A Study Of Bacteriological Profile And Their Antibiotic Susceptibility Patterns Of Isolated Organisms From ICU's With Special Reference To Multi-Drug Resistant Organisms.

Background and Aim: Microbes are notorious for rapidly develop drugs resistant due to gene transfer and spontaneous mutation. So their continues surveillance of antibiogram pattern is necessary to detect muti-drugs resistant organisms to improve patients outcome admitted in ICUs. Objective is to detect bacterial organisms causing infection in different ICUs and to know their antibiotic resistance pattern. Methodology: Total 602 different samples were collected from different ICUs and processed for culture, bacterial identification and antibiotic susceptibility testing done according to CLSI recommendation. Results: Out of total 602 samples, 248 (41.02%) were culture positive. The number of isolated Gram negative and Gram positive organisms were 196 (79.03%) and 52 (20.97%) respectively. Most common isolated of Gram negative organism was Pseudomonas spp. 58(23.38%), followed by Acinetobacter spp. 46 (18.55%). While, most common isolated gram positive cocci was coagulase negative staphylococcus spp. 32 (12.95%), followed by Enterococcus spp 8 (3.24%). From total 196 isolates of gram negative, 71.43% were MDROs, 7.14% were XDROs. Out of total 52 gram positive isolates, 40.38% were MDRO, 3.85% were XDRO. Conclusion: Routine Microbiological surveillance helps to guide in implementing better antibiotic policies to improve patient’s morbidity and mortality suffering from multi-drug resistant infections in ICUs.

Prevalence and antimicrobial susceptibility pattern of methiciliin resistant Staphyllocococcus Aureus in tertiary care teaching hospital - Western India.

Background: Methicillin resistant Staphylococcus aureus (MRSA) infection traditionally has been associated with healthcare settings, colonizing patients with underlying debilitating health conditions. Now a day, Hospital management has become increasingly aware of issues related to MRSA infections in the patient population. Aims & Objective: To know the prevalence of MRSA amongst hospitalized as well as OPD based patients and to find out and compare the antibiotic resistance patterns of Methicillin resistant and Methicillin sensitive S. aureus. Material and Methods: Total of 534 Staphylococcus aureus isolated from various clinical specimens using the standard procedures during June 2010 to June 2011. Screening and confirmation of MRSA isolates were done by standard methods recommended by Clinical and Laboratory Standards Institute (CLSI). CDC definition was used to classify hospital and community Acquired Methicillin-Resistant Staphylococcus aureus. Antibiotic susceptibility test was done using Kirby-Bauer disk diffusion method. Detailed information regarding duration in hospital stay, ward, unit and clinical history were collected. Results: Out of 534 Staphylococcus aureus recovered from different clinical samples, 152 (28.46%) were found to be Methicillin resistant. 113 out of 152 isolates (74.34%) were Hospital acquired MRSA (HA-MRSA) while 39 out of 152 isolates (25.66%) were Community acquired MRSA (CA-MRSA). The antibiotic susceptibility result shows that MRSA isolates were resistant to multiple antibiotics than MSSA isolates. All isolated MRSA were sensitive to Vancomycin. Conclusion: Measures to control the emergence and spread of MRSA are needed to be improved because there are fewer options available for the treatment of MRSA infections. Thus, together with good professional practice and routine infection control precautions constitute the major measures in controlling and preventing MRSA.

Seroprevalence of Dengue in Gujarat, Western India: A study at a tertiary care hospital.

Background: Dengue is one of the most serious mosquito borne viral infection mainly affecting tropical and subtropical countries of the world. In absence of specific treatment and vaccine for dengue fever (DF); vector control is the only method by which the spread of dengue can be prevented. Aims & Objective: This study was conducted to report the prevalence of Dengue virus infection in Gujarat, Western India. Material and Methods: Study was performed at a tertiary care hospital in Ahmedabad, Gujarat in year 2012. Patients attending various hospitals across Gujarat for suspected dengue were tested. Blood samples collected in plain tubes were tested for dengue IgM antibodies, NS1 antigen and viral nucleic acid detection by Dengue IgM capture enzyme linked immune sorbent assay, Dengue Early ELISA and real time reverse transcriptase PCR, respectively. The laboratory records were analyzed for demographic features and seasonal variations. Descriptive statistics were used. Data were expressed in proportions. Results: Out of total 4401 serum samples tested, 927 were found positive for dengue virus infection. 65% positive samples were of male patients and 58% positive samples were from 18 to 35 years age group (Adult population) (58%). Seasonal trend showed a gradual increase in dengue positives started from August with a peak in October (34.5%). The most common presentation was fever (97%) while only 1% cases presented haemorrhagic manifestations. Conclusion: Dengue has established its transmission in urban and semi-urban areas of Gujarat with predominantly affecting males and active adult population. Virus activity is high during monsoon and post monsoon period which coincides with increased vector breeding. This study thus emphasizes the need for continuous sero epidemiological surveillance for the timely formulation and implementation of effective dengue control programme.

