Ravinder Pal Singh

Antimicrobial susceptibility pattern of extended-spectrum beta- lactamase producing Klebsiella pneumoniae clinical isolates in an Indian tertiary hospital.

Objective: There is an increased prevalence of extended-spectrum beta-lactamase producing Klebsiella pneumoniae (ESBL-KP) worldwide including India, which is a major concern for the clinicians, especially in intensive care units and pediatric patients. This study aims to determine the prevalence of ESBL-KP and antimicrobial sensitivity profile to plan a proper hospital infection control program to prevent the spread of resistant strains. Methods: KP isolates obtained from various clinical samples were evaluated to detect the production of ESBL by phenotypic methods. Antimicrobial susceptibility profile was also determined of all the isolates. Findings: Of 223 nonduplicate isolates of K. pneumoniae, 114 (51.1%) were ESBL producer and antimicrobial susceptibility profile showed the isolates were uniformly sensitive to imipenem and highly susceptible to beta-lactamase inhibitor combination drugs (67–81%) and aminoglycosides (62–76%), but less susceptible to third generation cephalosporins (14–24%) and non-β-lactam antibiotics such as nitrofurantoin (57%), fluoroquinolones (29–57%), piperacillin (19–23%), and aztreonam (15–24%). Conclusion: This study found that beta-lactamase inhibitor combinations are effective in treatment of such infections due to ESBL-KP thus these drugs should be a part of the empirical therapy and carbapenems should be used when the antimicrobial susceptibility tests report resistance against inhibitors combinations.

Spectrum of opportunistic and other parasites among HIV/AIDS patients attending a tertiary care hospital

Abstract Objective To determine the spectrum of opportunistic as well as non-opportunistic parasitic infections in HIV/AIDS patients. Methods A total of 250 HIV sero-positive individuals are included in study. Among them, 76 clinical cases of diarrhea and 8 clinically suspected cases of toxoplasmosis were identified. Fresh stool samples were collected in a suitable container on three consecutive days and processed immediately for identification of oocysts of Cryptosporidium parvum , Isospora belli and Cyclospora . Blood sample was collected from suspected cases of toxoplasmosis and tested for antitoxoplasma immunoglobulin M antibodies using immunoComb Toxo IgM test. Estimation of CD4 counts was also done by flow cytometry from these patients. Results The opportunistic parasites identified in total HIV sero-positive patients were Cryptosporidium spp. (20.8%) and Isospora belli (0.8%). While the non-opportunistic parasite identified were Entamoeba histolytica (4%), Giardia intestinalis (1.6%) and Hymenolepis nana (0.8%). Toxoplasmosis was identified in 2.4% HIV sero-positive patients. Conclusions Increasing prevalence of parasitic infections in HIV/AIDS patients suggests that simple steps such as drinking safe water, maintaining high level of environmental and personal hygiene and avoiding contact with contaminated soil are necessary to prevent the occurrence of these diseases in AIDS patients

Evaluation of total lymphocyte count (TLC) as a surrogate marker for CD4 count in HIV-positive patients for resource-limited settings

Context: The immunity in HIV-infected patients becomes low due to involvement of CD4 cells. The single best predictor of AIDS onset identified is the percentage or absolute number of circulating CD4+ T cells. However, providences in resource-constraint settings may not have access to this laboratory measurement, or its cost may be prohibitive resulting in the need for an alternative, surrogate marker. Hence, total lymphocyte count (TLC) was evaluated as a probable surrogate marker for CD4 count in this study. Aims: To evaluate the correlation of CD4 counts with the TLC for predicting the progression of HIV infection, and to determine a range of TLC cut-offs for predicting CD4 count <200 cells/μl, which is important for the initiation of antiretroviral therapy (ART) and opportunistic infection (OI) prophylaxis. Settings and Design: This study was conducted in the Department of Microbiology at Government Medical College, Aurangabad. Materials and Methods: A total of 250 HIV-positive patients were included in the study. Their Complete Blood count and CD4 count were measured and the TLC was computed. Statistical Analysis Used: SPSS software version 10.0. Results: A positive correlation between TLC and CD4 count was observed in our study, highlighting the role of this surrogate marker in resource-limited settings. Further, a TLC cut-off of ≤1700 cells/μl was found to be the best predictor for a CD4 count <200 cells/μl. Conclusions: A general correlation between the surrogate marker TLC and expensive CD4 counts could be elicited for the population under study. A TLC cut-off of ≤1700 cells/μl was the best predictor of CD4 count <200 cells/μl. This study demonstrates the ability of TLC, whether used as a continuous or dichotomous data, to predict CD4 count or a CD4 count <200 cells/μl, respectively.

