Annie Bakorlin Khyriem

Association of biofilm production with multidrug resistance among clinical isolates of Acinetobacter baumannii and Pseudomonas aeruginosa from intensive care unit

Background and Aims: Given choice, bacteria prefer a community-based, surface-bound colony to an individual existence. The inclination for bacteria to become surface bound is so ubiquitous in diverse ecosystems that it suggests a strong survival strategy and selective advantage for surface dwellers over their free-ranging counterparts. Virtually any surface, biotic or abiotic (animal, mineral, or vegetable) is suitable for bacterial colonization and biofilm formation. Thus, a biofilm is “a functional consortium of microorganisms organized within an extensive exopolymeric matrix.” Materials and Methods: The present study was undertaken to detect biofilm production from the repertoire stocks of Acinetobacter baumannii (A. baumannii) and Pseudomonas aeruginosa (P. aeruginosa) obtained from clinical specimens. The tube method was performed to qualitatively detect biofilm production. Results: A total of 109 isolates of both organisms were included in the study, out of which 42% (46/109) isolates showed biofilm detection. Among the biofilm producers, 57% of P. aeruginosa and 73% of A. baumannii showed multidrug resistance (MDR) pattern which was statistically significant in comparison to nonbiofilm producers (P < 0.001). Conclusion: To the best of our knowledge, this is the only study to have tested the biofilm production in both P. aeruginosa and A. baumannii in a single study. Biofilm production and MDR pattern were found to be significantly higher in A. baumannii than P. aeruginosa. Antibiotic resistance was significantly higher among biofilm producing P. aeruginosa than non producers. Similarly, antibiotic resistance was significantly higher among biofilm producing A. baumannii than non producers.

Clinico-mycological profile of dermatophytosis in Meghalaya

Background: Dermatophytosis though trivial, exerts a psychological effect and requires effective treatment which is often costly. Numerous studies on clinico-mycological aspects of dermatophytosis have been conducted in different parts of India but no reports are available from the state of Meghalaya. Aims: The study was therefore aimed at determining the prevalence and etiological agents of dermatophytosis amongst the patients attending the Department of Dermatology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) Shillong. Materials and Methods: A total of 259 samples obtained from 237 clinically diagnosed cases of fungal infection of the skin, hair and nails were included. Direct microscopy (Potassium hydroxide (KOH) mount), culture and identification were done according to standard procedures. Results: The major clinical group was found to be Tinea pedis (26.6%) followed by Tinea corporis (18.9%) and Tinea cruris (14.3%). Tinea capitis was predominantly seen in children (72.7%). The maximum cases were seen in the age group of 21-30 years (34.4%) showing a male predominance. Direct microscopy (KOH mount) were positive in 99(38.2%) of the 259 samples whereas; 76 (29.3%) were positive on culture. The predominant dermatophyte species isolated was Trichophyton rubrum (30.3%) followed by Trichophyton mentagrophytes (28.9%). Conclusion: The present study, gives an insight about the etiological agents of dermatophytosis in this part of India. This data provides an assessment of the prevalence and etiological profile which would help in the estimation of the problem and hence in the prevention of dermatophytosis with adequate control measures.

Sub-cutaneous abscess caused by Nocardia asteroides in renal transplant recipient

Nocardia is a significant opportunistic pathogen in patients with compromised immunity. Nocardia asteroides was isolated from subcutaneous abscesses on the left thigh and shoulder of a renal transplant recipient. Direct examination of the aspirated pus showed branching filaments that were gram-positive and acid fast. The abscesses were drained and the patient responded to high dose co-trimoxazole therapy.

Inducible and constitutive clindamycin resistance in Staphylococcus aureus in a northeastern Indian tertiary care hospital

INTRODUCTION Staphylococcus aureus is one of the most common pyogenic bacteria. They are notorious for developing prompt resistance to newer antimicrobials. With increasing incidence of methicillin-resistant S. aureus (MRSA) isolates, the treatment options are also becoming limited. Clindamycin is an excellent drug for skin and soft tissue infections, but resistance mediated by the inducible phenotype (iMLS(B)) leads to in vivo therapeutic failure even though there may be in vitro susceptibility. The double disk approximation test (D-test) can reliably detect the presence of such isolates. This study was aimed to detect and report the prevalence of the iMLS(B) phenotype in NEIGRIHMS, a tertiary care center in Northeast India. METHODOLOGY A total of 243 consecutive isolates were subjected to routine identification tests followed by antimicrobial sensitivity testing. Erythromycin-resistant isolates were tested for inducible resistance phenotype by the D-test. RESULTS Among strains tested, 95 (39%) were erythromycin resistant. Twenty-six (10.7%) isolates were D-test positive (iMLS(B) phenotype), 41 (16.88%) were constitutively resistant (cMLS(B) phenotype), and 28 isolates (11.52%) were found to be negative by D-test. The incidence of both inducible and constitutive phenotypes was higher in MRSA isolates compared to methicillin-sensitive S. aureus (MSSA) isolates. CONCLUSIONS This study revealed a moderate prevalence of the inducible clindamycin phenotype in the staphylococcal isolates tested. Clinical microbiology laboratories in areas of high MRSA prevalence should consider performing the D-test routinely. This will help prevent prescription of drug(s) whose therapeutic efficacy is doubtful.

