Study of Prevalence and Antimicrobial Susceptibility Pattern of Enterococci Isolated from Clinically Relevant Samples with Special Reference to High Level Aminoglycoside Resistance (HLAR) in a Rural Tertiary Care Hospital...

Enterococci are important human pathogens that cause many infections including nosocomial infections. Some important clinical infections caused by Enterococcus species are urinary tract infections, bacterial endocarditis, genital tract infections, surgical wound infections, bacteraemia and meningitis.Around, 80 - 90% of infections are commonly caused by E. faecalis followed by E. faecium with a contribution of about 10 - 15% along with emergence of multi-drug resistance (MDR) including to vancomycin. Enterococci have developed both intrinsic and acquired resistance towards many antibiotics including to high level aminoglycosides. This short term project was undertaken to study the prevalence and antibiotic susceptibility (AST) pattern of Enterococcus species isolated from clinical specimen with special reference to high level aminoglycoside resistance (HLAR) in a rural tertiary care hospital. Methods100 Enterococci isolated from clinically relevant samples were identified according to standard procedures and AST was carried out according to CLSI guidelines. ResultsOut of 100 enterococci, 70 E. faecalis, 21 E. faecium and 09 other Enterococcus species were isolated. The results showed that majority of enterococci was isolated from >60 age group (37%), from male patients (59%), from urine samples (59%) and from medicine department (36%). AST showed overall high resistance to Penicillin (98%) Ampicillin (86%), Gentamicin (85%), Ciprofloxacin (60%), Vancomycin (12%) (VRE), high level gentamicin (42%) (HLGR) and high level streptomycin (34%) (HLSR) and 15% isolates showed resistance to HLGR + HLSR. Multi drug resistance was seen in 40 (57.1%) E. faecalis isolates and 11 (52.3%) E. faecium isolates. Minimum resistance was observed with Linezolid (3%). ConclusionsThe present study showed high prevalence of antibiotic resistance in Enterococci. Hence, Enterococcus species isolated from samples should be routinely screened for HLAR, MDR and VRE so as to prevent the spread of multi drug resistant Enterococci and for proper selection of antibiotics.

Comparison of the Three Phenotypic Methods to Detect Biofilm Production in Coagulase Negative Staphylococci

Coagulase Negative Staphylococci species (CoNS) have been recognized as etiological agents in wide variety of infections, patients with implants and devices. CoNS has the ability to produce biofilm which is responsible for resistance to host defense mechanisms and to the antibiotics. Hence this study was undertaken to study biofilm production by the isolated species of CoNS by three different phenotypic methods and compare these methods for biofilm production.METHODSIn this cross-sectional study, 200 CoNS isolates from clinically significant samples were identified up to species level by conventional phenotypic methods. Biofilm production was detected by Tissue Culture Plate method (TCP), Standard Tube method (ST) and Congo Red Agar Plate method (CRA). Biofilm production in test strains were compared with reference strains.RESULTSOut of 200 CoNS isolates, 122 were positive by TCP method, 106 by ST method & 67 by CRA method for biofilm production. Considering TCP method as gold standard, sensitivity, specificity, PPV and NPV of ST & CRA method were found to be 86.06%, 98.71%, 99.05%, 81.91% and 54.09%, 98.71%, 98.50% and 57.89% respectively. Analysis of Kappa agreement between TCP and ST method showed good agreement while between TCP & CRA, moderate agreement. Comparison of ST and CRA method with TCP by Pearson correlation coefficient test showed strong association between ST and TCP method (p= 0.006) & poor association between TCP and CRA method. (p<0.01).CONCLUSIONSBiofilm production by TCP method was higher compared to the other methods. ST method is comparable to TCP but CRA alone cannot be considered for biofilm detection in CoNS. ST method can be used in routine as it gives reliable results with good sensitivity & specificity and is easy to perform.

White coats: how much safe are they.

Various studies have suggested that health care workers'(HCW) clothing, including white coats, are potential reservoirs for microorganisms causing health care associated infections, reinfecting the hands of HCWs and may be a vector for transmission of nosocomial pathogens. Hence the present study was undertaken to detect the incidence of pathogenic microorganisms that contaminate nurses white coats. Methods: Total 324 swabs, collected by swabbing the three sites of the surface of the Nurses’ white coat (pockets, abdominal zone and the sleeve ends) were inoculated on blood agar, Mac-Conkey’s agar and incubated at 37°C overnight. Microbial growth was identified by standard methods. Antibiotic sensitivity test was carried out by Kirby-Baur disc diffusion method as per CLSI guidelines. Results: Non-pathogenic bacteria (skin flora) were isolated from all white coat culture and pathogenic bacteria from 76 (70.3%) white coats (45 from Surgery & allied departments, 31 from Medicine & allied departments). From total 324 samples, 85 (26.2%) samples were positive for pathogenic bacteria and total 94 pathogenic bacteria were isolated which includes 33 (35.1%) Staphylococcus aureus (6 MRSA, 27 MSSA), 56 gram negative bacilli (17 ESBL producers). The rate of contamination with pathogens, was higher on pockets (57.4%) compared with abdominal zone (27.6%) and sleeve ends (14.8%). Conclusions: The study highlights the importance of white coats as potential source of cross infection. A strict protocol should be followed for preventing cross-contamination from the white coats.