Bacteriological profile of ventilator-associated pneumonia in a tertiary care hospital

Background: Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection. The etiology of VAP and their antimicrobial susceptibility pattern varies with different patient populations and types of ICUs. Materials and Methods: An observational cross-sectional study was performed over a period of 2 years in a tertiary care hospital to determine the various etiological agents causing VAP and to detect the presence of multidrug-resistant (MDR) pathogens in these VAP patients. Combination disk method, Modified Hodge test, ethylenediaminetetraacetic acid disk synergy test, and AmpC disk test were performed for the detection of extended-spectrum beta-lactamase (ESBL), carbapenemases, metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively. Results: The prevalence of VAP was 35%. Enterobacteriaceae (66.66%) and Staphylococcus aureus (20%) were common in early-onset VAP, while nonfermenters (50%) and Enterobacteriaceae (40.61%) were predominant from late-onset VAP. Nearly 60.87% of the bacterial pathogens were MDR. ESBL was produced by 21.74% of Enterobacteriaceae. AmpC ?-lactamase was positive in 35.29% nonfermenters and 26.08% Enterobacteriaceae. MBL was positive in 17.64% nonfermenters and 17.39% Enterobacteriaceae. Among the S. aureus isolates, 75% were cefoxitin resistant. Prior antibiotic therapy (P = 0.001) and hospitalization of 5 days or more (P = 0.001) were independent risk factors for VAP by MDR pathogens. polymyxin B, tigecycline, and vancomycin were the most sensitive drugs for Gram-negative and positive isolates respectively from VAP. Statistical Analysis: SPSS for Windows Version SPSS 17.0 (SPSS Inc., Chicago, IL, USA) and Chi-square with Yates correction. Conclusion: Late-onset VAP is increasingly associated with MDR pathogens. Treatment with polymyxin B, tigecycline, and vancomycin should be kept as last-line reserve drugs against most of the MDR pathogens.

Biofilm as a virulence marker in Candida species in Nosocomial blood stream infection and its correlation with antifungal resistance.

Nosocomial blood stream infections (BSI) due to fungi especially Candida is increasing steadily. A two year prospective study was conducted in the S.C.B. Medical College with an aim to evaluate the species distribution, antifungal susceptibility and biofi lm formation of Candida spp. isolated from nosocomial BSIs. 34 Candida spp. were isolated from 359 blood cultures. Antifungal susceptibility was performed by microbroth dilution technique and both visual and spectrophotometric method were used for biofi lm detection. C. tropicalis was the common spp. isolated followed by C. parapsilosis and others. Most (92%) of the isolates were susceptible to Amphoterecin-B and highest resistance was observed against Flucytosine (37%) and Fluconazole(35%). Biofi lm production and antifungal resistance was observed more in nonalbicans Candida spp.

Bilateral Tinea Nigra of palm: A rare case report from Eastern India.

A 14 year old girl from a coastal district of Odisha presented with a six month history of asymptomatic brownish patches on the palm of the both hands. Epidermal scrape from these patches showed brown septate hyphae with occasional yeast like cells. Hortaea wernekii was isolated from the fungal culture. A diagnosis of Tinea nigra was made. The patches resolved completely after treatment with topical 1% clotrimazole cream.

Changing Trends in the Fungal Isolates from Clinical Specimens of Suspected Superficial Mycosis.

Introduction: The local patterns of fungal isolates from clinical specimens may change with time and geographical area and it is important to be familiar with recent local trends in order to improve diagnosis. Objective: The local patterns of fungal isolates from clinical specimens of suspected superficial mycosis was studied in a tertiary care centre in Orissa between 2009 - 2011. Material and Methods: Mycological examinations of 311 materials sampled from various sites in patients with suspected superficial mycosis was done by KOH wet mount and culture. Results: A total of 311 specimens were sent for mycological study . Out of 217 specimens of suspected superficial mycosis, Trichophyton (68.42%) was the most frequently isolated genus,with T. rubrum (62.82%) as the most common species, followed by the T. mentagrophytes (29.48%) . T. schoenlenii was responsible for 18.75% of T. pedis and 38.4% of T. capitis cases. T. tonsurans was responsible for 50% of T. barbae and 23.8% T. cruris cases. Out of the other 94 specimens , Aspergillus (35.1%) was the most frequently isolated genus , with A. fumigates (57.57%) as the most common species; followed by Candida (17.02%) in which C. tropicalis (31.25%) was the most commonly isolated species followed by C. albicans (25%). Conclusions : An evident change in the spectrum of fungal isolates causing superficial mycosis has been observed with T. schoenlenii and T. tonsurans emerging as a causative agent of T. pedis , T. capitis and T. barbae and T. cruris respectively. There is a decrease in the relative frequency of C. albicans and increase in Candida tropicalis causing superficial fungal infections.

