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Introduction: Therapy for infections due to Vancomycinresistant Enterococci presents real challenge for the clinician.Despite increasing reports of VRE from different countries,there is a paucity of information on this issue from our country.Hence, the present study aims to study of demographic profileamong cases of isolates of Enterococci from various clinicalsamples of PBM and associated group of hospital SPMC,Bikaner up to the species level.Materials and Methods: The present descriptive study wascarried out in the Department of Microbiology, S.P.M.C.Bikaner over a period of one year. 194 isolates of Enterococcalwere obtained from various clinical samples of patientsattending P.B.M. Hospital, Bikaner.Results: The maximum number of samples (30.41%) wasisolated from patients in the 0-10 year age group. It should benoted that out of the 59 patients in this group, 21 (35.59%)were <1year old. The mean age of incidence of enterococcalinfections was 31.53 years. 21 babies included in the 0-10 yearage group were <1 year old. Out of the 194 enterococcalisolates, 79 (40.72%) were from female patients, and 115(59.28%) were from male patients.Conclusion: Majority of the isolates were from the pediatricage group as the maximum number of samples was isolatedfrom patients in the 0-10 year age group The E.faecium strainsshowed a higher percentage of resistance to all the antibioticstested, as compared to the E.faecalis strains.
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Background: Infection is a continuous and significant problemin patients with cancer. Bloodstream infection remains a majorcause of morbidity and mortality in patients undergoingtreatment for cancer. Bloodstream infection (BSI) is a leadinginfectious complication among cancer patients and has anegative impact on patients' outcome. Hence; the presentstudy was undertaken for characterizing bacteria from bloodcultures of cancer patients admitted to cancer institute.Materials & Methods: A total of 344 blood samples werecollected for culture from the suspected cases blood streaminfection from cancer patients. Blood samples were collectedbefore starting the antimicrobial therapy. Regardless of visualappearance every blood culture bottle was sub cultured afterovernight incubation and on the fourth and seventh days. Theinoculated pates of solid media were incubated overnight at37°C. Organism identification was done. All the results weresummarized in Microsoft excel sheet.Results: Out of 344 blood culture samples, 86 blood streaminfections were recovered from blood culture samples from allages and both sexes. Out of total 61 blood culture samples forneutropenic patients, Gram positive cocci, CONS was isolatedin 7(11.5%) while 2(3.3%) COPS were isolated. In GramNegative bacilli enterobacteriaceae members, E. coli wasisolated in 3(4.9%) and klebsiella was isolated in 6(9.8%). andin gram negative bacilli non fermenter, pseudomonas wasisolated in 8(13.1%) and acinetobacter was isolated in7(11.5%) of blood stream infection.Conclusion: The study highlighted the variations observed inthe pattern of aerobic bacterial profile from suspected cases ofBSIs and also the changing trends in the susceptibility patternsof the isolates to routinely used antibiotics.
