Spectrum and antimicrobial susceptibility of bacterial organisms isolated from patients in a bone marrow transplant centre-A review of 6 years

To determine the spectrum and antimicrobial susceptibility pattern of pathogens isolated from bone marrow transplant centre and to examine the evolution of bacterial resistance to antibiotics in these patients. It was a retrospective study conducted in the department of Microbiology, Armed Forces institute of Pathology [AFIP] from January 2004 to December 2009. Isolation, identification and antimicrobial susceptibilities were performed by standard methods. Gram negative bacterie accounted for 50.4% of the total isolates and Gram positives 49.6%. Escherichia coli was the most common isolate among the gram negative rods followed by Pseudomonas spp and Acinetobacter spp. Amongst the Gram positive organisms staphylococcus aureus and coagulase negative staphylococci followed by enterococci were the predominant organisms. The susceptibility of methicillin resistant staphylococcus aureus remained 100% for Vancomycin and Linezolid, while those of minocycline, fusidic acid and doxycycline were at an acceptable level of above 60%. Imipenem remained the most effective antibiotic for Gram negative rods. Acinetobacter spp. was the most problematic organism as only 62% isolates were susceptible to imipenem. Linezolid, vancomycin and tigecycline were very effective for enterococci. Ciprofloxacin sensitivity has been reduced among most of the bacteria isolated. The spectrum of isolates from neutropenic patients in our population appears to be changing with a shift towards Gram-positive microorganisms. At the same time resistance to most of the commonly used antimicrobials is increasing. Continuous surveillance of their susceptibility patterns is essential for formulation of empiric therapeutic regimens for these patients

Antimicrobial activity of tigecycline against methicillin resistant staphylococcus aureus in a tertiary care setting

To determine the in vitro efficacy of tigecycline against methicillin resistant Staphylococcus aureus [MRSA]. Department of Microbiology Army Medical College and Armed Forces Institute of Pathology Rawalpindi, from Feb 2008 to Jan 2009. One hundred clinical isolates of MRSA were taken, Detection of MRSA was done using 30 microg disc of cefoxitin as recommended by Clinical laboratory Standard Institute [CLSI]. Susceptibility of the isolates to tigecycline was done by employing modified Kirby Bauer disk diffusion technique, according to the guidelines provided by the Food and Durg Administration [FDA]. Minimum inhibitory concentrations [MICs] of the isolates were determined by using E-strips [bioMerieux] of tigecycline. Results were interpreted according to FDA recommendations. All MRSA isolates were susceptible to tigecycline by disc diffusion method. The MICs of tigecycline revealed that all MRSA isolates were in sensitive range. In an era of rapidly growing antibiotic resistance, tigecycline has been found to have very good in vitro efficacy against MRSA isolates

In Vitro efficacy of ethionamide and clarithromycin in mycobacterium tuberculosis isolates

To determine the sensitivity of clinical isolates of Mycobacterium tuberculosis isolates against ethionamide, and clarithromycin. Cross-sectional study. Department of Microbiology, Armed Forces Institute of Pathology [AFIP] Rawalpindi from June 2003 to June 2004. All routine clinical samples received for acid fast bacilli [AFB] culture and yielding positive growth on Lowenstien Jensen medium and Bactec 460 were included in the study. The isolates were from sputum [n=70], bronchioalveolar lavage [n=10], fine needle aspiration [n=6], lymph nodes [n=7], pleural fluid [n=4], endometrium [n=3]. After the identification of M. tuberculosis [MTB] sensitivity was performed against first-line antituberculosis drugs. Then susceptibility of M. tuberculosis isolates against ethionamide and clarithromycin was performed on LJ medium. Mycobacterium H37Rv was used as control strain. Results were interpreted using resistance ratio method. Out of 100 M. tuberculosis isolates, sensitivity to ethionamide was 93% and 9% to clarithromycin. Clarithromycin when used alone is ineffective as antituberculosis drug but its efficacy in combination needs to be tested. However ethionamide may be used as an alternative antituberculosis drug

Efficacy of amikacin and ciprofloxacin against clinical isolates of mycobacterium tuberculosis

