Características epidemiológicas de la Osteomielitis aguda en niños internados en un hospital infeccioso de referencia

Introducción: La osteomielitis aguda es una infección del hueso que afecta principalmente a los niños y tiene generalmente diseminación hematógena, a veces asociada a un trauma. En la etiología influyen factores, como la edad, el estado inmunológico y las enfermedades concomitantes. En la mayoría de los casos, el principal agente etiológico es Staphylococcus aureus. Es importante el diagnóstico oportuno para evitar secuelas a mediano o largo plazo. Objetivo: Describir las características epidemiológicas de un grupo de pacientes con osteomielitis aguda. Métodos: Se realizó la revisión retrospectiva de los expedientes clínicos de pacientes egresados del servicio de pediatría del Instituto de Medicina Tropical, entre enero de 2016 y diciembre de 2020, con diagnóstico de osteomielitis aguda. Resultados: Los varones con osteomielitis corresponden al 67,8% del total de 59 casos registrados, en cuanto a los signos y síntomas, el dolor, la tumefacción y la impotencia funcional fueron predominantes, la fiebre se documentó en 49 (83,1%) pacientes, se registró antecedentes de cirugía en 37 (62,7%) de los pacientes y complicaciones en 42 (71,2%) de los pacientes, la complicación más frecuente fue osteomielitis crónica El sitio anatómico más frecuente fueron los miembros inferiores. El tratamiento empírico fue realizado con cefalosporinas de 3G en 72,9% de los pacientes, ya sea solo o combinado con clindamicina o vancomicina, un paciente con aislamiento de M. tuberculosis recibió tratamiento HRZE. Se aisló algún germen 44 pacientes (74,5%), el microorganismo predominante fue Staphylococcus aureus en 81,8 %, la mitad (52,3%) correspondieron a SAMR Se encontró una alta resistencia a oxacilina del 55,8% y un solo paciente resistente a clindamicina (2,2%). Conclusión Los hallazgos fueron similares a los reportados en la literatura en cuanto a etiología, sitio anatómico afectado y cobertura antibiótica.

Introduction: Acute osteomyelitis is a bone infection that mainly affects children and generally has hematogenous spread, sometimes associated with trauma. The etiology is influenced by factors such as age, immune status, and comorbidities. In most cases, the main etiologic agent is Staphylococcus aureus. Timely diagnosis is important to avoid sequelae in the medium or long term. Objective: To describe the epidemiological characteristics of a group of patients with acute osteomyelitis. Methods: A retrospective review of the clinical records of patients discharged from the pediatric service of the Institute of Tropical Medicine was carried out between January 2016 and December 2020, with a diagnosis of acute osteomyelitis. Results: Men with osteomyelitis correspond to 67.8% of the total of 59 registered cases, in terms of signs and symptoms, pain, swelling and functional impotence were predominant, fever was documented in 49 (83.1%) patients, a history of surgery was recorded in 37 (62.7%) of the patients and complications in 42 (71.2%) of the patients, the most frequent complication was chronic osteomyelitis The most frequent anatomical site was the lower limbs. Empirical treatment was performed with 3G cephalosporins in 72.9% of the patients, either alone or in combination with clindamycin or vancomycin. One patient with M. tuberculosis isolation received HRZE treatment. Some germ was isolated in 44 patients (74.5%), the predominant microorganism was Staphylococcus aureus in 81.8%, half (52.3%) corresponded to MRSA. A high resistance to oxacillin of 55.8% and a only patient resistant to clindamycin (2.2%). Conclusion The findings were similar to those reported in the literature in terms of etiology, affected anatomical site, and antibiotic coverage.

