Frequency of group d streptococci isolated from UTI cases among hospitalized patients and their antibiotic sensitivity pattern

Objective: To determine the frequency and antibiotic susceptibility pattern of Enterococci obtained from UTI patients

Methods: A total of 2653 urine samples have been received for culture and sensitivity during the study period, 1387 were culture positive and 117 urine specimens have recovered Enterococci. The repeated urine cultures recovering Enterococci from the same patient and with mix growth were excluded from the study. The patients were asked to wash the perineal area with clean tap water. Females patients were instructed to apart the labia majora and minora to wash the area before collecting sample to avoid vaginal contamination.. Sterile plastic, wide mouthed containers were used to collect early morning, clean catch, mid-stream urine samples, and the samples were processed as soon as possible within 30 min. In case of delay, the samples were refrigerated. The urine samples were inoculated on Cysteine Lactose Electrolyte Deficient [CLED] media [Oxoid, England] and incubated at 37 degree C for 24 hours. Bacterial growth was taken significant as per count [single species count > 105 organisms]. The growth appeared was identified by colonial morphology, Grams Staining, Catalase Test, Bile Esculin test and growth in nutrient broth with 6.5 % NaCl. The antibiotic sensitivity pattern was determined by modified Kirby Bauer disc diffusion method

Results: The eighty six [73.50%] samples showed salt tolerance as growth appeared and turned out as Group D Enterococci whereas 31 [26.50%] did not show salt tolerance as no growth was observed and labelled as group D non Enterococci. The antibiotic sensitivity of the Group D Enterococci by Kirby bauer disk diffusion mehod with Penicillin 81[82.65%], Ampicillin 73[74.49%], Gentamicin 61[62.24%], Vancomycin 90 [91.84%], Linezolid 98[100%], Ciprofloxacin and Levofloxacin 55 [56.12%] and 57 [58.16%], Nitrofurantoin and Fosfomycin is 42 [42.86%] and 34 [34.69%]. While antibiotic sensitivity of Group D non Enterococci with Penicillin 18[68.71%], Ampicillin 9[47.36%], Gentamicin 10[52.63%], Vancomycin 19 [100%], Linezolid 19 [100%], Ciprofloxacin and Levofloxacin is 9 [47.36%] and 9 [47.36%], Nitrofurantoin and Fosfomycin is 11 [57.89%] and 14 [73.68%]

Conclusion: The frequency of the Group D Enterococci is 86 [73.50%] while that of Group D non Enterococci is 31 [26.50%]. The Enterococci are most susceptible to Linezolid, Vancomycin, Penicillin, Ampicillin, Nitrofurantoin, Levofloxacin, Ciprofloxacin, Gentamicin and Fosfomycin in descending order while the non Enterococci are most susceptible to Linezolid, Vancomycin, Fosfomycin, Penicillin, Nitrofurantoin, Gentamicin, Ciprofloxacin and Levofloxacin in descending order

Frequency and treatment of methicillin resistant staphylococcus aureus in obstetric and gynaecological sepsis

To perform culture and sensitivity for pathogens causing puerperal and postoperative wound sepsis and determine the frequency of Methicillin Resistant Staphylococcus aureus [MRSA] in such infections. Observational study. Obstetrics and Gynaecology Ward, Jinnah Postgraduate Medical Centre, Karachi, from December 2008 to May 2010. All patients presenting with puerperal sepsis or postoperative wound infection were enrolled. Pus was collected for culture and sensitivity using standard technique. Two samples were taken from each patient; one before starting the treatment and one at the end of treatment. Ames transport medium was used. Empirical treatment with triple regimen [Ampicillin, Metronidazole and Gentamicin] was started immediately to cover Gram positive as well as negative bacteria in addition to anaerobic infection. After receiving the sensitivity report, antimicrobial agent were changed accordingly. Samples from ward and theater staff and environment were also taken to look for possible mode of transmission. Data was recorded on a proforma. Discrete variables are expressed as percentages. Staphylococcus aureus was the most frequent organism isolated in 34% cases. Methicillin sensitive Staphylococcus aureus was seen in 20% cases and methicillin resistant Staphylococcus aureus was seen in 14.6%. Out of these 14.6% MRSA, [17] 77% was associated with puerperal sepsis and rest [5] 23% was associated with post-operative wound infection. It showed best sensitivity to vancomycin. Staphylococcus aureus and E.coli were common agent of postoperative infections and puerperal sepsis

study on Acute Myocardial Infarction with special reference to age, sex, type of infarct and associated risk factors

To study the frequency of acute myocardial infarction [AMI] and its types in patients admitted in CCU of Divisional Headquarter Hospital [DHQ], Faisalabad Institute of Cardiology [FIC] Faisalabad and to investigate associated risk factors. It was an observational hospital based study conducted at Cardiac Care Centre, DHQ Hospital Faisalabad and FIC from 30th March 2009 to 30th June 2009. One hundred patients were included in the study at both centers. A Performa was filled with tabulated questions and information was recorded. The data was analyzed on SPSS version 13. It revealed statistically significant difference by patient's age and sex. AMI was higher in males [CI = 75 - 91%] than females [CI = 9 - 25%]. Types of infarction including inferior and anteroseptal were observed in significantly higher number of patients, while extensive anterior, non-STEMI and lateral infarction was observed in significantly less number of patients. Results showed significant association [P<0.05] of fat sources in diet with types of AMI. Hypertension [CI = 36-56], smoking [CI = 30-50], family history of IHD [CI = 26-45] were stronger risk factors than others and 19% patients admitted with AMI had Diabetes Mellitus. AMI was significantly higher in patients between 40 and 50 years of age. Age and sex and fat sources in the diet showed significant association with AMI, while family history of IHD, hypertension and smoking were other stronger risk factors

