ABSTRACT
Objective: To evaluate the pathogen burden and antibiotic-resistance trends of Pseudomonas aeruginosa among hospitalised patients at a tertiary care hospital. Study Design: Retrospective, hospital record-based, cross-sectional study. Place and Duration of Study: Microbiology Laboratory, Allama Iqbal Medical College/Jinnah Hospital, Lahore, from January 2014 to December 2016
Methodology: A total of 5,960 samples were collected from clinically suspected cases of bacterial infections, admitted to the hospital. Microbial identification and antibiotic susceptibility pattern were carried out and analysed
Results: Out of a total of 5,960 samples, Pseudomonas aeruginosa was isolated from 1,268 [21.2%] specimens. Department-wise isolation rate was n=600 [42.9%], n=268 [15.4%], n=201 [12.6%], and n=199 [16.0%] from intensive care unit [ICU], surgical units, medical units, and Gynae wards, respectively [p<0.0001]. Sample-wise isolation rate was, wound swabs n=448 [35%], urine n=356 [28%], sputum n=187 [14 %], tracheal aspirate n=127 [10%], blood n=99 [7%], and broncho-alveolar lavage n=51 [4%] [p<0.0001]. Drug-resistance pattern showed low rates for carbapenems [meropenem n=440 [35%], Imipenem n=436 [34%] and beta-lactam + beta-lactamase inhibitor combination [piperacillin+ tazobactam n=437 [34%] while alarming rates were observed for cephalosporins [ceftazidime n=716 [56%], fluoroquinolones [ciprofloxacin n=690 [54%], cefoperazone+sulbactam n=685 [54%], aminoglycosides [gentamicin, n=669 [53%], amikacin n=608 [48%], and monobactams [aztreonam n=666 [52%]. Decreasing trend was observed only for amikacin 63% to 37%, aztreonam showed similar pattern throughout, while there was an increasing trend of drug resistance in all groups of antibiotics
Conclusion: Emerging drug-resistant strains of Pseudomonas aeruginosa are probably linked to the injudicious use of antibiotics, leading to ineffective empirical therapy. Therefore, we suggest that culture and antimicrobial susceptibility testing should be done for targeted antimicrobial therapy against Pseudomonas aeruginosa
ABSTRACT
Objective: To evaluate the false negative results of Ziehl-Neelsen [ZN] smear microscopy
Study Design: Descriptive study
Place and Duration of Study: Mycobacteriology Laboratory, Allama Iqbal Medical College [AIMC] and Jinnah Hospital, Lahore [JHL], Pakistan, from February 2014 to August 2016
Methodology: A total of 3,951 [pulmonary 2,773 and extra-pulmonary 1,178] samples were collected from strong TB suspected patients attending JHL Lahore. Follow-up cases were excluded. Every specimen was processed for ZN smear microscopy, Lowenstein Jensen [LJ] culture. SPSS 21.0 was used; false negative and positive results of ZN smear were calculated keeping LJ culture as gold standard
Results: Out of total 3,951 samples, sputum was most freqently found pulmonary sample 48.4% [n=1915], extrapulmonary samples, pleural fluid and pus samples were most commonly observed samples 12.0% [n=476] and 8.3% [n=329], respectively. Overall false negativity was 23.1% [pulmonary=19.6%, extra-pulmonary=29.2%] [p<0.001], Maximum false negative results were observed in pericardial, synovial, pleural fluids, and pus samples as 40.0%, 38.0%, 33.0% and 32.0%, respectively
Conclusion: ZN smear microscopy is not a very efficient tool in case of patients with the low mycobacterial load. Therefore, National TB Control programs should consider extending their diagnostic approaches from ZN microscopy to more advanced techniques
Subject(s)
Humans , Clinical Laboratory Techniques , Tuberculosis/epidemiology , False Negative Reactions , Developing CountriesABSTRACT
This study was planned to evaluate sample wise isolation and antimicrobial resistant trends of Acinetobacter spp in different departments of a tertiary care hospital. This was a transversal descriptive study, carried out in the clinical microbiology laboratory of the Allama Iqbal Medical College/ Jinnah Hospital, Lahore, Pakistan, during the period of January 2015 to December 2016. Every clinical specimen was processed for bacterial culture and antimicrobial susceptibly testing. A total of 3590 [2015=1780, 2016=1810] clinical specimens were processed. Of the total, only 54.7% were gram-negative, among these Acinetobacter spp were isolated from 10.1% and 16.5% samples respectively in 2015-16 with an overall rate of 24.3%. The highest occurrence of Acinetobacter spp isolates was reported from Intensive care units [ICU] [54%] followed by surgical units [25%] and medical units [16%]. It is noteworthy that ICU and internal medicine showed the highest resistance rates, whereas, lower resistance rate was observed for the outdoor patients [OPD]. Although collistin showed 