Clinico-aetiologic profile of Onychomycoses in a tertiary care centre in northeast India:

Onychomycosis refers to fungal nail infection. Despite a clearly diseased appearance, it is often deemed a merely cosmetic problem of relatively minor importance. However, it may result in much psychological or occupational turmoil, diminished self-esteem and resulting reluctance for public interaction. A wide number of factors determine the treatment outcome and its prevalence varies greatly. Our study was conducted between January 2011 and December 2014 in northeast India. Of 243 patients presenting with nail abnormalities, 158 (65%) were positively diagnosed by either direct microscopy or culture or both. A distal lateral subungual infection was the most predominant clinical pattern observed, and the most frequent aetiological agents were dermatophytes, of which Trichophyton rubrum was predominant.

Pulmonary Strongyloidiasis - A case report

Strongyloides stercoralis is an intestinal nematode with both free-living and parasitic stages and is common in the tropics. Chronic infection may lead to cutaneous, gastrointestinal, or pulmonary symptoms. We present the case of a 40-year-old male farmer, with on and off loose motions, productive cough, and loss of weight and was admitted with the provisional diagnosis of pulmonary tuberculosis. Rhabditiform larva of S. stercoralis was discovered in the sputum which was sent for screening of acid-fast bacilli. Stool examination was not done. There was no history suggestive of immunocompromised status and the screening test for HIV antibody was negative. Sputum culture showed growth of Escherichia coli. Other laboratory parameters were within normal limits. His chest X-ray revealed bilateral diffuse infiltrates. He was thereby diagnosed to be a case of pulmonary strongyloidiasis, but his condition deteriorated, and he expired before institution of any treatment. Although a potentially lethal opportunistic infection, strongyloidiasis is amenable to treatment with anthelmintics if detected in time. Hence, clinical suspicion with timely diagnosis and aggressive treatment becomes mandatory.

Comparative evaluation of the role of single and multiple blood specimens in the outcome of blood cultures using BacT/ALERT 3D (automated) blood culture system in a tertiary care hospital

Introduction: Bloodstream infection (BSI) is a leading cause of mortality in critically ill patients. The mortality directly attributable to BSI has been estimated to be around 16% and 40% in general hospital population and Intensive Care Unit (ICU) population, respectively. The detection rate of these infections increases with the number of blood samples obtained for culture. The newer continuous monitoring automated blood culture systems with enhanced culture media show increased yield and sensitivity. Hence, we aimed at studying the role of single and multiple blood specimens from different sites at the same time in the outcome of automated blood culture system. Materials and Methods and Results: A total of 1054 blood culture sets were analyzed over 1 year, the sensitivity of one, two, and three samples in a set was found to be 85.67%, 96.59%, and 100%, respectively, which showed a statistically significant difference (P < 0.0001). Similar findings were seen in few more studies, however, among individual organisms in contrast to other studies, the isolation rates of Gram-positive bacteria were less than that of Gram-negative Bacilli with one (or first) sample in a blood culture set. In our study, despite using BacT/ALERT three-dimensional continuous culture monitoring system with FAN plus culture bottles, 15% of positive cultures would have been missed if only a single sample was collected in a blood culture set. Conclusion: The variables like the volume of blood and number of samples collected from different sites still play a major role in the outcome of these automated blood culture systems.

Characterization of Candida species from Intensive Care Unit Isolates in a Tertiary Care Centre in North-East India: A retrospective study

Background: Fungi have emerged as major causes of human diseases. Intensive Care Units (ICU), harbor almost all the risk factors for opportunistic fungal infections. Among these, Candida infections are very common with recent trends being rise in the non- Candida albicans (NCA) species along with an increase in resistance of these species to antifungal drugs. Aims: To characterize the Candida species from the clinical specimens of patients admitted in the ICU of Tertiary Care Centre in North-East India and to perform their antifungal susceptibility. Settings and Design: This retrospective study was conducted in the Department of Microbiology from January 2011 to December 2011. Materials and Methods: The following techniques were employed to characterize the isolates in the study - KOH mount, Grams stain, India ink preparation, culture on Sabourauds Dextrose Agar, Germ Tube test, Urea hydrolysis, morphology in Cornmeal Agar and chromogenic agar media, sugar fermentation and sugar assimilation tests and automated identification system, and the results were interpreted using standard protocols. Statistical Analysis Used: SPSS version 17.0 was used for all statistical computations and P Results: Out of 85 Candida isolates, Candida tropicalis (38%) was the most common, in all age groups. Infections were more common in patients above 40 years and males were affected more than females. NCA species were more resistant to fluconazole than C. albicans . Conclusions: The study highlights the change in epidemiology in the species distribution of Candida and a rise in infections by NCA species as compared to those by C. albicans . Knowledge of the local species distribution of Candida along with their antifungal susceptibility is essential to initiate and optimize therapy and outcome, especially in an ICU setup, which harbors patients susceptible to fungal infections.