Bacterial keratitis in a tertiary hospital in São Paulo: a 21-year review of the epidemiological, laboratory, and clinical data

ABSTRACT Infectious keratitis is a sight-threatening condition that is usually an ocular emergency. The visual outcome depends on prompt and accurate clinical management as well as geographic and epidemiological awareness. We conducted a retrospective observational study to define the epidemiological and laboratory profile, as well as the clinical course of bacterial keratitis in a tertiary hospital in São Paulo over 21 years. Information about age, sex, predisposing factors, topical and surgical treatment, visual acuity, ulcers' classification, bacterioscopy, culture, and antibiotic sensitivity tests were collected. This study included 160 patients. The mean age was 65.1 ± 18.4 years and risk factors were identified in 83.1 % of the patients. Empirical topical fortified cephalosporin with an aminoglycoside or fourth-generation fluoroquinolone was curative for 66.2 % of the cases. The mean treatment duration was 22.5 ± 9 days. The mean variation of visual acuity was −0.25 logMAR, p < 0.001. Culture revealed 64 % of Gram-positive bacteria. All Gram-positive bacteria were sensitive to cephalothin, vancomycin, and quinolones. All Gram-negative bacteria were sensitive to gentamicin, tobramycin, amikacin, and ciprofloxacin. These findings reinforce the importance of prompt empirical treatment of severe corneal ulcers with a fortified cephalosporin and aminoglycoside or a fourth-generation fluoroquinolone as there are equally effective. Collected data was insufficient to evaluate resistance of ocular infections over time in this population.

Antibiotic susceptibility pattern of bacterial isolates from microbial keratitis in North and Central India: A multi centric study

Purpose: This study was conducted to examine microbiological profile with their antibiotic sensitivity in cases of bacterial keratitis in north and central India to ensure appropriate use of antibiotics. Methods: The microbiology laboratory records of 228 patients with culture?proven bacterial keratitis from 1st January to 31st December 2019 were analyzed. Cultured bacterial isolates were subjected to antimicrobial susceptibility testing to antibiotics commonly used in the treatment of corneal ulcer. Chi?squared or Fisher’s exact test were applied to check the significance of difference between the susceptibility levels of antibiotics. Results: The prevalence of Staphylococcus aureus and Pseudomonas aeruginosa–induced keratitis was higher in northern India, whereas that by Streptococcus pneumoniae was more prevalent in central India. In central India, 100% of S. pneumoniae isolates were found to be sensitive to ceftriaxone compared to 79% in northern India (P = 0.017). In comparison to 67% of isolates from north India, 15% of S. aureus isolates from central India were found to be sensitive to ofloxacin (P = 0.009). Similarly, 23% of isolates from central India were found sensitive to amikacin compared to 65% of isolates from north India (P = 0.012). P. aeruginosa isolates from central India were found to be sensitive to ceftazidime in 63% of cases compared to 21% of isolates from north India (P = 0.034). Conclusion: Prevalence of bacteria and their susceptibility to antibiotics are not uniform across geography. Vancomycin remained the most effective drug in all gram?positive coccal infections. S. aureus susceptibility to amikacin was significantly greater in north India. P. aeruginosa showed less susceptibility as compared to previous reports.

STUDY OF BACTERIURIA AMONG PREGNANT WOMEN ATTENDING A TERTIARY CARE HOSPITAL IN PANIPAT DISTRICT, INDIA

Most common population at risk for both symptomatic urinary tract infection (UTI) and asymptomatic bacteriuria, however, is sexually active women. Although asymptomatic infection in this group does not clearly produce serious medical problems, it may be a predictor of future symptomatic infection. Women are more susceptible to infection than men because of the shorter length of the female urethra. Perineal bacterial microbiota that originate in the gastrointestinal tract are the usual pathogens, especially if the bacteria possess factors that facilitate their binding to the uroepithelium. Sexual intercourse facilitates entry of the bacteria into the female urethra. Pregnant women are extra at risk of expand UTIs due to physiological adjustments withinside the urinary tract. UTI constitute severe threats to human health worldwide and hundreds of thousands of the humans affected every year. The aim of this study was to know the prevalence and antimicrobial susceptibility pattern of isolates in pregnant female patients. A total two hundred pregnant and non-pregnant females patients had been included on this study after obtaining the consent. Under strict aseptic precautions midstream urine samples had been taken from all sufferers. All the samples had been processed with the aid of using the usage of standard bacteriological methods i.e. wet mount, inoculation on blood agar and MacConkey's agar after which diagnosed with the aid of using standard biochemical tests, antibiotic sensitivity trying out changed into completed with the aid of using Kirby Bauer's disc diffusion method. In this study 80 out of 200 females patient i.e. 40% were showed UTI of which a most of 20 to 30 years age group had a considerably better occurrence of UTI i.e. 56.25%, while the age group of 60 years and above suggests the lowest contamination rate i.e 2.5% as compared to others. Females belonging to lower socioeconomic status had been extra liable to UTI then others. Pregnant females were more prone to UTI then non-pregnant females i.e. 52.73% and 35.17% respectively. Amongst pregnant females, primigravida and those in the first and second trimesters had been at higher risk. All isolates had been sensitivity to ampicillin+sulbactam, sparfloxacin, and gatifloxacin. Our study mentioned that the prevalence of UTIs was 40%; the pregnant female patients were more prone to UTI than non-pregnant females. The most isolated microorganism had been Escherichia coli which was maximum accountable for UTIs. The sexually active age group 26-30 years was highly at risk of UTI. Females belonging to lower socioeconomic status had been extra liable to contamination. Pregnancy was one in each of the predisposing elements for UTI. All isolates had been confirmed sensitivity to ampicillin+sulbactam, sparfloxacin, and gatifloxacin.