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Background: Malignancy is a leading cause of deathworldwide, and accounted for 7.6 million deaths (around 13%of all deaths) in 2008. Broad spectrum antibiotics arecommonly used as empirical therapy in febrile cancer patients.Hence; the present study was undertaken for determiningantimicrobial susceptibility pattern of different antimicrobialsused for treating infections in cancer patients.Materials & Methods: From the suspected cases of bloodstream infection from cancer patients, a total of 344 bloodsamples were collected for culture. Blood samples werecollected before starting the antimicrobial therapy. Theantibiotic susceptibility testing of the isolates were done byKirby- Bauer disk diffusion method on Mueller Hinton agar.Isolates were grown in peptone water by incubating at 37°Cand turbidity was matched with 0.5 MacFarland standards.Then lawn culture was done on Mueller Hinton agar plate andcommercial antibiotic disks were placed. The plates wereincubated at 37°C overnight and on the next day the zones ofinhibition were measured and susceptibility/ resistanceinterpreted.Results: Out of total 30 CONS cases, sensitivity was found inVancomycin (100%), Linezolid (93.3%), Amoxy-clav (80%),Cefoxitin (80%), Amikacin (73.3%), Ceftriaxone (73.3%),Ciprofloxacin (53.3%), Cotrimaxazole (33.3%), Erythromycin(26.7%), and Tetracycline (20%). Out of total 12 COPS cases,sensitivity was found in Vancomycin (100%), Linezolid (91.7%),Amoxy-clav (83.3%), Ceftriaxone (83.3%), Amikacin (66.7%)Ciprofloxacin (41.7%), Erythromycin (41.7%), Tetracycline(41.7%), Cotrimaxazole (25%) and Cefoxitin (25%). Out of total12 isolates of Staph aureus (COPS) 3(25%) cases were foundto be MRSA. Above table shows sensitivity pattern of gramnegative bacilli enterobactericae (E coli and klebsiella).Conclusion: The clinicians should have thorough knowledgefor appreciating empirical therapy as well switch over to thebest regime based on antibiotic susceptibility pattern toimprove the overall outcome of the patient’s health.
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Germline mutations of RET gene are pathognomonic of multiple endocrine neoplasia (MEN; MEN 2A/MEN 2B) and familial medullary thyroid carcinoma (FMTC), constituting 25% of medullary thyroid carcinomas (MTCs). We investigated RET gene mutations and polymorphisms at exons 10, 11, 13, 14, 15 and 16 in 140 samples, comprising 51 clinically diagnosed MTC patients, 39 family members of patients and 50 normal individuals. The method of choice was PCR and direct nucleotide sequencing of the PCR products. RET gene mutations were detected in 15 (29.4%) patients, with MEN 2A/FMTC in 13 patients and MEN 2B in 2 patients. Further, 39 family members of seven index cases were analysed, wherein four of the seven index cases showed identical mutations, in 13 of 25 family members. We also examined single nucleotide polymorphisms (SNPs) in RET gene exons in 101 unrelated samples. Significant differences in the allelic frequencies of SNPs at codons 691, 769, 836 and 904 between patient and control groups were not observed. However, SNP frequencies were significantly different in the Indian group as compared with other European groups. We identified two novel, rare and unique SNPs separately in single patients. Our study demonstrated presence of MEN 2A/MEN 2B/FMTC-associated mutations in accordance with the reported literature. Thus, RET gene mutations in exons 10, 11, 13, 14, 15 and 16 constitute a rapid test to confirm diagnosis and assess risk of the disease in familial MEN 2A/MEN 2B/FMTC.
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A total of 50 cases of blood culture proved enteric fever were studied for clinical response to the treatment and compared with in vivo antibiotic sensitivity pattern. Out of 50 Salmonella strains isolated, 37 were S typhi and 13 S paratyphi A. All S typhi isolates were sensitive in vitro to gentamicin and ceftriaxone while sensitivity to ciprofloxacin was 73%, ampicillin 29.7%, chloromphenicol 27%, tetracycline 27% and co-trimoxazole 13.5%. Multidrug resistance (Ampicillin, Chloramphenicol, Cotrimoxazale and Tetracycline) was observed in 62% isolates. All Sparatyphi A isolates were sensitive to all the antibiotics. Clinical response to the antibiotic therapy was as follows: Group I--Ampicillin + Gentamicin: 15 cases, clinical response (CR), 9.1% (S typhi) and 75% (S paratyphi A), mean day of defervescence 5.33 days. Group II--Ciprofloxacin: 29 cases, clinical response 47.6% (S typhi) and 75% (S paratyphi A), mean day of defervescence--5.22 days. Group--III Ceftriaxone: 30 cases, clinical response 100% in all, mean day of defervescence--4.93 days. Thus we observed highly significant discrepancy in antibiotic sensitivity pattern of the isolates and clinical response. Most importantly we observed significantly delayed clinical response to the ceftriaxone. This may be indicative of evolving resistance to ceftriaxone.