CC BY-NC-ND 4.0 · J Lab Physicians 2022; 14(02): 109-114
DOI: 10.1055/s-0041-1731136
Original Article

The Prevalence and Antimicrobial Susceptibility Pattern of Gram-Positive Pathogens: Three-Year Study at a Tertiary Care Hospital in Mumbai, India

Sweta Shah
1   Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, Maharashtra, India
Ritika Rampal
2   Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
Pooja Thakkar
1   Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, Maharashtra, India
Sushima Poojary
1   Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, Maharashtra, India
Shweta Ladi
1   Department of Laboratory Medicine, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, Maharashtra, India
› Author Affiliations


Introduction The growing resistance pattern of the gram-positive pathogens along with a steady increase in minimum inhibitory concentration of the currently available antibiotics have led to an increase in morbidity and mortality rates in India. This study aims to access the shifting antibiotic susceptibility paradigm of the gram-positive pathogens in various infections at a tertiary care center.

Methods This is a 3-year retrospective observational study which was performed from January 2016 to December 2018 at a tertiary care hospital in Mumbai. All clinically significant gram-positive cocci isolated from a variety of clinical specimens were studied for their prevalence and antimicrobial susceptibility.

Results Out of 4,428 gram-positive isolates, Staphylococcus aureus (35.3%) was the commonly encountered pathogen, followed by Enterococcus spp. (32.1%) and coagulase-negative Staphylococcus (CoNS) (25.7%). S. aureus was majorly isolated from skin and soft tissue infections (60.3%), followed by patients with respiratory tract infections (18.2%) and blood stream infections (13%). Among S. aureus, particularly methicillin-resistant S. aureus (MRSA), prevalence increased from 29.5% in 2016 to 35.1% in 2018, with an overall prevalence of 33.6%. All S. aureus isolates were 100% sensitive toward vancomycin, linezolid, tigecycline, and teicoplanin. However, the CoNS isolates showed a higher resistance rate with reduced susceptibility toward linezolid and teicoplanin. High prevalence of resistance was observed across gram-positive isolates with commonly used antibiotics such as ciprofloxacin, levofloxacin, and erythromycin. While the prevalence of linezolid-resistant enterococcus (LRE) was 3.6%, vancomycin (VRE) and teicoplanin resistance among the enterococcus species was as high as 7.7% and 7.5%, respectively.

Conclusion Rising methicillin resistance among the Staphylococcal species (MRSA and MR-CoNS) along with reduced susceptibility toward currently available anti-MRSA agents is a matter of serious concern as it limits the therapeutic options for treating multidrug resistant (MDR) gram-positive infections.

Authors’ Contribution

R.R. S.S: Data analysis, drafting of the manuscript, and critical revision. P.S., L.S.: Data generation and data entry. S.S., T.P.: Study concept and design, study supervision, data interpretation, critical revision, and final approval of the manuscript.

Publication History

Article published online:
02 July 2021

© 2021. by The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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  • References

