. Pandrug resistance (PDR), extensive drug resistance (XDR), and multidrug resistance (MDR) among Gram-negative bacilli: need for international harmonization in terminology. Clin Infect Dis. 2008 Apr 1;46(7):1121-2; author reply 1122. doi: 10.1086/528867. PMID: 18444833.

Taneja N, Sharma M. Antimicrobial resistance in the environment: The Indian scenario. Indian J Med Res. 2019 Feb;149(2):119-128. doi: 10.4103/ijmr.IJMR_331_18. PMID: 31219076; PMCID: PMC6563737.

Bhattacharya S. Early diagnosis of resistant pathogens: how can it improve antimicrobial treatment? Virulence. 2013 Feb 15;4(2):172-84. doi: 10.4161/viru.23326. Epub 2013 Jan 9. PMID: 23302786; PMCID: PMC3654618.

Smout E, Palanisamy N, Valappil SP. Prevalence of vancomycin-resistant Enterococci in India between 2000 and 2022: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2023 Aug 21;12(1):79. doi: 10.1186/s13756-023-01287-z. PMID: 37605268; PMCID: PMC10441759.