Microbiological And Epidemiological Profile Of Keratomycosis In A Tertiary Care Hospital – A Prospective Analysis

Introduction: Microbial keratitis is predominantly an opportunistic, serious ocular infectious disease that can lead to significant vision loss and ophthalmic morbidity.1 The fungi are significant pathogens causing ocular infections due to their frequent involvement and difficulty in establishing definitive diagnosis.. Material and Methods: We prospectively analyzed 106 cases of keratomycosis in our tertiary care hospital. Corneal scrapings were collected, processed and fungal pathogens were identified by standard laboratory techniques. Results: Out of 106 suspected cases, culture was positive in 31 cases. Aspergillus species were the most frequent isolates (51.61%). Next to this were Candida spp. (19.35%) followed by Fusarium spp., Alternaria spp., Mucor spp , Penicillium spp, Drechslera spp and Exserohilum spp . Males were more affected than females and trauma was the most common predisposing factor. Conclusions: This study highlights important risk factors and organisms responsible for mycotic keratitis.

Antimicrobial resistance in bacteria causing ventilator-associated pneumonia in a tertiary care hospital: one year prospective study.

Background: Ventilator-associated pneumonia (VAP) is the most common infection diagnosed in intensive care units (ICUs). The causative organisms of VAP vary among different populations and are increasingly associated with resistance against various antimicrobial agents. Objective of current study was to determine the bacteriological etiology of VAP, antimicrobial susceptibility pattern of the isolates and detect the presence of extended-spectrum -lactamases (ESBL), metallo β-lactamases (MBL) and AmpC -lactamases in multidrug resistant isolates causing VAP in the medical ICU. Methods: A prospective study was carried out over a year to know the various etiological agents of VAP and their drug susceptibility patterns. ESBL, MBL and AmpC -lactamases were detected in various isolates by combination disk method, imipenem-EDTA combined disk method and AmpC disk method respectively. Results: The majority of bacterial isolates causing VAP were found to be gram negative bacilli. Acinetobacter spp accounted for 34.28% of VAP cases followed by Pseudomonas aeruginosa which was responsible for 25.71% cases. Other gram negative bacilli isolated were Klebsiella pneumoniae, Citrobacter freundii, Enterobacter spp, and Escherichia coli. Out of the total 70 isolates, 67 (95.7%) were multidrug resistant and not even a single isolate was sensitive to all the drugs tested. Conclusions: Most of the pathogens causing VAP in our institute were multidrug resistant and in many isolates this resistance was due to production of ESBL, MBL, and AmpC β-latamases. Polymixin-B and colistin were found to be highly effective against multidrug resistant Acinetobacter spp and P. aeruginosa.

Incidence of neonatal sepsis in tertiary care hospital: An overview.

Background: Neonatal sepsis is one of the commonest causes of neonatal mortality in the developing world. Aims & Objective: To determine the bacteriological profile of neonatal septicaemia, their antibacterial susceptibility pattern (AST) and production of extended spectrun β-lactamase (ESBL) by gram negative bacteria. Material and Methods: Blood culture specimens were collected from 238 neonates. Identification of organisms, their AST, methicillin resistant Staphylococcus aureus (MRSA) and ESBL detection was done. Results: Gram negative bacteria were more frequently isolated than gram positive bacteria. The gram positive bacteria were highly resistant to penicillin. Vancomycin and amoxyclav exhibited good activity against both Staphylococcus aureus and coagulase negative Staphylococcus. Gram negative bacteria also exhibited high resistance to the commonly prescribed group of drugs such as penicillins, cephalosporins and aminoglycosides. Out of the total 16 isolates of S. aureus, 31.25% were MRSA. ESBL production was seen in 52.9% of Escherichia coli and 50% of Klebsiella pneumoniae. Conclusion: E. coli and S. aureus were the most common bacteria associated with neonatal sepsis. Gram negative bacteria were isolated predominantly and many of them were resistant to several groups of drugs. Also high resistance was seen to third generation cephalosporins in case of E. coli and K. pneumoniae due to ESBL production.

Surgical site infections with special reference to methicillin resistant Staphylococcus aureus: experience from a tertiary care referral hospital in North India.

Objective: Surgical site infections are an important cause of health care associated infections among surgical patients. Aim: To determine the prevalence of Staphylococcus aureus and Methicillin resistant Staphylococcus aureus (MRSA) in surgical site infections with relation to age and sex and its antimicrobial susceptibility pattern. Methods: During a period of three years, 5,259 specimens received from surgical site infections were processed for isolation and identification of bacterial pathogens according to the standard microbiological techniques. Results: Abscess drainage was the most common type of surgical site infection (26.62%) and Staphylococcus aureus (34%) was the most common isolate. The most frequent isolation of the S. aureus in relation to age was noted in the age group of 21–40 years and the prevalence rate was higher in male patients. Out of the total S. aureus isolates, 27.96% were found to be methicillin resistant. Conclusions: There is a need for continuous surveillance and monitoring for the frequency of MRSA with its antimicrobial resistance patterns which may help in decreasing the prevalence of MRSA and antibiotic resistance.

Third generation cephalosporin-resistance in Klebsiella pneumoniae isolates: an emerging threat.

Background: Newer generation cephalosporin-resistance among Klebsiella pneumoniae organisms has increased recently. Present study is undertaken to find incidence, antimicrobial susceptibility and prevalence of extended spectrum beta-lactamase (ESBL) in K. pneumoniae isolates in a tertiary care hospital. Methods: Prospective study was carried out between June to December 2011. Samples of pus, blood, urine, cerebro-spinal fluid, stool, peritoneal, pleural and synovial fluid were collected from indoor and outdoor patients for isolation and antimicrobial susceptibility pattern of K. pneumoniae in the department of microbiology, G.R. Medical College Gwalior, M.P. Ceftazidime resistant K. pneumoniae were subjected to Phenotypic Confirmatory Disc Diffusion Test (PCDDT) and Double Disc Synergy Test (DDST) for detection of ESBL. Results: Out of 2480 samples collected a total of 530 K. pneumoniae were isolated and subjected to antimicrobial susceptibility. Antibiotic sensitivity to imipenem, cefoperazone, amikacin and ofloxacin were 82, 74, 73 and 72% respectively whereas sensitivity to ceftizoxime, ceftriaxone cefotaxime, ceftazidime ranged between 47-50%. K. pneumoniae were found to be resistant to ampicillin, co-trimoxazole, doxycycline and gentamicin, by 91, 82, 54 and 50% respectively. Among third generation cephalosporins K. pneumoniae were least sensitive (47%) to ceftazidime. About 33 and 32% of the ceftazidime resistant strains were found to be ESBL positive by PCDDT and DDST respectively. Conclusions: This study has shown that prevalence of ESBL producing K. pneumoniae is the most important reason for increased resistance to third generation cephalosporins. There is need to carry out tests for detection of ESBL producing bacteria routinely.