ABSTRACT
Background: Carbapenems have the broadest activity spectra of any β-lactam antibiotic and are often the most appropriate agents for use in the treatment of infections caused by multi resistant gram negative bacteria. The recent worldwide emergence and dissemination of carbapenemase-producing Gram negative rods that are resistant to carbapenems is a significant concern with respect to patient care and infection control strategies. Hence this study was undertaken to study the magnitude of carbapenem resistance among routine clinical isolates of family Enterobacteriaceae so as to guide the clinicians in selection of appropriate antimicrobial chemotherapies and infection control measures.Methods: The present study was conducted in the Department of Microbiology over a period 18 months from January 2017 to July 2018. All the clinical isolates of Enterobacteriaceae were screened for carbapenem resistance as per CLSI guidelines. Such strains were then subjected to phenotypic confirmation of carbapenemase production by the Modified Hodge test. All isolates that gave a positive screening test were further evaluated for metallo-β-lactamase production. The technique used was the Combined Disk Test using a combination of Imipenem and Imipenem-EDTA.Results: Out of the 400 total clinical isolates of Enterobacteriaceae isolated in the laboratory,57 were found to be Meropenem resistant (14.25%) and were labelled 'Carbapenem resistant Enterobacteriaceae" or CRE. Modified Hodge test (MHT) performed on the 57 carbapenem resistant isolates showed 41 (71.93%) isolates to be carbapenemase enzyme producers. Combined disc test (CDT) conducted on the 57 isolates of CRE detected Metallo-β-lactamase (MBL) enzyme production in 39 isolates (68.42%).Conclusions: Since there is a high prevalence of carbapenemase resistance in our setting hence we need to be cautious with the indiscriminate use of broad spectrum antimicrobials, more so, the carbapenems.
ABSTRACT
Background: Acute febrile illness is a common presenting complaint during the rainy season. Rains predispose to both water and vector borne diseases. Co-infection of dengue with malaria, leptospirosis, typhoid, scrub typhus and other arboviral diseases can occur in endemic areas. Such dual infections are difficult to diagnose and create a diagnostic dilemma for the treating physician. Here in this study authors attempt to find out rates of concurrent dengue and typhoid infection.Methods: This retrospective study was done between August to November 2017. 403 patients presenting with acute febrile illness were studied. Diagnosis of dengue was done by rapid card test detecting NS1 antigen, IgM and IgG antibodies. Serodiagnosis of Salmonella infection was done by tube Widal test.Results: : Out of 403 febrile sera samples tested 154 (38.2%) were positive for dengue (either NS1 antigen or IgM antibodies or both), 71(17.6%) were positive for Widal test O and H titres ≥1:160) and 28 (6.9%) were positive for both dengue as well as Salmonella (Widal test).Conclusions: Acute febrile illnesses with diagnostic dilemma may be seen in cases of co-infection. Only better clinical judgement and right choice of laboratory tests can diagnose these diseases timely and prevent fatal outcomes.
ABSTRACT
Background: Tuberculosis is a significant cause of morbidity and mortality in the Indian subcontinent. A major challenge to clinical microbiology is the detection of Mycobacterium tuberculosis as accurately as possible. Objective: Tthe most important tool in the diagnosis of tuberculosis is direct microscopic examination of appropriately stained specimens for acid- fast bacilli and the gold standard for diagnosing tuberculosis is MTB convention culture on L-J media So, the present study was undertaken to compare smear microscopy by Z – N staining with conventional culture on L-J media, in cases of clinically suspected Pulmonary Tuberculosis and Extra Pulmonary Tuberculosis. Methods: 279 samples were processed within 24 hours of receipt. Samples from non-sterile sites were subjected to decontamination by the modified Petroff’s method. Sterile samples were directly processed as per conventional methods. Smear microscopy was done by Z- N staining and culture was done on L- J media. A control organism in the form of M. tuberculosis H37Rv was also tested with each batch of clinical isolates. Result: Results of smear microscopy and conventional culture of pulmonary and extra pulmonary specimens were compared. 22 and 14 more cases were detected by culture as compared to smear in case of pulmonary and extra pulmonary specimens respectively. Conclusion: From this study we can state that direct microscopic examination of appropriately stained Pulmonary and Extra Pulmonary specimens for acid fast Bacilli is an important tool in the diagnosis of tuberculosis. The Technique is simple, inexpensive and fast .However many Paucibacillary cases may be missed on smear microscopy. Thus specimens from all suspected cases of Pulmonary and Extrapulmonary Tuberculosis should be subjected to conventional culture on LJ media. This is the Gold Standard for Diagnosing Tuberculosis.
ABSTRACT
Introduction: Urinary Tract infections caused by Escherichia coli have become a significant global public health problem. The resistance to β- lactam antibiotics in these clinically important gram negative bacteria further adds to the problem. Knowledge about their prevalence is essential to guide towards appropriate antibiotic treatment. The study was thus undertaken to know prevalence and susceptibility pattern of Extended spectrum β - lactamase (ESBL) producing Escherichia coli isolates among urinary samples. Methods: A total of 216 E. coli isolates in urinary samples were studied for ESBL production by using CLSI Phenotypic screening and confirmatory tests. Results: 53% of E.coli isolates were ESBL producers. The susceptibility of ESBL producers to Imipenem, Tigecycline and Nitrofurantion was found to be 100%, 100% and 88% respectively. A high degree of associated resistance to Amikacin, Co-trimoxazole and Quinolones was found in ESBL producers. Majority of ESBL producers were detected among patients admitted in various ICUs and surgery ward. Conclusion: Our study shows presence of ESBL producer E.coli in large number of urinary isolates.