Kiran Bala

Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the intensive care unit

Background: Lower respiratory tract infections (LRTIs) are the most frequent infections among patients in Intensive care units (ICUs). Aims: To know the bacterial profile and determine the antibiotic susceptibility pattern of the lower respiratory tract isolates from patients admitted to the ICU. Settings and Design: Tertiary care hospital, retrospective study. Materials and Methods: Transtracheal or bronchial aspirates from 207 patients admitted to the ICU were cultured, identified, and antibiotic sensitivity was performed by standard methods. Statistical Analysis Used: SPSS software was used for calculation of % R of 95% confidence interval (CI). Results: Of 207 specimens, 144 (69.5%) were culture positive and 63 (30.4%) showed no growth. From 144 culture positives, 161 isolates were recovered, of which 154 (95.6%) were Gram negative bacilli (GNB). In 17 (11.0%) patients, two isolates per specimen were recovered. The most common GNB in order of frequency were Pseudomonas aeruginosa (35%), Acinetobacter baumannii (23.6%), and Klebsiella pneumoniae (13.6%). A very high rate of resistance (80-100%) was observed among predominant GNB to ciprofloxacin, ceftazidime, co-trimoxazole, and amoxycillin/clavulanic acid combination. Least resistance was noted to meropenem and doxycycline. Conclusion: Nonfermenters are the most common etiological agents of LRTIs in ICU. There is an alarmingly high rate of resistance to cephalosporin and β-lactam-β-lactamase inhibitor group of drugs. Meropenem was found to be the most sensitive drug against all GNB. Acinetobacter and Klebsiella spp. showed good sensitivity to doxycycline.

Detection of extended-spectrum β-lactamase in Pseudomonas aeruginosa

Purpose: The present study was designed to detect the extended-spectrum β-lactamase (ESBL) production in Pseudomonas aeruginosa and to evaluate the susceptibility pattern. Materials and Methods: One hundred forty-eight isolates of P. aeruginosa were analyzed for the presence of ESBL enzyme by double disc synergy test. Antibiotic sensitivity pattern of ESBL-positive P. aeruginosa was determined. Results: Of the 148 isolates tested, 30 (20.27%) were found to be positive. Maximum ESBL production was found in sputum and tracheostomy swabs (28.57%), followed by pus (24.13%), urine (19.04%), cerebrospinal fluid (CSF) and other sterile body fluids (15.38%) and blood (7.14%). All the ESBL-producing P. aeruginosa isolates were multi-drug-resistant. Isolates were 100% sensitive to imipenem. Ofloxacin was the second most (70%) effective drug. Conclusion: From this study, we conclude the presence of ESBL-positive P. aeruginosa in our hospital. This has important implications as carbapenems remain the only choice of treatment for infections caused by these organisms. The control measures include judicious use of antibiotics and implementation of appropriate infection control measures to control the spread of these strains in the hospital

Vancomycin and High Level Aminoglycoside Resistance in Enterococcus spp. in a Tertiary Health Care Centre: A Therapeutic Concern

Aims. This study was aimed at knowing the prevalence of vancomycin and high level aminoglycoside resistance in enterococcal strains among clinical samples. Study Design. It was an investigational study. Place and Duration of Study. It was conducted on 100 Enterococcus isolates, in the Department of Microbiology, Pt. BDS PGIMS, Rohtak, over a period of six months from July to December 2014. Methodology. Clinical specimens including urine, pus, blood, semen, vaginal swab, and throat swab were processed and Enterococcus isolates were identified by standard protocols. Antibiotic sensitivity testing of enterococci was performed using Kirby-Bauer disc diffusion method. Results. High level gentamicin resistance (HLGR) was more common in urine samples (41.5%) followed by blood (36%) samples. High level streptomycin resistance (HLSR) was more common in pus samples (52.6%) followed by blood samples (36%). Resistance to vancomycin was maximum in blood isolates. Conclusion. Enterococci resistant to multiple antimicrobial agents have been recognized. Thus, it is crucial for laboratories to provide accurate antimicrobial resistance patterns for enterococci so that effective therapy and infection control measures can be initiated.