Prevalence of metallo-β-lactamase producing pseudomonas spp.(in Tertiary Care Hospital).

Background: Metallo-β-lactamase (MBL) mediated resistance to carbapenem is an emerging threat in Pseudomonas isolates. The aim of this study is to detect metallo-β-lactamase producing isolates of Pseudomonas spp. from various clinical samples from indoor patients in a teaching hospital. Materials and Methods: Total 900 bacterial strains were isolated from different clinical samples from indoor patients. The bacterial strains were isolated and identified as per the standard guidelines. Amongst them 100 isolates of Pseudomonas were taken for the present study. All pseudomonas isolates were subjected to antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method (CLSIs). In all imipenem resistant isolates of Pseudomonas spp., MBL detection was carried out by Imipenem-EDTA combined-disc synergy test (CDST). Results: Out of 100 isolates of Pseudomonas, 44 (44%) were imipenem resistant. Of these 44 isolates, 30 were producing MBL enzyme. 30 MBL positive isolate included 12 (40%) from surgical wards, 10 (33.33%) from tuberculosis ward, 4 (13%) from medicine ward, 2 (7%) from paediatric ward, 1 (3%) from urology ward and 1 (3%) from neonatal ICU. All MBL positive strains were resistant to β-lactams, aminoglycosides and fluoroquinolones. Conclusion: Prevalence of MBL producing Pseudomonas spp. is 30%. The MBL producing Pseudomonas spp. isolates were multidrug resistant. It is important to identify MBL producing pseudomonas isolates in laboratory as may cause serious infections and may cause a nosocomial outbreak.

Candida prevalence and its antifungal susceptibility in various clinical specimens in tertiary care center.

Background: The purpose of this study was to isolate the Candida spp. & examine their susceptibility to antifungal drugs from various clinical specimens. One hundred fifty isolates of Candida spp. were included in this study. Clinical history revealed that all patients were on systemic broad spectrum antibacterial drugs. Materials and Methods: Candida spp. was differentiated by germ tube test, culture characteristics on special media for fungus, sugar fermentation, sugar assimilation and growth on corn meal agar. Antifungal drug susceptibility testing against Fluconazole, Ketoconazole, Itraconazole, Voriconazole, Nystatin and Amphotericin B were done on basis of CLSI guidelines on Methylene blue containing Mueller Hinton Agar by disk diffusion method. Result: We found 52% and 48%, C.albicans & Non albicans candida spp., respectively. There were no resistance to Nystatin and Amphotericin B. C.albicans was more susceptible than Non albicans candida. Nystatin & Amphotericin B were susceptible to all isolated Candida spp. In present scenario, Fluconazole is most commonly used empirical antifungal drug, which is more effective to C.albicans than Non albicans Candida. Conclusion: Due to emergence of resistance in Azole group of antifungal among Non albicans candida, it should be mandatory to use antifungal drugs as per the susceptibility testing.

Epidemiological and microbiological profile of infective keratitis in Ahmedabad.

Context: Study of patients attending tertiary care ophthalmology institute at Ahmedabad. Aims: To study the microbiological etiology and epidemiological factors associated with suppurative keratitis. Settings and Design: A total of 150 corneal scrapings were evaluated from patients presenting with corneal ulcers at a tertiary ophthalmology center, Ahmedabad from July 2007 to June 2008. Materials and Methods: Scrapings were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. Socio-demographic data and risk factors were recorded. Results: Ninety percent (135/150) people with corneal ulcers had trauma as predisposing factor for keratitis. Trauma due to wooden objects was the leading cause (46/135) followed by vegetable matter and stone injury (23/135). Microbial etiology was established in 59.3% (89/150) of scrapings. Out of 89 positive isolates, 65.1% (58/89) were bacterial while 34.9% (31/89) were fungal. Among the bacterial isolates, 60.3% (35/58) were Gram-positive cocci while 39.7% (23/58) were Gram-negative bacilli. The most common bacterial isolate was Staphylococus aureus (32.7%, 19/58) followed by coagulase-negative Staphylococci (25.8%, 15/58) and Pseudomonas (18.9%, 11/58). Among the 31 fungal pathogens, Aspergillus species was the most common (35.4%11/31), followed by Fusarium species (22.5%, 7/31). Conclusion: Trauma with wooden material is the most common predisposing factor for suppurative keratitis. Males were more affected than females. Bacterial ulcers were more common than fungal in areas in and around Ahmedabad. Staphylococcus aureus and Aspergillus were the commonest bacterial and fungal isolates respectively. Geographical variation persists in microbial etiology of suppurative keratitis.

