Prevalence of Extended Spectrum β-lactamases Producing Clinical Isolates from Patients of Urinary Tract Infection in a Tertiary Care Hospital in Delhi.

A total of 250 urinary isolates (188 Escherichia coli and 62 Klebsiella pneumoniae) were studied for ESBL production by double disc approximation test and disc diffusion confirmatory test (NCCLS). ESBL production was found to be 56% in E. coli and 52% in K. pneumoniae. The double disc approximation test showed false ESBL production in five (2.6%) isolates of E. coli and one (1.6%) K.pneumoniae. The susceptibility of ESBL producers to imipenem, amikacin, nitrofurantion was found to be 100%, 86% and 84% respectively. A high degree of co-resistance to co- trimaxazole and norfloxacin was found in strains of ESBL producers. Seventy five per cent of ESBL producers detected were from hospitalized patients admitted in ICU or undergoing surgery.

Occurrence and detection of AmpC beta lactamases among clinical isolates of E. coli and K. pneumoniae causing UTI.

Presence of Bush class C enzymes in uropathogenic strains of Klebsiella pneumoniae & E. coli resistant to extended spectrum cephalosporins is an emerging threat to clinical therapeutics. These resistant strains result in considerable treatment failure and cannot be detected by routine antibiotic sensitivity screening methods. An effort was therefore made to study AmpC beta lactamase production in E. coli and Klebsiella pneumoniae strains causing UTI. A total of 126 E. coli and 49 K. pneumnoniae strains isolated from urine samples were selected for study out of which AmpC beta lactamase production was seen in 23% E. coli (29 isolates) and 18% K. pneumoniae (49 isolates). The susceptibility of AmpC beta lactamase producers to Imipenem, Nitrofurantoin and Amikacin was found to be 100%, 92% and 80% respectively. Thereby the present study emphasizes the importance of monitoring and control of usage of extended spectrum cephalosporins.

Aminoglycoside resistance in enterococci isolated from paediatric septicaemia in a tertiary care hospital in north India.

BACKGROUND & OBJECTIVES: Enterococci are important nosocomial agents and serious infections caused by them are often treated with a combination of cell wall inhibitor and aminoglycoside. However, the presence of high level aminoglycoside resistance in these isolates makes this treatment combination ineffective. The prevalence of such isolates in a tertiary care set up has important diagnostic and therapeutic implications. The present study was carried out to find out the occurrence of high level aminoglycoside resistant isolates of enterococci in paediatric septicaemia cases in a tertiary care set up in north India. METHODS: Blood of paediatric cases with a clinical diagnosis of septicaemia was cultured to isolate and identify enterococci. Agar screen method was used to detect high level streptomycin and gentamicin resistance in these isolates. Vancomycin susceptibility of these isolates were determined as per the National Committee for Clinical Laboratory Standards (NCCLS) recommendations. RESULTS: Fifty one enterococcal strains were isolated from 21 neonates, nine infants and 21 children with a clinical diagnosis of septicaemia. Sixty eight per cent of these isolates had high level gentamicin resistance and forty three per cent had high level streptomycin resistance. All the isolates with high level streptomycin resistance also had high level gentamicin resistance. More than ninety five per cent of these isolates were sensitive to vancomycin. INTERPRETATION & CONCLUSION: The occurrence of high level gentamicin and high level streptomycin resistance in enterococcal isolates in our set up was high. This would require routine testing of the enterococcal isolates for high level aminoglycoside resistance. Alternative treatment regimes need to be sought, besides prudent use of antibiotics.

Early diagnosis of filarial pleural effusion.

This paper describes a case of pleural effusion due to filariasis. Microfilaria of Wucheraria bancrofti were detected in the pleural fluid on cytological examination. Treatment with diethylcarbamazine cleared the pleural effusion.

Changing trends of candida species in neonatal septicaemia in a tertiary North Indian hospital.

Four hundred and fifty four blood samples of clinically diagnosed septicemic neonates were collected over a period of six months from the neonatal ICU of Kalawati Saran Children Hospital, New Delhi. 144 samples were culture positive; out of which 50 (34.7%) were Candida isolates. 92% isolates were Candida tropicalis, 4% were C. albicans and C. kefyr each. The study emphasises the changing pattern of Candida species and their importance in blood stream infections in neonates.

Comparison of endoscopic brush cytology with biopsy for detection of Helicobacter pylori in patients with gastroduodenal diseases.

