An epidemiological study in the greater Durban area of gram negative bacilli resistant to aminoglycoside antibiotics
This study was undertaken to investigate resistance to aminoglycoside antibiotics and the transfer of resistance in selected Gram negative bacilli in hospitals in the Greater Durban area in order to determine whether the development of resistance in this region was similar to that found in other countries and whether it was the same in the hospitals in the region. It was intended that the study might expose the existence of nosocomial pathogens of a particular strain or endemic plasmids responsible for aminoglycoside antibiotic resistance. Strains of Klebsiella, Enterobacter and Serratia species and Escherichia coli resistant to gentamicin, tobramycin, netilmicin or amikacin were obtained. Resistance of the isolates obtained to the above aminoglycoside antibiotics was confirmed using a disc diffusion technique. Resistance mechanisms were initially assigned on the basis of resistance to these four aminoglycoside antibiotics. In approximately 50% of the isolates, including donor isolates and their respective transconjugants, resistance mechanisms were confirmed or revised on the basis of a changed resistance profile to a range of 12 aminoglycoside antibiotics in conjunction with DNA/DNA hybridization tests. Bacterial conjugation studies were performed on selected isolates to investigate the transfer of aminoglycoside resistance from Klebsiella pneumoniae isolates to recipient Escherichia coli. Plasmid profiles of all isolates and Escherichia colitransconjugants were compared to establish similarities. Isolates in three of the four genera of bacteria and all isolates collectively, demonstrated the greatest incidence of resistance to tobramycin. Amikacin resistance was, in all groups of isolates, the least frequently encountered. Collectively, the most frequent mechanisms of resistance were the AAC(3)-V and AAC(6')-1 enzymes One large hospital showed a high frequency of the AAC(3)-V modifying enzyme while in other hospitals a wider range of enzyme resistance mechanisms were evident. Plasmid profiles were generally dissimilar within and between different genera and the different hospitals.