Post-traumatic thrombotic microangiopathy: What trauma surgeons need to know? / 中华创伤杂志(英文版)

Thrombotic microangiopathy (TMA) is characterized by systemic microvascular thrombosis, target organ injury, anemia and thrombocytopenia. Thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome and Shiga toxin E-coli-related hemolytic uremic syndrome are the three common forms of TMAs. Traditionally, TMA is encountered during pregnancy/postpartum period, malignant hypertension, systemic infections, malignancies, autoimmune disorders, etc. Recently, the patients presenting with trauma have been reported to suffer from TMA. TMA carries a high morbidity and mortality, and demands a prompt recognition and early intervention to limit the target organ injury. Because trauma surgeons are the first line of defense for patients presenting with trauma, the prompt recognition of TMA for these experts is critically important. Early treatment of post-traumatic TMA can help improve the patient outcomes, if the diagnosis is made early. The treatment of TMA is also different from acute blood loss anemia namely in that plasmapheresis is recommended rather than platelet transfusion. This article familiarizes trauma surgeons with TMA encountered in the context of trauma. Besides, it provides a simplified approach to establishing the diagnosis of TMA. Because trauma patients can require multiple transfusions, the development of disseminated intravascular coagulation must be considered. Therefore, the article also provides different features of disseminated intravascular coagulation and TMA. Finally, the article suggests practical points that can be readily applied to the management of these patients.

Outbreak of Salmonella Typhi enteric fever in sub-urban area of North India: a public health perspective

Outbreaks of enteric fever are a major health concern not only due to significant human morbidity and mortality but also fear of spread of multidrug resistant strains. We report an outbreak of enteric fever caused by Salmonella enterica serotype Typhi in a suburban area, in city Chandigarh of North India. Twenty-seven strains of S. typhi were isolated from blood cultures over a period of two weeks with 18 of these 27 patients residing in the same area. Maximum cases were in the age group 5-14 years (10 patients, 55.5%) while 4 (22.2%) cases were children under 5 years. All the strains showed similar resistogram being resistant to ampicillin and nalidixic acid, intermediate to ciprofloxacin and sensitive to chloramphenicol, ceftriaxone, cefotaxime, cotrimoxazole and azithromycin on disc diffusion testing. Minimum inhibitory concentration of ciprofloxacin was determined by agar dilution method and was found to be raised (≥ 2 μ g/mL). This nalidixic acid resistant S. typhi outbreak report warrants the necessity of implementing stringent sanitation practices in public health interest.

Trends in the Antibiotic Resistance Patterns of Enteric Fever Isolates – a Three Year Report from a Tertiary Care Centre

Objectives: The incidence of multidrug resistant enteric fever is increasing alarmingly. This study was planned to determine the rate of isolation of Salmonella spp. and to compare the isolates for their epidemiological parameters and antimicrobial susceptibility patterns at our center. Methods: The study was conducted over a span of three years with a total of 8142, 8134, and 8114 blood culture samples processed for the years 2008, 2009, and 2010 respectively. The minimum inhibitory concentration (MIC) for ciprofloxacin and chloramphenicol was determined using an agar dilution method. The MIC for ciprofloxacin was also confirmed by Epsilon-test (E -test) strips. Results: Of the total 302 Salmonella spp. isolated, 257 were Salmonella enterica serotype Typhi (85.1%) and 45 (14.9%) were S. enterica serotype Paratyphi A. The majority of the isolates recovered were from the pediatric age group (54.6%) and males (60.6%). Complete susceptibility was observed to chloramphenicol, cefotaxime, ceftriaxone, and azithromycin over the last two years (2009 and 2010), with an increase in resistance to nalidixic acid (100%) and ciprofloxacin (13.6%). Conclusions: In our study, we found augmentation of resistance to nalidixic acid and fluoroquinolones and complete sensitivity to ceftriaxone along with reemergence of chloramphenicol sensitivity for Salmonella isolates. This report emphasises the necessity of continuous surveillance of antibiograms of enteric fever isolates in an area.

Metallo- β - lactamase producing nonfermentative gram-negative bacteria: an increasing clinical threat among hospitalized patients

OBJECTIVE@#To detect and evaluate the various methods for metallo- β -lactamases (MBL) production in Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter species.@*METHODS@#A total of 109 P. aeruginosa and 85 Acinetobacter species were screened for imipenem resistance by Kirby-Bauer disc diffusion methods. Detection of MBL production was done by imipenem-EDTA combined disc test, double disc synergy test (DDST) and imipenem-EDTA MBL E test.@*RESULTS@#A total of 63 (57.8%) strains of P. aeruginosa and 46 (54.1%) strains of Acinetobacter spp. were found to be resistant to imipenem. Of the 63 imipenem resistant P. aeruginosa tested for MBL production, 44 (69.8%) were found to be positive and among 46 imipenem resistant Acinetobacter, 19 (41.3%) were shown to be the MBL producers.@*CONCLUSIONS@#Imipenem-EDTA combined disc test and MBL E test are equally effective for MBL detection in both P. aeruginosa and Acinetobacter spp., but given the cost-constraints, combined disc can be used as a convenient screening method in the clinical microbiology laboratory.

Linezolid resistant Staphylococcus haemolyticus: first case report from India

Linezolid is being increasingly used in the treatment of infections with gram-positive organisms especially methicillin resistant Staphylococcal isolates. Though resistance to this antimicrobial is emerging but it is extremely rare. Here we document first case of linezolid resistant Staphylococcus haemolyticus (S.haemolyticus) from India. This organism was isolated from pus oozing from a postsurgical site in 61 year old male hailing from an adjoining state of Haryana.

Salmonella-salmonellosis-rare presentations of a common pathogen

Salmonella are most commonly associated with gastroenteritis and enteric fever in humans. Occasionally, dissemination of bacilli throughout the body results in establishment of localized foci of persistent infection especially in patients with debilitating diseases and immunosuppressive states. Infection at various aberrant sites due to Salmonella has been reported relatively seldom. It has perfected the art of intracellular survival in niches from where they can cause myriad of effects. Six cases with Salmonella infection at unusual sites without any preexisting or underlying disease diagnosed over a period of two years are presented here. Salmonella etiology was not suspected in these patients and the diagnosis was made microbiologically only after culture isolation.

Surveillance of quality of drinking water

To study the status of bacteriological contamination of drinking water being supplied by the municipal corporation. Community based longitudinal study. Department of Community Medicine and Microbiology of Government Medical College. 133 Hand pumps and 107 taps from which people were using water for drinking purposes were included in the study. Bacteriological quality of drinking water was checked by Mackie and Mc Cartney's method; calculating most probable number [MPN] by presumptive coliform count. Water samples with MPN > 3 were considered unfit for drinking purposes. The bacteriological analysis of water samples was carried out for two years from July 2002 to June 2004. It showed that 47.4% hand pumps and 15.9% taps were supplying contaminated water; the range was from 40-70% and 27.8-57.9% during pre-monsoon to post-monsoon, seasons of respective years. The contamination of drinking water unfortunately appears to be a universal phenomenon in most of the developing countries. The authors conclude that there are two spheres, which needs to be strengthened. Firstly, the bacteriological quality of drinking water needs to be improved in general and special care is to be taken during pre-monsoon and monsoon periods. Secondly, regular campaigns may be carried out to inform the public about the importance of safe and potable water including methods for household disinfection of drinking water, during the pre-monsoon and monsoon periods when the incidence of contaminated water samples is highest in the region