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Background: Respiratory infections among critically ill Patient are associated with high morbidity and mortality. Mechanically ventilated patients are at a high risk of acquiring respiratory infections due to complex interplay between the endotracheal tube, host immunity and virulence of invading bacteria. Irrational use of antibiotics increases the emergence of drug – resistant bacteria. Objectives: The aim of study was to investigate the bacterial isolates in the endotracheal aspirates of mechanically ventilated patients in ICU and see the antimicrobial resistance pattern of bacterial isolates. Methods: Analysis of E.T aspirates of 459 patients over a period of 1 year (Aug 14 to Aug 15) was done. Aspirates were cultured on Blood and MacConkey agar isolation and identification was done using conventional techniques and biochemical reactions. Antibiotic sensitivity testing was done by Kirby-Bauer disc diffusion method as per CLSI guidelines. Results: Out of 459 Samples 365 was found to be positive. Acinetobacter sp (44.65%) was the most common isolate followed by Klebsiella sp (18.63%), Pseudomonas sp (11.23%), Candida (10.46%), Escherichia Coli (7.94%), COPS (3.28%), CONS (2.46%), Enterococci (0.82%), and Citrobacter (0.54%). The gram-negative bacilli were mostly sensitive to Tigecycline, Colistin, Imipenem, Meropenem, Amikacin and Piperacillin/Tazobactam. Gram positive Cocci were mostly sensitive to Vancomycin, Linezolid and Gentamicin. Conclusion: The isolation and antimicrobial resistance pattern of the microorganisms is necessary for their effective management. Endotracheal intubation is one of the major risk factors in causing iatrogenic infections to patients. A local antibiogram for each hospital, based on bacteriological patterns and susceptibility is essential to initiate empirical therapy.
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Background: Hepatitis B virus infection is an important health problem and a leading cause of death worldwide. The most important marker for HBV infection is HBsAg. A proper identification of kit is required for proper diagnosis of infection, as well as disease management and prevention. Aims& Objective: - The aim of the present study was to compare rapid HBsAg detection ICT kits for the screening of HBV infection with gold standard ELISA method. Methods: The study comprised 500 blood samples of pregnant women. These samples were tested with ICT kits of (Hepa Card Company) and ELISA (HEPLISA by J. Mitra.). Results: In present study we found 100% sensitivity, 99.59% specificity, 81.81% positive predictive value ,100%Negative predictive value and 99.60% diagnostic efficiency of rapid card test with comparison to ELISA for HBsAg detection. Conclusion: The present study concluded that the overall performance of the rapid ICT kit for HBsAg was equally sensitive to ELISA and yet they were cheap and quicker. It can be recommended that ELISA comparable rapid devices may be allowed to be used for preliminary screening of HBsAg especially in remote areas or where cost is an issue.
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Background: Hepatitis B virus infection is a major global health problem and India accounts for 10- 15%of the entire pool of HBV carriers of the world. Prevalence of Hepatitis B in pregnant women worldwide is 2.5 to 1.5%, whereas in India it is 2 to 7%. Hepatitis B virus is a double stranded DNA virus. The study was undertaken to determine the seroprevalence of Hepatitis B among the pregnant women in southern part of Rajasthan at a rural based tertiary care teaching hospital. Methods: This is a prospective study conducted at a tertiary care hospital, Udaipur, Rajasthan, from August 2015 to December 2017.Blood samples were collected from 1011 pregnant women with age ranging from 15- 45 years. Screening of HBsAg was done by RPHA method and positive HBsAg tests were confirmed by ELISA. The data of those , who were found to be positive for HBsAg was statistically analyzed with the chi square tests, and results were considered significant if the p value was <0.05. Results: The overall HBsAg seroprevalence rate was 1.28%, among the total 1011 pregnant women included in this study. HBsAg seroprevalence was highest, (1.64%) in 15-25 years of age group, and 1.71% in the second trimester of pregnancy. The correlations of seroprevalence rate of HBsAg among selected age groups and according to second trimester of pregnancy were not found statistically significant. (p value>0.05) Conclusion: In this study the seroprevalence of Hepatitis B surface antigen was 1.28%. To prevent vertical transmission in the pregnant women, they should be screened for HBsAg at the first antenatal visit for appropriate management.