Insertion of intrauterine contraceptive device at caesarean section

To determine the safety [infection, conception rate and perforation] of intrauterine contraceptive device [IUCD, Multiload Cu 375] insertion at caesarean section and compare their postoperative period [in term of pain, amount of bleeding and expulsion rate] of women who had caesarean section without IUCD insertion and to women who had IUCD inserted as an interval procedure. A case control study. Jinnah Postgraduate Medical Centre, Karachi, from November 2006 to October 2007. Group 1 [cases] were 50 women who had IUCD inserted at caesarean section. Groups 2 and 3 were controls, group 2 consisted of 50 matched women who had a caesarean section without IUCD insertion and group 3 consisting of 50 women who had IUCD inserted as an interval procedure. Degree of pain was assessed by doses of analgesics needed and amount of bleeding by the soaked pads, which were observed by doctor. Infection and expulsion was observed in immediate postoperative period during admission and at follow-up visits at 6 weeks and 6 months and conception was also checked. Analysis of variance was undertaken to compare characteristics at baseline on SPSS version 13. Data were analyzed using univariate methods, two-tailed t-test for continuous variables and chi-square test or Fisher's exact test as appropriate for dichotomous variables. Hospital stay of group 1 was 3.48 days as compared to 3.46 in group 2 [p=0.93]. Wound was infected in 10% women in group 1 and 2% in group 2 [F-test=0.10]; lochia was heavy in 4% in group 1 and 0% in group 2 [F-test=0.25]. Thread was visible in 92% in group1 and 96% in group 3 [p=0.50]. Eighty two percent women were willing to continue with IUCD in group 1 and 86% in group 3 after 6 months. Women undergoing caesarean section, who are desirous of, and suitable for using this method, should be given the option of IUCD insertion at the same time

Loading dose of magnesium sulphate versus standard regime for prophylaxis of pre-eclampsia

To determine the efficacy of single dose of magnesium sulphate versus the standard Pritchard regime in the management of pre-eclampsia. Quasi-experimental study. Jinnah postgraduate Medical Centre, Karachi from January 2004 to January 2006. All women with severe pre-eclampsia and impending eclampsia were included in the study. Patients with pregnancy induced hypertension and mild to moderate pre-eclampsia were excluded. From the 100 women included in the study, after matching for age, parity and gestational age, 50 were given only bolus dose of magnesium sulphate and 50 were given the standard regime. They were observed for one week for the number of convulsions. Fisher's exact test and Chi-square test were used to analyze results. There was no significant difference in the two groups in term of occurrence of seizures, one patient developed fit with Pritchard regimen. The rate of caesarean section was lower in group A, 12% versus 30% in group B [p=0.05]. There was no significant difference in prenatal outcome in either group [82% live births in group A versus 72% amongst group B [p=0.2]. Few side effects like vomiting, dizziness and irritation at the site of injection were observed when standard treatment was used. Single dose treatment was also found to be cost-effective costing Pak Rs. 45 [US $ 0.56] as compare to Pak Rs. 195 [US $ 2.4] in control group. No maternal death was observed in either group. Having the equal effectiveness, ease of monitoring and cost effectiveness, single loading dose of magnesium sulphate is preferable over the standard regime in the management of pre-eclampsia as a prophylactic measure for prevention of seizure

Therapeutic termination of second trimester pregnancies with low dose misoprostol

To determine the effectiveness of 50micro g misoprostol for midtrimester termination of pregnancies. Experimental, cross-sectional study. Department of Gynaecology and Obstetrics, Unit II, Jinnah Postgraduate Medical Centre, Karachi, a tertiary care centre, from 1st Jan 2003 to 30th June 2005. The study subjects were 54 pregnant women admitted during the 2nd trimester [14-26 weeks] of gestation, willing or requiring termination of pregnancy. Those patients were included in the study who were admitted with closed cervical os, either had intrauterine death, fetal anomaly, medical disorder [hypertension or diabetes] or history of previous ceasrean section. Cases of placenta previa, acute asthma, glaucoma, cardiac diseases and allergy to prostaglandins were excluded. Each patient received 50micro g misoprostol intravaginally. Maximum 4 doses were given at 4 hours interval and state of cervical os was assessed by vaginal examination before insertion of next dose or at the onset of uterine contractions. After 4 doses of misoprostol, patients were kept under observation and watched for uterine contractions to start or for expulsion of products. Syntocinon infusion was started to augment labour where products of conception failed to expel out inspite of open os. Outcome measures include success rate of termination within 12, 24, 36 and 48 hours, mean induction - abortion time interval and maternal side effects. The success rate of termination within 12, 24, 36 and 48 hours were 27.7%, 83.3%, 94.4% and 96.3% respectively. Mean induction to abortion time interval, in case of abortion within 48 hours, was found to be 18.9 +/- 11.58 [range 4-48 hours]. Dead fetuses were aborted earlier than alive fetuses. The mean induction abortion time interval was 17.01 +/- 8.7 hours in dead and 23.4 +/- 15.9 hours in alive fetuses [t -value:1.9, p: 0.05]. Two patients failed to deliver within 48 hours of induction. Two patients suffered from febrile illness. Vaginal administration of 50 micro g misoprostol every 4 hourly is an effective and safe agent for ripening of cervix and convenient way of inducing abortion during 2nd trimester of pregnancy in a women either with alive or dead fetus. It is associated with a low frequency of side effect