Munesh Sharma

Microbiology of chronic suppurative otitis media in a tertiary care setup of uttarakhand state, India.

Background: Chronic suppurative otitis media (CSOM) is a notorious infection and a major health problem in developing countries causing serious local damage and threatening complications. Early and effective treatment based on the knowledge of causative micro-organisms and their antimicrobial sensitivity ensures prompt clinical recovery and possible complications can thus be avoided. Aims: The aim of this study was to isolate the organisms associated with CSOM and to detect the antibiogram of the aerobic isolates. Materials and Methods: A total of 204 patients clinically diagnosed of CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and cultured for microbial flora. Drug susceptibility testing for aerobic isolates was conducted using Kirby-Bauer disc diffusion method. Results: The most common causative organisms isolated were Staphylococcus aureus (48.69%) and Pseudomonas aeruginosa (19.89%) amongst the 191 aerobic isolates. Anaerobes accounted for 29.41% of the isolates while 12.25% were fungi. Antimicrobial profile of aerobic isolates revealed maximum sensitivity to amikacin (95.5%), ceftriaxone (83.4%) and gentamicin (82.7%). Conclusion: Knowing the etiological agents of CSOM and their antimicrobial susceptibility is of essential importance for an efficient treatment, prevention of both complications and development of antibiotic resistance and finally, the reduction of the treatment costs.

Emergence of non-albicans Candida species in neonatal candidemia.

Background: Candida species are one of the most common causes of blood stream infections among neonates and account for 9-13% of such infections. Although Candida albicans remains the most common fungal isolate from neonatal candidemia, longitudinal studies have detected a shift towards non-albicans Candida (NAC) species. Aim: To examine the prevalence and epidemiology of candidemia among infants admitted to our hospital. Materials and Methods: Blood samples were collected from 548 neonates and only those which yielded pure growth of Candida spp. were included in the study. The isolates were identified as per standard mycological techniques and antifungal susceptibility (AFS) was done by disc diffusion method. Results: Of the total 132 neonates included in the study, NAC species were responsible for 80.30% cases with C. parapsilosis (25.0%) and C. tropicalis (21.97%) as the most predominant species; whereas 19.70% of cases were caused by C. albicans. AFS results revealed that 65.91, 73.49, and 96.21% isolates were sensitive to fluconazole (FLK), itraconazole (ITR), and amphotericin B (AMB), respectively. Conclusion: Candidemia in neonates is an ominous prognostic sign and is an important entity in our hospital. Strict infection control strategies, appropriate preventive and therapeutic measures such as prophylactic antifungal use and a restrictive policy of antibiotic use should be implemented.

Mobile phones: Reservoirs for the transmission of nosocomial pathogens

Background: Global burden of hospital-associated infection (HAI) is on the rise and contributes significantly to morbidity and mortality of the patients. Mobile phones are indispensible part of communication among doctors and other health care workers (HCWs) in hospitals. Hands of HCWs play an important role in transmission of HAI and mobile phones which are seldom cleaned and often touched during or after the examination of patients without hand washing can act as a reservoir for transmission of potent pathogens. This study aimed to investigate the rate of bacterial contamination of mobile phones among HCWs in our tertiary care hospital and to compare it with personal mobile phones of non-HCWs (control group). Materials and Methods: The mobile phones and dominant hands of 386 participants were sampled from four different groups, hospital doctors and staff (132), college faculty and staff (54), medical students (100) and control group (100). Informed consent and questionnaire was duly signed by all the participants. Samples were processed according to standard guidelines. Results: 316 mobile phones (81.8%) and 309 hand swab samples (80%) showed growth of bacterial pathogens. The most predominant isolates were Coagulase-negative Staphylococcus, Staphylococcus aureus, Acinetobacter species, Escherichia coli, Klebsiella pneumoniae, Pseudomonas species and Enterococcus species. Conclusion: Hundred percent contamination was found in mobile phones and hands of HCWs indicating mobile phones can be the potential source of nosocomial pathogens. Our study results suggest that use of mobile phones in health care setup should be restricted only for emergency calls. Strict adherence to infection control policies such as proper hand hygiene practices should be followed.

The prevalence of inducible clindamycin resistance among staphylococci in a tertiary care hospital - a study from the garhwal hills of uttarakhand, India.

