Puneet Bhatt

Burden of extensively drug-resistant and pandrug-resistant Gram-negative bacteria at a tertiary-care centre

The emergence of resistance to multiple antimicrobial agents in Gram-negative bacteria is a significant threat to public health, as it restricts the armamentarium of the clinician against these infections. The aim of this study was to determine the burden of extensively drug-resistant (XDR) and pandrug-resistant (PDR) Gram-negative bacteria at a tertiary-care centre. Antimicrobial susceptibility testing of 1240 clinical isolates of Gram-negative bacteria obtained from various clinical samples during the study period was carried out by the Kirby-Bauer disc diffusion method. Minimum inhibitory concentration of all antibiotics including tigecycline and colistin was determined by Vitek-2 automated susceptibility testing system. Out of 1240 isolates of Gram-negative bacteria, 112 isolates (9%) were resistant to all the antibiotics tested by Kirby-Bauer disc diffusion method. This finding was corroborated by Vitek-2. In addition, Vitek-2 found that 67 isolates were resistant to all antibiotics except tigecycline and colistin. A total of 30 isolates were susceptible to only colistin, and four isolates were susceptible to only tigecycline. It was also found that six isolates (excluding five isolates of Proteus spp.) were resistant to both colistin and tigecycline. Thus, 101 (8.1%) out of 1240 isolates were XDR and 11 isolates (0.9%) were PDR. The findings of this study reveal increased burden of XDR and PDR Gram-negative bacteria in our centre. It also highlights the widespread dissemination of these bacteria in the community. This situation warrants the regular surveillance of antimicrobial resistance of Gram-negative bacteria and implementation of an efficient infection control program.

Species distribution and antimicrobial resistance pattern of Coagulase-negative Staphylococci at a tertiary care centre

BACKGROUND Coagulase-negative Staphylococci (CoNS), previously dismissed at contaminants, have now emerged as an important cause of nosocomial infections especially in patients with implants and prosthetic devices. They are a well-known cause of bloodstream infections, urinary tract infections, wound infections, prosthetic valve endocarditis and eye infections. This study was conducted with an aim to identify CoNS at the species level from various clinical samples and determine the antimicrobial resistance pattern of these isolates. METHODS This cross sectional study was carried out from September 2011 to February 2014 in which 150 non-repetitive clinical isolates of CoNS were identified at the species level by conventional phenotypic methods. Complete antimicrobial susceptibility profile was also determined by Kirby Bauer disc diffusion method. Susceptibility testing to vancomycin was done by E-test method. RESULTS Only three species of CoNS were isolated, the most common being Staphylococcusepidermidis (60%) followed by Staphylococcussaprophyticus (27.3%) and Staphylococcushemolyticus (12.7%). Most S. epidermidis were isolated from blood and intravascular catheter tip samples, whereas all S. saprophyticus were isolated from urine samples of female patients. All isolates were found to be resistant to penicillin, but were susceptible to glycopeptides and linezolid and showed variable resistance to fluoroquinolones, aminoglycosides and macrolides. CONCLUSION CoNS are emerging nosocomial pathogens and should not always be overlooked as contaminants. However, growth of CoNS from blood cultures and intravascular catheter tips should be clinically correlated and carefully interpreted. As many CoNS strains exhibit drug resistance, antimicrobial susceptibility profile should be determined prior to treatment of these infections.

Emergence of multidrug resistant enterococci at a tertiary care centre.

BACKGROUND Enterococci have assumed great clinical importance because of their increasing resistance to various antimicrobial agents. Thus, knowledge about the antibiogram of these multidrug resistant isolates is of utmost importance in formulating an effective antibiotic policy to treat these infections and reducing the morbidity and mortality. Aim of this study was to assess the antimicrobial resistance pattern of enterococci and determine the prevalence of multidrug resistance among them. METHODS This cross sectional study was carried out from August 2011 to February 2014, in which 200 non-repetitive clinical isolates of enterococci were included. Antimicrobial susceptibility testing was done by disc diffusion method. Minimum inhibitory concentration (MIC) of gentamicin, streptomycin, vancomycin, teicoplanin and linezolid was determined by E-test method. RESULTS The prevalence of multidrug resistance among enterococcal isolates was found to be 63%. Varying levels of resistance was seen to various antibiotics. Most of the isolates were resistant to penicillin (95%), ampicillin (95%) and cotrimoxazole (90%). High level aminoglycoside resistance (HLAR) and glycopeptide resistance was seen in 39% and 14% isolates respectively. Only 4 isolates (2%) were found to be resistant to linezolid. CONCLUSION The prevalence of multidrug resistance among enterococci was found to be 63%, the resistance being more common in Enterococcus faecium as compared to Enterococcus faecalis. The study highlights the emergence and increased prevalence of multidrug resistant enterococci which pose a serious therapeutic challenge.

