Yogesh Chander

ANTIBIOTIC RESISTANCE PATTERN OF ISOLATES FROM WOUND AND SOFT TISSUE INFECTIONS

Two-hundred and eighty bacterial isolates from wound and soft tissue infections were studied for species identification and antibiotic resistance pattern. Amongst them 122 isolates were from community acquired infection and 158 were from nosocomial infections. The common community acquired pathogens were Staphylococcus aureus (67.8%) and Streptococcus pyogenes (10.7%), whereas Staphylococcus aureus (60.1%) and E. Coli (8.9%) were common in nosocomial infection. Only two anaerobes (Cl perfringens) were isolated. Penicillin resistance was found to be 87% and 92% for Staphylococccus aureus in community acquired and noscomial infections respectively. 85% of Proteus isolates were resistant to ampicillin. There was relatively lower level of resistance by all isolates to cefotaxime. Gentamicin showed higher rate of resistance than netilmicin and amikacin. Resistance of E. coli isolates to fluoroquinolones being 79% for norfloxacin, 81% for ciprofloxacin and 60% for ofloxacin. The study showed a higher resistance of methicillin resistant Staphylococcus aureus (MRSA) to other antibiotics. Amikacin and ofloxacin were the best recommended drugs for empirical therapy for all organisms, the susceptibility rate being 80.7% and 80.4%.

UREAPLASMAS UREALYTICUM AND HUMAN INFERTILITY: EFFECT ON SPERMATOZOA MORPHOLOGY

Seminal fluids of 197 males with complaints of involuntary infertility were examined for spermatozoal counts, morphological changes in the spermatozoa and cultured for ureaplasmas and mycoplasmas. In 12, no spermatozoa were present, 29 had a count of less than one million and 156 had more than one million spermatozoa per mL of the seminal fluid. Various morphological changes were detected in the spermatozoa in some cases. U urealyticum and M hominis were grown in 43.15% and 16.75% in comparison to control figures of 15.9% and 11.4% respectively. There was no correlation between growth of ureaplasmas and the spermatozoal count. Among the morphological changes, presence of coiled tails, presence of a fuzzy coat around the tail and microcolonies were highly specific for culture positivity (98.2, 98.2 and 97.35% respectively) but of low sensitivity (55.2%, 14.1% and 8.2% respectively).

HIV INFECTION IN HERPES ZOSTER

The interaction of Herpes zoster and Human Immunodeficiency Virus (HIV) was evaluated in 120 cases of herpes zoster admitted to our hospital and in 157 HIV positive cases detected in the hospital during the same period. The incidence of HIV seropositivity was 22.5 per cent in cases of herpes zoster without AIDS defining disease conditions. Whereas the incidence of Herpes zoster in cases detected to be HIV positive in the same period was 17.2 per cent. A large number of herpes zoster cases found to be HIV positive were in the sexually active age group viz. 21-30 years. Thoracic dermatomal segments were most frequently involved. None of the cases had severe complications or showed evidence of progression to symptomatic HIV disease.

TO STUDY INCIDENCE OF CHLAMYDIAL GENITAL TRACT INFECTIONS USING ENZYME IMMUNO ASSAY-ANTIGEN DETECTION AND CELL CULTURE METHODS

Endocervical swabs from 315 patients were screened for chlamydial infection by using Enzyme Immuno Assay technique for antigen detection. Of these, 190 patients were of infertility and 125 patients were with history suggestive of pelvic inflammatory disease (PID). 100 age matched controls were also screened for the detection of chlamydial antigen by using EIA. The overall incidence of chlamydial infection in this study group was 15.2%. 21 (11.05%) of the infertility patients and 27 (21.6%) of the pelvic inflammatory disease cases were found to be positive for chlamydial antigen. The prevalence rate was found to be high in the age group of 31-40 years in both study groups i.e. infertility group (14.7%) and PID group (50%). All the ELISA positive cases (48) and randomly selected (10) age matched controls were screened by tissue culture using McCoy cell line. In the tissue culture, 44 of the 48 samples were found to be positive and none of the controls groups were found positive. 4 samples showed discordant results possibly due to the presence of non-viable organism or inhibitory material present at the sample site. The sensitivity and specificity of ELISA with respect to tissue culture are 100% and 71% respectively. The positive predictive value and the negative predictive value of the ELISA are 91.6% and 100% respectively. The efficiency of the test was found to be 93.1%.

CHANGES IN URINARY ISOLATES AND THEIR ANTIBIOTIC RESISTANCE PATTERN

A total of 338 urinary isolates were studied at AFMC, Pune during 1998 for species identification and antibiotic resistance. Out of 145 community isolates E coli were 67% followed by Staph aureus (11%). The hospital isolates of E coli and Proteus spp showed higher resistance to ampicillin (81% and 89% respectively) than to cefotaxime (23% and 22% respectively). K pneumoniae showed relatively higher resistance to cefotaxime i.e. 54% for community strains and 75% for hospital strains. Proteus spp showed higher resistance to fluoroquinolones i.e. 78% for norfloxacin and 82% for ofloxacin as compared to other coliforms and Pseudomonas aeruginosa. Among aminoglycosides bacterial resistance to amikacin is less than to commonly used netilmicin and gentamicin. Hospital isolates of K pneumoniae are 100% resistant to sulphamethoxazole and to trimethoprim. Susceptibility testing is emphasized as a must both for hospital and community isolates, but when empirical treatment is contemplated for community isolates nitrofurantoin, nalidixic acid, amikacin, cefotaxime, gentamicin and piperacillin are recommended as first line choices and for hospital isolates amikacin, cefotaxime and netilmicin are recommended until susceptibility report is available.

INVESTIGATION OF A CASE OF CLOSTRIDIAL MYONECROSIS

C lostridial myonecrosis (gas gangrene) occurs in a setting of common muscle injury and contamination with soil or other foreign material containing the spores of C perfringens or other histotoxic clostridia; (a) penetrating war wounds (b) accidental traumatic civilian injuries (c) surgical wounds particularly after bowel or billiary tract surgery. Rarely, cases of gas gangrene have been reported following parentral injections and at sites of venepuncture in granulopenic patients [1]. Clostridia commonly associated with gas gangrene are C perfringens (80%), C novyi (40%), C septicum (20%) followed occasionally by C histiolyticum, C sordelli, C fallax, C bifermentans and C sporogenes. Gas gangrene may occasionally develop in the absence of an obvious external wound . This form of gas gangrene is designated as spontaneous nontraumatic gas gangrene and is caused by C septicum.