ABSTRACT
Background and Objectives: Acute pyogenic meningitis is one of the most serious infections in infants and children. It is associated with serious complications and risk of morbidity and mortality. The purpose of present study was to identify the pathogen in acute pyogenic meningitis and to determine its antibiotic susceptibility pattern. Methods: Present study was undertaken for a period of one year from July 2009 to June 2010 included 100 CSF samples of clinically suspected acute pyogenic meningitis cases in children below 12 years. The samples were subjected to Gram’s stain, culture and antibiotic sensitivity test. The cases positive in either of Gram stain or culture were diagnosed as acute bacterial meningitis cases. Results were tabulated and antibiotic sensitivity pattern was compared. Results: Of the 100 cases studied, 26 cases were diagnosed as acute bacterial meningitis. Gram’s stain positivity was 73% (19/26 cases), culture positivity was 100%. The most common organism isolated in the study was Streptococcus pneumoniae, followed by Haemophilus influenzae, Escherichia coli and Klebsiella pneumoniae. Aminoglycosides, cefotaxime and cotrimoxazole showed high sensitivity. Interpretation and conclusion: Though Gram stain is very essential in diagnosis of meningitis, it may miss some cases. Culture and latex agglutination tests overcome this disadvantage. Streptococcus pyogenes still remains predominant pathogen. Antibiogram of the bacteria causing meningitis is also slowly undergoing a change. This calls for change in the empirical therapy for bacterial meningitis cases.
ABSTRACT
Objectives: Extended spectrum beta lactamase (ESBL) producers have posed a great threat to the use of many classes of antibiotics, particularly cephalosporins. Their detection has proved to be difficult for many laboratories because the resistant ESBL producing organisms appear to be susceptible by in vitro routine testing but result in treatment failure.The present study aims to detect the prevalence of ESBLs in organisms like E.coli and Klebsiella spp. which are responsible for many serious infections. Method: Isolates were screened for ESBL production using cefotaxime, ceftazidime and ceftriaxone by disk diffusion method. Isolates showing resistance to one or more than one of these drugs were futher subjected to Phenotypic Confirmatory Test (PCT) using CAZ/CAZ-CAC as per CLSI guidelines. Results: Of the 230 isolates, 116 (50.43%) tested positive by initial screening method. But on PCT only 94 tested positive. Out of 94 ESBL producers, 59 (62.76%) were E.coli and 35(37.23%) were Klebsiella spp. Of the various clinical samples urine 90(39%) showed maximum number of ESBL producers (32, 34%), followed by pus (27, 29%). Out of 230, 126 (54.7%) were females and 104 (45.2%) were males with a male to female ratio of 0.82:1 showing female preponderance. This study also showed increasing resistance to fluoroquinolones among ESBL producers. Conclusion: The results of our study show that there is an increased prevalence of ESBL producers in our tertiary care centre and also an increased resistance to fluoroquinolones among ESBL producers. Hence infections caused by E.coli and Klebsiella spp. which are prime producers of ESBL have to be considered seriously and proper screening methods and antibiotic policies have to be drawn to confine their spread.
ABSTRACT
Objectives: Resistance to third generation cephalosporins in E. coli and K. pneumoniae are due to various factors. The present study was undertaken to detect resistance mediated by ESBL’s. Multidrug resistance in isolates producing ESBL was also studied. Methods: The study included a total of 200 clinical specimens which include 95 urine, 45 pus, 32 sputum, 11 blood, 9 throat swabs, 6 suction tips and 2 vaginal swabs. The E. coli and K. pneumoniae isolates which were screen positive were studied for ESBL production by DDST method. Results: Culture of 200 samples yielded 200 isolates (117 E. coli and 83 K. pneumoniae). Out of these, 98 (49%) were screen positive for ESBL. Among them 79 (53 E. coli and 26 K. pneumoniae) were found to produce ESBL. Among them, 4 (7.6%) isolates of E. coli and 4 (15.3%) isolates of K. pneumoniae were positive by DDST method. The prevalence of 39.5% of ESBL production was noted in the present study. Among ESBL positive isolates, 98.1% were resistant to cefoxitin, however all of them were susceptible to imipenem. Conclusion: The prevalence of ESBL producing E. coli and K. pneumoniae was found to be high and routine screening of ESBL should be preformed on all isolates showing decreased susceptibility to one or more of third generation cephalosporins.