Emergence of coryneform bacteria as pathogens in nosocomial surgical site infections in a tertiary care hospital of North India

A prospective study was conducted to assess the role of coryneform bacteria in surgical site infections among obstetric and gynecological patients undergoing surgery. The surgery was graded according to the degree of contamination, and surgical site infections [SSIs] were classified as superficial or deep. Pus samples were collected from SSIs according to rigorous aseptic precautions, and the quality of specimens was assessed by Q-score. A detailed clinical and treatment history was elicited from all patients. The samples were processed using standard protocols. Coryneform bacteria were considered significant pathogens only if they fulfilled rigorous clinical and microbiological criteria. Antibiotic susceptibility testing was performed using the Kirby-Bauer method according to the CLSI guidelines. In total, 127 patients developed SSIs among 882 postoperative patients. Of these, 89 [70.1%] were culture positive: 40 [44.9%] were Gram-positive cocci, 27 [30.3%] were coryneform, and 22 [24.7%] were Gram-negative bacilli. All coryneform-infected patients had fever and post-operative wound dehiscence leading to a prolonged hospital stay. The most commonly isolated organism was Staphylococcus aureus [33.7%], followed by Corynebacterium amycolatum [11.2%], Escherichia coli [8.9%], Citrobacter spp. [7.8%] and coagulase-negative Staphylococci [6.7%]. In our study, 45.5% were ESBL producers, 18.2% were Amp C producers, and 40% were MRSA. All the coryneform bacteria were multidrug resistant, and 51.8% of isolates were sensitive to only gatifloxacin and vancomycin. Symptomatic improvement was observed in all coryneform-infected patients after the administration of appropriate therapy. Coryneform bacteria appear to be emerging as significant nosocomial surgical site pathogens. The high level of multidrug resistance observed in coryneform bacteria in our study is cause for alarm

Bacterial meningitis in North India: Trends over a period of eight years

Background: Acute bacterial meningitis is a medical emergency which warrants early diagnosis and aggressive therapy. It is important to know the regional bacterial etiology in semitropical countries like India along with their sensitivity profi le to allow optimum management of such patients with least possible mortality. This study was undertaken to study the trends in etiology and the antimicrobial resistance pattern of the pathogens prevalent in North India over a period of 8 years. Methods: The study was performed from June 2001 to June 2009. CSF and blood samples were collected from all patients suspected of meningitis and inoculated on chocolate agar, blood agar and MacConkey agar. Antimicrobial susceptibility testing was done using Kirby Bauer disc diffusion method. Detection of methicillin resistant Staphylococcus aureus (MRSA), high level aminoglycoside resistance (HLAR) in Enterococcus species, extended spectrum β lactamases (ESBL), Amp C and metallo-betalactamases was also done. Results: 403 samples were positive on culture. S. aureus was the most common pathogen. Among the gram positive cocci as well as the gram negative bacilli, a gradual decline in the antimicrobial susceptibility was seen. The aminoglycosides had the best spectrum of antimicrobial activity. Towards the end of the study, an alarming rise of MRSA to 69.4%, HLAR among the Enterococci to 60% was noted. Among the Enterobacteriaceae, ESBL and Amp C production was found to be 16.7% and 42% respectively. No vancomycin and imipenem resistance was observed. Conclusion: An entirely different trend in etiology in bacterial meningitis was observed in the semitropical region of North India. The high prevalence of drug resistant pathogens is a cause for worry and should be dealt with by rational use of antimicrobials. Frequent revision in drug policy may be necessitated for optimum management of patients.

Increasing secondary bacterial infections with Enterobacteriaceae harboring bla(CTX-M-15) and bla(CMY-6) in patients with bronchogenic carcinoma: an emerging point of concern

OBJECTIVE@#To look for secondary bacterial infections in bronchogenic carcinoma (BC(A)) with resistant organisms harboring bla genes considering the paucity of relevant studies.@*METHODS@#A total of 137 confirmed cases of BC(A) and 34 healthy volunteers were studied for the occurrence and prevalence of bla(CTX-M) and and bla(AmpC) harboring-enterobacteriaceae. A subset of these patients (n=69) was previously reported for the secondary infection with the Aspergillus species. Bronchoalveolar lavages (BAL) were subjected for bacterial and fungal cultures and the bacterial isolates were screened by multiplex PCRs for the presence of bla(CTX-M) and bla(AmpC). The isolates were also screened for the association of insertion sequence (IS26) by PCR and characterized by RAPD for any clonal relatedness.@*RESULTS@#A total of 143 bacterial isolates were obtained from 137 BAL specimens of BC(A) patients. The Enterobacteriaceae-isolates were multidrug-resistant showing concomitant resistance to fluoroquinolones and aminoglycosides. Both bla(CTX-M) and bla(AmpC) of CIT family were detected in 77.4% and 27.4% isolates, respectively. Sequencing revealed the presence of bla(CTX-M-15) and bla(CMY-6). Twenty one percent of the isolates were simultaneously harboring bla(ampC) and bla(CTX-M-15). IS26 PCR and RAPD typing revealed the presence of diverse bacterial population but no predominant clone was identified. The present study also suggests strong association of aspergillosis with lung cancer and further strengthens the potential use of non-validated serological tests suggested earlier.@*CONCLUSIONS@#We emphasize that all patients of bronchogenic carcinoma should also be screened for secondary bacterial infections, along with secondary fungal infections, so as to introduce early and specific antimicrobial therapy and to prevent unwanted deaths.

