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Introduction: Pseudomonas aeruginosa species can be dangerous opportunistic pathogen because of its tolerance to physical, chemical, antibacterial compounds. In hospitals, P. aeruginosa is a formidable opportunistic pathogen, and therefore, the medical concern with infection of immunologically compromised patients in burns and neonatal units, is well justified. Material and methods: Total 1583 samples like swab, urine, sputum, pus, pleural fluid, bronchoalveolar lavage (BAL), ascitic fluid and blood samples from different clinical departments were tested at Clinical Microbiology Department of B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat during April 2009 to April 2010. Results: Out of 1583 samples, 807 samples turned culture positive. Out of 807 culture positive samples, 100 were culture positive for P. aeruginosa. The maximum number (68%) of P. aeruginosa isolates were obtained from swab samples. The highest number of such isolates (48%) belonged to surgical ward. P. aeruginosa showed highest sensitivity against Cefepime - Tazobactam (97%). Conclusion: This study showed that P. aeruginosa is acquiring resistance to commonly used antibiotics as well as newer antibiotics. The antimicrobial agents are losing their efficacy because of spread of the resistant organism, indiscriminate use of antibiotics, and unhygienic condition. It is the need of the time that antibiotic policies should be formulated and implemented to resist and overcome this serious problem.
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Introduction: Salmonella typhi is widely prevalent in India and it causes endemic and epidemic typhoid fever. Early and proper antibiotic administration is necessary to reduce morbidity, complication and mortality of typhoid. Material and methods: A total of 1006 febrile patients, receiving treatment at Guru Govindsingh Hospital, Jamnagar, were included in this study. 1006 blood culture samples for S.typhi Were collected from these patients. Blood cultures were tested for clinical bacteriology, as per standard protocol. Results: 30 blood cultures grew positive for S. typhi with the isolation rate of 2.98%. 60% S. typhi isolates were resitant to chlorampheenical, amppicillin, and co-trimoxazole and hence, were multidrug resistent S. typhi ciprofloxacin was the most effective drug with 93.33% senstivity. Conclusion: Ciprofloxacin remains the drug of choice for treatment of typhoid fever. Unchecked use of ciprofloxacin antibiotic should be rationalized, since selection pressure has now emerged as ciprofloxacin resistant in S. typhi.
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Objecu've: On-site evaluation of laboratories with standard checklist is a first step to promote effective and consistent supervision. The present study was carried out to evaluate the impact of the RNTCP- Intermediate Reference Laboratory External Quality Assessment- On-Site Evaluation visits on quality of sputum smear microscopy services of Gujarat, India. Data of three IRL-EQA-OSE visit rounds, carried out between January 2005 and December 2010 are presented here. Materiaf and Methods: Within the Revised National Tuberculosis Control Programme EQA framework, the IRL, Ahmedabad visited all Gujarat District Tuberculosis Centres, and evaluated their sputum smear microscopy services. The study covered a cohort of 29 DTCs during each of the three IRL-EQA-OSE visits. The authors focused on section III of Annexure A to study and analyse the said impact. In order to convert qualitative data into quantitative one, the authors denoted a score of 1 to "Acceptable" (No Error) remark and 0 to "Not-Acceptable" (Error) one. Results.' Alarger degree of improvement was noted in Standard Operating Procedure practices, Disinfection practices, and Internal Quality Control practices. Many DTCs did not retrain their laboratory staff in EQA methodology. The Gujarat DTCs achieved an overall score of (8201957) 86% during the initial OSE visits which consistently improved to (842/957) 88% and (885/957) 92% during the two follow-up OSE visits along with sustenance and improvement in many important laboratory parameters. Conclusion' The co-sponsoring organisation (IRL) recognises the challenges and therefore, is committed to supporting state-level implementation of EQA through additional training, technical assistance to districts, and improving this technical guidance. By periodic IRL. EQA-OSE visits, sputum smear microscopy services can be sustained and improved at field level.
ABSTRACT
Objective: To assess the proficiency of Senior TB Laboratory Supervisors (STLSs) and district level Laboratory Technicians (LTs) in sputum smear microscopy. Method: Intermediate Reference Laboratory (IRL), Ahmedabad had manufactured and validated Proficiency Panel Testing slides from sputum samples, made On Site Evaluation (OSE) visits of District TB Centres (DTCs) in two rounds, and conducted Proficiency Panel Testing of STLSs & DTC-LTs from January 2005 to June 2009. Results: High level of concordance in Z-N smear grading was found between Microbiologist and district laboratory staff. DTC readers reported overall consistency level of more than 98% in Z-N grade agreement during both the IRL, EQA, OSE visits. The tendency to over-grade the panel slides was much higher (more than 22%) as compared to under-grade (less than 2%) them in “correct slides”. High False Positive (HFP) error was not observed in the present study. Conclusion: Laboratory supervisor’s proficiency can be quickly assessed by Proficiency Panel Testing, under multi-level quality assurance network system of sputum smear microscopy in public health programmes like the RNTCP. Proficiency Panel Testing is highly replicable and reproducible tool for quick and reliable assessment of proficiency of the staff and it can be made more effective by raising the proportion of lower grade positive slides in panel set of each reader. DTC readers’ overall agreement level of more than 98% in Z-N grade suggests high level of precision and excellent consistency during both the IRL, EQA, OSE rounds. It is concluded that even for a large network of sputum smear microscopy centres under public health programmes like the RNTCP in order to take corrective action, Proficiency Panel Testing can be effectively used for quick identification of suboptimal- technical performance of the supervisory staff.