Inducible clindamycin resistance in staphylococcus species

To determine the frequency of inducible clindamycin resistance in clinical isolates of Staphylococcus species by phenotypic D-test. Observational study. Ziauddin University Hospital, Karachi, from July to December 2011. Consecutive clinical isolates of Staphylococcus species were collected and identified by conventional microbiological techniques. Antimicrobial susceptibility testing and inducible clindamycin resistance was carried out by performing D-test using CLSI criteria. Methicillin resistance was detected by using Cefoxitin disk as a surrogate marker. Statistical analysis was performed by SPSS version-17. A total of 667 clinical isolates of Staphylococcus species were obtained during the study period. In these isolates, 177 [26.5%] were Staphylococcus aureus, and 490 [73.5%] were coagulase negative Staphylococci. The total frequency of inducible clindamycin resistance among isolates of Staphylococcus species was 120/667 [18%]. Frequency of inducible clindamycin resistance among coagulase negative Staphylococci group and Staphylococcus aureus group were 18.57% and 16.38% respectively. Median age of patients in D-test positive group was 19.5 [1 - 54] years. The frequency of inducible clindamycin resistance among Staphylococcus species may differ in different hospital setup. Clinical microbiology laboratories should implement testing simple and effective D-test on all Staphylococcus species. D-test positive isolates should be reported clindamycin resistant to decrease treatment failure

Fatal primary meningoencephalitis caused by naegleria fowleri

Naegleria fowleri is a free living parasite which habitats in fresh water reservoirs. It causes a fatal nervous system infection known as primary amoebic meningoencephalitis by invading through cribriform plate of nose and gaining entry into brain. We report a case of primary amoebic meningoencephalitis caused by Naegleria fowleri in Karachi, Pakistan, in a 42 years old male poultry farm worker having no history of swimming. Clinical course was fulminant and death occurred within one week of hospital admission. Naegleria fowleri was detected by wet mount technique in the sample of cerebrospinal fluid collected by lumbar puncture of patient. This is a serious problem and requires immediate steps to prevent general population to get affected by this lethal neurological infection

Bacteremia due to aeromonas hydrophila in acute lymphoblastic leukemia

Aeromonas hydrophila [A. hydrophila] is a low virulent organism but may cause devastating fatal infections in immunocompromised host especially in liver cirrhosis. It is rarely reported to cause septicemia in a patient with Acute Lymphoblastic Leukemia [ALL]. The mortality rate of septicemia due to A. hydrophila is 29% to 73%. We report a case of 59-year-old female patient who was a known case of ALL, presented with the complaints of fever, lethargy and generalized weakness for one month. After taking blood samples for investigations, empirical antimicrobial therapy was started. She did not improve after 48 hours of therapy. Meanwhile blood culture revealed pure growth of A. hydrophila. After sensitivity report was available, ciprofloxacin was started. Patient became afebrile after 48 hours of treatment with ciprofloxacin. It is very vital to correctly identified and treat bacteremia due to A. hydrophila especially in the underlying leukemic patient.

Activity of beta-lactam beta-lactamase inhibitor combinations against extended spectrum beta-lactamase producing enterobacteriaceae in urinary isolates

To determine the susceptibility pattern of beta-lactam beta-lactamase inhibitor combinations against extended spectrum beta-lactamase [ESBL] producing Enterobacteriaceae in urinary isolates. Observational study. Ziauddin University Hospital, Karachi, from February to October 2008. A total of 190 consecutive non-duplicate isolates of ESBL producing Enterobacteriaceae from urine samples of in-patients were included in the study. Urinary samples from out-patients, repeat samples and non-ESBL producing isolates were excluded. Detection of ESBL was carried out by double disk diffusion technique. Antimicrobial susceptibility testing was performed using modified Kirby Bauer's disk diffusion method according to CLSI guidelines. Statistical analysis was performed by SPSS version 10. Of the 190 ESBL isolates tested, 88 cases [46.31%] were sensitive and 6 cases [3.15%] were resistant to all three combinations, the rest 96 cases [50.52%] were resistant to at least one of the combinations. Susceptibility pattern of cefoperazone/sulbactam, piperacillin/tazobactam, and amoxicillin/clavulanic acid was 95.26, 92.10, and 44.31 percent respectively. Cefoperazone/sulbactam exhibited the best activity against ESBL producing Enterobacteriaceae followed by piperacillin/tazobactam. Hospital antibiotic policies should be reviewed periodically to reduce the usage of extended spectrum cephalosporins and replace them with beta-lactam beta-lactamase inhibitor combinations agent for treating urinary tract infections

