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J Lab Physicians. 2018 Oct-Dec;10(4):432-436. doi: 10.4103/JLP.JLP_80_18.

Pattern of antimicrobial resistance of Gram-negative bacilli in surgical site infections in in-patients and out-patients at an apex trauma Center: 2013-2016.

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Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Department of Surgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India.



Antimicrobial resistance is an increasing problem worldwide especially among the surgical site infections (SSIs). SSI is becoming more serious due to hospital-acquired infections/nosocomial infections, which further leads to the overuse of broad-spectrum antibiotics. To investigate the antimicrobial resistance patterns among Gram-negative bacteria in SSI in in- and out-patients the present study was designed.


During the 4 years (January 2013-December 2016), the antimicrobial resistant pattern was studied in the admitted patients and in the patients who were followed up to the outpatients department (OPD) after discharge. Antimicrobial resistance pattern testing was done by the disk diffusion method on Mueller-Hinton agar and by E-test for ten antibiotics according to The Clinical and Laboratory Standards Institute guidelines for Gram-negative bacilli.


A total of 2,447 strains were isolated from the studied population on over the period of 4 years. Of 2447, 1996 (81%) were isolated from patients who had SSI during the hospital stay, and 451 (18%) were from patients who attended the OPD after discharge. In the outpatients, who followed up in the OPD for the SSI, Escherichia coli (148), and Pseudomonas aeruginosa (93), whereas in the patients who develop SSI during their hospital stay, Acinetobacter baumannii (622), E. coli (424), and Klebsiella pneumoniae (315) were found to be common. A very high resistance pattern was observed in both the studied groups; however, a higher resistance pattern was seen in in-patients as compared to outpatients.


In our study, we have reported resistance pattern in Gram-negative bacteria isolated from the patients who were came for the follow as well as in the inpatients. For the outpatients, it can be concluded that it could be a community-acquired infection which is also an alarming condition for our society.


Antimicrobial resistant; in- and out-patients; surgical site infections

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