Drug resistance in mycobacterium tuberculosis: a four years experience

OBJECTIVE: To assess the prevalence of drug resistance amongst the clinical isolates of M. tuberculosis. SETTING: Armed Forces Institute of Pathology, Rawalpindi. METHOD: Four first line anti-tuberculosis drugs, isoniazid [INH], rifampicin [RIF], ethambutol [ETH] and streptomycin [STR] were tested on 300 isolates from clinical samples, by agar dilution method on Lowenstein Jensen medium. The sensitivities were interpreted by the resistance ratio method. One hundred and fifty eight [52.66%] isolates were found resistant to one drug at least. Among the resistant isolates, 79 [26.33%] were resistant to INH, 72 [24.0%] to RIF, 84 [28.0%] to STR and 70 [23.33%] to ETH with or without resistance to other drugs. Multi-drug resistance [MDR] was found in 41 isolates [13.66%]. To overcome this problem there is a need to establish centres at a number of places all over the country with professionals trained to handle the emerging problem of MDR. Each centre must be equipped with adequate facilities for susceptibility testing so that the resistance pattern can be ascertained and treatment regimens tailored accordingly

outbreak of neonatal sepsis in a nursery

An outbreak of neonatal sepsis caused by a Gram negative bacterium [Klebsiella pneumomae] occurred in the nursery of an eight hundred bedded hospital. Eight neonates were affected and the same strain of Klebsiella pneumonia was isolated front the blood of all the babies. Four of the neonates including the index case expired and four were saved. On investigation the same strain of klebsiella pneumomae was isolated from the resuscitator being used in the nursery. The outbreak was contained by temporarily closing down the nursery and thorough disinfection of its equipment and environment. Such lethal and unfortunate incidents arc a common happening in our setup and can be avoided by the practice of strict aseptic techniques. Careful analysis of the situation and institution of immediate remedial measures arc recommended to contain such outbreaks