ABSTRACT
Objectives: To determine the isolation rate of Alternaria alternata in patients with clinical Onychomycosis
Study Design: Descriptive [cross sectional] study
Place and Period of Study: Department of Microbiology, Armed Forces Institute of Pathology Rawalpindi, from August 2011-April 2012
Material and Methods: Sample size; 200 nail samples, Sampling Technique; Non probability convenience sampling. Nail clippings and nail scrapings were obtained from affected nails of patients clinically having onychomycosis. Direct microscopic examination with 30% potassium hydroxide mounts and culture on Sabouraud's dextrose agar [SDA], SDA containing Chloramphenicol, and SDA containing actidione and chloramphenicol were used for species identification
Results: Out of 200 nail specimens, 94 [47%] yielded positive fungal growth, while 106 [53%] nail specimens were found negative on culture. Non-dermatophyte moulds [NDMs] accounted for 62 [66%] of total culture positive cases, out of which Alternaria alternata was the commonest species [29%]. Dermatophytes were isolated from 20 [21%] all belonging to genus Trichophyton spp. and 12 [13%] were yeast
Conclusion: Study has yielded high number of NDMs especially Alternaria alternata, hence large scale multicenter clinical studies are required to ascertain the clinical significance of Alternaria alternata as pathogen particularly in patients with immunosuppression, as a causative agent of onychomycosis. Moreover, clinical trials to see the treatment outcome of NDMs isolated from these patients, will further help to unfold the clinical significance of this study
ABSTRACT
Staphylococcus aureus [S. aureus] has remained always an important pathogen of common infections acquired in community and as well as serious nosocomial infections. With advent of penicillins and cephalosporins, infections could be effectively treated, but with the global emergence of Methicillin Resistant Staphylococcus aureus strains [MRSA] physicians were again left with limited treatment options. This scenario of increasing resistance is even more intense and challenging for developing countries like Pakistan. Hence with this background the study was carried out to establish the frequency of MRSA in clinical specimens and look into the available antibiotic treatment options. Samples of pus, blood, urine, body fluids and catheter tips submitted for culture in Microbiology department between August to September 2012, from outdoor and indoor adult patients of Pakistan Institute of Medical Sciences Islamabad, yielding growth of S. aureus were included in the study. After identification by standard methods, antibiotic susceptibility of the isolates was performed by Kirby Baeur disc diffusion method. The study was retrospective descriptive and observational. Total 106 S. aureus were isolated. 45.3% of them were MRSA and majorities were from pus samples of hospitalized patients. All MRSA were 100% sensitive to vancomycin, whereas 87.5% to chloramphenicol. To rest of the non -beta lactam drugs, resistance of 80% or more was noted. S. aureus is a common clinical isolate from patients in this region of Pakistan and significant number were MRSA especially from hospitalized patients. Treatment options are limited to vancomycin and chloramphenicol
ABSTRACT
Background and Objectives: Acinetobacter baumannii can cause a wide range of infections, including bacteremia, pneumonia, urinary tract infection, peritonitis, etc. This organism is becoming resistant to a large group of antibiotics, especially beta-lactam antibiotics. The reason for multi-drug resistance may be the production of extended- spectrum beta-lactamses [ESBLs], carbapenemases/metallo beta-lactamases or AmpC beta-lactamases. The aim of the present study was to determine the prevalence of multi-drug resistant Acinetobacter baumannii isolated from the patients in Surgical Intensive Care Units [SICUs] of Pakistan Institute of Medical Sciences [PIMS], Islamabad, Pakistan
Methods: A total of 91 A. baumanni isolates were collected from PIMS during the period from February 2011 to December 2011. The antibiotic susceptibility testing was performed by standard disc diffusion method as recommended by CLSI. Combination disc method, Modified Hodge test, EDTA disc synergy test and AmpC disc test were performed for detection of ESBLs, carbapenemases, metallo beta-lactamases, and AmpC beta-lactamases, respectively
Results: The prevalence of MDRs was reported 100% among A. baumannii. The antibiotic susceptibility profile showed that minocycline and tigecycline were the most effective drugs against A. baumannii. Almost all of A. baumannii isolates were carbapenemase and metallo beta-lactamase producers. AmpC prevalence was observed in 41.76%, while none of the isolates was ESBL producer. Antibiogram and minimal inhibitory concentrations [MICs] indicated tetracycline is relatively effective against A. baumanii