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Background: The aim of our study was to analyse the hospital data on AECOPD in patients with special reference in males and female cases, the pathogens involved, antibiotic susceptibility pattern. Methods: 107 patients (72 males, 35 females) aged between 45 and 85 years were included in the study. A detail history was elicited and complete examination was done. The sputum specimen was collected using sterile sputum cups and subjected to Gram’s stain, culture and biochemical reactions. Results: Our study shows 44 positive sputum cultures out of total 107 cases. Out of 107 cases 67% were males and 33% were females. The predominant clinical feature observed in our study was cough with expectoration, exertional dyspnoea and production of mucopurulent sputum. The prevalence of Gram negative bacteria was 55% and Gram positive bacteria was 45%. Klebsiella pneumoniae was the commonest bacteria isolated (38%) followed by Staphylococcus aureus (18%). The drug sensitivity reveals that 79.55% of the isolates were sensitive to amikacin followed by 68.18% sensitive to amoxyclavulinic acid and 54.55% of the isolates were sensitive to ciprofloxacin. Conclusions: In a developing country like India AECOPD is more common in adults more than 55 years of age due to smoking habits and high indoor pollution. This leads to a major impact on the quality of life of patients with the condition. They are a major cause of hospital admission and health care utilization.
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Background: Aerobic vaginitis (AV) is caused by a displacement of the healthy vaginal Lactobacillus species with aerobic pathogens such as Enterococcus faecalis, Escherichia coli and Staphylococcus aureus that triggers a localized vaginal inflammatory immune response. AV if it is not diagnosed and treated early, especially during pregnancy can place the health of both the mother and the foetus at risk as it is associated with preterm birth, premature rupture of membranes (PROM) and chorioamnionitis. Hence the present study aims at analysing the prevalence of aerobic vaginitis in females in the reproductive age group (15-45 years) with special reference to pregnancy, pathogens involved and their antibiogram. Methods: Over one year period, high vaginal swabs were collected from 125 women with clinical suspicion of vaginitis. They were then subjected to Gram’ staining and culture was made onto blood agar, chocolate agar and MacConkey agar and incubated aerobically at 37 0c for 24 hours. The AV score was determined and the organisms were then identified and antibiotic sensitivity test of isolates were performed. Results: The prevalence of Aerobic vaginitis in this study was 20.8% (26/125) and the most common age group affected was between 26-30 years. Out of the 26 positive cases, 21 samples yielded monobacterial growth and 5 cases polybacterial growth. The most common organism isolated was Enterococcus faecalis (32.26%), followed by Escherichia coli (25.8%), Staphylococcus aureus (19.35%) and β-hemolytic streptococci (9.68%). Antibiotics like β–lactams/ β–lactamase inhibitor combinations, vancomycin and linezolid were found to be more effective against all Gram positive isolates whereas the Gram negative isolates were more sensitive towards β–lactams/ β–lactamase inhibitor combination, aminoglycosides and meropenem. Conclusions: This study emphasized on the need to identify the aerobic vaginal pathogens associated with vaginitis especially in reproductive age group women which can go a long way in preventing the adverse outcomes associated with pregnancy and also ensures the necessity to determine the antibiotic sensitivity pattern of the pathogens which can aid in making a suitable therapeutic choice for 'aerobic vaginitis' by considering an antibiotic that is characterized by an intrinsic activity against the majority of bacteria of faecal origin, bactericidal effect and without any interference with the vaginal microbiota.
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Background: Coagulase negative Staphylococci (CONS) are normal human microbiota and sometimes cause infections, often associated with implanted devices, such as joint prosthesis, shunts and intravascular catheters, especially in very young, old and immunocompromised patients. These infections are difficult to treat because of the risk factors and the multiple drug resistant nature of the organisms. The study is undertaken to speculate CONS isolates from various clinical samples and to determine antibiotic susceptibility pattern of CONS by Kirby Bauer disc diffusion method. Methods: A total of 134 clinically significant CONS isolated from pus, urine, blood, fluid, sputum, ear swabs, endotracheal tube, ophthalmic, semen and nail samples. These isolates initially identified by colony morphology, Gram staining, catalase test, slide coagulase test, tube coagulase test and mannitol fermentation. Speciation of CONS was done by novobiocin resistance test, urease activity, ornithine decarboxylase and aerobic acid production from mannose. Results: S. epidermidis is the most frequent isolate 62 (46.3%) followed by S. saprophyticus 38(28.4%), S. haemolyticus 27(20.1%), S. lugdunensis 3(2.2%). S. warneri 3(2.2%), S. cohinii 1(0.7%). Antibiotic susceptibility testing of the isolates showed maximum resistance to penicillin 128 (95.5%) and ampicillin118 (88%) followed by erythromycin 96 (71.6%), cefoxitin 89 (66.4%), gentamicin 33(24.6%), piperacillin & tazobactam 31(23.8%), amoxicillin & clavulanic acid 25 (18.7%), linezolid 23 (17.2%), levofloxacin 9 (6.7%), vancomycin & teicoplanin 2 (1.5%), tigecycline 1 (0.7%). Conclusion: S. epidermidis is the more common isolate identified and CONS are often resistant to multiple antibiotics (Penicillin, ampicillin) & glycopeptides have been considered as the drugs of choice for the management of infections caused by these organisms.