Tuberculous Synovitis of Knee Joint.

Tuberculosis of the appendicular skeleton is an uncommon infection by tubercle bacilli. Thirty percent of the skeletal tuberculosis involves joints, the knee being the third most common joint affected. We report a case of tuberculous synovitis of the knee joint in a 69 years old male. The diagnosis was done by Ziehl – Neelsen stain and culture on Lowenstein – Jensen medium of the synovial fluid along with X-ray finding of the knee joint. Though the sputum sample was negative for AFB, X-ray of the chest showed finding suggestive of old pulmonary tuberculosis. The patient was treated with the anti tubercular regimen and responded well .

Role of azithromycin against clinical isolates of family enterobacteriaceae: A comparison of its minimum inhibitory concentration by three different methods.

PURPOSE: To determine the effect of azithromycin, a new azalide antibiotic, on clinical isolates of the family Enterobacteriaceae and to determine and compare its minimum inhibitory concentration (MIC) by disk diffusion, agar dilution and E-test methods. MATERIALS AND METHODS: One hundred fifty-nine bacterial strains belonging to the family Enterobacteriaceae, isolated from different clinical samples, were tested for their susceptibility to azithromycin by disk diffusion, agar dilution and E-test methods. The MIC values were analysed and the percentages of agreement between the different methods were mentioned. RESULTS: Of the 159 isolates of the family Enterobacteriaceae, 60.37% were E. coli followed by Klebsiella species 28.3%, Salmonella and Shigella species 3.77% and Enterobacter and Citrobacter species 1.88% each. Maximum isolates were obtained from urine 117/159 (73.58%). Azithromycin was found to be more active against Salmonella and Shigella species, showing 100% sensitivity the by E-test and 83.33% by the disk diffusion methods. In the agar dilution method, 83.33% of Salmonella and 66.66% of Shigella species were sensitive to azithromycin. The overall agreement between disk diffusion and agar dilution method was 96.8%, between agar dilution and E-test was 88% and between disk diffusion and E-test was 91.2%. CONCLUSION: Azithromycin may become an important addition to our antimicrobial strategies, especially for the treatment of bacterial diarrhoea and infections caused by Salmonella typhi.

Comparison of parasite lactate dehydrogenase based immunochromatographic antigen detection assay (optimal) with microscopy for detection of malaria parasites.

This study was done to compare the ability of a newly developed rapid malaria test OPtiMAL, an immunochromatographic antigen detection assay for the diagnosis of malaria using parasite lactate dehydrogenase, against standard microscopy. Blood samples were obtained from 232 patients suspected of having malaria. A total of 122 samples (52.5%) were positive by blood films while 118 (50.8%) were positive by OPtiMAL test. The blood film indicated that 21.4% (26 of 122) of the patients were positive for P. falciparum and 78.6% (96 of 122) were infected with P. vivax. OPtiMAL test showed that 21.2% (25 of 118) were positive for P.falciparum and 78.8% (93 of 118) were infected with P. vivax. This assay had sensitivities of 88.4% and 96.8% compared to traditional blood films for detection of P.falciparum and P.vivax malaria respectively. Thus OPtiMAL test can be used with or without traditional blood film examination for detection of both P. vivax and P. falciparum malaria and can be effectively used for the rapid diagnosis of malaria.

Seroprevalence of anti HCV antibody in and around Cuttack, Orissa.

One hundred ninety (190) serum samples and 52 control samples consisting of high risk individuals were screened for anti HCV antibody by 3rd generation ELISA test. The prevalence rate was found to be 1.57% in total but it was 2.12% in healthy voluntary blood donors. All were males between the age group of 21 to 40 years. All the control samples were found to be seronegative for anti HCV ab.