Upper GI endoscopy was performed in 50 adult patients attending the gastroenterology OPD with gastroduodenal diseases. Gastric antral mucosal brushings were taken for cytological evaluation and urea broth test followed by antral biopsy. The slides prepared were stained with Wright Giemsa (WG), Hema toxylin & Eosin (H&E) and Papanicolaou (Pap). Brush Cytology Smears were compared with biopsy sections for detection of Helicobacter pylori and the staining techniques were evaluated to see which stain was easiest to perform and interpret on routine basis. H&E stained sections were examined for histomorphological parameters associated with H. pylori infection. Brush cytology was rapid and simple with observed sensitivity of 90% and specificity of 100%. On evaluating the various stains, M.B. and W.G. were found to the rapid and easy to perform and the bacteria stood out very well against the background. Of the histomorphological parameters studied, presence of actively and lymphoid aggregates and absence of intestinal metaplasia correlated positively with the presence of the bacteria. Cytological brushing urea broth test was not very sensitive (55.2%) and specific (51%) for detection of the bacteria.

Needle stick injuries among medical students.

Questionnaires were distributed among 200 medical students regarding safety precautions observed while perfonning various invasive procedures during their clinical posting. Only 106 students responded with the completed questionnaire. The most common procedure performed by the students was drawing of blood, with an average frequency of 60.8 per month. Sixty-one per cent of the students reported being injured during the various procedures and only 3 5.5% of them used gloves. Resheathing the needle was responsible for causing injury to 69% of the students, which was significantly higher than injuries occurring while entry into the vein or withdrawing the needle (p<0.05).

CSF interleukin-1 beta, tumor necrosis factor-alpha and free radicals production in relation to clinical outcome in acute bacterial meningitis.

OBJECTIVE: To study the relationship of CSF IL-1 beta and TNF-alpha with free radicals in acute bacterial meningitis (ABM) and to evaluate the clinical outcome in relation to the levels of these cytokines and free radicals in CSF. DESIGN: Prospective with controls. SETTING: Referral unit of a teaching hospital. METHODS: 32 children between 3m-12 yrs of age with proven acute bacterial meningitis comprised the study group. In the control group, 20 children with febrile seizures were included. CSF cytokines- Interleukin Ib and tumour necrosis factor a,free radicals O(2)-, H(2)O(2) and enzymes SOD and CPK were measured in all the children. RESULTS: CSF IL-Ib and TNF-a concentration were markedly elevated in children with ABM (441.5 +/- 216.1 pg/ml, and 1009 +/- 529.1 pg/ml, respectively) as compared to controls (52.67 +/- 6.92 pg/ml, and 86.42 +/- 16.24 pg/ml) (p <0.0001). Free radicals viz., superoxide anion, hydrogen peroxide production and enzymes creatinine phosphokinase and superoxide dismutase were also significantly elevated in ABM as compared to controls. There was direct correlation of CSF cytokines with CSF cytology, protein and free radicals production in ABM. Patients who expired or had neurological sequelae had markedly elevated concentrations of cytokines and free radicals. CONCLUSION: IL-I beta, TNF-alpha and free radicals are significantly elevated in CSF of patients with ABM. The concentration of these cytokines correlated well with free radical production, and with routinely measured CSF parameters and had a direct bearing on outcome of ABM

Incidence of HTLV-I in high-risk population in Delhi.

Human infection due to HTLV-I occurs by transmission of infected T-cells via sexual intercourse, blood transfusion or breastfeeding. The present investigation was carried out to find the incidence of HTLV-I in high risk population and its relationship with syphilis and HIV infection. The study group comprised 124 antenatal cases, 9 patients attending Sexually Transmitted Disease (STD) clinics and 144 blood donors. Passive particle agglutination test was performed on all the test sera for anti HTLV-I antibodies. VDRL and Treponema pallidum haemagglutination tests were carried out on sera from antenatal and STD cases. Sera from blood donors were tested for HIV antibodies by ELISA and confirmed by Western Blot. Anti HTLV-I antibodies were found in 10.6% of the cases studied. There was no association between the presence of anti HTLV-I antibodies and syphilis in expectant mothers and STD cases. However, significant association was found between the former and HIV infection in blood donors.

Serum TNF-alpha and free radical scavengers in neonatal septicemia.

Tumor necrosis factor-alpha (TNF-alpha) and free radicals have been implicated in the pathogenesis of neonatal septicemia and its complications. This case control study was conducted between November 1996 to July 1997 to determine the levels of TNF-alpha and free radical scavengers viz. superoxide dismutase (SOD) and glutathione peroxidase (GPX) in the serum of 30 septic neonates and 20 healthy controls. Patients with neonatal sepsis registered significantly higher levels of TNF-alpha, SOD and GPX in comparison to controls (p < 0.05). The neonates with septic shock had five fold increase in TNF-alpha levels (2262 +/- 605.8 pg/ml) as compared to those without shock (738.8 +/- 728.8 pg/ml). There was no statistically significant difference in levels of antioxidant enzymes between neonates with shock and without shock. The levels of TNF-alpha and antioxidant enzymes were not affected by the type of organism isolated in blood culture.