ABSTRACT
Background & Objectives: Extended-Spectrum Beta-Lactamase (ESBL) producing members of the family Enterobacteriaceae are emerging worldwide The aim of this study was to evaluate risk factors, co-morbidity status and short term mortality rates among hospitalized patients with and without ESBL producing Enterobacteriaceae spp. urinary isolates. Methods: An analytical cross-sectional study conducted in a super-specialty hospital from December 2014 to July 2015. Urine samples from 100 patients which repeatedly yielded significant colony counts of Enterobacteriaceae spp. isolates were identified using standard biochemical tests. Antibiotic susceptibility testing of these isolates was carried out by modified Kirby Bauer disk diffusion method as per CLSI guidelines 2014. Isolates which were resistant to cefotaxime and/or ceftazidime were tested for the production of ESBL by phenotypic confirmatory disc diffusion test. Relevant clinico-epidemiological details of these patients were subsequently obtained from Medical records as per the proforma formulated. The original version of the Charlson Index (CI) was used to assess co-morbidity and short term mortality rates. Results & Interpretation: Escherichia coli followed by Klebsiella pneumonia were the predominant isolates. 40 isolates were confirmed as ESBL producers. All isolates had Multiple Antibiotic Resistance (MAR) index of >0.2. The p-value of difference in proportion of all the risk factors distributed among patients with and without ESBL producing urinary Enterobacteriaceae spp. isolates respectively was found to be >0.05. The p-value of difference in mean Charlson index scores between these two groups of patients was 0.45. Conclusions: The results obtained in our study are largely inconclusive. It is imperative that more number of multicentre studies should be conducted in order to generate conclusive evidence on this subject. [Mohit B NJIRM 2016; 7(5):40-45]
ABSTRACT
Allergic bronchopulmonary aspergillosis (ABPA) is a slowly progressive disease caused by hypersensitivity to Aspergillus fumigatus. This condition is most commonly seen in patients with asthma and cystic fibrosis. ABPA mimics a wide range of diseases, thereby further accentuating the difficulties faced by medical practitioners in diagnosing this condition. Even today, this condition remains under diagnosed in many countries with reports of mean diagnostic latency of ten years between the occurrence of symptoms and the diagnosis. We present a case report and review of literature with the aim of highlighting the complicated nature of this enigmatic illness.
ABSTRACT
Objectives: Urinary tract infection (UTI) as a result of Candida spp. is becoming increasingly common in hospitalized setting. Clinicians face dilemma in differentiating colonization from true infection and whether to treat candiduria or not. The objective of the present study was to look into the significance of candiduria in catheterized patients admitted in the ICUs and perform microbiological characterization of yeasts to guide treatment protocols. Materials and Methods: One hundred consecutive isolates of Candida spp. from the urine sample of 70 catheterized patients admitted in the ICU were collected and stocked for further characterization. A proforma was maintained containing demographic and clinical details. Blood cultures were obtained from all these 70 patients and processed. Species identification of yeasts was done on VITEK. Results: Candiduria was more common at extremes of age. The mean duration of catheter days was 11.1 ± 6 days. Other associated risk factors such as diabetes mellitus and antibiotic usage were seen in 38% and 100% of our study group. Concomitant candidemia was seen in 4.3% of cases. Non-albicans Candida spp. (71.4%) emerged as the predominant pathogen causing nosocomial UTI. Conclusion: The present study reiterates the presence of candiduria in catheterized patients, especially in the presence of diabetes and antibiotic usage. Non-albicans Candida spp. are replacing Candida albicans as the predominant pathogen for nosocomial UTI. Hence, we believe that surveillance for nosocomial candiduria should be carried out in hospitalized patients.