Bacterial ventriculoperitoneal shunt infections: changing trends in antimicrobial susceptibility, a 7-year retrospective study from Pakistan

Table 1 Antimicrobial susceptibility rates among the bacteria causing ventriculoperitoneal shunt infections over 7 years (2015–2021)

Acinetobacter species	2015			2016			2017			2018			2019			2020			2021			Total			p-value*
	N = 211			N = 330			N = 762			N = 840			N = 1100			N = 1230			N = 1425			N = 5898
	T	S	S %	T	S	S %	T	S	S%	T	S	S%	T	S	S%	T	S	S %	T	S	S %	T	S	S %
Amikacin	101	52	51.5	271	130	48.0	636	322	50.6	840	378	45.0	1082	510	47.1	1220	490	40.2	1410	503	35.7	5560	2385	45.4	0.965
Cefepime	211	73	34.6	271	52	19.2	636	134	21.1	820	161	19.6	1100	145	13.2	1220	140	40.2	1410	211	15.0	5668	916	23.3	0.553
Cefotaxime	90	21	23.3	157	9	5.7	231	23	10.0	193	12	6.2	660	54	8.2	1160	80	40.2	1425	160	11.2	3916	359	15.0	0.925
Ceftazidime	149	13	8.7	300	13	4.3	762	110	14.4	810	101	12.5	1100	113	10.3	1230	110	40.2	1425	177	12.4	5776	637	14.7	0.689
Ceftriaxone	211	15	7.1	300	20	6.7	379	31	8.2	793	72	9.1	1073	127	11.8	1220	130	40.2	1425	155	10.9	5401	550	13.4	0.295
Cotrimoxazole	211	41	19.4	330	82	24.9	120	10	8.3	810	133	16.4	904	194	21.5	1233	220	40.2	1410	332	23.6	5018	1012	22.0	0.867
Gentamicin	100	31	31.0	65	23	35.4	181	63	34.8	840	251	29.9	1100	344	31.3	1230	450	40.2	1425	491	34.5	4941	1653	33.9	0.873
Meropenem	20	20	100.0	70	61	87.1	231	151	65.4	840	592	70.5	1100	596	54.2	1220	673	40.2	1287	666	51.8	4768	2759	67.0	0.576
Piperacillin_tazobactam	180	157	87.2	254	182	71.7	334	264	79.0	838	597	71.2	1100	571	51.9	1220	570	40.2	1410	603	42.8	5336	2944	63.4	0.776
Ampicillin_sulbactam	211	140	66.4	271	211	77.9	340	280	82.4	780	287	36.8	1100	532	48.4	1230	410	40.2	1425	330	23.1	5357	2190	53.6	0.845

Pseudomonas species	2015			2016			2017			2018			2019			2020			2021			Total			p-value*
	N = 110			N = 302			N = 393			N = 330			N = 340			N = 453			N = 440			N = 2368
	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%
Amikacin	72	51	70.8	284	188	66.2	393	288	73.3	327	222	67.9	340	261	76.8	453	311	68.7	440	211	48.0	2309	1532	67.4	0.742
Cefepime	100	63	63.0	221	89	40.3	313	170	54.3	327	181	55.4	340	209	61.5	450	161	35.8	434	142	32.7	2185	1015	49.0	0.818
Ceftazidime	83	21	25.3	289	90	31.1	360	99	27.5	325	129	39.7	340	121	35.6	450	101	22.4	440	127	28.9	2287	688	30.1	0.984
Gentamicin	37	11	29.7	37	14	37.8	360	101	28.1	330	158	47.9	340	175	51.5	453	258	57.0	440	178	40.5	1997	895	41.8	0.807
Meropenem	110	87	79.1	71	60	84.5	128	93	72.7	310	182	58.7	60	41	68.3	450	267	59.3	62	45	72.6	1191	775	70.7	0.852
Piperacillinn	110	81	73.6	302	124	41.1	56	21	37.5	220	111	50.5	332	185	55.7	450	172	38.2	440	150	34.1	1910	844	47.2	0.926
Piperacillin_tazobactam	100	89	89.0	160	155	96.9	56	51	91.1	330	243	73.6	340	261	76.8	450	341	75.8	427	245	57.4	1863	1385	80.1	0.991