OBJECTIVE This study was undertaken to assess the frequency of the phenotypic expression of the inducible resistance to clindamycin which was due to the expression of the erm genes in various clinical isolates of the Staphylococcus species. MATERIALS AND METHODS This was a cross sectional study conducted in the Dept. of Microbiology and Immunology, Veer Chandra Singh Garhwali Govt. Medical Sciences and Research Institute, Srikot, Uttarakhand, from July 2010 to December 2011. A total of 373 consecutive, non duplicate strains of Staphylococci isolated from various clinical samples like pus, wound swab, blood, urine and other body fluids, were tested. The isolates which had a discordant resistance pattern (clindamycin-sensitive and erythromycin-resistant) by Kirby Bauer Disk Diffusion method were selected and subjected to the D-test for inducible clindamycin resistance, as per the Clinical and Laboratory Standards Institutes (CLSI) guidelines. RESULTS Among the 373 clinical isolates of Staphylococci which were studied, 134 isolates showed a discordant resistance pattern. Among these discordant strains, 45 (33.6%) isolates were D-test positive, which had inducible clindamycin resistance and belonged to the inducible macrolide lincosamide streptogramin- B phenotype (MLSBi). 89 (66.4%) isolates were D-test negative and they belonged to the macrolide streptogramin phenotype (MS). Among the MLSBi phenotypes, 6 (13.3%) isolates were methicillin-resistant Staphylococcus aureus (MRSA), 13 (28.9%) were Methicillin-sensitive S.aureus (MSSA) and 26 (57.8%) were coagulase negative staphylococci (CONS). CONCLUSION The D-test is a simple, effective and an important method for the phenotypic detection of inducible clindamycin resistance and it should be used routinely, as it will help in guiding the empirical therapy. The possible clinical failures can thus be avoided.

Bacteriological Profile of Surgical Site Infections and Their Antibiogram: A Study From Resource Constrained Rural Setting of Uttarakhand State, India.

INTRODUCTION Surgical site infections (SSI) constitute a major public health problem worldwide and are the second most frequently reported nosocomial infections. They are responsible for increasing the treatment cost, length of hospital stay and significant morbidity and mortality. AIM To determine the incidence of SSIs and the prevalence of aerobic bacterial pathogens involved with their antibiogram. MATERIALS AND METHODS Samples were collected using sterile cotton swabs from 137 patients clinically diagnosed of having SSIs and were processed as per standard microbiological techniques. Antimicrobial susceptibility testing was done using modified Kirby-Bauer disc diffusion method. This cross sectional study was conducted for a period of six months (January 2013 to June 2013) in the Department of Microbiology at a rural tertiary care hospital of Uttarakhand state, India. RESULTS Out of 768 patients, 137 (17.8%) were found to have SSIs and samples were collected from them. Out of total 137 samples, 132 (96.4%) yielded bacterial growth and 139 bacterial isolates were obtained. Staphylococcus aureus (50.4%) was the commonest organism followed by Escherichia coli (23.02%), Pseudomonas aeruginosa (7.9%) and Citrobacter species (7.9%). Antimicrobial profile of gram positive isolates revealed maximum sensitivity to vancomycin, teicoplanin and linezolid, whereas among gram negative isolates meropenem, piperacillin-tazobactam, and amikacin were found to be most sensitive. CONCLUSION The rate of SSI observed in this study was comparable to other similar studies, however we observed a higher degree of antimicrobial resistance. Adherence to strict infection control measures, maintenance of proper hand hygiene and optimal preoperative, intraoperative and postoperative patient care will surely reduce the incidence of SSIs.

Significance of fungal flora in chronic suppurative otitis media

Introduction: Chronic suppurative otitis media (CSOM) is defined as infection of the middle ear that lasts for >3 months and is accompanied by tympanic membrane perforation. The incidence is higher in developing countries, especially among the low socioeconomic strata of the society. Many authors have focused their attention on the bacterial flora of CSOM, but very little is known about the mycological aspects of these, the importance of which has been increasing in the recent years. Objective: The present study was aimed to speculate the etiological fungal flora responsible for the cases of CSOM among patients who attended the Ear, Nose, and Throat Department of our hospital a tertiary care center in Uttarakhand. Materials and Methods: The total of 107 patients (both males and females) who were clinically diagnosed with CSOM and were on any antibiotics (oral, topical or systemic) for >14 days and still persisted with symptoms were included in this study. Results: Among the 107 cases of CSOM studied, fungi were isolated in 83 (77.57%). Majority of the patients were in second and third decades of life (62.62%). Of the 83 fungal culture positive cases, the predominantly isolated fungi were Aspergillus species (47%), Candida species (41%), and Penicillium species (9.6%). Among the Aspergillus, the predominant species were Aspergillus flavus (17 isolates) and Aspergillus niger (12 isolates). Candida albicans (19 isolates) and Candida tropicalis (9 isolates) were the commonly isolated species of Candida. Conclusion: A definite search for fungal etiology is desirable in all cases of CSOM. Prolonged use of topical antibiotics or antibiotics-steroids ear drops may cause suppression of bacterial flora and the subsequent emergence of fungal flora. This probably increases the incidence of fungal superinfection. Otologists should suspect mycotic otitis media in patients with continuous otorrhea and who do not respond to the antibacterial treatment.