Evaluation the Pattern of BSI in Cancer Patients and Their Sensitivity and Resistance toward Antibiotic

Background: Bloodstream infections (BSIs) account for large-scale morbidity and mortality among cancer patients requiring a rational antibiotic policy. In Bangladesh, there is a paucity of data regarding incidence and pattern of BSI in such patients. Objective:To evaluate the pattern of BSI in cancer patients and their sensitivity and resistance toward antibiotic.Material & Methods:The present study was a retrospective analysis of BSI patterns among various cancer patients treated at Department of Oncology, Enam Medical College Hospital, Saver, Bangladesh during the period from January to June 2021. Blood culture results and their sensitivity patterns of these cancer patients along with the demographic characteristics were collected from the records and maintained in the structured pro forma. Before starting empirical antibiotics, 10 ml of blood was collected into Bract/ALERT culture media.Results:A total of 82 patients/episodes had confirmed BSI. Gram-negative bacteria accounted for 43 (52.4%) cases, followed by Gram positive 38 (46.4%) cases and 1 case of candida species. The most common organisms isolated were Klebsiella pneumonia and Staphylococcus aureus consisting of 17 cases each. The Gram-negative bacterial isolates (n = 43) were sensitive to cefoperazone plus sulbactam, piperacillin plus tazobactam, carbapenem, and colitis in 18 (41.9%), 19 (44.2%), 29 (67.4%), and 40 (93%) episodes, respectively. The sensitivity of Gram-positive bacteria (n = 38) to vancomycin, linezolid, and teicoplanin was seen in 37 (97.3%), 37 (97.3%), and 35 (92.1%) episodes, respectively. Multidrug-resistant bacteria accounted for 17 (39.5%) cases of Gram-negative isolates and 9 (53%) of which were K. pneumonia. Extended spectrum beta-lactamase activity was seen in 11 of 26 episodes of Enterobacteriaceae. Four of 17 S. aureus and 3 of 11 coagulase-negative Staphylococci were methicillin resistant, and 1 of 2 cases of Enterococcus was vancomycin resistant.Conclusions:Gram-negative bacteria are the predominant cause of BSI in cancer patients and development of a high degree of resistance to commonly used antibiotics is challenging.

Extended Spectrum Beta Lactamase producing Gram negative bacteria - An emerging menace in Neonatal Sepsis.

Introduction: Neonatal sepsis caused by extended spectrum beta lactamase (ESBL) producing Gram negative bacteria (GNB) is associated with significantly high mortality and morbidity. Clinical features and risk factors for such neonatal sepsis can help in identifying it early. Objectives: Aim of the study was to estimate the incidence, risk factors, clinical features and antibiotic sensitivity of GNB and outcomes of ESBL GNB in neonatal sepsis. Methodology: A prospective observational conducted at regional tertiary care health center. Statistical analysis was carried out with SPSS version 23.0. Results: A total of 87 cases of Gram negative neonatal sepsis were included in study. Male: female was 1.7:1. Forty nine (56.3%) isolates were ESBL positive strains. The clinical features in order of frequency were shock, lethargy, sclerema, disseminated intravascular coagulation and severe thrombocytopenia. Out born neonates (p=0.03), late onset sepsis (p=0.05) and mechanical ventilation (p=0.002) were the risk factors for ESBL GNB sepsis. Mortality associated with ESBL sepsis was 26.5%. Carbapenems and Piperacillin + Tazobactum were most sensitive antibiotics and high resistant for cephalosporins was observed. Conclusion: ESBL GNB neonatal sepsis is an emerging threat with high mortality in Neonatal Intensive care unit.

