Neonatal sepsis: Incidence, risk factors, common pathogens and antimicrobial pattern in a multiethnic population in Ajman, UAE

To determine the incidence, source of infection, impact of gestational age, pattern of delivery, birth weight, feeding pattern on the occurrence of neonatal sepsis and to assess the frequency of pathogens and their antibiotic susceptibility pattern. Medical record review based study was done during Jan-Dec 2011 at GMCH Ajman. Blood was collected aseptically before the administration of antibiotics from 255 sepsis suspected neonates for culture by BACTEC system. The microorganisms isolated were identified by Gram staining and biochemical test; these isolates were further subjected for antibiogram by Kirby-Bauer disc diffusion method. Analysis was performed on SPSS version 20. The neonates were from 28 nationalities, 82% were Asians. Male female ratio was 61: 59. The proportion of sepsis was 6.6%; of which male female ratio was 76:24. Of the 209 early onset sepsis [EOS] cases 8 were culture proven sepsis, and among the 46 late onset sepsis [LOS] cases 9 were culture positive. Of the culture proven cases, 65% were preterm and 35% were term neonates. Of which 53% were delivered by caesarian section and 47% by vaginal delivery. Thirty five percent were low birth weight, 47% were normal birth weight and 18% were overweight. Eighty eight percent were breast fed, 6% were breast fed along with infant formula and 6% were on IV fluids. Microorganisms isolated were Candida albicans, Staphylococcus species, Streptococcus species and Gram negative bacilli. Gram negative bacilli showed 100% susceptibility towards Amikacin, Augmentin and Ciprofloxacin. Gram positive cocci were 100% susceptible for Azithromycin, Ciprofloxacin and Chloramphenicol. The proportion of sepsis among the suspected neonates was 6.6% with male predominance. Mortality rate was 5.8% among the sepsis proven neonates. Multidrug resistance was not observed among the isolates. The response towards the prophylactic and therapeutic antibiotic regime was effective for the prognosis of sepsis

Prevalence of biofilm and betalactamase-producing staphylococcus in nasal and throat isolates from healthy volunteers: a medical alert

To study the prevalence of virulence factors such as Biofilm and Beta-lactamase in Staphylococcus isolates residing in nasal and throat mucosa in healthy volunteers. Nasal and throat swabs were taken from 100 healthy volunteers at Gulf Medical University and Gulf Medical College Hospital, Ajman, UAE, and cultured for Staphylococcus isolates on appropriate culture media. The isolate were classified as Staphylococcus aureus or Coagulase Negative Staphylococcus [CoNS] based on the growth characteristics on Mannitol Salt Agar and standard tube coagulase test. They were further tested for Biofilm production by Christensen's tissue culture plate and Congo red agar methods. The positive samples were identified for beta-lactamase by iodometric tube method. Of the 100 Staphylococcus isolates, 41 were Staphylococcus aureus of which 25 [61%] were positive for biofilm production whereas 19 [46.3%] were Beta-lactamase positive. Of the 16 [39%] biofilm negative Staphylococcus aureus isolates, 13 [31.7%] were Beta-lactamase positive. Among the 59 CoNS isolates, 38 [64.4%] were positive for biofilm production and 18[30.5%] were Beta-lactamase positive. Twenty one CoNS samples [35.5%] were negative for both biofilm and Beta-lactamase production. Biofilm production in Staphylococcus aureus and CoNS did not show any significant difference [61% and 64.4%]. Predominance of Staphylococcal isolation was in males between the age group of <20 years, mostly from the nasal site. Biofilm-producing Staphylococcus appear to inhabit the normal flora of the nasal and throat mucosa of healthy individuals. Beta-lactamase production was found to be higher in Staphylococcus aureus positive for biofilm producers as compared to CoNS. Transmission of these biofilm producers with drug resistance factors from the healthy individuals to those at risk, like patients on long term catheterization or with indwelling devices need to be considered