bla(CTX-M), bla(TEM), and bla(SHV) in Enterobacteriaceae from North-Indian tertiary hospital: high occurrence of combination genes

OBJECTIVE@#To delineate the frequency of occurrence of bla(CTX-M), bla(TEM), and bla(SHV) in Enterobacteriaceae from North-Indian tertiary hospital.@*METHODS@#A random collection of a subset of 45 Escherichia coli (E. coli) and 28 Klebsiella pneumoniae (K. pneumoniae) that was resistant to a third generation cephalosporin and obtained during 2007-2008 was selected for detailed screening for bla(CTX-M), bla(TEM), and bla(SHV) by monoplex PCRs. The isolates demonstrating the presence of bla(CTX-M) alleles were characterized for the specific CTX-M-genogroup by using a multiplex PCR.@*RESULTS@#Resistance to cefoperazone, ceftazidime, ceftriaxone, cefotaxime, cefoxitin and piperacillin was 100% each in K. pneumoniae isolates, whereas these resistance-rates for E. coli isolates were 93.1%, 83.8%, 91.9%, 93.6%, 97.3% and 97.1%, respectively. Concomitant resistance to aminoglycosides, quinolones and aztreonam was also noticed. Presence of any of the bla genes (bla(CTX-M), bla(TEM), and bla(SHV)) was noticed in a total of 28 (38.4%) isolates of the 73 isolates studied. Many isolates demonstrated occurrence of these genes in various combinations. bla(CTX-M), bla(TEM), and bla(SHV) were noticed in 28.8%, 10.9% and 13.7% isolates, respectively. Multiplex PCR in bla(CTX-M) harboring isolates demonstrated the presence of CTX-M-Genogroup-1 and sequencing for the specific CTX-M-type revealed presence of CTX-M-15 type. RAPD typing showed wide diversity in isolates.@*CONCLUSIONS@#This is amongst the premier report describing the simultaneous occurrence of bla(TEM), bla(SHV), and bla(ampC) in Indian Enterobacteriaceae and that wider dissemination of these genes, as demonstrated by diversity of isolates, raises concern and emphasizes a need for extensive search for the presence of these gene pools in Indian subcontinent.

Association between serum C- reactive protein levels and other important predictive markers of outcome in COPD

C-reactive protein [CRP] is an acute-phase protein synthesized predominantly by the hepatocytes in response to tissue damage or inflammation. Levels of acute-phase proteins rise rapidly, during infection and after injury. We take up the study to correlate serum CRP levels with other important predictive markers of outcome in COPD. Patient with stable COPD [no exacerbation in the last two months] were taken up for the study. Parameters taken to correlate were age, grade of dyspnea, FEV1. It was found the CRP is negatively correlated with FEV1 and grade of dyspnea but not correlated with age

Frequency of HIV infection amongst children with disseminated tuberculosis and tuberculous meningitis in Aligarh [North India] - a low HIV prevalence area

To determine frequency of HIV in children with disseminated tuberculosis and tuberculous meningitis in a low HIV prevalence area, and to study clinical profile of those found HIV positive. Cross-sectional, descriptive study. Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India from February 2005 to January 2008. The study was conducted on 215 children under 14 years of age with either disseminated tuberculosis or tuberculous meningitis. HIV infection was diagnosed in accordance with WHO strategy II. In children younger than 18 months, the strategy [to cut down costs] was to screen first by HIV antibody testing and subject only positive cases to virological tests. Parents of HIV positive children were also tested for HIV and counselled. The clinical profile of HIV positive patients was noted. The frequency of HIV was 5.12%, while that in cases of disseminated tuberculosis was much higher [22%]. No case with isolated tuberculous meningitis was HIV positive. The majority [45.45%] of patients with HIV were between 1-5 years of age. The mode of infection in 7[63.63%] cases was parent to child transmission. Loss of weight, prolonged fever, pallor, hepato-splenomegaly and oral candidiasis were the commonest clinical manifestations among HIV positive patients. Clinically directed selective HIV screening in cases of disseminated tuberculosis can pickup undiagnosed cases of the same in areas with low prevalence of HIV infection

Prevalence and some clinical predictions of occult bacteremia in febrile children below 5 years of age

225 febrile children between 3 months to 5 years, with rectal temperature above 39C and with no focus of infection, comprised the study sample. Clinical scoring for toxicity was done in all cases and blood culture was sent in each child. Bacteremia was detected in 15%. of cases, which was significantly higher in children between 3-12 months of age Culture positivity increased with increasing temperature. Temperature cut off values at 39.5% provided a desired combination of good sensitivity [68%] and specificity [92%]. Acute illness observation score of >10 was associated with significantly high percentage of bacteremia and high sensitivity [97%] and specificity [89%]

prospective study of bacteriuria in Libyan adults

A prospective study was carried out to discover the prevalence of asymptomatic bacteriuria among Libyan adults attending one of the polyclinics at Benghazi for reasons other than urinary complaints. A total of 628 cases were screened. Covert bacteriuria was found in 4.5% males were bacteriuric. Escherichia coli was the commonest organism isolated from these patients. An increased resistance was found to some of the commonly prescribed antibiotics, especially ampicillin [75% resistant] cotrimoxazole [62%] and teracyclin [62%]. Nitrofurantoin was active against 81% and cephaloridine against 87.5% of isolate