Conclusions: Increased frequency of multi-drug resistance supports the need for continuous surveillance to determine prevalence and evolution of these enzymes in Pakistan
ABSTRACT
To find the prevalence of Hepatitis B and C and to assess the current Hepatitis B vaccination status and knowledge of standard prophylaxis against blood borne infections in selected group of health care workers at Pakistan Institute of Medical Sciences [PIMS] Islamabad. Descriptive cross sectional prospective study. Between 15th June 2009-30[th] June 2009. Infection Control Committee in collaboration with Microbiology Department, Pakistan Institute of Medical Sciences Islamabad. Three hundred eighty three health workers comprising of nurses and Lab workers were interviewed after taking verbal consent using a self administered questionnaire. Data was analyzed using SPSS version 13. Among the 383 HCWs interviewed nurses were 72% [277] and Lab workers were 27.5% [106] .There age ranged from 17-59 years with mean age of 34.38 years. 41% of health care workers had service length between 1-5 years. 57.6% [221] were completely vaccinated, 18.3% [70] partially vaccinated and 24% [92] were not vaccinated at all. Awareness and attitude problem was identified as the main factor responsible for lack of vaccination. 53.5% [206] had been exposed to needle stick injury at least 1-5 times in their whole professional life. 48.1% [99] of the needle stick injury exposed personnel were aware of post exposure prophylaxis whereas 51.9% [107] of them were ignorant of standard prophylaxis. Most of the individuals knew their Hepatitis B and C status i.e. 93.7% [359] while 6.3% [24] had never got themselves tested for hepatitis Band C. Hepatitis B positive were 0.5% [2], while 1 .6% [6] were Hepatitis C positive among 359 HCWs. Percentage of HCWs vaccinated was low and the main factor responsible was awareness and attitude problem. At the same time non- availability of vaccine by the employer had been identified as the second most important reason for non vaccination. Half of the studied group was not aware of the precise post exposure prophylaxis .The prevalence of Hepatitis B and C was low in this high risk group as compared to general population of the area
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Hepatitis C/epidemiology , Prevalence , Hepatitis B/prevention & control , Hepatitis C/prevention & control , Awareness , Health Personnel , Cross-Sectional Studies , Prospective Studies , Surveys and QuestionnairesABSTRACT
To determine the prevalence of Methicillin Resistant Staphylococcus aureus [MRSA] in post-operative wound infections in surgical wards and surgical ICU and also to define the antimicrobial susceptibility pattern of the strains isolated. A cross sectional prospective study. Departments of Pathology and Surgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad, Pakistan. January 2004 to August 2005. Wound swabs from patients who had undergone surgery and were suspected of having postoperative infection of the wounds were collected and inoculated on blood agar and MacConkey agar plates. After incubation for 24-48 hours, plates were examined for the growth of S. aureus. Anti-microbial susceptibility test was performed using oxacillin 1ug disc to detect methicillin resistance. An inhibition zone = or <10mm was taken as indicative of MRSA. A total of 1310 surgical wound swabs yielded growth of bacterial pathogens out of which 273 [20%] were found to be S. aureus. 225 of the affected patients were admitted in surgical wards and 48 in SICU. Analysis of the antimicrobial susceptibility patterns of the isolates revealed that 105 [39%] were strains of Methicillin Resistant Staphylococcus aureus [MRSA] as indicated by their resistance to Oxacillin [1ug disc]. Significantly higher proportion of the MRSA isolates were from SICU, 31/48 - 65% than from the surgical wards, 74/225 - 35% [p < 0.05] indicating the inherent tendency of these strains to become endemic in the critical care units as well as their propensity for nosocomial spread. Susceptibility patterns further revealed that Vancomycin and Teicoplanin were the most effective antimicrobial agents for MRSA infections - 100% of the strains being fully susceptible - followed by Fusidic acid [80% susceptible]. The reverse was true as regards the efficacy of Gentamicin and Ciprofloxacin, to which 100% of the isolates were resistant. Other antibiotics yielded variable results. 273 [20%] out of 1310 post-operative wound infections were caused by S. aureus, 105 [39%] were strains of MRSA whose prevalence was found to be significantly higher in surgical ICU than in the surgical wards [65% as compared to 35% respectively -p < 0.05]. All the isolates were found to be susceptible to Vancomycin. It is concluded that MRSA is a serious nosocomial pathogen in surgical site infections and requires strict intervention for its prevention and control