Knockout of ribosomal genes bS22 and bL37 increases the sensitivity of mycobacteria to antibiotics / 生物工程学报

In recent years, two novel proteins in the ribosomes of mycobacteria have been discovered by cryo-electron microscopy. The protein bS22 is located near the decoding center of the 30S subunit, and the protein bL37 is located near the peptidyl transferase center of the 50S subunit. Since these two proteins bind to conserved regions of the ribosome targeted by antibiotics, it is speculated that they might affect the binding of related drugs to these targets. Therefore, we knocked out the genes encoding these two proteins in wild-type Mycolicibacterium smegmatis mc2155 through homologous recombination, and then determined the growth curves of these mutants and their sensitivity to related antibiotics. The results showed that compared with the wild-type strain, the growth rate of these two mutants did not change significantly. However, mutant ΔbS22 showed increased sensitivity to capreomycin, kanamycin, amikacin, streptomycin, gentamicin, paromomycin, and hygromycin B, while mutant ΔbL37 showed increased sensitivity to linezolid. These changes in antibiotics sensitivity were restored by gene complementation. This study hints at the possibility of using ribosomal proteins bS22 and bL37 as targets for drug design.

Susceptibilidad antimicrobiana en Pseudomona spp, en el Hospital General Docente Cuenca-Ecuador / Antimicrobial susceptibility in Pseudomona spp, in the General Teaching Hospital Cuenca-Ecuador / Suscetibilidade antimicrobiana em Pseudomona spp, no Hospital Geral Escola Cuenca-Ecuador

La Pseudomona aeruginosa es un patógeno nosocomial por excelencia; la aparición de cepas multidrogoresistentes (MDR) y extremodrogoresistentes (XDR) cada vez es más frecuente y genera gran preocupación; el uso indiscriminado de antibióticos ha ocasionado esta situación. El objetivo de este estudio fue conocer los diferentes perfiles de resistencia que presentan los aislados objetos de estudio según su procedencia, ya sea a nivel intrahospitalario o de origen comunitario además de caracterizar los principales mecanismos de resistencia y antibiotipos. La presente investigación fue de tipo documental, descriptiva, de corte transversal, para lo cual se utilizó los datos acumulados de susceptibilidad reportados por el departamento de microbiología del Hospital General Docente durante el enero de 2015 hasta diciembre de 2019. Se encontró que en este hospital existe una mayor prevalencia de resistencia a aminoglucósidos (20-25%), fluoroquinolonas (22-25%) y carbapenémicos (19-21%); siendo P. aeruginosa la especie más prevalente. Respecto al tipo de carbapenemasas que son las de interés clínico por su limitante opción terapéutica, se identificó una cepa con fenotipo compatible con metalobetalamasa, se presume que el mecanismo de resistencia predominante fue impermeabilidad. No se identificaron cepas PDR, pero el 21,6% se mostraron con un perfil MDR, aisladas principalmente en los servicios hospitalarios al igual que las cepas XDR.

Pseudomonas aeruginosa is a nosocomial pathogen par excellence; the appearance of multidrug resistant (MDR) and extreme drug resistant (XDR) strains is becoming more frequent and is causing great concern; the indiscriminate use of antibiotics has caused this situation. The objective of this study was to know the different resistance profiles presented by the isolated objects of study according to their origin, either at the intrahospital level or of community origin, in addition to characterizing the main resistance mechanisms and antibiotypes. The present investigation was of a documentary, descriptive, cross-sectional type, for which the accumulated susceptibility data reported by the microbiology department of the General Teaching Hospital from January 2015 to December 2019 was used. It was found that in this hospital there is a higher prevalence of resistance to aminoglycosides (20-25%), fluoroquinolones (22-25%) and carbapenems (19-21%); being P. aeruginosa the most prevalent species. Regarding the type of carbapenemases that are of clinical interest due to their limiting therapeutic option, a strain with a phenotype compatible with metallobetalamase was identified, it is presumed that the predominant resistance mechanism was impermeability. No PDR strains were identified, but 21.6% were shown with an MDR profile, isolated mainly in hospital services as well as the XDR strains.