Asymptomatic bacteriuria in pregnant women: a hospital based study

To study the incidence of bacteriuria during pregnancy with no presenting symptoms of UTI and to study the antimicrobial susceptibility pattern of the bacterial isolates. The study was conducted among 411 pregnant women [primi- or multigravida] on their first antenatal checkup visit in GMC hospital, Ajman over a period of one year. A structured questionnaire was administered to collect the demographic and health information from the subjects giving consent. The results of the laboratory investigations [bacteriuria, pus cells and culture sensitivity] were noted from the medical records. Bacteriuria was present in 48 [11.7%] cases, and 10 samples sent for culture sensitivity showed positive growth in 3 samples [30%]. Prevalence of culture positivity among patients with no bacteriuria, but showing presence of significant number of pus cells, was 22.2% [18/81]. Out of total 91 samples cultured, no growth was isolated in 70 samples on incubation. However, various gram positive and gram negative organisms were isolated from the remaining samples which showed variable sensitivity to different antibiotics. Asymptomatic bacteriuria among pregnant women suggests dormant urinary tract infection which might lead to complications such as low birth weight, hypertension and higher fetal mortality rates, if left untreated. It has been suggested that a urine culture should be obtained from all women during antenatal checkup even in the absence of UTI symptoms

Prevalence of biofilm and betalactamase-producing staphylococcus in nasal and throat isolates from healthy volunteers: a medical alert

Objective: To study the prevalence of virulence factors such as Biofilm and Beta-lactamase in Staphylococcus isolates residing in nasal and throat mucosa in healthy volunteers

Materials and Methods: Nasal and throat swabs were taken from 100 healthy volunteers at Gulf Medical University and Gulf Medical College Hospital, Ajman, UAE, and cultured for Staphylococcus isolates on appropriate culture media. The isolate were classified as Staphylococcus aureus or Coagulase Negative Staphylococcus [CoNS] based on the growth characteristics on Mannitol Salt Agar and standard tube coagulase test. They were further tested for Biofilm production by Christensen's tissue culture plate and Congo red agar methods. The positive samples were identified for beta-lactamase by iodometric tube method

Results: Of the 100 Staphylococcus isolates, 41 were Staphylococcus aureus of which 25 [61%] were positive for biofilm production whereas 19 [46.3%] were Beta-lactamase positive. Of the 16 [39%] biofilm negative Staphylococcus aureus isolates, 13 [31.7%] were Beta-lactamase positive. Among the 59 CoNS isolates, 38 [64.4%] were positive for biofilm production and 18[30.5%] were Beta-lactamase positive

Twenty one CoNS samples [35.5%] were negative for both biofilm and Beta-lactamase production. Biofilm production in Staphylococcus aureus and CoNS did not show any significant difference [61% and 64.4%]. Predominance of Staphylococcal isolation was in males between the age group of <20 years, mostly from the nasal site

Conclusion: Biofilm-producing Staphylococcus appear to inhabit the normal flora of the nasal and throat mucosa of healthy individuals. Beta-lactamase production was found to be higher in Staphylococcus aureus positive for biofilm producers as compared to CoNS. Transmission of these biofilm producers with drug resistance factors from the healthy individuals to those at risk, like patients on long term catheterization or with indwelling devices need to be considered

Asymptomatic bacteriuria in pregnant women: a hospital based study

Objective: To study the incidence of bacteriuria during pregnancy with no presenting symptoms of UTI and to study the antimicrobial susceptibility pattern of the bacterial isolates

Materials and Methods: The study was conducted among 411 pregnant women [primi- or multigravida] on their first antenatal checkup visit in GMC hospital, Ajman over a period of one year. A structured questionnaire was administered to collect the demographic and health information from the subjects giving consent. The results of the laboratory investigations [bacteriuria, pus cells and culture sensitivity] were noted from the medical records

Result: Bacteriuria was present in 48 [11.7%] cases, and 10 samples sent for culture sensitivity showed positive growth in 3 samples [30%]. Prevalence of culture positivity among patients with no bacteriuria, but showing presence of significant number of pus cells, was 22.2% [18/81]. Out of total 91 samples cultured, no growth was isolated in 70 samples on incubation. However, various gram positive and gram negative organisms were isolated from the remaining samples which showed variable sensitivity to different antibiotics

Conclusion: Asymptomatic bacteriuria among pregnant women suggests dormant urinary tract infection which might lead to complications such as low birth weight, hypertension and higher fetal mortality rates, if left untreated. It has been suggested that a urine culture should be obtained from all women during antenatal checkup even in the absence of UTI symptoms

Prevalence and antimicrobial susceptibility pattern of Methicillin-resistant Staphylococcus aureus among clinical samples in a tertiary care hospital