Burkholderia cepacia pseudobacteremia traced to contaminated antiseptic used for skin antisepsis prior to blood collection

Background: Burkholderia (previously Pseudomonas) cepacia is a Gram-negative bacillus commonly found in soil and moist environments and capable of surviving and growing in nutrient-poor surroundings. It is a problematic pulmonary pathogen in patients with cystic fibrosis and is associated with a poor prognosis. Small hospital outbreaks are frequent, usually because of a single contaminated source such as disinfectant. Aim: To identify the source and route of infection of B. cepacia grown from 12 patients from a surgical ICU. Methods: We carried out an environmental and epidemiological investigation to identify the source and route of infection. Environmental samples previously reported to be potential reservoirs of B. cepacia were collected and processed. Results: Out of 67 blood samples received in a 2-month period from the ICU (surgical) of a tertiary care centre, B. cepacia was isolated from blood specimens of 12 patients, whereas 34 samples grew organisms other than B. Cepacia, 20 specimens were culture negative. There were no cases of B. Cepacia in the last 1 year before this outbreak. We isolated B. cepacia from the cetrimide + chlorhexidine solution used for skin antisepsis prior to blood collection. Conclusion: B. cepacia has the potential to cause fatal infections and its multidrug resistance makes its presence dangerous in hospital settings. The surveillance of B. cepacia infections should not be neglected, especially in the ICUs. Given the high transmissibility of the microorganism and previous epidemic reports, strict infection control measures should be applied in the case of diagnosis of B. cepacia infection.

Nattrassia mangiferae: An uncommon agent of onychomycosis

Onychomycosis constitutes frequent fungal infections of the nails. It is commonly seen in dermatological practice worldwide. The clinical picture though variable is characterized by alterations in the nail architecture such as changes in color, thickness, onycholysis and onychodystrophy.1 In most cases they are caused by filamentous fungi like dermatophytes or yeasts of the genus Candida.2 However, in a small fraction of cases, the etiological agent comprises of non-dermatophyte molds, belonging to several genera and species.1,3 The prevalence of non-dermatophytic onychomycosis varies widely, depending on the geographical location or the climate, but is more frequent in hot and humid tropical areas.3 They are often considered contaminants or secondary pathogens that invade nails previously damaged by trauma or disease. However, in some cases they actually act as primary pathogens to humans, as has been seen for Nattrassia mangiferae, otherwise better known as a plant pathogen. The objective of this case report is to present a rare case of onychomycosis caused by N. mangiferae in a diabetic adult residing in Mumbai, Maharashtra.

Meningitis caused by Lactococcus garvieae

Maj Kundan Tandel*, Maj Puneet Bhatt, Col Praveer Ranjan, Col K.R. Rathi Graded Specialist (Microbiology), DRDE, Gwalior, India Graded Specialist (Microbiology), Command Hospital (Southern Command), Pune 411040, India Senior Advisor (Pathology), Command Hospital (Southern Command), Pune 411040, India Senior Advisor (Path & Neuropath), Command Hospital (Southern Command), Pune 411040, India m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a x x x ( 2 0 1 5 ) x x x – x x x

