ABSTRACT
Background: Extended-spectrum β-lactamase-producing K. pneumoniae (ESBL-Kp) has recently become an important nosocomial pathogen. Intensive care units infections are predominant hospital acquired infections especially in tertiary health care. It is essential to know about ESBL prevalence in tertiary health care to take necessary actions by curbing resistant microorganisms. We aimed to study ESBL prevalence in Klebsiella species among respiratory samples from ICU patients. Methods: Respiratory samples collected from Intensive care unit patients, were processed under aseptic precautions. All Klebsiella isolates were subjected to routine antibiotic susceptibility testing by modified Kirby Bauer’s disc diffusion method and also for ESBL testing along with control. The results were interpreted as per CLSI (Clinical Laboratory Standards Institute) guidelines. Results: 153 (47.2%) Klebsiella species were isolated from 324 culture positive respiratory samples. Out of the 153 isolates which were screened for ESBL production, 90 (58.8%) isolates were found to be ESBL positive by CLSI disc diffusion. On performing confirmatory tests on the 90 isolates which were ESBL positive by screening tests, 84 (54.9%) were found to be ESBL producers on CLSI phenotypic confirmatory test (PCT) and 88 (57.5%) were found to be ESBL producers on Double Disc Synergy Test (DDST). Conclusion: Discussing with clinical microbiologist about antibiotic therapy helps clinicians to tackle with these resistant pathogens; also prevents transmission of resistant bugs and indirectly aid to increase life expectancy of patients.
ABSTRACT
New onset diabetes after transplantation (NODAT) is one of the serious side effects of immunosuppressive medications used in renal transplant recipients. Diabetes in transplantation increases the risk of cardiovascular disease and has adverse outcome on graft and patient survival. The aim of this study was to evaluate the incidence of NODAT in renal transplant recipients, the risk factors for the development of NODAT and its effect on graft and patient survival. Total 210 patients underwent renal transplantation from Jan 2010 to June 2016. Mean follow-up period after renal transplantation was 38.14 + 20.12 months. NODAT was defined as two consecutive fasting blood glucose determinations above 126 mg/dL. Thirty five (16.66%) recipients developed NODAT, the duration of onset of NODAT was 4.22 months (range 1 month to 30 months) after transplantation. All of them required insulin treatment. NODAT disappeared in 3(8.57%) recipients with reduction in tacrolimus dose and conversion to everolimus. Cox-Regression analysis was done to estimate the hazard ratio at confidence interval to assess whether the age more than 50 years, deceased donor, induction therapy, graft dysfunction, graft rejection, tacrolimus toxicity, everolimus based immunosuppression, HCV and CMV infection were risk factors for the development of NODAT. Induction therapy and graft dysfunction had 2 fold increased risk of development of NODAT and tacrolimus toxicity had 4 fold increased risk of development of NODAT. Fungal infection (17.14% Vs 2.28%, P value 0.00) was significantly higher in NODAT group compared to recipients without G. Swarnalatha, K.R. Karthik, N. Bharathi, S. Raghavendra, K. Siva Parvathi, A. Deepti, T. Gangadhar. New onset diabetes after renal transplantation: An experience from a developing country – India. IAIM, 2017; 4(7): 74-82. Page 75 NODAT. There was no significant difference in 6 months, 1, 2, 3 and 5 years patient survival or the death censored graft survival of recipients with NODAT compared to patients without NODAT
ABSTRACT
Paraphenylene diamine (PPD) is a major component of hair dyes. The aim is to study the renal manifestations and outcome of PPD consumption. During a four-year period from 2002 to February 2006, 10 persons were admitted to our Institute after consuming a hair dye in a suicidal bid. The percentage of ARF due to PPD at our Institute was 0.95%. Seven patients out of 10 (70%) who consumed PPD developed ARF. All 10 patients, including the patients who had normal renal function had features of rhabdomyolysis. Two patients required ventilator support for respiratory distress and two more required tracheostomy due to upper airway tract edema. One patient has expired after two sessions of dialysis. Renal biopsy in two patients (one, postmortem) showed acute tubular necrosis along with presence of casts in tubules due to myoglobin.