Pseudomonas aeruginosa é um patógeno nosocomial por excelência; o aparecimento de cepas multirresistentes (MDR) e extremamente resistentes aos medicamentos (XDR) está se tornando mais frequente e causando grande preocupação; o uso indiscriminado de antibióticos tem causado essa situação. O objetivo deste estudo foi conhecer os diferentes perfis de resistência apresentados pelos objetos isolados de estudo de acordo com sua origem, seja em nível intra-hospitalar ou de origem comunitária, além de caracterizar os principais mecanismos de resistência e antibióticos. A presente investigação foi do tipo documental, descritiva, transversal, para a qual foram utilizados os dados de suscetibilidade acumulada reportados pelo departamento de microbiologia do Hospital Geral Universitário no período de janeiro de 2015 a dezembro de 2019. Verificou-se que neste hospital há maior prevalência de resistência aos aminoglicosídeos (20-25%), fluoroquinolonas (22-25%) e carbapenêmicos (19-21%); sendo P. aeruginosa a espécie mais prevalente. Em relação aos tipos de carbapenemases de interesse clínico devido à sua opção terapêutica limitante, foi identificada uma cepa com fenótipo compatível com metalobetalamase, presume-se que o mecanismo de resistência predominante foi a impermeabilidade. Nenhuma cepa PDR foi identificada, mas 21,6% mostraram ter um perfil MDR, isolado principalmente em serviços hospitalares, bem como as cepas XDR.

Common microbes detected by conjunctival swab analysis and their antibiotic sensitivety / Шинэ санаа Шинэ нээлт

Background@#Bacterial ocular infection is a common problem.[1;6]. Microbiological investigation of the conjunctival swab is one of the broadly used method to study etiological agent of conjunctivitis[2]. Microbial culture techniques have shown that 80% of conjunctival swabs yield cultivable microbes.[3]. Conjunctival sac contains variety of pathogenic and non-pathogenic microbes. Normal microbes play a protective immunological role in preventing the proliferation of pathogenic species that can cause ocular infections whereas pathogenic microbes contribute to infectious and autoimmune diseases of the eye. [4;5]@*Purpose@#To investigate common microbes detected by conjunctival swab analysis and their antibiotic sensitivity.@*Methods@#In our descriptive study, 264 conjunctival swab samples that had been analyzed by MALDI-TOF technology using VITEX MS at Gyals Medical Center from July 2019 to November 2020 were evaluated.@*Results@#Cultivable microbes and fungus were detected in 71.56% of overall swabs. 28.44% were non cultivable. Fungus and 43 different types of microbes were found. 35% of all microbes were Staphylococcus including Methicillin -resistant Staphylococcus aureus, Staphylococcus aureus, Staphylococcus epidermidis. 28% of microbes were Streptococcus including Streptococcus mitis, Streptococcus pneumoniae, Streptococcus anginosus, Streptococcus parasanguinis, Streptococcus agalactiae, Streptococcus pyogenes, Streptococcus salivarius, Streptococcus spp. 20% of all microbes were miscellaneous bacterium including Enterococcus, Corynebacterium, Klebsiella, Acinetobacter, Escherichia, Candida parapsilosis and the remaining are others. Staphylococcus aureus is sensitive to Quinupristin/Dalfopristin, Linezolid, Vancomycin, Tigecycline, Nitrofurantoin whereas they are resistant to Benzylpenicillin, Ciprofloxacin, Amoxicillin, Amoxicillin/ Clavulanic Acid, Cefazolin that are widely used in Mongolia.@*Conclusion@#In 76.71% of overall conjunctival swab samples were found cultivable microbes. Methicillin -resistant Staphylococcus aureus, Staphylococcus aureus, Staphylococcus epidermidis are the most common microbes detected by conjunctival swab analysis. The common microbes are resistant to Benzylpenicillin, Ciprofloxacin, Amoxicillin, Amoxicillin/Clavulanic Acid, whereas they are sensitive to Quinupristin/Dalfopristin, Linezolid, Vancomycin, Tigecycline, Nitrofurantoin, Erythromycin, Clindamycin.