To determine the prevalence and antimicrobial susceptibility pattern of MRSA isolates among clinical samples in a tertiary care hospital. This cross sectional study was carried out among patients between the age group one and seventy years, admitted to a tertiary care hospital in India. A total of 2850 clinical samples from patients attending various clinical departments were collected over a period of two years. staphylococcus aureus was identified by culture characteristics and confirmed by tube coagulase test. Methicillin resistance was determined by oxacillin [1 micro g] disc diffusion method using MHA with 5% NaCl supplementation. Antimicrobial susceptibility testing was done by Kirby-Bauer's method for all the isolated MRSA strains. The prevalence for age, gender and clinical samples were calculated. Of the total 2850 clinical samples studied, 1262 [44%] samples were from pyogenic materials. 490 [17%] from aspirates and 1098 [39%] from wound secretions of a patients of various clinical departments. 586 samples were positive for S. aureus. Out of the 586 S. aureus isolated, 236 [40.2%] isolates were positive for MRSA and 350 [59.7%] isolates were positive for MSSA. The yield of MRSA was the highest among 20-40 year age group [47.4%], predominantly males and were mostly from surgical post-operative patients [39.8%]. All the 236 MRSA isolates were 100% susceptible to Vancomycin and 100% resistant to Penicillin. The Prevalence of MRSA in our hospital was 40.2%. We conclude that knowledge of prevalence and antibiotic sensitivity pattern of MRSA help the clinician in providing the first line treatment in the health care settings. Also we recommend a universal rapid MRSA screening strategy for patients admitted for surgery in order to control and minimize the spread of MRSA in patients

Staphylococcus aureus: prevalence among normal healthy individuals

To determine the prevalence of Staphylococcus aureus among normal healthy individuals in relation to age, gender and site of isolation. This cross sectional study was carried out among normal healthy individuals in the age group 15-65 years, at Gulf Medical University and Gulf Medical College Hospital and Research Center, Ajman. The study included a detailed proforma of all the volunteers. The nasal and throat swabs were collected with strict aseptic precautions and were subjected to direct microscopic examination and culture on appropriate media. Staphylococcal isolates were subjected for Tube Coagulase test and growth on Mannitol Salt Agar [MSA] and were grouped as Staphylococcus aureus and Coagulase Negative Staphylococci [CoNS]. Of the 127 human volunteers screened, 67 were from GMU [22 were staff and 45 M.B.B.S students] and 60 volunteers from GMCH and RC, Ajman [doctors, staff nurses and ward boys]. Staph, aureus isolation was the highest among the 21-30 year age group [37%] with male predominance [59.6%] and mostly from the nasal swabs [56.45%]. The yield of Staph. aureus isolates from the nasal mucosa and throat were only from 49 normal individuals, hence the prevalence of Staph. aureus in our study being 38.5%. Among the total 124 Stapylococcal isolates, 62 [50%] were Staph. aureus and 62 [50%] were coagulase negative staphylococci. Of the 62 Staph aureus isolates, 35 [56.45%] were from nasal swabs and 27 [43.54%] from throat swabs. Of the 62 coagulase negative Staphylococcus isolates, 44 [70%] were from nasal swab, four [6%] from throat swab and 14 [22%] were from both nasal and throat swabs. The study indicates an alarming prevalence rate of Staph. aureus. Hence we conclude that the data observed reflected the need for a complete revision for all the infection control programs at GMU and GMCH and RC which includes education programs, aseptic techniques, hospital hygiene and periodic microbiological surveillance in order to control the spread of infection

Betalactamase production of Staphylococcus aureus: a comparison study of different iodometric methods

