Vol 11, Issue 8, 2018 Online - 2455-3891 Print - 0974-2441 CONSUMPTION AND BACTERIAL RESISTANCE TO AMINOGLYCOSIDES AT SUDANESE UNIVERSITY HOSPITAL EINAS A BAKHEIT 1 , KAMAL M ELHAG 2 , ABDUELMULA R ABDUELKAREM 3 *, NADA A BASHEER 4 1 Department of Pharmaceutics, Clinical Pharmacy Program, University of Khartoum, Sudan. 2 Department of Microbiology, Ahfad University for Women, Omdurman, Sudan. 3 Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, P.O. Box 27272, Sharjah, UAE. 4 Department of Microbiology, International University of Africa, Sudan. Email: aabdelkarim@Sharjah.ac.ae Received: 02 April 2018, Revised and Accepted: 10 May 2018 ABSTRACT Objectives: The objective of this study was to describe patterns of antimicrobial resistance to gentamicin (Gen) and amikacin (Ak) among Gram- negative aerobic bacteria during 1-year period and to determine the association between antibiotic resistance and the consumption of Gen. Methods: Aminoglycosides consumption at Soba University Hospital wards was measured and susceptibility of Gram-negative bacteria for the same period was evaluated. Consumption data were converted to defined daily doses (DDDs)/100 bed days based on DDD/anatomical therapeutic chemical the WHO system. The association between the frequency of strains resistant to Gen and Ak and their consumption was assessed by linear regression analysis using Spearman’s correlation. The level of statistical significance was set at p<0.05. Results: A total of 973 Gram-negative isolates were identified and tested for antimicrobial susceptibility to Gen and Ak. Resistance to Gen alone was found to be 19.42%; n=189, resistance to Ak alone was found to be 3.08%; n=30, and resistance to Gen plus Ak was found to be 5.24%; n=51. Pseudomonas aeruginosa was the most resistant pathogen to Ak plus Gen (2.26%; n=22). A positive correlation between the increases in the use of Gen and the prevalence of bacterial resistance among hospital wards was found (correlation coefficient r=0.6; p=0.04). Conclusion: Gen and Ak are still highly active antimicrobial agents for the treatment of aerobic Gram-negative bacteria at times of intensified resistance to other antimicrobial agents. Monitoring the use of aminoglycosides is very important too. Keywords: Aminoglycosides, Resistance, Gram-negative bacteria, Hospital Prescribing, Sudan. INTRODUCTION After seven decades in clinical use, aminoglycoside antibiotics still remain crucial drugs for the treatment of acute infections and specific conditions such as tuberculosis. They are especially effective in the containment of Pseudomonas bacteria in patients with cystic fibrosis, regardless of the harmful side effects that are being gradually solved by extensive research around the world. The development of bacterial resistance to aminoglycosides during therapy is rare [1], and the prevalence of resistance to aminoglycoside remained relatively low compared to cephalosporins or fluoroquinolones [2]. The most predominant resistance mechanism is through aminoglycoside- modifying enzymes. Resistance may occur when bacteria produce 16S rRNA methylases, which cause high level and broad-spectrum aminoglycoside resistance [3]. Other resistance mechanisms do exist, which can act simultaneously in the same cell [4]. These include reduced permeability by modification of outer membrane or diminished inner membrane transport [5], export outside the cell by activation of efflux pumps [6,7], adaptive resistance [8], active swarming, and a non-specific mechanism newly shown in Pseudomonas aeruginosa cells specially against gentamicin (Gen), which revealed adaptive antibiotic resistance against numerous antibiotics [9] and sequestration of the drug by tight binding to an altered aminoglycoside acetyltransferase [10]. Aminoglycoside-modifying enzymes catalyze the modification at − OH or −NH2 groups of the 2-deoxystreptamine nucleus or the sugar moieties and can be acetyltransferases, nucleotidyltransferases, or phosphotransferases [11,12]. The DDD is known as the average standard daily dose of a drug used in an adult assuming 70 KGs as average weight [13]. DDD has been used extensively to compare frequencies of antimicrobial use between wards, hospitals, and even countries. A small number of studies have used the DDD methodology in children with justification [14-17]. The use of the adult Anatomical Therapeutic Chemical (ATC)/DDD methodology to compare pediatric to adult antibiotic prescribing is misleading because it does not take into account either age or weight of the child. Accordingly, the total DDD from an adult ward would be much higher than that for a neonatal ward, which makes straight judgments very challenging between hospitals or wards containing such problem. When the use of antibiotic in adult ward is negligible, and the same antibiotic is extensively used in pediatric wards such problem will not affect the significance of consumption variation. The practice mentioned above is because pediatricians are very adherent to sepsis management guidelines, which is the most prevalent disease among pediatric and neonate patients in our institution, while other practitioners always find the way to skip aminoglycosides for another option even if the culture results are positive. That is because of low knowledge about aminoglycosides, their efficacy, low resistance rate and finally the ghost of nephrotoxicity and ototoxicity. In the last years, several studies were carried out to determine the relationship between consumption of antimicrobial agents and the development of bacterial resistance and build a hypothesis of a positive correlation. In a study, which investigated the development of resistance in Gram-negative bacteria and evaluated its association with consumption of various groups of antibiotics, a statistically significant © 2018 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4. 0/) DOI: http://dx.doi.org/10.22159/ajpcr.2018.v11i8.26381 Research Article