Acinetobacter lwoffii An Emerging Pathogen in Neonatal ICU

BACKGROUND Acinetobacter species are ubiquitous in the environment and are important causative agent for nososcomial infection especially in immunocompromised patients. Multi drug resistant Acinetobacter lwoffii are emerging as a pathogen in neoanatal sepsis. AIMS AND OBJECTIVE This study was aimed to evaluate the clinical and antibiotic profile of Acinetobacter lwoffii. MATERIAL AND METHODS This study was done on blood samples from neonates admitted to neonatal intensive care unit during a period of one year from January to December 2012, who developed Acinetobacter infection. The diagnosis of isolates and antibiotic susceptibility testing was done by both conventional as well as by automated system. RESULTS Out of total 13,133 blood samples received for culture, 1418(10.8%) were from NICU. Ninety (6.3%) isolates were found to be positive for the growth of Acinetobacter species. Of these isolates 31.11% were found to be Acinetobacter lwoffii, 68.9% were Acinetobacter baumannii calcaetius complex. Acinetobacter lwoffii isolates were most commonly sensitive to imepenem 16(57%), cotrimoxazole 9(32%), ciprofloxacin 6(21%) followed by amoxyclavulanic acid 2(7%) and cefuroxime 1(3.5%). CONCLUSION Multi drug resistant Acinetobacter lwoffii infection is increasing particularly in premature and very low-birth weight neonates. Judicious and timely antibiotic use in NICUs are one of the important key in controlling multi-drug resistant Acinetobacter infection and improving clinical outcome.

Anti-CCP Antibody Vs Rheumatoid Factor: A Comparison of Diagnostic Characteristics for Rheumatoid Arthritis

Approximately 20-30% of untreated rheumatoid arthritis patients become permanently disabled (Rindfleisch and Muller, 2005). Thus, early and accurate diagnosis results in better treatment modality and lengthens healthy life. In 1998, Schelleken reported that antibodies, against citrullinated peptide, are highly specific seromarker for the diagnosis as well as prognosis of rheumatoid arthritis, before that rheumatoid factor (RF) was the only serological marker for the diagnosis of rheumatoid arthritis (Schellekens et al., 1998; Hill et al., 2003).

Peripheral Neuropathy in Thalassemia Major

To the Editor: Neurological complications, including peripheral neuropathy have been described in adolescents and adults with thalassemia major. However, its prevalence in children and the impact of effective chelation on the development of peripheral neuropathy is mostly undetermined. These complications have been attributed to various factors such as iron overload, chronic hypoxia, and drug-induced neurotoxicity with desferrioxamine [1]. This cross-sectional study included children aged 5–15 y with transfusion-dependent thalassemia major. Children on any form of vitamin supplementation (except folic acid) in preceding six months, those with known neuromuscular disease or with a family history of inherited muscle/nerve disease were excluded from the study. Awritten informed consent was obtained, and the study was approved by the Institutional ethical committee. Data were categorized into two groups: effective chelation (Serum ferritin level < 2500 ng/ml) and ineffective chelation (Serum ferritin level > 2500 ng/ml) groups. All patients were subjected to detailed age appropriate neurological examination and detailed nerve conduction study for any clinical evidence of mono or polyneuropathy. Mean (SD) age of enrolled patients (n = 50) was 10.5 (4.5) y with a male predominance [36 (72%)]. Mean (SD) hemoglobin was 8.9 (1.2) g/dl. Majority of children were on deferasirox [30 (60%)]. None of the children had either clinical or electrophysiological evidence of peripheral neuropathy. Electrophysiological parameters including compound muscle action potential (CMAP), sensory nerve action potential (SNAP), and conduction velocity (CV) of the tested motor and sensory nerves were comparable between the two groups of effective and ineffective chelation. Prevalence of electrophysiological peripheral neuropathy ranged from 18.6 to 76% among adolescents and adults with thalassemia major [1–4]. The study findings are consistent with previous studies showing a lack of significant correlation of electrophysiological parameters with serum ferritin levels [2, 5]. Based on this preliminary cross-sectional study with a limited sample size, we conclude that children with beta-thalassemia major did not demonstrate any clinical or electrophysiological evidence of peripheral neuropathy. Peripheral neuropathy shown in thalassemia patients is probably agedependent and does not develop until adolescence. Further research would be of benefit with a larger sample size and age-matched controls.