The study of antibiotic-sensitivity and resistance pattern of bacteria causing catheter associated urinary tract infection

Background: present study is done to study the antibiotic-sensitivity and resistance pattern of bacteria causing catheter associated urinary tract infection. Objectives of this study were to study the bacterial etiology of CAUTI, to study the prevalence of various bacteria causing catheter associated urinary tract infection, the antibiogram (sensitivity and resistance) pattern of isolated bacteria and the percentage of asymptomatic bacteriuria in the study population.Methods: In this prospective observational study, under aseptic precautions, urine sample was taken after 48 hours of catheterization and sent for culture and sensitivity pattern is studied.Results: In this study 500 urine samples were cultured and its antibiotic sensitivity pattern was observed. Out of the 53 culture positive samples most the subjects had asymptomatic bacteriuria. The study gave the incidence of catheter associated urinary tract infection (CAUTI) to be 10.6% and about 9% were polymicrobial. In this study about 7 causative bacteria were isolated. Escherichia coli were the most common organism that was isolated. On studying the antibiotic susceptibility pattern of each isolate, it has been observed that all of them are multidrug resistant and the sensitivity pattern is migrating towards higher antibiotics.Conclusions: Empirical use of antibiotics must be avoided and antibiotics must be used only after sensitivity testing. This will help in selection of the appropriate antibiotic for therapeutic use and prevent indiscriminate and irrational use of antibiotics. This will also improve the cost efficiency and decrease the duration of hospital stay.

Chronic Nonhealing Ulcers ‒ Garhwal Region (Etiopathology, Microbiology with Susceptibility, Managements & Outcomes)

Introduction:Chronic nonhealing ulcers, with varied etio-pathologies, are difficult to manage and warrant meticulous, early and prolonged directed treatment to prevent their development and complications.Methods:Patients of chronic ulcers (>3 months’ duration), having undergone surgical management at our Institute, VCSGGMS&RI-UT, between January 2018 –August 2019, numbering one hundred twenty five (N= 125), were included in this concurrent observational study, aimed at identifying implicated microrganism(s) and their antibiotic susceptibility, for promoting wound healing, along with surgical measures Results:Male patients (M:F :: 87:38; 69.6% males) in the “20-50 year” age-group (74; 59.2%), with diabetic ulcers (35;28.0%), burns etc. (21;16.8%) and traumatic ulcers (18;14.4%) etc. predominated in the chronic non-healing state. Gram positive (68; 54.4%) organisms (including Staphylococcus) were the major isolates from the ulcers; organisms showing higher sensitivity to the newer generations/groups of antibiotics. Uncontrolled Diabetes, other prolonged illnesses &/or under-nutrition were important causative factors, requiring their remediations and also debridements ± skin/flap coverage (45; 36.0%) with prolonged course of antibiotics and occasional amputations (18; 14.4%) for adequate treatment.Conclusion:Skilled intensive multidisciplinary effort is essential to achieve satisfactory healing and prevent disfigurement and to limit disability and death (11; 8.8%) among the patients.

The anatomical site of perforation peritonitis and their microbiological profile: a cross-sectional study

