Phenotypic & genotypic profile of antimicrobial resistance in Pseudomonas species in hospitalized patients

Background & objectives: Nosocomial infections caused by multidrug-resistant, Pseudomonas species have become a major clinical and public health concern. The aim of this study was to characterize phenotypic and genotypic profile of antimicrobial resistance (AMR) in Pseudomonas spp. isolated from hospitalized patients. Methods: A total of 126 consecutive, non-duplicate isolates of Pseudomonas spp. isolated from various clinical samples were included in the study over a period of two years. Identification and antimicrobial sensitivity was performed using automated culture system according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. Phenotypic detection of extended-spectrum ?-lactamases (ESBLs), Amp-C ?-lactamase (AmpC) and metallo-?-lactamases (MBLs) were done by various combinations of disc-diffusion and E-test methods, followed by polymerase chain reaction-based detection of ?-lactamase-encoding genes. Results: Among 126 clinical isolates, 121 (96.1%) isolates were identified as Pseudomonas aeruginosa. Most of the isolates were recovered from pus sample, 35 (27.8%) followed by urine, 25 (19.84%); endotracheal aspirate, 24 (19.04%); blood, 14 (11.11%) and sputum, four (3.17%). The highest rate of resistance was against ticarcillin-clavulanic acid, 113 (89.7%) followed by meropenem, 92 (72.5%) and ceftazidime, 91 (72.3%). Overall, ESBLs, AmpC and carbapenemase production was detected in 109 (96.4%), 64 (50.8%) and 105 (94.6%) isolates by phenotypic methods. The most prevalent ESBL gene was blaTEMin 72 (57.1%) and the least prevalent was blaSHVin 19 (15.1%) isolates. AmpC gene was seen less compared to ESBL gene. The most prevalent carbapenemases gene was blaNDM-141 (46.06%) followed by blaVIM and blaOXA-1. Interpretation & conclusions: Our findings suggested that a high rate of ESBLs and carbapenemases production was observed in Pseudomonas spp. Therefore, phenotypic and genotypic detection of AMR needs to be combined for better characterization of resistance patterns in Pseudomonas spp.

Flooding adds pathogenic Escherichia coli strains to the water sources in southern Khyber Pakhtunkhwa, Pakistan.

Purpose: Seasonal rains in Pakistan result in heavy floods across the country, whereby faecal contaminants will be added to the water bodies and cause numerous food‑borne outbreaks. The present study was aimed to determine the prevalence of diarrheagenic Escherichia coli (DEC) strains in the water sources. Materials and Methods: Two hundred water samples collected during (2011–2012) were processed for the isolation of E. coli (EC) strains. EC strains were further analysed for antibiotic susceptibility patterns, and pathogroups‑specific virulence factors stx1, stx2, stx2c, eae, tir, hlyA, bfpA, estA and eltA were detected using multiplex polymerase chain reaction. Results: Thirty‑three percent of the water samples were contaminated with EC pathotypes. Fifty percent (33/66) of the DEC pathotypes were identified as enterotoxigenic EC (ETEC). Seventy‑two percent (13/18) of the enteropathogenic EC (EPEC) strains were identified as typical EPEC and 28% (5/18) as atypical EPEC. Eleven percent (7/66) of the Shiga toxin EC (STEC) isolates carried a combination of stx1 and stx2 genes. Summer was found as a peak season with 47% (31/66) for EC pathogroups’ activities. Eighty‑nine percent of the strains showed resistance against tetracycline. Conclusion: ETEC and EPEC are the primary causes of water contamination in southern regions of Khyber Pakhtunkhwa province, Pakistan. Firm adherence to the prescribed drugs can decrease trends in antibiotic resistance.