0% resistant while ceftriaxone, ciprofloxacin, gentamicin, and tigecycline showed 90%, 68%, 66%, 66% and 62% resistance against Acinetobacter spp. respectively. An alarming increase in the resistance rate of meropenem, cefoperazone/sulbactam, piperacillin/ tazobactam, ciprofloxacin, and imipenem was observed from the year 2015 to 2016. This startling resistance acquired by Acinetobacter spp. within a period of one year, represent very limited therapeutic options left for the infections caused by Acinetobacter spp. Unavailability of effective drugs and limited therapeutic options enforce the health care practitioners to prescribe expensive and broad range antibiotics, which may cause harm to the patient. Therefore, it is need of an hour to better understand the antimicrobial patterns and optimize antimicrobial prescription policies for the control of multidrug-resistant Acinetobacter spp
ABSTRACT
Objective: To determine neonatal congenital hypothyroidism among neonates born in a tertiary care hospital of Lahore Pakistan
Methods: This cross-sectional study was carried out at Pathology Department of Allama Iqbal Medical College, Lahore in collaboration with Pediatrics and Gynecology and Obstetrics Department, Jinnah Hospital, Lahore Pakistan. A total of 770 babies were included in this study, both male and female. About 2 ml venous blood samples were collected aseptically from the neonates in sterile clotted tube. Serum was separated and serum TSH was determined by ELISA method
Results: Out of total 770 neonates, 48.9% were female and 51.0% were males with the ratio of 1:1.04. Neonatal congenital hypothyroidisim [TSH, >30 mlU/L], was observed in 0.4% [Frequency, 1:257] nenates, with the incidence rate of 1:257. Female to male ratio of hypothyroid neonates was 2:1. The mode of delivery vise distribution showed, among n=251 neonates born by normal delivery, only a single case of hypothyroidism was detected, and among n=519 neonates delivered by cesarean section, only two neonates were belong to hypothyroidism
Conclusion: The frequency of Congenital Hypothyroidism is notably higher in pediatric community than reported in most other countries. This result emphasizes the necessity of a nationwide screening program
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant, Newborn , Tertiary Care Centers , Cross-Sectional Studies , Thyrotropin/bloodABSTRACT
To evaluate the diagnostic accuracy of the Xpert MTB/RIF assay for the detection of M. tuberculosis in pulmonary and extrapulmonary specimens and to compare it with conventional techniques. During a period of 10 months from December 2012 through September 2013, two hundred and forty five clinically TB suspects were enrolled for Xpert MTB RIF assay. The cohort comprised of 205 suspects of pulmonary TB and 40 of extrapulmonary TB [EPTB]. The 40 EPTB samples included pus aspirated from different sites of the body [n=19], pleural fluid [n=11], ascitic fluid [n=7], pericardial fluid, CSF and urine one each. Ziehl-Neelsen [ZN] Stained smear microscopy, culture on LJ media and Xpert MTB/RIF assay was performed on samples from these patients. M. tuberculosis [MTB] were detected by Xpert MTB/RIF test in 111 [45.3%] out of 245 samples. Of these, 85 [34.7%] were smear positive on ZN staining and 102 [41.6%] were positive on LJ cultures. Rifampicin resistance was detected in 16 [6.5%] patients. Nine out of 19 pus samples [47.3%] were positive for MTB by Gene Xpert, 03 [15.8%] on ZN staining and 04 [21%] on LJ culture. MTB could not be detected in any other extrapulmonary sample. Xpert MTB/RIF is a sensitive method for rapid diagnosis of Tuberculosis, especially in smear negative cases and in EPTB as compared to the conventional ZN staining. Among EPTB cases the highest yield of positivity was shown in Pus samples. For countries endemic for TB GeneXpert can serve as a sensitive and time saving diagnostic modality for pulmonary and EPTB
ABSTRACT
Blood stream infections [BSI] remain a major cause of debility and death around the world. BSI accounts for 10-20% of all Nosocomial infections. Empirical antimicrobials are based on the susceptibility pattern of the pathogens isolated in a specific institute from time to time. We have conducted this study only on cardiac Patients over two and half years of study duration
Study design: cross sectional study
Settings: microbiology Department, Allama Iqbal Medical College/Jinnah Hospital, Lahore
Study Period: January 2013 to July 2015