Background: Initiation of early appropriate antibiotic therapy influences the outcome of perforation peritonitis, which otherwise is delayed till culture reports are available. The knowledge of microbial profile and sensitivity of peritoneal fluid culture with respect to the anatomical site of perforation peritonitis will help in initiation of early appropriate antibiotic therapy in the post-operative period.Methods: A cross-sectional study conducted from January 2017 to December 2017 where intraoperative peritoneal fluid sample in patients of perforation peritonitis was subjected to culture (aerobic and anaerobic) and sensitivity and results analysed with respect to anatomical site of perforation.Results: 50 patients were studied. The most common site of perforation was ileum (32%) followed by appendix (18%) and stomach (18%). In aerobic culture, the culture positivity rate was highest in colonic perforation (100%) and least in gastric perforation (44.4%). The most common organism isolated in all sites of perforation peritonitis was E. coli followed by Klebsiella spp. In anaerobic culture, although facultative anaerobes were isolated, no strict anaerobe was isolated. The most sensitive antibiotics covering all isolated organisms were gentamycin (p=0.006), colistin (p=0.018), piperacillin and tazobactum (p=0.022).Conclusions: The predominant differential normal flora according to site of gastrointestinal tract was not reflected in the peritoneal fluid culture of patients with perforation peritonitis and E. coli was the most common organism isolated in all sites of perforation peritonitis. The antibiotic sensitivity profile showed the increasing resistance against third generation cephalosporins. Aminoglycosides, piperacillin and tazobactum, meropenem and colistin showed a significant antimicrobial activity against organisms isolated from cases of perforation peritonitis.

Clinical profile and antibiotic sensitivity pattern of typhoid fever in children: a hospital based prospective study from a tertiary care center

Background: Typhoid fever is a serious public-health problem in many developing countries including India. There is a wide spectrum of clinical presentation and with the emergence of multidrug resistant typhoid now a days, the treatment has become still more complex. The present study authors describe the clinical profile and antibiotic sensitivity pattern of typhoid fever in children from a tertiary care in Mahabubnagar, Telangana, South India.Methods: This hospital based prospective observational study was done in Department of Pediatrics, SVS Medical College, Mahabubnagar, Telangana over a period of 3-year period from January 2017 to December 2019. The study was approved by institutional ethics committee. Written informed consent was obtained from children's parents. All pediatric patients diagnosed as typhoid fever if presented with fever (temperature >38'C) for at least 3 days with positive blood culture for S. typhi or paratyphi were included in the study. The demographic profile and clinical data were recorded and tests including antibiotic sensitivity and resistance were done.Results: A total of 136 patients were included in the study. Majority of the children were between 8 to 12-year age group (38.2%). Out of 136 children, 78 were males and 58 were females. Majority of the cases were from rural areas accounting for 69%. Drinking water source was tap water in 63% cases and bore well water in 37% cases. Majority (65%) belonged to lower socioeconomic class and 68% were during rainy seasons. The clinical findings observed were fever (100%), vomiting (98, 72%), diarrhea (55.8%), headache (45.5%), and splenomegaly (42.6%). Other clinical features found were coated tongue, abdominal pain, hepatomegaly, constipation, and dehydration. Six children had complications, 3 had enteric hepatitis, 2 had shock, and 1 had encephalopathy. Ampicillin, amoxicillin and chloramphenicol resistance was observed in 76%, 71% and 22% of patients with typhoid fever respectively. Maximum sensitivity was observed with ceftriaxone (95%), followed by aztreonam (92%), ciprofloxacin (84.5%), and azithromycin (77%).Conclusions: Clinical presentation in the study subjects was similar to available reports from literature. Increasing resistance of salmonella to Ampicillin and amoxicillin were observed.

Antibiotic sensitivity trends of pseudomonas endophthalmitis in a tertiary eye care center in South India: A 12-year retrospective study

Purpose: To assess trends in antibiotic sensitivity of pseudomonas and compare multidrug resistance (MDR) between Pseudomonas endophthalmitis cases presenting in two consecutive 6-year time frames in a tertiary center in South India. Methods: This is a retrospective comparative series of all Pseudomonas endophthalmitis cases treated from June 2004 to May 2016. Microbiological culture results in all endophthalmitis patients were screened for pseudomonas. Positive cases in the initial 6 and final 6 years were compared for sensitivity to antibiotics and the proportion of MDR. MDR was defined as resistance to at least two different classes of antibiotics. Results: Pseudomonas accounted for 74 of 389 endophthalmitis cases (19%), 42 in initial 6 and 32 in final 6 years. Sensitivity to ciprofloxacin, ofloxacin, gatifloxacin, moxifloxacin, and ceftazidime was 85.7%, 82.9%, 76.5%, 76.9%, 88.1% up to 2010 which reduced to 75%, 59.4%, 68.8%, 56.3%, 56.3%, respectively, after 2010, being significant for ofloxacin (P = 0.0349) and ceftazidime (P = 0.0028). Susceptibility to amikacin, gentamicin, and tobramycin changed non-significantly from 83.3%, 43.9%, 47.6% to 71.9%, 61.3%, 61.3%, respectively. Twenty of 74 cases (27%) were MDR with 16.7% in first 6 years versus 40.6% in final 6 years. Postoperative MDR cases rose from 10.3% to 50% (P = 0.0048). Conclusion: This study shows rising resistance of Pseudomonas to fluoroquinolones, amikacin, and ceftazidime in endophthalmitis. MDR also showed an upward trend, particularly in postsurgical cases.