Development of antibiotic resistance in Gram negative bacilli: An eye opener

Context: Antibiotic resistance is a global problem. Organisms are showing resistance to not only the conventional antibiotics but also to the higher generation drugs. This enormous amount of resistance faced is a serious threat to mankind and this is further accentuated by the fact that the antibiotic pipeline is fast drying up. We are now left with only a handful of antibiotics to deal with all infections - serious or otherwise. The present paper highlights the current scenario of drug resistance especially in nosocomial settings. Aims and Objectives: To determine the distribution of bacterial pathogens causing nosocomial infections and their antibiogram, a surveillance data from January to December 2011 was collected in Mohan Dai Oswal Hospital. A total of 1800 samples were taken of which maximum samples were urine (766) followed by blood (428) and pus (216), and so on. Settings and Design: This observational study was conducted in the microbiology department of a multispeciality hospital during January-December 2011. Materials and Methods: A total of 1800 samples from different sources were included in the study like pus, blood, urine, sputum, etc., which were taken from patients admitted in the hospital for more than a week. Gram negative bacilli were isolated, identified, and subjected to antibiotic sensitivity test. Statistical Analysis Used: Descriptive statistics using percentages. Results: Out of the total 1800 samples included, maximum positivity was found in the pus samples (70%). Extended-spectrum beta-lactamase (ESBL) positivity was also maximum in the pus samples (90%). These ESBL positive organisms were further subjected to antibiotic sensitivity tests and huge amounts of resistance was noted to the conventional drugs including the higher end agents like Carbapenems. In light of this, newer drugs like Tigecycline, Colistin, and Polymyxin B were also tested. Barring Tigecycline, none showed favorable results. A noteworthy finding was the sensitivity of the urinary ESBL isolates to Nitrofurantoin. Conclusions: The situation is quite dangerous. The time is not far when we will be back in the dark ages of the preantibiotic era. The need of the hour is to be alert of the gravity of this situation and take necessary measures to halt its progress.

Bacterial and antimicrobial resistance profile of bloodstream infections: A hospital-based study

Background: Bloodstream infections (BSIs) are one of the serious infections causing significant morbidity and mortality among hospitalized patients. Large numbers of cases of treatment failure are being reported due to emergence of drug resistance. Early microbiological diagnosis and determination of antimicrobial susceptibility pattern have been shown to improve treatment outcome. The present study was aimed to determine the bacterial and antimicrobial resistance profile of BSIs in a major tertiary care hospital. Materials and Methods: Blood samples in brain heart infusion (BHI) broth submitted to the microbiology laboratory for culture and sensitivity during a period of 1 year were included in the study. Samples were processed as per standard protocol of laboratory for isolation and identification. The antimicrobial susceptibility profile of bacterial isolates was determined by the disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of 4862 blood samples, 494 (10.16%) isolates were obtained. Of these isolates, 256 (51.82%) were Gram-negative and 230 (46.56%) were Gram-positive bacteria. The most commonly identified organism was coagulase-negative Staphylococcus (CoNS) (25.91%) followed by Acinetobacter spp. (20.24%) and Escherichia coli (14.98%). Gram-negative bacteria showed a higher rate of resistance as compared with Gram-positive bacteria. Conclusion: High prevalence of antimicrobial resistance was noted in this study, especially in Gram-negative bacteria. Hence, appropriate treatment of BSIs should be based on the current knowledge of bacterial resistance profile as provided by microbiology laboratory. It would be advisable for the clinicians to mandate antimicrobial sensitivity testing for suspected cases of BSIs.

Prevalence of nasal colonization of methicillin-resistant Staphylococcus aureus among schoolchildren of Barabanki district, Uttar Pradesh, India.