A case of Aspergillus nidulans causing white granule mycetoma

Mycetoma is a frequent fungal infection encountered in dermatological practice. The clinical picture is slowly progressive, causing chronic granulomatous infection of skin and subcutaneous tissues with involvement of underlying fasciae and bones usually affecting the extremities.1 This disease is defined by the triad of tumefaction of affected tissue, formation of multiple draining sinuses and presence of oozing granules.1 In most cases it is caused by two groups of organisms – fungi (eumycetoma) and bacteria (actinomycetoma and botryomycosis). The eumycetoma is classified into black granule eumycetoma and white granule eumycetoma. The white granule mycetoma is caused by more than 10 species of fungi such as Acremonium species, Pseudoallescheria boydii, Aspergillus nidulans, Aspergillus flavus, Fusarium species and Scedosporium apiospermum. The black granule mycetoma is caused by Madurella mycetomatis, Madurella grisea, Exophiala jeanselmei, Curvularia geniculata.1, 2 Mycetoma is worldwide in distribution, mostly seen in rural areas and is mainly occupation related. The prevalence of mycetoma varies widely being more frequent in hot, humid, tropical and sub-tropical areas. Mycetoma is endemic in Africa, Sudan, Senegal, southern and northern parts of India. As there is a huge difference between treatment of mycetoma due to fungal and bacterial cause, identification of the etiological agent plays a major role in the management.2, 3, 4, 5 White granule mycetoma is very rare and has been reported rarely worldwide as well as in India. Till now, only a few cases of white granule mycetoma caused by A. nidulans have been reported. The objective of this case report was to present a rare case of white granule mycetoma caused by A. nidulans in a diabetic adult individual residing in Pune, Maharashtra.

Biotreatment of waste gas containing pyridine in a novel rotating rope biofilter.

A novel Rotating Rope Biofilter (RRB) has been developed especially for the treatment of Volatile Organic Compounds (VOCs) at higher loadings and characterised by high volatility along with high water solubility. The RRB provides a higher interfacial area (per unit reactor liquid volume) along with high oxygen mass transfer rate, greater microbial culture stability, and consequently higher substrate loadings and removal rates in comparison with other conventional reactors (e.g. biofilters) widely used for the treatment of VOCs. Pyridine was used as a model compound to demonstrate the enhanced performance of the RRB. The experimental results indicate that the novel RRB system is able to degrade pyridine with removal efficiency of more than 90%, up to a loading of 250 g/m³/h. The reactor has been in operation for the past 15 months and no loss of activity has been observed.

Simultaneous detection and serotyping of dengue infection using single tube multiplex CDC Dengue Real-Time RT-PCR from India

AbstractFour antigenically different dengue virus serotypes (DENV-1, DENV-2, DENV-3 and DENV-4) are known to cause infections in humans. Some of these are known to cause more severe disease than the others. Chances for developing Dengue hemorrhagic fever-dengue shock syndrome (DHF-DSS) increases significantly with history of previous infection with one of the four serotypes. Therefore, early diagnosis, serotyping and providing early warning of dengue fever epidemics to concerned authorities becomes very important for better patient outcome and to curb the rapid spread in the community. During the 2014 outbreak, a total of 100 samples from suspected cases of dengue were collected. NS1 antigen based rapid test was used for serological diagnosis. Dengue complex one step reverse transcription-polymerase chain reaction was performed to look for presence of viral RNA. Single tube multiplex RT-PCR was also performed to look for infecting serotype. CDC Dengue Multiplex Real Time PCR assay was performed for rapid diagnosis and simultaneous serotyping of the dengue virus. Out of the 100 samples screened, 69 were found to be positive by NS1Ag Rapid test. 34 samples were found positive by dengue consensus RT-PCR assay. 22 samples were found to be positive by single tube Dengue multiplex RT-PCR assay. Serotype DEN-2 was present in maximum numbers followed by DEN-3. 44 samples were found positive by DENV CDC Multiplex Real time PCR assay. DEN-2 was found in maximum numbers followed by DEN-1. Dengue remains to be an important health problem in India and across the globe. Few serotypes of dengue are more dangerous than the others. Rapid diagnosis and serotyping remains the key for better patient management and prevention of disease spreading in the community. Highly sensitive, specific and rapid CDC real time RT-PCR assay was found to be most promising tool among all available molecular diagnostic methods. This will serve a rapid and reliable simultaneous dengue virus detection as well serotyping assay in near future for rapid identification of dengue suspected sample screening.

Disseminated melioidosis: a case report

Melioidosis, an infectious disease caused by Burkholderia pseudomallei, has recently gained importance as an emerging infectious disease in India. Reports of this infection in India are limited, although cases have been reported in Northern Australia and Southeast Asian countries such as Thailand, Malaysia and Vietnam. We report a case of disseminated melioidosis who developed pneumonia, meningitis and septicemia following blunt trauma to the chest. To the best of our knowledge, this is the first case of meningitis caused by B. pseudomallei being reported from this part of the country. The patient was successfully treated with imipenem and cotrimoxazole.