¹Aung Ba Tun,²Kyaw Khine Win,³Tun Tun Win,⁴Kyaw Wunna,⁵Khine Khine Su,⁶Kyaw Myo Tun

^1,3,6Public Health Department, Defence Services Medical Academy, Yangon, Myanmar

^2,5Microbiology Department, Defence Services Medical Academy, Yangon, Myanmar

⁴Microbiology Department, Military Institude of Nursing and Paramedical Science, Yangon, Myanmar

Antimicrobial resistance is becoming a global health emergency. Likewise, multidrug resistance of gram-negative bacteria also has a high impact on public health. This cross-sectional study aimed to study antibiotic prescription patterns and class-1 integron-associated antibiotic resistance among gram-negative bacteria in No (1) Defence Services General Hospital, Yangon. The research was conducted by modifying the WHO PPS methodology. All eligible patients who were prescribed antibiotics on the day of the survey were investigated. Among the participants whose culture samples were sent to the laboratory, gram-negative bacterial culture samples undergone the class 1 integron test. There were 441 patients from 12 eligible wards with a total of 781 prescriptions in the study in January and July of 2020. The leading indication was surgical prophylaxis 257 (32.91%). Cephalosporins and Penicillins were mostly prescribed antibiotic classes. Among bacterial culture, (52.31%) were multidrug- resistant, and (47.69%) were gram-negative. Class 1 integron positivity and rate of multidrug resistance among GNB were (54.84%) and (90.32%). Class 1 integron positivity among multidrug resistance was (60.71%). There was no statistically significant association between class 1 integron and multidrug resistance in this study. Three and more antibiotic prescriptions, surgical prophylaxis, and old age group were positively associated with multi-drug resistance with (AOR=8.9, 95% CI; 2.3-34.2), (AOR=21.1, 95% CI; 2.1-210.0), and (AOR=4.6, 95%CI; 1.2-17.2) respectively. Antibiotic policy and standard treatment guidelines for the tertiary military hospital should be developed while surveillance of antibiotic resistance must be performed simultaneously.

Antimicrobial resistance, class-1 integron, PPS methodology, gram-negative bacteria

1) Maugeri, G., Lychko, I., Sobral, R., & Roque, A. C. A. (2019). Identification and Antibiotic-Susceptibility Profiling of Infectious Bacterial Agents: A Review of Current and Future Trends. Biotechnol J, 14(1), e1700750. https://doi.org/10.1002/biot.201700750

2) Kapoor, G., Saigal, S., & Elongavan, A. (2017). Action and resistance mechanisms of antibiotics: A guide for clinicians. J Anaesthesiol Clin Pharmacol, 33(3), 300-305. https://doi.org/10.4103/joacp.JOACP_349_15

3) WHO. (2015). Global Action Plan on Antimicrobial Resistance. WHO.

4) Kaushik, M., Kumar, S., Kapoor, R. K., Virdi, J. S., & Gulati, P. (2018). Integrons in enterobacteriaceae: diversity, distribution and epidemiology. International Journal of antimicrobial agents, 51(2), 167-176.

5) Win, K. K. (2022). “Molecular Detection of Class 1 Integron Gene and Antibiotics Susceptibility Patterns of Pseudomonas Species Isolated from Clinical Specimens”. AIJR Preprints, 413, Version 1, 2022.

6) Thu, M. K. (2022). “Detection of Class 1 Integron Among Klebsiella Species Isolated from Clinical Samples at No (1) Defence Services General Hospital (1000 Bedded)”. AIJR Preprints, 414, Version 1, 2022.

7) WHO. (2018). Methodology for Point Prevalence Survey of antibiotic use in hospitals. WHO.

8) Oo, W. T., Carr, S. D., Marchello, C. S., San, M. M., Oo, A. T., Oo, K. M., . . . Crump, J. A. (2022). Point-prevalence surveys of antimicrobial consumption and resistance at a paediatric and an adult tertiary referral hospital in Yangon, Myanmar. Infect Prev Pract, 4(1), 100197. https://doi.org/10.1016/j.infpip.2021.100197

9) Williams, A., Mathai, A. S., & Phillips, A. S. (2011). Antibiotic prescription patterns at admission into a tertiary level intensive care unit in Northern India. J Pharm Bioallied Sci, 3(4), 531-536. https://doi.org/10.4103/0975-7406.90108

10) Sydenham, R. V., Justesen, U. S., Hansen, M. P., Pedersen, L. B., Aabenhus, R. M., Wehberg, S., & Jarbøl, D. E. (2021). Prescribing antibiotics: the use of diagnostic tests in general practice. A register-based study. Scandinavian Journal of Primary Health Care, 39(4), 466-475. https://doi.org/10.1080/02813432.2021.2004721

11) Limato, R., Nelwan, E. J., Mudia, M., de Brabander, J., Guterres, H., Enty, E., . . . Hamers, R. L. (2021). A multicentre point prevalence survey of patterns and quality of antibiotic prescribing in Indonesian hospitals. JAC Antimicrob Resist, 3(2), dlab047. https://doi.org/10.1093/jacamr/dlab047

12) Demoz, G. T., Kasahun, G. G., Hagazy, K., Woldu, G., Wahdey, S., Tadesse, D. B., & Niriayo, Y. L. (2020). Prescribing Pattern of Antibiotics Using WHO Prescribing Indicators Among Inpatients in Ethiopia: A Need for Antibiotic Stewardship Program. Infect Drug Resist, 13, 2783-2794. https://doi.org/10.2147/IDR.S262104