Klebsiella species	2015			2016			2017			2018			2019			2020			2021			Total			p-value*
	N = 141			N = 109			N = 211			N = 153			N = 271			N = 240			N = 310			N = 1435
	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%
Amikacin	92	71	77.2	72	39	54.2	211	142	67.3	153	73	47.7	271	129	47.6	240	110	45.8	308	163	52.9	1347	727	56.1	0.529
Amoxicillin_clavulanicacid	140	32	22.9	109	22	20.2	190	10	5.3	153	12	7.8	269	20	7.4	240	21	8.8	308	31	10.1	1409	148	11.8	0.833
Cefepime	141	19	13.5	68	10	14.7	180	22	12.2	153	21	13.7	260	60	23.1	233	44	18.9	308	69	22.4	1343	245	16.9	0.534
Cefoperazone	140	39	27.9	109	33	30.3	211	53	25.1	153	39	25.5	271	91	33.6	230	51	22.2	310	31	10.0	1424	337	24.9	0.645
Ceftazidime	127	64	50.4	100	31	31.0	180	52	28.9	153	31	20.3	270	21	7.8	240	23	9.6	310	48	15.5	1380	270	23.3	0.588
Ceftriaxone	129	52	40.3	109	9	8.3	180	19	10.6	150	21	14.0	270	20	7.4	240	21	8.8	310	29	9.4	1388	171	14.1	0.726
Cotrimoxazole	110	41	37.3	109	41	37.6	38	11	29.0	153	19	12.4	268	29	10.8	240	47	19.6	306	31	10.1	1224	219	22.4	0.413
Gentamicin	20	10	50.0	51	23	45.1	180	65	36.1	147	55	37.4	270	122	45.2	240	89	37.1	307	100	32.6	1215	464	40.5	0.506
Meropenem	22	16	72.7	109	50	45.9	157	79	50.3	153	66	43.1	271	110	40.6	240	101	42.1	300	142	47.3	1252	564	48.9	0.61
Piperacillin_tazobactam	91	70	76.9	100	79	79.0	19	13	68.4	153	67	43.8	270	119	44.1	227	92	40.5	310	134	43.2	1170	574	56.6	0.657

Escherichia coli	2015			2016			2017			2018			2019			2020			2021			Total			p-value*
	N = 103			N = 92			N = 103			N = 177			N = 127			N = 320			N = 232			N = 1154
	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%
Amikacin	57	50	87.7	71	59	83.1	76	38	50.0	177	120	67.8	127	83	65.4	320	201	62.8	227	197	86.8	1055	748	71.9	0.897
Amoxicillin_clavulanicacid	103	11	10.7	92	11	12.0	71	10	14.1	170	20	11.8	120	20	16.7	320	25	7.8	232	30	12.9	1108	127	12.3	0.706
Ampicillin	29	9	31.0	92	10	10.9	110	11	10.0	80	10	12.5	110	11	10.0	320	32	10.0	232	28	12.1	973	111	13.8	0.939
Cefepime	90	31	34.4	50	10	20.0	77	14	18.2	177	80	45.2	127	22	17.3	320	57	17.8	232	39	16.8	1073	253	24.3	0.564
Cefoperazone	40	11	27.5	50	13	26.0	40	10	25.0	177	100	56.5	120	50	41.7	320	41	12.8	232	81	34.9	979	306	32.1	0.584
Ceftazidime	67	29	43.3	92	28	30.4	103	11	10.7	177	70	39.6	120	27	22.5	247	32	13.0	232	27	11.6	1038	224	24.4	0.876
Ceftriaxone	103	33	32.0	90	11	12.2	77	9	11.7	175	40	22.9	120	11	9.2	320	30	9.4	227	33	14.5	1112	167	16.0	0.613
Cotrimoxazole	37	9	24.3	50	13	26.0	40	10	25.0	177	50	28.3	120	20	16.7	320	61	19.1	232	31	13.4	976	194	21.8	0.656
Gentamicin	80	70	87.5	39	27	69.2	40	20	50.0	177	100	56.5	127	53	41.7	320	189	59.1	232	140	60.3	1015	599	60.6	0.362
Meropenemn	50	41	82.0	39	33	84.6	55	37	67.3	134	97	72.4	120	70	58.3	320	177	55.3	220	127	57.7	938	582	68.2	0.406
Piperacillin_tazobactam	77	63	81.8	50	39	78.0	40	29	72.5	134	103	76.9	120	57	47.5	320	163	50.9	232	139	59.9	973	593	66.8	0.892