  • 1 Antimicrobial resistance: tackling a crisis for the health and wealth of nations. London: Welcome Trust; 2014. Accessed on May 20, 2020
  • 2 Chaudhry D, Tomar P. Antimicrobial resistance: the next big pandemic. Int J Community Med Public Health 2017; 4: 2632-2636
  • 3 Taneja N, Sharma M. Antimicrobial resistance in the environment: the Indian scenario. Indian J Med Res 2019; 149 (02) 119-128
  • 4 Van Boeckel TP, Gandra S, Ashok A. et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis 2014; 14 (08) 742-750
  • 5 Klein EY, Van Boeckel TP, Martinez EM. et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A 2018; 115 (15) E3463-E3470
  • 6 Melzer M, Eykyn SJ, Gransden WR, Chinn S. Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus? A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin Infect Dis 2003; 37 (11) 1453-1460
  • 7 Chatterjee A, Rai S, Guddattu V, Mukhopadhyay C, Saravu K. Is methicillin-resistant Staphylococcus aureus infection associated with higher mortality and morbidity in hospitalized patients? A cohort study of 551 patients from South Western India. Risk Manag Healthc Policy 2018; 11: 243-250
  • 8 National Centre for Disease Control. National Treatment Guidelines for Antimicrobial Use in Infectious Diseases. New Delhi, India: Ministry of Health and Family Welfare, Government of India; 2016
  • 9 AMRSN Annual Report 2018. Accessed May 18, 2020
  • 10 Tacconelli E, Carrara E, Savoldi A. et al. WHO Pathogens Priority List Working Group. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis 2018; 18 (03) 318-327
  • 11 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 26th ed. CLSI supplement M100S. Wayne, PA: Clinical and Laboratory Standards Institute; 2016
  • 12 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 27th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2017
  • 13 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 28th Informational Supplement. CLSI Document M100. Wayne, PA: CLSI; 2018
  • 14 Center for Disease Dynamics, Economics and Policy. State of the World’s Antibiotics. Washington, DC: Center for Disease Dynamics, Economics and Policy; 2015. Accessed May 20, 2020
  • 15 AMR Surveillance Network Indian Council of Medical Research. Published 2018. Accessed May 28, 2020
  • 16 Kaur K, Gill AK, Kaur M. Methicillin resistance, vancomycin intermediate and vancomycin resistance Staphylococcus aureusprevalence in a tertiary care hospital of Punjab, India. National J Lab Med 2019; 8 (03) MO01-MO03 DOI: 10.7860/NJLM/2019/41137:2352.
  • 17 Mohanty S, Behera B, Sahu S, Praharaj AK. Recent pattern of antibiotic resistance in Staphylococcus aureus clinical isolates in Eastern India and the emergence of reduced susceptibility to vancomycin. J Lab Physicians 2019; 11 (04) 340-345
  • 18 Center for Disease Dynamics, Economics & Policy. State of the World’s Antibiotics. Washington, D.C.: CDDEP; 2015
  • 19 Barros EM, Ceotto H, Bastos MC. Dos Santos KR, Giambiagi-Demarval M. Staphylococcus haemolyticus as an important hospital pathogen and carrier of methicillin resistance genes. J Clin Microbiol 2012; 50 (01) 166-168
  • 20 Cavanagh JP, Hjerde E, Holden MT. et al. Whole-genome sequencing reveals clonal expansion of multiresistant Staphylococcus haemolyticus in European hospitals. J Antimicrob Chemother 2014; 69 (11) 2920-2927
  • 21 Walia K, Madhumathi J, Veeraraghavan B. et al. Establishing antimicrobial resistance surveillance and research network in India: journey so far. Indian J Med Res 2019; 149 (02) 164-179
  • 22 Amberpet R, Sistla S, Sugumar M, Nagasundaram N, Manoharan M, Parija SC. Detection of heterogeneous vancomycin-intermediate Staphylococcus aureus: a preliminary report from south India. Indian J Med Res 2019; 150 (02) 194-198
  • 23 Kumar M. Multidrug-resistant Staphylococcus aureus, India, 2013-2015. Emerg Infect Dis 2016; 22 (09) 1666-1667
  • 24 Thati V, Shivannavar CT, Gaddad SM. Vancomycin resistance among methicillin resistant Staphylococcus aureus isolates from intensive care units of tertiary care hospitals in Hyderabad. Indian J Med Res 2011; 134 (05) 704-708
  • 25 Wijesooriya WRPLI, Kotsanas DN, Korman TM, Graham M. Teicoplanin non-susceptible coagulase-negative staphylococci in a large Australian healthcare network: implications for treatment with vancomycin. Sri Lankan Journal of Infectious Diseases 2017; 7 (01) 10-17
  • 26 Shivaprakasha S. Determination of vancomycin, teicoplanin and linezolid resistance among Staphylococcal isolates from a tertiary care hospital. J Acad Clin Microbiol 2015; 17: 3-6
  • 27 Kalawat U, Sharma KK, Reddy S. Linezolid-resistant Staphylococcus spp. at a tertiary care hospital of Andhra Pradesh. Indian J Med Microbiol 2011; 29 (03) 314-315
  • 28 Mathur P, Chaudhary R, Dhawan B, Sharma N, Kumar L. Vancomycin-resistant Enterococcus bacteraemia in a lymphoma patient. Indian J Med Microbiol 1999; 17: 194-195
  • 29 Kaur N, Chaudhary U, Aggarwal R, Bala K. Emergence of VRE and their antimicrobial sensitivity pattern in a tertiary care teaching hospital. J Med BiolSci. 2009; 8: 26-32
  • 30 Praharaj I, Sujatha S, Parija SC. Phenotypic and genotypic characterization of vancomycin resistant Enterococcus isolates from clinical specimens. Indian J Med Res 2013; 138 (04) 549-556
  • 31 Mamtora D, Saseedharan S, Bhalekar P, Katakdhond S. Microbiological profile and antibiotic susceptibility pattern of gram-positive isolates at a tertiary care hospital. J Lab Physicians 2019; 11 (02) 144-148
  • 32 Chou YY, Lin TY, Lin JC, Wang NC, Peng MY, Chang FY. Vancomycin-resistant Enterococcal bacteremia: comparison of clinical features and outcome between Enterococcus faecium and Enterococcus faecalis. J Microbiol Immunol Infect 2008; 41 (02) 124-129
  • 33 Purohit G, Gaind R, Dawar R. et al. Characterization of vancomycin resistant Enterococci in hospitalized patients and role of gut colonization. J Clin Diagn Res 2017; 11 (09) DC01-DC05
  • 34 Gupta V, Garg S, Jain R, Garg S, Chander J. Linezolid resistant Staphylococcus haemolyticus: first case report from India. Asian Pac J Trop Med 2012; 5 (10) 837-838
  • 35 Kumari S, Rawre J, Trikha A. et al. Linezolid-resistant Staphylococcus haemolyticus: emergence of G2447U & C2534U mutations at the domain V of 23S ribosomal RNA gene in a tertiary care hospital in India. Indian J Med Res 2019; 149 (06) 795-798
  • 36 Mittal G, Bhandari V, Gaind R. et al. Linezolid resistant coagulase negative Staphylococci (LRCoNS) with novel mutations causing blood stream infections (BSI) in India. BMC Infect Dis 2019; 19 (01) 717
  • 37 Tewhey R, Gu B, Kelesidis T. et al. Mechanisms of linezolid resistance among coagulase-negative Staphylococci determined by whole-genome sequencing. MBio 2014; 5 (03) e00894-e14
  • 38 Kumar S, Bandyoapdhyay M, Chatterjee M, Mukhopadhyay P, Poddar S, Banerjee P. The first linezolid-resistant Enterococcus faecium in India: high level resistance in a patient with no previous antibiotic exposure. Avicenna J Med 2014; 4 (01) 13-16