detection of ESBL-producing Escherichia coli in patients with symptomatic urinary tract infections using different diffusion methods in a rural setting

This study aimed to determine the prevalence of extended spectrum of beta lactamases [ESBLs], to compare different phenotypic methods for ESBL confirmation and to evaluate the antibiotic resistance patterns among ESBL-producing urinary Escherichia coli. Urinary E. coli isolates that were resistant to at least one of the three indicator cephalosporins [cefotaxime, cefpodoxime and ceftazidime] were tested for ESBL production using the double disc synergy test [DDST], the inhibitory potentiated disc diffusion [IPDD] test and the quantitative E-strip method. Of the 163 E. coli strains isolated, 80 [49%] were resistant to at least one of the three cephalosporins, and 38 [47.5%] tested positive for ESBLs by the IPDD test and the E-strip test. However, only15 [18.7%] strains tested positive by the DDST. Among the third-generation cephalosporins, cefpodoxime [46.1%] was the best screening indicator, followed by ceftazidime [43%] and cefotaxime [39.9%]. Most of the ESBL producers [97.3%] were resistant to three or more drugs, compared with 51.2% of non-ESBL producers. Compared with the DDST, the IPDD and E-strip tests appear to be preferable methods for detecting ESBLs, with better sensitivity [100%] and specificilty [97.6%] and positive predictive values [97.3%]. ESBL producers showed significantly [p < 0.05] higher resistance to tobramycin, co-amoxyclav and amikacin than did non-ESBL producers

Diabetes mellitus and HIV as co-morbidities in tuberculosis patients of rural south India

OBJECTIVES: Incidence of tuberculosis [TB] is greatest among patients with impaired immunity. India is experiencing a double epidemic of HIV and diabetes mellitus [DM], both of which are strongly associated with immuno-suppression. This study aimed to discover the prevalence of HIV and DM in both the pulmonary and extra-pulmonary TB patients of rural south India, retrospectively. Methods: Medical records of 192 microbiologically diagnosed pulmonary TB and 37 extra-pulmonary TB patients were thoroughly studied and data were extracted. The frequency distribution of HIV and DM was evaluated along with other demographic details such as age, sex and occupation in both groups. Results: The mean age of the pulmonary TB patients was 41.11+/-15.7 years, with significantly higher [p<0.0001] preponderance of DM [31.8%] over HIV [8.9%]. 72.13% of the diabetic patients belonged to the age group of 41-60 years. Extra-pulmonary TB patients had a mean age of 34.62+/-12.9, years with a significantly higher [p<0.006] HIV prevalence of 32.43% over DM [5.4%]. 75% of the HIV patients belonged to the age group of 41-60 years. Occupationally, the majority of the pulmonary TB patients were agricultural labourers [25.2%] while the majority of the extra-pulmonary TB patients were housewives or self employed [18.92%]. Conclusion: Though more importance is being given to HIV-TB coinfection, we cannot overlook DM, which showed a significantly higher prevalence in pulmonary TB patients compared to HIV. The rising prevalence of DM in high TB burden countries may adversely affect TB control.