13) Amponsah, O. K. O., Buabeng, K. O., Owusu-Ofori, A., Ayisi-Boateng, N. K., Hameen-Anttila, K., & Enlund, H. (2021). Point prevalence survey of antibiotic consumption across three hospitals in Ghana. JAC Antimicrob Resist, 3(1), dlab008. https://doi.org/10.1093/jacamr/dlab008

14) Horumpende, P. G., Mshana, S. E., Mouw, E. F., Mmbaga, B. T., Chilongola, J. O., & de Mast, Q. (2020). Point prevalence survey of antimicrobial use in three hospitals in North-Eastern Tanzania. Antimicrob Resist Infect Control, 9(1), 149. https://doi.org/10.1186/s13756-020-00809-3

15) Lim, C., Takahashi, E., Hongsuwan, M., Wuthiekanun, V., Thamlikitkul, V., Hinjoy, S., . . . Limmathurotsakul, D. (2016). Epidemiology and burden of multidrug-resistant bacterial infection in a developing country. Elife, 5. https://doi.org/10.7554/eLife.18082

16) Bitew, A., & Tsige, E. (2020). High Prevalence of Multidrug-Resistant and Extended-Spectrum beta-Lactamase-Producing Enterobacteriaceae: A Cross-Sectional Study at Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia. J Trop Med, 2020, 6167234. https://doi.org/10.1155/2020/6167234

17) Alam, M. M., Islam, M. N., Hossain Hawlader, M. D., Ahmed, S., Wahab, A., Islam, M., . . . Hossain, A. (2021). Prevalence of multidrug resistance bacterial isolates from infected wound patients in Dhaka, Bangladesh: A cross-sectional study. International Journal of Surgery Open, 28, 56-62. https://doi.org/10.1016/j.ijso.2020.12.010

18) Agyepong, N., Govinden, U., Owusu-Ofori, A., & Essack, S. Y. (2018). Multidrug-resistant gram-negative bacterial infections in a teaching hospital in Ghana. Antimicrob Resist Infect Control, 7, 37. https://doi.org/10.1186/s13756-018- 0324-2

19) Nagvekara, V., Sawantb, S., & Ameyc, S. (2020). Prevalence of multidrug-resistant Gram-negative bacteria cases at admission in a multispeciality hospital. Journal of Global Antimicrobial Resistance, 22, 457-461. https://doi.org/10.1016/j.jgar.2020.02.030

20) Chaisathaphol, T., & Chayakulkeeree, M. (2014). Epidemiology of infections caused by multidrug-resistant gram-negative bacteria in adult hospitalized patients at Siriraj Hospital. Journal of the Medical Association of Thailand, 97.

21) Huang, J., Lan, F., Lu, Y., & Li, B. (2020). Characterization of Integrons and Antimicrobial Resistance in Escherichia coli Sequence Type 131 Isolates. Canadian Journal of Infectious Diseases and Medical Microbiology, 2020, 3826186. https://doi.org/10.1155/2020/3826186

22) Barraud, O., Guichard, E., Chainier, D., Postil, D., Chimot, L., Mercier, E., . . . François, B. (2022). Integrons, a predictive biomarker for antibiotic resistance in acute sepsis: the IRIS study. Journal of Antimicrobial Chemotherapy, 77(1), 213-217.

23) Moosavian, M., Khoshkholgh Sima, M., Haddadzadeh Shoushtari, M., & Fazeli Naserabad, M. a. (2018). Detection of Class 1 Integrons among Gram-negative Bacilli Isolated from Sputum Cultures of Patients with Lower Respiratory Tract Infections in Ahvaz, Iran. Journal of Medical Microbiology and Infectious Diseases, 6(4), 103-107. https://doi.org/10.29252/JoMMID.6.4.103

24) Pormohammad, A., Pouriran, R., Azimi, H., & Goudarzi, M. (2019). Prevalence of integron classes in Gram-negative clinical isolated bacteria in Iran: a systematic review and meta-analysis. Iran J Basic Med Sci, 22(2), 118-127. https://doi.org/10.22038/ijbms.2018.32052.7697

25) Al-Hammadi, M. A., Al-Shamahy, H. A., Ali, A. Q., Abdulghani, M. A. M., Pyar, H., & Al-Suboal, I. (2020). Class 1 Integrons in Clinical Multi Drug Resistance E. coli, Sana'a Hospitals, Yemen. Pak J Biol Sci, 23(3), 231-239. https://doi.org/10.3923/pjbs.2020.231.239

26) Huang, J., Lan, F., Lu, Y., & Li, B. (2020). Characterization of Integrons and Antimicrobial Resistance in Escherichia coli Sequence Type 131 Isolates. Canadian Journal of Infectious Diseases and Medical Microbiology, 2020, 3826186. https://doi.org/10.1155/2020/3826186

27) Chokshi, A., Sifri, Z., Cennimo, D., & Horng, H. (2019). Global Contributors to Antibiotic Resistance. J Glob Infect Dis, 11(1), 36-42. https://doi.org/10.4103/jgid.jgid_110_18

VOLUME 06 ISSUE 04 APRIL 2023

There is an Open Access article, distributed under the term of the Creative Commons Attribution – Non Commercial 4.0 International (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/), which permits remixing, adapting and building upon the work for non-commercial use, provided the original work is properly cited.