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Background: The Biofilms are densely packed communities of microorganisms consisting of layers of cell clusters embedded in a matrix of extracellular polysaccharide called polysaccharide intercellular adhesin. This layer impedes the delivery of antibiotics to the biofilm forming microbial cells leading to emergence of drug resistance. Staphylococci are commensal bacteria on the human skin and mucous membranes. So it may be easily introduced as a contaminant during the surgical intervention. So, this study was conducted to identify the Biofilm producing strains from clinical isolates of Staphylococci. Methods: A total of 182 non-repetitive clinical strains of Staphylococci isolated from various clinical samples from Feb 2014 to Oct 2014 were included in the study. All the isolates were identified using standard microbiological procedures. All the samples were tested for biofilm production by modified Congo-red agar method and tube method. Results: Out of 182 samples that were included in the study, a total of 90 (49.45%) samples showed biofilm formation of which 58 (75.32%) were methicillin resistant and 32 (30.47%) were methicillin sensitive. Also these strains were resistant to other antibiotics. Conclusion: Our study showed biofilm production by methicillin resistant strains which were also multidrug resistant. Treatment of methicillin resistant strains of Staphylococci is one of the most challenging task for the clinicians and the microbiologists. So they should be routinely screened for biofilm formation in order to prevent emergence and spread of multidrug resistant strains.
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Background: Asymptomatic bacteriuria is common in women with prevalence of 4-7% in pregnancy. The traditional reference test for bacteriuria is quantitative culture of urine which is relatively expensive time consuming and laborious. The aim of this study was to know the prevalence of asymptomatic bacteriuria in pregnancy, to identify pathogens and their antibiotic susceptibility patterns and to device a single or combined rapid screening method as an acceptable alternative to urine culture. Methods: Clean catch mid-stream urine were collected from 250 pregnant women aged between 18-45 years attending antenatal clinic, for a period of one year (November 2008-2009). Screening tests such as gram staining of uncentrifuged urine, pus cell count, nitrite test and leukocyte esterase test were done. Identification of organisms and antibiotic sensitivity tests were performed as per standard methods. Results: Out of the 250 pregnant women, 21 (8.4%) had significant bacteriuria. High percentage of asymptomatic bacteriuria was seen in 2nd trimester (42.86%) and in primigravidas (52.38%). E. coli (57.14%) was the most common organism. Among screening tests gram staining of uncentrifuged urine had a sensitivity of 85.71%. Nitrite and leukocyte esterase tests alone showed sensitivity of 71.42%. However, the combination of these two tests, either tests positive, showed sensitivity and negative predictive value of 90.47% and 99.09% respectively. Conclusion: Asymptomatic bacteriuria in pregnancy can be identified by simple and combined rapid screening methods and urine culture along with antibiogram so that early treatment can be started thereby preventing complications.
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Background: All postoperative surgical infections occurring in an operative site are termed surgical site infections (SSI). Superficial incisional surgical site infection occurs within 30 days after the operation and infection involves only skin or subcutaneous tissue of the incision and represents a substantial burden of disease for patients and health services. The study was conducted to know the incidence of surgical site infection in our hospital, risk factors associated with it and the antibiotic susceptibility pattern of the pathogens. Methods: This prospective study was carried out in the Department of Microbiology at Dr B R AMC for a period of 1 year from Jan 2013to Jan 2014. Samples of SSI received in the Microbiology laboratory were processed and Data collected. Results: The overall surgical site infection rate in our hospital during the study period is 4.3%. Staphylococcus aureus (S. aureus) was the most common isolate obtained followed by Escherichia coli (E. coli) and Coagulase negative Staphylococcus (CONS). Other organisms isolated were Pseudomonas aeruginosa, Enterococcus, Klebsiella pneumoniae and Proteus mirabilis. Among them, 88.8% of S. aureus and 50% of CONS isolates were methicillin-resistant strains. 80% of E. coli and 100% of Klebsiella species were ESBL producers. 50% of Enterococci were Vancomycin resistant. Risk factors like diabetes mellitus and duration plays a significant role in causing surgical site infection. Conclusion: Implementation of an effective infection control programme and judicious use of antibiotic prophylaxis reduces the incidence of SSI in the hospital.