Seroprevalence of sporadic acute viral hepatitis with their co-infection at tertiary care hospital.

Background: Viral hepatitis is one of the major causes of mortality & morbidity in developing countries. Present study was aimed to know the seroprevalence and co infection of the acute viral hepatitis caused by hepatitis A, hepatitis B, hepatitis C and hepatitis E virus from patient attending one of the largest tertiary care hospitals. Material and Methods: Study was carried out from May 2009 to June 2010 at our hospital. A total of 556 serum samples were tested for HBsAg, antibody for HCV, IgM antibody of HAV and HEV by ELISA method from the patients having clinical signs & symptoms of acute viral hepatitis. Statistical analysis: Chi square test was done and the association was considered to be statistically significant if p < 0.05. Results: Out of 556 suspected cases of acute hepatitis 281 were positive. Among the total positive cases, IgM anti HAV antibodies was 70 (24.91%), IgM anti HEV antibodies was 141 (50.18 %), HBsAg was 65 (23.13%) and HCV was 5 (1.78 %). Dual infection was seen in 14 (4.98 %) cases with 6 children cases. Among the HAV positive patients, 80% were children, In contrast to that HEV infection (63.1%) and HBsAg infection (61.5%) was common in young adult. HCV infection was found common in adults more than 20 years of age. Overall male was affected more than female. Conclusion: Sporadic HEV infection constitutes significant cause of the acute viral hepatitis. In the light of this result a nationwide survey is recommended to confirm this pattern in the other areas. As vaccine for HEV is not available, prevention in form of improvement of socio - economic and hygienic standards of the population is the better option.

Prevalence of HIV, Hepatitis B and Hepatitis C infection in Thalassemia major patients in tertiary care hospital, Gujarat.

Background: Children suffering from beta thalassemia major, due to various genetic defects, have deficient synthesis of ß globin chain of Hemoglobin. This leads to severe anemia, general fatigue and debility asking for repeated or frequent blood transfusion. On the other hand repeated blood transfusions such expose them to dangerous infections such as HIV, HBV and HCV. Aim: The aim of this study was to determine the prevalence of HIV, HBV and HCV infection among thalassemia major patients in an apex tertiary care hospital of Gujarat in west India. Materials and methods: Data were obtained from 100 ß thalassemia major patients attending thalassemia clinic for blood transfusion at regular interval in an apex tertiary care hospital of Gujarat between April 2008 and September 2008. Their laboratory results were subsequently analyzed. Results: Out of 100 patients 65 and 35 were male and female respectively. 18 (18%) patients were found Anti HCV Ab positive, 6 (6%) were found HBsAg positive and 9(9%) patients were Anti HIV 1 and or 2 Ab positive. Older age, more number of transfusions were associated with increased chances of the test to come positive suggestive of infection with respective virus. Completion of vaccination against HBV, completely or partially, was associated with less chances getting infection with HBV Conclusion: The prevalence of HCV infection is much higher compared to HBV and HIV infection due to possibly infected blood transfusion among thalassemia major patients. Screening of Anti HCV Ab detection with highly sensitive and specific test for donated blood is mandatory. Techniques like P24 Antigen detection or RT-PCR should be introduced to shorten the window period for detection of HIV infected donated blood.

“Seroprevalence of transfusion associated hepatitis c virus (Hcv) in multi-transfused thalassemic children of the tertiary care hospital.”

Aim: To know the seroprevalence of Hepatitis C Virus (HCV) in Multi-transfused Thalassemic Children attending a tertiary care hospital, Ahmedabad, Gujarat. Material and Methods: Serum sample were tested by Enzyme Linked Immuno Sorbent Assay (ELISA) test for Anti HCV antibody from the thalassemic children over a period of 4 years from January 2006 to December 2009. Result: A total of 163 thalassemic children were tested for antibody of HCV. Out of these HCV antibodies were positive in 38 (23.31 %) patients. Conclusion: Prevalence of HCV infection among the thalassemic cases is much higher than the routine blood donors. in the light of this result a nationwide survey is recommended to confirm this pattern in the other areas and more sophisticated diagnostic tool should be employed to rule out window period of these Transfusion Associated infections.

Salmonella paratyphi-B meningitis, isolated from CSF.

We report a case of meningitis due to Salmonella paratyphi-B, in an 11 month old male infant. The child was admitted in Emergency department with the complains of generalized convulsion and vomiting. On examination patient appearance of child was lethargic and irritable, had marked neck stiffness, with bulging fontanelle, lumbar puncture was done and sent for routine investigation, microscopy, culture and sensitivity. Later on Salmonella paratyphi-B was isolated from CSF.