Pleural empyema due to salmonella typhi

Salmonella serotypes most often produce gastroenteritis, enteric fever, bacteremia, vascular infection and chronic carrier state. Localized infection may occur at any site after Salmonella bacteremia. Pulmonary involvement due to Salmonella infection is rare. Empyema occurs usually in elderly patients or in patients with underlying diseases such as diabetes mellitus, malignancy, or pulmonary disease. We report the case of an 83-year-old male diabetic patient who presented with fever, productive cough, and difficulty in swallowing. The chest radiographs revealed soft shadowing mild atelactasis and pulmonary abscess on left side. CT-guided aspiration of pus was done. Salmonella enterica serotype typhi was isolated from pus sample. Pleural empyema or abscess usually requires surgical drainage in addition to antimicrobial therapy. After complete course of antimicrobial therapy, the patient improved

Frequency of extended spectrum beta lactamase producing enterobacteriaceae among urinary pathogen isolates

To determine the frequency of extended-spectrum beta lactamase [ESBL] producing Enterobacteriaceae in urinary isolates. Observational study. Ziauddin University Hospital, Karachi, from February to October 2008. All members of Enterobacteriaceae isolated from urinary samples of in-patients were included and identified using standard biochemical tests. Urinary samples from out-patients were excluded. Detection of ESBL was carried out by double disk diffusion technique. Statistical analysis was performed by SPSS version 10. A total of 289 isolates of Enterobacteriaceae were identified during the study period. Of those 190/289 [65.7%] of the isolates were found to be ESBL producing. ESBL positivity within individual organism group was highest in Klebsiella species 84.16%, followed by Escherichia coli 68.55%, Enterobacter species 36.84%, and Proteus mirabilis 28.55%. Mean age of patients with ESBL producing organisms was 58.69 +/- 18.97 years. ESBL production was almost similar in all age groups. A high frequency of ESBL producing organisms especially Klebsiella species and Escherichia coli amongst the hospital obtained urinary isolates was documented particularly in the older age group. The data points towards an urgent need for regular screening and surveillance for ESBL producing organisms in this region

impact of renal lower pole radiographic anatomy on the clearance of stone fragments after extracorporeal shock wave lithotripsy

1. To determine the frequency of clearance of stone fragments after extracorporeal shock wave lithotripsy [ESWL] for isolated lower pole renal calculi. 2. To compare the average Lower Infundibular diameter and lower infundibulo-pelvic angle [L-IPA] between patients with residual stone fragments and those who become stone free after extracorporeal lithotripsy [ESWL] for isolated lower pole renal calculi. Descriptive Study. This study was conducted at Department of Urology, Liaquat National Postgraduate Medical Centre, Karachi from June 2006 to June 2010. One Hundred patients of either sex, aged > 14 years with isolated lower pole calculi [LPC] of <20mm undergoing ESWL were included in the study, while patients with lower pole calculi > 20mm, multiple renal calculi, congenitally distorted pelvi-calyceal anatomy, with concomitant Ureteric calculi, with decreased urine output due to renal insufficiency, with Hydronephrosis, with previous pyelo-uretral surgery, who required ancillary procedures e.g. Ureteroscopy, DJ Stent insertion were excluded from the study. The confirmation of stone in lower pole and LPC anatomy [width of the infundibulum and lower infundibulo-pelvic angle] were viewed on the IVU. The Infundibular width was measured as the narrowest point of the infundibulum. The L-IPA was determined in two axes, the ureteropelvic axis and the infundibulo-pelvic axis. Frequency of clearance of stone fragments after ESWL for lower pole renal calculi was 82%. Average L-IPA was significantly higher in those who become stone free after ESWL than patients with residual stone fragments [79.34 +/- 8.33 vs. 64.56 +/- 5.53, p<0.001]. Average Lower Infundibular diameter was slightly higher in stone free patients after ESWL but not statistically significant [5.02 +/- 0.76 vs. 4.89 +/- 0.78, p=0.631]. Successful ESWL is sensitive to lower pole anatomical variables especially lower Infundibulo-pelvic angle and preferably first line treatment in patient with a lower pole stone has L-IPA >80 degrees and lower infundibular diameter of >5mm