Intestinal parasitic infection-intensity, prevalence and associated risk factors, a study in the general population from the Uttarakhand hills

Background: Intestinal parasitic infection is an important public health problem in developing countries. Low socioeconomic conditions, lack of access to potable drinking water, poor personal hygiene and environmental sanitation are the factors associated with intestinal parasitic infection. Aim: The aim of this study was to estimate the prevalence of intestinal parasitic infections and identify the associated risk factors. Materials and Methods: Study was performed on 327 stool specimens of all age groups from August 2012 to May 2013. Specimen collected and examined with direct wet mount, formal ether sedimentation and salt flotation methods. Results: Out of the total 327 participants prevalence of intestinal infections was 11.62%. Among the Protozoa, Giardia lamblia (3.06%) was the most common, followed by Entamoeba histolytica (0.92%). Hookworm (2.75%) and Hymenolepis nana (2.14%) were the most common helminthes found. Parasitosis was seen more in female (17.07%) than male (8.33%) and highest between 51 and 60 years (22.22%) age group with risk factors like open defecation (22.69%), untreated river water (17.91%) and among people living in rural areas (15.17%). Conclusion: There is a need to create awareness about safe drinking water, personal hygiene and environmental sanitation and to take urgent remedial steps to prevent and control intestinal parasitic infections.

Disseminated trichosporonosis due to Trichosporon asahii in a diabetic patient

Trichosporon asahii (formerly known as Trichosporon beigelii) is an emerging, life-threatening opportunistic pathogen and has been found to be invariably associated with disseminated or deep-seated trichosporonosis, more so among the patients with granulocytopenia or hematological malignancies. We here report a successfully treated case of disseminated trichosporonosis in a known diabetic, 14-year-old girl, admitted to our hospital with chief complaints of fever, chills, and burning micturition since 3 weeks. Disseminated trichosporonosis is usually an insidious disease with poor prognosis. Early diagnosis is crucial for successful treatment. High index of clinical suspicion and extensive microbiological investigations can clinch the diagnosis.

Node inoculation: A quick and easy technique to screen pigeonpea for resistance to Phytophthora blight

The petiole on pigeonpea was removed for easy, precise inoculation of node with Phytophthora drechsleri f. sp. cajani. After node inoculation, 96.0% plants were infected compared with 89.0% after stem-cut inoculation. Among various nodes inoculated on 30-day-old plants, the 5th node had the greatest relative susceptibility (90.0%), followed by the 3rd node (78.0%). This technique was validated on different cultivars (ICP 7119, Bahar, MA 6 and MAL 13), and 586 lines were successfully screened in the field, confirming the rapidity and effectiveness of the technique for resistance screening.

Pseudomonas aeruginosa and its sensitivity spectrum in chronic suppurative otitis media: A study from Garhwal hills of Uttarakhand State, India

Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity, with recurrent ear discharge through a perforated tympanic membrane. It is a major health problem in developing countries causing serious local damage and life-threatening complications. The advent of sophisticated systemic antibiotics and their irrational use has led to the emergence of multidrug-resistant (MDR) bacterial strains and disease complication in return. Pseudomonas aeruginosa, one of the most common organisms to cause CSOM, is a notorious pathogen and is known for its MDR attribute. Objective: The aim of this study was to know the prevalence of P. aeruginosa among the patients suffering from CSOM, to analyze their antimicrobial susceptibility pattern, and to find out MDR P. aeruginosa strains. Materials and Methods: A total of 571 patients clinically diagnosed of CSOM were enrolled in the study (559 patients with unilateral and 12 with bilateral discharge), and 583 samples were obtained from them. Sample processing and identification was done by standard bacteriological methods. One hundred eighty-seven strains were identified as P. aeruginosa and were subjected to antimicrobial susceptibility testing for 10 different antibiotics categorized into five classes. Results: Of total 583 samples collected, growth was seen in 576 (98.8%) samples. P. aeruginosa strains were isolated from 187 (32.1%) samples. Piperacillin-tazobactam (75.4%), amikacin (74.3%), imipenem (70.6%), and cefepime (69.0%) were found to be the most effective antibiotics. Twenty-nine (15.5%) strains were resistant to all the five classes of antibiotics tested. The rate of resistance to fluoroquinolones (48.7%) was highest, followed by antipseudomonal penicillin (41.7%), and was lowest for carbapenems (29.4%). Conclusion: Knowing the etiological agents of CSOM and their antibiogram is of paramount importance for an efficient treatment and prevention of both disease complications and antimicrobial resistance.