Tuberculosis was a leading cause of death at the turn of the 20[th] century and continues to be one of the medical scourges of mankind. Before the availability of antimicrobial drugs the cornerstone of treatment was rest in the open air in sanatoria. The major breakthrough in treatment of tuberculosis came with the discovery of Streptomycin. Later, INH, Ethambutol, Pyrazinamide, Rifampicin were added to the arsenal. Objective of this study was to determine the sensitivity of clinical isolates of Mycobacterium tuberculosis against two second-line anti-tuberculosis drugs, Amikacin and Ciprofloxacin. This cross-sectional study was conducted at Department of Microbiology, Armed Forces Institute of Pathology [AFIP] Rawalpindi. All routine clinical samples received for acid fast bacilli [AFB] in the Department of Microbiology, AFIP, Rawalpindi were processed by modified Petroff's technique and inoculated on Lowenstein Jensen [LJ] medium and Bactec 460 Mycobacterium tuberculosis culture system. After identification of M. tuberculosis sensitivity was performed against first-line anti-tuberculosis drugs. Then susceptibility of M. tuberculosis isolates against Amikacin and Ciprofloxacin was performed on LJ medium. H37Rv was used as control strain. Results were interpreted using resistance ratio method. Out of 100 M. tuberculosis isolates, 98% were sensitive to Amikacin and 97% to Ciprofloxacin. Amikacin and Ciprofloxacin are very effective 2[nd] line anti-tuberculosis drugs against tuberculosis isolates in our set-up

Vancomycin resistant enterococcal sepsis in an acute myeloid leu kemic patient

Neutropenic fever is an important cause of morbidity and mortality during therapy of acute myeloid leukemia. Patients with acute myeloid leukemia are at increased risk of acquiring vancomycin resistant enterococcal infection and its treatment remains problematic. Vancomycin therapy for more than 7 days is usually associated with inducible vancomycin-resistant enterococcal infections. We report a case of vancomycin resistant enterococcal sepsis in a patient of acute myeloid leukemia

Extended-spectrum beta-lactamase production in sbigella flexneri

Emergence of multidrug-resistant strains of Shigella is a growing concern across the globe. Third-generation cephalosporins are used for treating infections caused by multidrug-resistant Shigellae. However, resistance to these cephalosporin antibiotics due to extended-spectrum beta-lactamases, has emerged as a new problem. So far extended-spectrum beta-lactamases producing Shigella has not been reported from Pakistan. We report such a case in Shigella flexneri from an 8-year old girl with acute dysentery

Changing trends in frequency of extended spectrum beta lactamase producing gram negative bacilli in intensive care units of a tertiary care hospital

To determine the frequency of isolation of extended spectrum beta lactamase [ESBL] producing Gram negative bacteria from intensive care units [ICUs] of a tertiary care hospital. Retrospective descriptive study. The study was carried out at the department of microbiology Army Medical College Rawalpindi from Dec 2003 to Nov 2007. This study was carried out from Dec 2003 to Nov 2007. A total of 590 consecutive Gram-negative bacilli were recovered during the four year study period from various samples including urine, blood, pus, sputum, high vaginal swabs [HVS], ascitic fluid, central venous lines [CVP], chest tubes, catheter tips, NBL [nasobronchial lavage], CSF, tissue, endotracheal tube [ETT] tip and pleural fluid in ICUs. Extended spectrum Beta-lactamase detection in these isolates was carried out by Kirby- Bauer double disc synergy method. The frequency of ESBL producing organisms was 84 [66%] [December 03 to November 04], 80[54%] [December 04 to November 05], 80[57%] [December 05 to November 06] and 82 [47%] [December 06 to November 07] [p<0.0001] Our study shows a decrease in the frequency of ESBL producing organisms. However there is an increase in the resistant organisms having same resistance pattern, but not detected as ESBL producers, therefore we need to improve the methods for ESBL detection

Evaluation of effects of extract from seeds of myristica fragrans on volume and acidity of stimulated gastric secretion. liver and kidney function

This study was conducted to observe the effects of extracts from the seeds of medicinal plant "Myristica fragrans" [which has documented calcium channel blocker] on volume and acidity of carbachol induced gastric secretion, liver and kidney function in fasting rabbits. Thirty rabbits of local breed were included in the study and they were divided into three equal groups. Group A was injected with Carbachol. Group B was injected with extract and carbachol and group C was injected only extract and liver and kidney function was determined. The drugs and extract were injected intraperitoneally. It was observed that the extract inhibited volume, free and total acidity of gastric secretion in group B. This inhibition was statistically highly significant for all the three parameters [P< 0.001]. It was also noticed that there were non significant changes in liver function and kidney function test before and after 45 days treatment with extract in group C. It is concluded that the extract is an excellent inhibitor of gastric acid secretion and can be safely used for peptic ulcer and other diseases which need calcium channel blockers for their treatment. This will also enable a lay man to use the crude drug obtained from easily available local plant