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Aims: To find out the prevalence and risk factors for vancomycin resistant Enterococci in a leading tertiary care center of north India. Design: Cross sectional study. Place and Duration of Study: Sher-I-Kashmir Institute of Medical Sciences, Srinagar. Kashmir. One year study. Methodology: A total of 400 isolates of Enterococci from patients admitted to our hospital were recovered using standard microbiological procedures, during a period of one year. Antimicrobial susceptibility of these isolates to various antibiotics was performed according to Clinical Laboratory Standard Institute (CLSI) guidelines. Minimum inhibitory concentration (MIC) of isolates found to be resistant to vancomycin on disc diffusion was done by microbroth dilution method. Various risk factors like placement of IV line catheter, urinary catheter, hospital stay and prior use of antimicrobial agents was noted for all the patients. Results: A total of 25 (6.3%) isolates of Enterococci were found to be vancomycin resistant, most of them recovered from the blood samples. E. faecium 16 (64%) was the predominant VRE isolated followed by E. faecalis 9 (36%). Factors like stay in an ICU, prior use of antimicrobials, placement of IV line and urinary catheter were associated with vancomycin resistant Enterococci (VRE) acquisition. Conclusion: VRE were recovered from our hospital and strict adherence to infection control guidelines needs to be followed to control their dissemination.
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Title: Lower respiratory tract infections in intensive care units. A four year study from North India. Study Design: Prospective study Place and Duration of Study: Sher-i-Kashmir Institute of Medical Sciences, Srinagar Kashmir. Four years (July 2010 and June 2014). Methodology: A prospective analysis of respiratory specimens from various intensive care units (ICUs) was done over a period of four years. Antimicrobial susceptibility of culture positive isolates to various antibiotics was performed as per Clinical Laboratory Standards Institute (CLSI) guidelines. Gram-negative bacteria (GNB) were screened for extended spectrum β-lactamase (ESBL) and metallo-β-lactamase (MBL) production; whereas methicillin and vancomycin resistance was searched in staphylococci and enterococci isolates respectively. Results: The frequencies of Gram-positive and Gram-negative bacteria were 26% and 68% respectively with yeast recovered in 8% of the specimens. K. pneumoniae and Acinetobacter spp were the most common Gram-negative bacteria and S. aureus the most common Gram-positive one. High level resistance to all the antimicrobials was seen; with K. pneumoniae being the most multidrug resistant GNB isolated in the ICU setting. ESBL production was also highest in K. pneumoniae isolates (67.1%). Also 59.6% of Acinetobacter isolates were found to be MBL producers. Methicillin resistance was seen in 48% of S. aureus and 85.5% of coagulase negative staphylococci (CoNS) isolates with vancomycin resistance seen in 6.7% of enterococcal isolates. Conclusion: An increasing trend over the years in the antibiotic resistance of respiratory pathogens in ICUs of this north Indian state was seen that calls for urgent measures to limit their continued rise.
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Aim: To evaluate the methodology of MTT tube assay and compare it with standard proportion method for detection of drug susceptibility of M. tuberculosis to rifampicin (RIF) and isoniazid (INH). Study Design: Prospective. Place and Duration of Study: Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India. One year study. Methodology: MTT [3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide] assay was performed on 60 clinical isolates of M. tuberculosis. An inoculum of 107CFU/ml prepared in Middlebrook 7H9 with OADC (Oleic acid, albumin, dextrose and catalase) was chosen as standard. For each drug three tubes were used, one drug containing (INH 0.2 μg/ml or RIF 1 μg/ml), second inoculum control and third blank control. The method was performed after incubating the tubes at 37°C for 4 days for RIF and 7 days for INH. Results were read visually and by spectrophotometer at 570 nm. Relative optical density units of 0.2, was taken as cutoff. Results of drug susceptibility were compared with those obtained by Lowenstein Jensen proportion method. Results: For RIF, sensitivity was 88.9% and 94.4%; specificity was 100% and 97.6% for visual MTT and MTT by RODU respectively. For INH similar sensitivity of 95.1% was seen while specificity was 97.0% and 95.0% by visual MTT and MTT by RODU respectively. There was almost perfect agreement between proportion and MTT method for both drugs. Turn-around time for MTT assay was 7 days. Conclusion: The MTT tube assay can be used for rapid drug susceptibility testing of M. tuberculosis to RIF and INH.
ABSTRACT
Background & objectives: Community outbreaks of disease amongst nomadic populations generally remain undocumented. Following a reported increase in acute respiratory tract infections (ARI) in May 2011 in a nomadic population of Sangerwini in Jammu & Kashmir, India, we examined the patients with ARI symptoms and their nasal swabs were tested for influenza virus. Methods: Patients with ARI (n=526) were screened from May 14 to 23, 2011 and nasopharyngeal swabs collected from 84 with Influenza like illness (ILI) for bacterial cultures and influenza virus testing. Samples were tested for influenza A and influenza B by real time (RT)-PCR. Results: Twelve (14.3%) of the 84 patients tested positive for influenza B, compared to only one (0.9%) of 108 patients with ILI in a parallel survey performed in Srinagar during the same period, suggesting a localized outbreak in the isolated nomadic community. All presented with respiratory symptoms of less than seven days. Familial clustering was seen in 40 per cent (25% of influenza B positives). Average daytime temperatures ranged from 15-16oC compared to 22oC in Srinagar. Four patients developed pneumonia whereas others ran a mild course with a total recovery with oseltamivir and symptomatic therapy. Interpretation & conclusion: Our report of confirmed influenza B in this underprivileged nomadic population argues for routine surveillance with efforts to improve vaccination and infection control practices.