Introduction: The study aimed to determine the prevalence of nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA), the minimum inhibitory concentration (MIC) of oxacillin and vancomycin, inducible clindamycin resistance, and antimicrobial resistance pattern of S. aureus among children of Barabanki district, Uttar Pradesh, India. Materials and Methods: School-going children of age group of 5–15 years were identified and selected according to the inclusion and exclusion criteria. Two nasal swabs were collected from each child as per the Centers for Disease Control and Prevention guidelines and transported to laboratory. Swabs were cultured on mannitol salt agar and 5% blood agar and incubated for 18–24 h at 37°C. Identification was done as per routine laboratory protocol. Detection of MRSA was done through cefoxitin 30 μg discs and D-zone test. Antibiotic susceptibility pattern of S. aureus by Kirby–Bauer disc diffusion method along with MIC for oxacillin and vancomycin was performed simultaneously according to Clinical Laboratory Standards Institute guidelines. Results: Out of 300 children, 140 (46.67%) were found to be nasal carriage for S. aureus, among which MRSA was found to be 23 (7.67%). All S. aureus and MRSA isolates were sensitive to vancomycin with MIC <2 μg/ml, whereas 23 S. aureus were found resistant to oxacillin with MIC value >4 μg/ml. Resistance to penicillin and co-trimoxazole was highest, whereas all were sensitive to linezolid. MRSA showed 100% susceptibility to linezolid, followed by gentamicin (91.4%) and tetracycline (87%). Conclusion: With the risk involved in transmission of infection, steps for identifying the carriers and its eradication should be carried out. Rational use of antibiotics should be given preference too.

Incidental detection of hepatitis B and C viruses and their coinfection in a hospital-based general population in tertiary care hospital of Uttar Pradesh

Introduction: Substantial proportion of liver diseases worldwide is caused by hepatitis B virus (HBV) and hepatitis C virus (HCV) infections which manifest not only as an acute illness but also lead to chronic sequelae. Together HBV and HCV cause chronic infection in more than 500 million persons and about one million deaths annually. Most of the people with chronic infection are not aware of the infection thus enabling it to go unnoticed, and undiagnosed and act as a potential source of infection for the community at large. Therefore, we aimed to find the prevalence of HBV and HCV in Barabanki, Uttar Pradesh among individuals attending the tertiary care hospital. Materials and Methods: From February 2015 to January 2016, 3750 patients attending the outdoor patient departments or admitted to the indoor patient departments of teaching hospital and advised to undergo HBV and HCV for screening before any invasive/surgical procedure were included in the study. Screening was done by rapid card test followed by the confirmation of all samples by enzyme immunoassay. Results: Seroprevalence of HBV and HCV was found to be 3.9% and 1.76% respectively with higher seroprevalence among males and in married participants in both infections. Blood transfusion is statistically a significant risk factor for HCV infection (P < 0.05). Coinfection with HBV/HCV was seen in 0.16% of the individuals visiting the hospital. Conclusion: Higher seroprevalence of HBV and HCV among the hospital-based population mandates screening of high-risk individuals. Awareness by health education of safe sexual practices and improved safety of blood and its products are among the most important preventive measures to control HBV and HCV infection.

Detection of anti-filarial antibody among hydrocele patients living in an endemic area for filariasis

Background: The knowledge of the current prevalence of lymphatic filariasis and its transmission will be helpful in its elimination. Thus, the present study is aimed to determine its prevalence among hydrocele patients which is a common presentation in chronically infected cases. Materials and Methods: One hundred patients suffering from hydrocele admitted to the surgical ward were included in the study. Blood samples were collected from the patients during the day hours for the detection of anti-filarial antibody and during night hours to detect the presence of microfilaria by smear examination. Blood samples were also collected from the family member attending the ward along with the patients to determine the presence of anti-filarial antibodies. Serum IgE level and eosinophil count were also determined in the patients showing a positive result for the anti-filarial antibody test. Results: Out of 100 hydrocele patients, 21% patients showed anti-filarial antibody card test positive with maximum patients belonging to age group of 20-40 years. Microfilaria was detected in 5% of the hydrocele patients, whereas none of the family members showed positive anti-filarial antibody test. Serum IgE level and eosinophil count were more than 1000 ng/ml and 500/mm 3 , respectively. Conclusions: The study has found a high prevalence of filariasis among hydrocele patients. It is suggested that more studies are needed to know the real time prevalence of the cases showing manifestations of the filariasis in the acute stage which will help the eradication program to formulate new strategies.

Surveillance of tuberculosis co-infection among HIV infected patients and their CD4+ cell count profile

Objective To determine the occurrence of tuberculosis (TB) among HIV infected patients and their CD4+ cell count profile.