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Abstract：
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.
摘要：
引言革兰氏阳性病原体的抗性模式以及当前可用抗生素的最低抑制浓度的稳定增加导致印度的发病率和死亡率增加。这项研究旨在访问三级护理中心各种感染中革兰氏阳性病原体的抗生素敏感性变化范例。方法这是一项为期3年的回顾性观察性研究，于2016年1月至2018年12月在孟买一家三级医院进行。研究了从各种临床标本中分离出的所有具有临床意义的革兰氏阳性球菌的患病率和抗菌药物敏感性。结果在4,428株革兰氏阳性分离物中，金黄色葡萄球菌(35.3%)是常见的病原菌,其次是肠球菌。（32.1％）和凝固酶阴性葡萄球菌（CoNS）（25.7％）。金黄色葡萄球菌主要从皮肤和软组织感染中分离出来（60.3%），其次是呼吸道感染(18.2%)和血流感染(13%)。在金黄色葡萄球菌中，特别是耐甲氧西林金黄色葡萄球菌（MRSA），患病率从2016年的29.5%上升至2018年的35.1%,总体患病率为33.6%.所有金黄色葡萄球菌分离株对万古霉素100%敏感，利奈唑胺,替加环素,还有替考拉宁.然而,CoNS分离株的耐药率较高,对利奈唑胺和替考拉宁的敏感性降低.在使用环丙沙星等常用抗生素的革兰氏阳性分离株中观察到高耐药率，左氧氟沙星,和红霉素。利奈唑胺耐药肠球菌(LRE)的患病率为3.6%,肠球菌对万古霉素(VRE)和替考拉宁的耐药性分别高达7.7%和7.5%,分别。结论葡萄球菌（MRSA和MR-CoNS）中甲氧西林耐药性的上升以及对当前可用的抗MRSA药物的敏感性降低是一个严重关注的问题，因为它限制了治疗多药耐药（MDR）革兰氏阳性感染的治疗选择。
