Increasing antimicrobial resistance among uropathogens: is fosfomycin the answer?

Urinary tract infection [UTI] is one of the most common infectious diseases in clinical practice. The choice of antibiotics for the treatment of UTI is limited by the rising rates of antibiotic resistance. There is an urgent need to discover new effective treatment solutions. Fosfomycin may be an interesting alternative to the currently used treatments of UTIs. The study was conducted over 6 months period [January to June 2013] in Department of Microbiology, JNMCH, AMU, Aligarh. A total of 1840 urine samples were submitted. Culture and sensitivity was done as per standard microbiological procedures. Methicillin-resistant Staphylococcus aureus [MRSA], high-level aminoglycoside resistance [HLAR], extended spectrum beta-lactamases [ESBL], AmpC and metallo-beta-lactamases [MBL] production was detected. Culture was positive in 504 [27.4%] cases. Gram-negative etiology was identified in 390 [73%] cases. ESBL production was detected in 154 [37.1%] while 82 [21.6%] were Amp C. No, MBL was detected. Among Gram-positive bacteria, 68 [51.5%] were MRSA, while 4 [13.3%] were vancomycin resistant enterococci [VRE]. HLAR was seen in 53.3% of enterococci. Fosfomycin was effective in 100% of MRSA, VRE, ESBL, HLAR, and overall, susceptibility to fosfomycin in AmpC producers was extremely high [99%]. Norfloxacin and cotrimoxazole were not proved effective as only three isolates were sensitive to norfloxacin, while all Gram-negative isolates were resistant to cotrimoxazole. Pseudomonas species showed 65% and 75% susceptibility to colistin and polymixin B, respectively. Fosfomycin has emerged as a promising option, especially in cases involving multi-drug-resistant pathogens in which previous antibiotics have failed to cure the infection

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

Antibacterial efficacy of the seed extracts of Melia azedarach against some hospital isolated human pathogenic bacterial strains

<p><b>OBJECTIVE</b>To investigate the antibacterial potential of the polar and non-polar extracts of the seeds of Melia azedarach (M. azedarach) L. (Meliaceae) against eighteen hospital isolated human pathogenic bacterial strains.</p><p><b>METHODS</b>Petrol, benzene, ethyl acetate, methanol, and aqueous extracts at five different concentrations (1, 2, 5, 10 and 15 mg/mL) were evaluated. Disk diffusion method was followed to evaluate the antibacterial efficacy.</p><p><b>RESULTS</b>All extracts of the seeds demonstrated significant antibacterial activity against tested pathogens. Among all extracts, ethyl acetate extract revealed the highest inhibition comparatively. The present study also favored the traditional uses reported earlier.</p><p><b>CONCLUSIONS</b>Results of this study strongly confirm that the seed extracts of M. azedarach could be effective antibiotics, both in controlling gram-positive and gram-negative human pathogenic infections.</p>

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.

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.

In vitro antimicrobial activity of Nigella sativa seeds extracts against multiple antibiotics resistant bacteria isolated from clinical specimens

To study the effect of Nigella sativa seeds against standard and multiple antibiotics resistant bacteria. Different extracts of N. sativa L. [N.O. Family Ranunculaceae] seeds were tested in varying dilutions for antimicrobial activity against standard strains and clinical isolates of various bacteria by Agar disc diffusion technique using impregnated filter paper discs on inoculated Muellar Hinton agar plates. Commercial antibiotic sensitivity testing discs were used for sensitivity testing and comparison. Methanolic extract showed highest antibacterial activity and zone of inhibition was seen even up to 1:100 dilution. Among the tested clinical strains, resistant to a number of antibiotics, antibacterial activity was more against gram +ve than gram -ve bacteria. Among gram +ve bacteria tested, Staphylococcus aureus, Staphylococcus epidermidis other coagulase -ve Staphylococci and Streptococcus pyogenes were found sensitive to methanolic extract. Among gram -ve bacteria tested, Escherichia coli and Pseudomonas aeruginosa were found sensitive. Out of 155 strains tested, most of them were resistant to a number of antibiotics and 102 were inhibited by the methanolic extract. Methanolic extract of Nigella sativa is found active against many sensitive as well as multiple antibiotics resistant bacteria isolated from clinical specimens, even up to the dilution of 1:100 and 1:50 respectively