Materials and Methods: a total of 5411 blood culture specimens were collected from cardiac patients including patients admitted to cardiology ward, coronary care unit [CCU], pre-operative and post-operative cardiac surgery patients. The bottles containing BHI broth were incubated and were subcultured after 24 hours, 72 hours, 120 hours, and 168 hours on blood and MacConkey agars. Isolates were further identified with the help of Gram staining, biochemical reactions and rapid tests like catalase, oxidase, coagulase, Analytical Profile Index [API] 20E and API 20NE. Antimicrobial susceptibility of the isolate was carried out on Mueller-Hinton agar by Modified Kirby Bauer disc diffusion technique according to the isolate as per recommendations of Clinical and Laboratory Standards Institute [CLSI] guidelines 2013
Results: out of total 5411 patients, 3958[73.14%] were male, 1453[26.85%] were females. Out of total 5411 Specimens, only 486 [8.98%] were positive for bacterial growth. Out of total 486 positive blood cultures, 261 [53.71%] were Gram positive isolates and 225 [46.29%] were Gram negative isolates. Out 486 positive blood cultures, 96 [19.75%] were from cardiology ward, 67 [13.78%] were from CCU, 113 [23.25%] were from pre operative cardiac surgery ward, 210 [43.20%] were from post operative cardiac surgery ward. Among Gram positives, Staphylococcus Species were most common organism isolated from 246 [50.61%] blood culture specimens. Among Gram negatives, Pseudomonas aeruginosa and E.coli were predominant organisms, isolated from 81[16.66%] and 72[14.81%] blood culture specimens respectively
Conclusion: gram Positive isolates were more common as compared to Gram negative isolates. Vancomycin and Linezolid were the most effective drugs among Gram positive isolates. Piperacillin-Tazobactam was most potent antimicrobial against Pseudomonas aeruginosa. For coli forms Tigecycline was most effective drug
ABSTRACT
Objective: To find out the prevalence of concomitant active pulmonary Tuberculosis [TB] in patients of Chronic Obstructive Pulmonary Disease [COPD] using the gold standard liquid and solid culture media for the detection of acid fast bacillus
Methods: Eighty clinically and radiologically diagnosed cases of COPD of any severity, >/= 40 years of age with no previous history of anti-tuberculous therapy were selected from department of Pulmonology, Jinnah Hospital, Lahore. Detailed demographic profile, clinical symptomatology and history of smoking were recorded. Sputum samples of these patients were subjected to ZiehlNeelsen [ZN] stain and culture on Lowenstein-Jensen [L.J] medium and Mycobacterium Growth Indicator Tube [MGIT] for the detection and isolation of Mycobacteriumtuberculosis [MTB]
Results: Out of 80 COPD patients, 6 [7.5%] were culture positive for acid fast bacillus consistent with active tuberculous infection. The concomitance was more prevalent in elderly, male, smokers. MGIT was a more sensitive and a rapid technique to detect the presence of mycobacterium as compared to LJ culture media and ZN stain
Conclusion: The prevalence of active TB in COPD patients was 7.5%. Detection was improved when liquid culture media was employed for the detection of acid fast bacillus. Regular monitoring and screening of patients with COPD for PTB should be routinely carried out in susceptible cohort to avoid cross spreading of infection and appropriate management
Subject(s)
Humans , Adult , Pulmonary Disease, Chronic Obstructive , Culture Media , Bacillus , Cross-Sectional StudiesABSTRACT
Anaemia in pregnancy is an important public health problem especially in developing countries. It is a major cause of maternal morbidity and mortality, and also has a significant impact on health of foetus .The causative factors vary in different communities. The purpose of study was to determine the prevalence and risk factors of anaemia among pregnant women receiving antenatal care at Aziz Bhatti Shaheed Hospital Gujrat. The attending doctor filled a Proforma at the first antenatal visit and blood sample was also drawn for complete blood counts. Out of 560 women studied,419 [74.8%] women were anaemic .Anaemia was more prevalent in multigravidae [77.6%] than in primigravidae [69.3%].Regarding severity 69.9% mild,26.7% moderate and 3.3% cases were of severe anaemia respectively. The severity increased with increasing parity. The prevalence also increased with decreasing birth intervals [p=0.001] and late booking [p=0.002].Anaemia was more common among uneducated [78.6%] or those educated up to primary [72.7%]. Intake of meat/chicken less than 2times/week [p=0.01] and PICA [p=0.005] were also the risk factors for anaemia development in pregnancy. The prevalence of anaemia in antenatal care attendees of ABSH is very high. Frequent child birth with lack of birth spacing, late booking, low educational status and poor dietary habits are the major risk factors that need urgent attention of health care providers