This study was undertaken to detect Beta-lactamase producing Staphylococcus aureus among healthy individuals by using different iodometric methods [filter paper, agar plate and tube]. The study was carried out among 127 normal healthy volunteers of Gulf Medical University and Gulf Medical College Hospital and Research Center, Ajman. Nasal and throat swabs were collected with strict aseptic precautions. All the swabs were examined by direct microscopy and inoculated into appropriate culture media. Staphylococcus aureus was identified by tube coagulase test and growth on MSA. Beta-lactamase enzyme activity of Staph. aureus was determined by the filter paper, agar plate and tube lodometric methods. Antimicrobial susceptibility testing by Kirby-Bauer's method was performed for all Beta-lactamase producing Staph. aureus. Out of 127 healthy volunteers screened, Staph. aureus were isolated from the nasal and throat swabs from 62 subjects. Of the 62 Staph. aureus isolates, 40 [64.5%] were positive by all the three iodometric methods. Six isolates [9.6%] were positive by two methods [4 isolates by filter paper and tube methods, one isolate by filter paper and agar plate methods and one isolate by agar plate and tube methods]. Four isolates [6.4%] were positive by one of these methods. Twelve isolates [19.4%] were totally negative by all the three methods. Overall susceptibility of filter paper and tube methods were found to have similar results 45 [72.5%]. Whereas the overall susceptibility of agar plate method was 42 [67.7%]. Antimicrobial susceptibility was 100% to Vancomycin and Rifampicin, and 100% resistance to Penicillin and Ampicillin. The study indicates that the filter paper and tube iodometric methods were accurate and superior to the agar plate method in the detection of Staphylococcal Beta-lactamase. We conclude that the alarming prevalence rate of Beta-lactamase among normal healthy individuals indicates the need for treatment by Beta-lactamase-susceptible antibiotics

Detection of methicillin-resistant strains of staphylococci by multiplex polymerase chain reaction

A rapid and accurate detection procedure for Methicillin resistance among Staphylococci isolates through the amplification of specific gene determinants by Multiplex PCR was done in the present study. A total 586 Staphylococcal clinical isolates were studied. Clinical samples including pyogenic materials, aspirates and wound secretions were collected under aseptic conditions from patients attending various departments of a tertiary care hospital. staphylococcus aureus isolates were identified by culture characteristics and confirmed by tube coagulase test. Methicillin resistance was determined by Oxacillin disc diffusion method [1 micro] using MHA with 5% NaCl supplementation. The multiplex PCR was used as the gold standard for the detection of mec A genes. Thirty five MRSA isolates were subjected for mec A gene detection by multiplex PCR at Sir Dorabji Tata center for Research in Tropical Diseases, IISc Campus, Bangalore, India. The multiplex PCR was performed according to the procedure of Oliveira et al. by using the lysates of Staphylococcal strains. [MRSA] as templates and Oligonucleotide sequences as primers, a 162 and 530-bp region of mec A, the structural gene of a low-affinity penicillin-binding protein [PBP2'] was amplified and detected by agarose gel electrophoresis. Of the total 586 Staphylococcal aureus isolates studied, 236 [40.2%] samples were positive for MRSA and 350 [59.7%] samples were MSSA by Oxacillin disc diffusion method [1 micro] using MHA with 5% NaCl supplementation. Thirty five isolates were subjected for mec A gene detection by multiplex PCR. Thirty three MRSA isolates [94%] were found to be positive at 162 and 530 base pairs and 2 MRSA strains were mec A negative. We conclude that the PCR assay isw a rapid and accurate procedure for the diagnosis of MRSA infection

overview of changing trends in systemic fungal infections

Invasive mycoses are a significant and growing public health problem. The increasing use of invasive monitoring and aggressive therapeutic technologies in intensive care units has resulted in improved survival of individuals with life-threatening illnesses, but has also contributed to an increase in number of persons at risk for fungal infections. Today, invasive fungal infections pose the chief infectious challenge in hematology, oncology and intensive care practice. This review discusses the changing patterns in the risk factors, epidemiology, the impact of changes in medical practice on the incidence of systemic fungal infection and the emergence of antifungal resistance. Relevant English-language articles were identified through search of four databases [PubMed, ProQuest, Medline and Embase [all, 2005-2011]] conducted in June 2011 using Keywords "systemic fungal infection", "aspergillosis", "candidosis" and "antifungal". Original research and review articles related to patients with systemic fungal infection were considered for the review. Despite marked reduction in the rates of invasive fungal infections in developed countries, the burden is increasing largely in developing countries. Infections with Candida albicans may be decreasing in frequency, yet the number of persons at risk for them continues to grow. Prolonged and deep neutropenia and treatments neutralizing macrophage inflammatory cytokines have increased the likelihood of opportunistic infections. Extensive use of fluconazole in neutropenic patients has resulted in marked decrease in the incidence of invasive candidosis but it has also resulted in a shift from highly susceptible to less susceptible Candida spp.: Candida glabrata. Along with Aspergillus app., Fusarium spp., Scedosporium spp., Penicillium spp. and Zygomycetes are gaining importance. Although there is improvement in the survival rates of patients with invasive fungal infection in recent years, continued research is required to meet the challenges associated with changes in epidemiology and resistance development