Staphylococcus aureus	2015			2016			2017			2018			2019			2020			2021			Total			p-value*
	N = 179			N = 231			N = 171			N = 176			N = 270			N = 203			N = 257			N = 1487
	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%
Amikacin	44	22	50.0	210	155	73.8	170	109	64.1	33	18	54.6	34	18	52.9	110	40	36.4	250	104	41.6	851	466	53.3	0.432
Oxacillin **	179	107	59.8	231	137	59.3	170	90	52.9	162	79	48.8	267	94	35.2	97	50	51.6	237	67	28.3	1343	624	48.0	0.765
Cotrimoxazole	140	27	19.3	210	50	23.8	170	52	30.6	170	50	29.4	270	110	40.7	200	81	40.5	240	116	48.3	1400	486	33.2	0.706
Gentamicin	140	50	35.7	27	11	40.7	170	79	46.5	160	83	51.9	270	109	40.4	200	132	66.0	250	87	34.8	1217	551	45.1	0.526
Penicillin	179	27	15.1	210	58	27.6	170	41	24.1	160	72	45.0	270	69	25.6	167	33	19.8	238	45	18.9	1394	345	25.2	0.827
Linezolid	193	193	100.0	231	231	100.0	137	137	100.0	176	176	100.0	270	270	100.0	203	203	100.0	257	257	100.0	1467	1467	100.0	0.989
Vancomycin	87	87	100.0	210	210	100.0	171	171	100.0	162	162	100.0	270	270	100.0	167	167	100.0	257	257	100.0	1324	1324	100.0	0.989

Coagulase-negative Staphylococcus	2015			2016			2017			2018			2019			2020			2021			Total			p-value*
	N = 230			N = 422			N = 270			N = 117			N = 310			N = 220			N = 311			N = 1880
	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%	T	S	S%
Amikacin	230	159	69.1	412	287	69.7	267	158	59.2	117	83	70.9	78	47	60.3	158	71	44.9	297	113	38.1	1559	918	58.9	0.761
Oxacillin ***	187	64	34.2	422	120	28.4	267	90	33.7	117	45	38.5	310	125	40.3	120	30	25.0	311	41	13.2	1734	515	30.5	0.601
Cotrimoxazole	187	111	59.4	387	179	46.3	270	110	40.7	110	40	36.4	310	121	39.0	220	83	37.7	311	98	31.5	1795	742	41.6	0.964
Gentamicin	84	41	48.8	420	210	50.0	270	140	51.9	110	41	37.3	300	139	46.3	220	83	37.7	300	147	49.0	1704	801	45.9	0.794
Linezolid	212	212	100.0	420	420	100.0	178	178	100.0	110	110	100.0	310	310	100.0	220	220	100.0	300	300	100.0	1750	1750	100.0	0.989
Penicillin	230	27	11.7	422	69	16.4	267	35	13.1	103	17	16.5	310	87	28.1	90	17	18.9	311	37	11.9	1733	289	16.7	0.315
Vancomycin	56	56	100.0	120	120	100.0	123	123	100.0	97	97	100.0	300	300	100.0	120	120	100.0	297	297	100.0	1113	1113	100.0	0.989

N Number of bacteria causing VP shunt infections, T Number of tested isolates, S Number of susceptible isolates, S(%) percentage of susceptible isolates
*Multivariate analysis of variance (MANOVA) for non-susceptible trend
**Isolates resistant to oxacillin (interpreted with cefoxitin disc diffusion) are defined as MRSA (Methicillin-resistant Staphylococcus aureus). They are considered resistant to other beta-lactam agents, i.e., penicillins, beta-lactam combination agents, cephems (with the exception of ceftaroline), and carbapenems [15].
***Isolates resistant to oxacillin (interpreted with cefoxitin disc diffusion) are methicillin-resistant. They are considered resistant to other beta-lactam agents, i.e., penicillins, beta-lactam combination agents, cephems (with the exception of ceftaroline), and carbapenems [15].

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