Antimicrobial Profile of Clinical Isolates in Intensive Car e Unit at a Tertiary Care Hospital

Introduction: Intensive Care Units (ICU’s) provides a suitable environment for the proliferation and persistence of multidrug organisms. The burden of nosocomial infections among critically ill patients is much higher in developing countries. Aims and Objectives: The present study was conducted to know the prevalence of bacterial pathogens from various ICU’s of a tertiary care hospital and to determine their resistance profile. Materials and methods: A retrospective study was done on 188 isolates collected over a period of 10 months from January 2018 to October 2018. The isolates were identified by the conventional biochemical method and antimicrobial susceptibility testing was performed by Kirby bauer disc diffusion method. Results: The most common gram negative isolate obtained in this study was Klebsiella spp. About 90/188 (47.87%), followed by Pseudomonas aeruginosa 22/188 (11.70%), Acinetobacter spp. 21/188 (11.17%), and E. coli 20/188 (10.64%). The predominant gram positive cocci isolated were Enterococcus spp. 9/188 (4.79%). All gram negative bacilli were sensitive to Imipenem. About 23.33% of Klebsiella isolates were resistant to Piperacillin tazobactam and 18.89% to Cefoperazone sulbactam. The most effective drugs against gram negative bacilli were Imipenem, Piperacillin tazobactam, and Cefoperazone sulbactam. Conclusion: This study showed the prevalence of multidrug resistant Klebsiella spp. from various ICU’s. These isolates were resistant to third generation cephalosporins, quinolones, and aminoglycosides and were sensitive to carbapenems. Among the non-fermenting gram negative bacilli, the resistant rates were higher for Acinetobacter isolates compared to Pseudomonas aeruginosa.

Floating Bodies in the Left Atrium by 2D-echo: A Differential Diagnosis.

Two-dimensional echocardiography (2D-echo) is sensitive in detecting floating bodies in the left atrium. Identification of a freefloating left atrial thrombus, as a source of embolus, is a common indication for 2D-echo. Screening for other cardiac conditions such as valvular heart diseases often, if not common, reveal floating bodies in the left atrium. The differential diagnosis of a floating body in the left atrium will be discussed.

Leptospirosis: clinical presentation and correlation with serovars.

A total of 2400 patients with pyrexia of unknown origin and or suspected leptospirosis were included in this study. Dark field microscopy detected Leptospira in 690 cases, Leptospira serological Investigations proved positive in 570 out of these 690 patients. Among them 212 had the classical icteric and the other 358 had anicteric type of presentation. Notably eptospira interrogans serovar ictero haemorrhagiae infection was encountered in 212 patients. In 30 patients, who had multi organ dysfunction which included renal failure, hepatic dysfunction or meningitis was due to Leptospira interrogans Serovar cannicola. Coexsistense of leptospirosis and hepatitis B virus infection were noted in 15 patients. Antibody to Leptospira interrogans was demonstrated by Micro agglutination test (MAT) in addition to dark field microscopy positivity in these cases. Similarly HIV antibody was demonstrated in 30 of the 330 anicteric patients. 554 out of 570 cases responded to intra venous penicillin (216), and oral Doxycycline (182) and Augmentin (156), and the remaining 16 patients succumbed to death.

Fusarium solani breast abscess.

An unusual manifestation of breast fusariosis was encountered in a 55-year-old female diabetic patient. Two fine needle aspirates (FNA) from the abscess were done at three days interval and they showed hyaline, septate, branched, fungal hyphae in 10% potassium hydroxide mount. Fungal infection was confirmed by demonstrating the fungal hyphae in the midst of lymphocytes, macrophages and neutrophils in Leishman stained smears. Culture of both FNAs yielded a heavy and pure growth of Fusarium solani. The patient responded to oral ketoconazole 200 mg once daily for 3 weeks. The breast fusariosis reported here is presumably the first case in India.