Co-infection of Central Nervous System by M. Tuberculosis, Cryptococcus and possibly Naegleria fowleri

Co-infection due to Mycobacterium tuberculosis, Cryptococcus and Naegleria fowleri has not been reported till now in literature, to the best of our knowledge. Here we report a curious case of co-infection of the central nervous system due to these three pathogens in an apparently immune-competent, HIV negative boy. The 15 year old boy was a diagnosed case of tubercular meningitis and was on anti-tubercular and anti-epileptic treatment. However, two months later he presented again in the emergency department with sudden loss of consciousness. His CSF showed presence of capsulated budding yeast cells (suggestive of Cryptococcus) and flagellated parasites (resembling the flagellated stage of Naegleria fowleri). CSF was also positive for Cryptococcal antigens by Latex Agglutination test. The boy was HIV negative and apparently immuno-competent. He was subsequently put on amphotericin B therapy for six weeks. Repeat microscopy, done towards the end of amphotericin B course, showed clearing of CSF. However, the patient’s condition improved only slightly, owing to neurological damage caused by the pathogens as suggested by brain CT and MRI scans. Thus infection caused by the members of three different kingdoms in an apparently immunocompetent boy highlights the importance of thinking beyond the ordinary causative pathogens, and actively searching for rarer etiologies to ensure timely intervention; especially in nonresponsive cases.

Effect of noise on human performance under variable load in a die casting industry--a case study.

The manual mode of working in industries is very common in the developing and under developed countries. Many industrial processes have generated high levels of noise and causing physiological effects on operators and thus leading to reduced performance. A survey was carried in various die casting industries to determine the levels of noise. It was found that the levels were in the range of 80-100dB(A). The survey also showed that the effects were more pronounced when the task was conducted under varying load conditions. Keeping this in view the problem was formulated to study whether the level of noise and amount of load has a bearing on human performance. For this purpose, experimental investigations in a simulated environment were carried out. Five subjects, all males and having no experience in the trade were selected for the task. The levels of noise under taken were 80, 90 and 100 dB(A) while the levels of load were 150, 200 and 250 N. A pulse oximeter was used to measure the human performance in terms of heart rate. The data was collected and analyzed on the basis of two factor repeated measure type of experimental design. Results of the study indicated that the level of noise and load both were having statistically significant effect on human performance. However, the interaction of level of noise and load was found to be statistically non-significant. The findings of the present work have been discussed in the light of the previous researches carried out on the topic. Suggestions have been made to reduce the levels of noise as per the recommendations of Occupational Safety and Health Association (1990). It is also suggested that instead of hand operated machines, foot operated versions should be used to reduce fatigue.

Pedunculated vulval fibroma: a case report

A case of vulval fibroma with huge bilateral growths in a woman with full term pregnancy is reported. Excision of the growths was carried out 3 weeks after delivery

Efficacy of different methods of induction of labour at JPMC, Karachi

Induction of labour was carried out in 146 patients, 58 [39.73%] primigravidae and 88 [60.27%] multigravidae. The methods used were PGE pessaries in 56 [38.36%] cases, I/V infusion of syntocinon in 54 [36.98%]; extra amniotic Foley's catheter and syntocinon infusion in 8 [5.48%] and ARM followed by syntocinon infusion in 28 [19.18%] cases. Common indications were hypertensive disorders of pregnancy in 40 [27.39%] women and postmaturity in 27 [19.86%] cases. Induction of labour was successful in 117 [80.13%] patients with prostin pessary insertion being the most effective method-success rate [85.71%]

Obstetrical injuries a study at Jinnah postgraduate medical center, Karachi

Seventy one cases of obstetrical injuries, seen during a period of 1 1/2 years, were analysed. Twenty three [32.4%] cases had rupture of uterus, 16 [2.5%] developed vesico-vaginal fistulae following prolonged and obstructed labour. In 13 [18.4%] cases, vulvo-vaginal haematoma was seen. Four [5.6%] patients had recto-vaginal fistulae and 7 [9.9%] suffered from 3rd degree perineal tear. 1.4% i.e. one case came with inversion of uterus