Development of Antibiogram for Secondary Health care Hospital

Antibiotics resistance is an emerging problem in the management for infectious diseases. Patients are many a time prescribed with antibiotics without knowing that particular antibiotic sensitivity patternwith respect to the infectious microorganism. This study aims to detect the type of microbes causing certain infections in the hospital and also to detect the sensitivity pattern of the antibiotics to these microbes. We conducted a prospective study for six months on the neonates whowere admitted in NICU. The blood samples were collected from these neonates before the administration of antibiotics. The swab sampleswere also collected fromvarious places of this hospital to detect the types of microorganisms present in the hospital and to study the sensitivity of the antibiotics toward thesemicrobes. The antibiotics used in this study were Gentamicin, Ampicillin, Cefotaxime, Amikacin, Piperacillin, Meropenam, andVancomycin. Staphylococcus aureus and Streptococcus pneumoniaewere found to be the most common pathogens implicated in neonate’s infection. All the organisms showed absolute sensitivity mostly to Ampicillin, Gentamicin, and Piperacillin and resistant to Cefotaxime, Amikacin, and Vancomycin. Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus in leunzae, Kleibseilla pneumoniae, Escherichia coli were the most common microorganism found in the swab samples collected from the hospital. Most of these microorganisms shows sensitivity towards Ampicillin, Gentamicin, and Meropenam but were resistance to Cefotaxime, Amikacin, and Vancomycin. A routine bacterial surveillance of prevalent organisms and the study of the sensitivity patterns of the pathogens responsible for neonatal infection should be made an essential component for neonatal care. This information from many parts of the country will be important in policymaking on antimicrobial use not only locally but also internationally.


INTRODUCTION
Antibiogram is the most important activities performed by clinical microbiology that involves reporting of antimicrobial susceptibilities. Antibiogram helps in monitoring of antimicrobial resistance in ICU or ward speci ic data and inpatient versus outpatient data, etc. (Joshi, 2010) Antibiograms are used by clinicians to ind out local susceptibility rates and to monitor resistance trends over time within an institution. Antibi-ograms can also be used to compare susceptibility rates. (Natarajan et al., 2016) This study aims to determine if the current empiric treatment is adequate and effective. This will help reduce the risk of undertreatment or over the treatment of infections, both of which are associated with the emergence and increasing of resistance to antibiotics. The current data will be necessary in policy decisions and the development of treatment guidelines that can help to mitigate neonatal mortality. The antibiotic policy aims to prevent communicable diseases, decrease morbidity, and mortality due to antimicrobial-resistant infection, and to preserve the effectiveness of antimicrobial agents in treatment.

MATERIALS AND METHODS
We conducted a prospective study for all wards present in hospitals. Swab samples were collected from the hospital for Antibiogram. The study was conducted at GHQH, Ooty, Nilgiris, Tamil Nadu, India. It is run by the State Government of Tamil Nadu. It has one labor ward, one ante-natal ward, and ive post-natal wards with 120 beds. It was chosen because it serves both low income and middleincome population and has a laboratory facility that was used for processing of the samples. The Institutional Ethical Committee approval was obtained from Institutional Ethics Committee, JSS College of Pharmacy, Rocklands, Ooty before the initiation of the study (Reference no: JSSCP/DPP/IRB/01/2017-18, Dated: 03.02.2018). Figures 1, 2, 3, 4 and 5 is shown below,

Figure 1: Swab samples incubated in nutrient broth
Swab samples were collected from NICU, Laboratory, Blood bank, Labor room, Children Ward, ICU, Microbiology lab, AN Ward was isolated in nutrient agar and incubated. Bacterial growth were identiied by gram staining, motility test, and antibiotics sensitivity, and resistance test was done.   In Table 2, Samples tested from children's ward -Patient cot (2A), Door window (2B), CH walls (2C), Incubator (2D), and Floor (2E). Growth was present in three agar except for EMB agar. Microorganisms present are H.in luenzae, S.epidermitis, Klebsiella pneumoniae, S.aureus, and E.coli.

Procedure for Gram Staining
Bacteria isolated were drop in their respective slides. After this, the slide was dried in the lame (Heat kill). After this, Crystal Violet was added and wait for 1 minute after a 1-minute wash with water. Add Gram's iodine and wait for 1 minute after a 1minute wash with water. Add Alcohol (5%) and wait for 15 seconds, wash with water. Add Safranine and wait for 45 seconds, wash with water. Focus under the microscope (Acharya, 2015).

Hanging Drop Method
Depression slide was used to ind the motility test in the hanging drop method. The microorganism was a drop in the middle of the coverslip. Each side of the coverslip, Vaseline, or liquid paraf in was drop. The coverslip was placed in the depression slide. The microorganism was observed under the micro-         domonas and H.in luenzae.
Antibiogram includes laboratory testing for sensitivity and resistance of an isolated bacteria to different common use antibiotics. Susceptibility patterns of antimicrobial is becoming less predictable. Due to the irrational use of antibiotics, resistance to antibiotics increases (Brook and Long, 2018). Bacteria resistance has become a threatening infection worldwide in both hospital and community set-tings (Namratha et al., 2015).
Antibiograms are used to de ine a rational use and selection of antimicrobial therapy in hospitals for treating patients.
It is made for multiple purposes and to assist clinicians to follow proper empirical therapy (Joseph et al., 2011).

CONCLUSIONS
From the collected swab samples, H.i luenzae, S.aureus, E.coli, and Klebsiella pneumoniae are the most common pathogens implicated in hospitals from different wards. All the organisms showed sensitivity towards antibiotics, but Gentamicin, Piperacillin, Meropenem, and Ampicillin showed higher sensitivity compared to other antibiotics. Antibiogram will be useful for the incorporation of informations and patients data. Antibiotic susceptibility may help in overcoming the problems of antibiotics use and to follow proper antibiotic policies.