Clinical and microbiological profile of type 2 diabetic patients with urinary tract infections

Background: Diabetes Mellitus is reported to increase the risk of Urinary Tract Infection (UTI) with higher probability of drug resistant organisms. Understanding the burden, microbiological profile and antibiotic sensitivity pattern is vital for effective prevention and management. To assess the microbiological profile and antibiotic sensitivity pattern of Urinary Tract infections among type 2 diabetes mellitus patients.Methods: The study was A prospective observational study done on 117 type 2 diabetic subjects aged above 18 years presenting with symptoms of UTI in a tertiary care hospital Urine was analyzed for urine routine examination, culture and antibiotic sensitivity using standard testing methods on a midstream urine sample. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results: The mean age of the study population was 57 years. Females constituted 62.39% of participants. Burning micturition (52.99%) was the most common presenting symptom. The prevalence of culture positive UTI was 51.28%. Among gram-negative bacilli, Escherichia coli (20.51%), Klebsiella (6.85%) dominated the culture reports. Enterococcus (4.27%) and Staphylococcus aureus (2.6%) were the common gram-positive organisms isolated.  Meropenem was the most effective antibiotic against E. coli (87.5%) and Klebsiella (95%) Vancomycin had 100% sensitivity against Enterococci and S. aureus.Conclusions: More than half of diabetic patients presenting with symptoms of UTI had culture positive UTI, predominantly caused by gram negative organisms. There is a need for comparative studies of Diabetes and controls to explore the key differences in the pattern of UTI.

Incidence of meningitis in term neonates with sepsis and antibiotic sensitivity pattern: an observational study

Background: To find out the incidence of meningitis in neonatal sepsis and antibiotic sensitivity pattern in term neonates.Methods: This prospective observational cohort study was done in a tertiary care hospital located in rural South India for a period of 2 years. Blood culture and lumbar puncture were performed for all term babies with clinically suspected sepsis. Growth, if detected was followed by antibiotic sensitivity testing.Results: Of a total of 50 neonates investigated with blood culture, 32(64%) were found to be culture positive for neonatal septicemia, 16 were diagnosed to have meningitis. Meningitis was present in 4(25%) early onset sepsis cases and in 12(75%) late onset sepsis cases (p-value: 0.008). Blood culture showed growth in all of the 16 cases of meningitis, but Cerebro Spinal Fluid (CSF) culture was positive in 5 cases. The most common presenting features are lethargy, seizures, decreased acceptance of feeds, instability of temperature regulation, vomiting, respiratory distress, and apnea. The most common organism in blood culture was Coagulase Negative Staphylococcus (CONS) (20%) followed by Klebsiella spp. (16%). CONS was most sensitive to Linezolid (100%), Vancomycin (90%). Of the 8 cases of Klebsiella, 62.5% cases were sensitive to Colistin and Tigecycline, 50% to Cotrimoxazole. CSF culture was positive in 5(31.25%) cases. CONS and Enterococci spp. were the most common organisms isolated in CSF.Conclusions: Clinical manifestations of meningitis overlap with those of sepsis and are nonspecific. Significant number of neonates with sepsis have meningitis. Hence, it is necessary to rule out meningitis in neonates presented with clinical features of sepsis. CONS was the most common agent isolated in both blood and CSF culture. Routine bacterial surveillance and study of their resistance patterns must be an essential component of neonatal care which helps in implementation of a rational empirical treatment strategy.

Clinical Profile and Antibiotic Sensitivity Pattern of Enteric Fever among Children Admitted in a Tertiary Care Hospital in Dhaka

Objective: In this study our main aims to know the clinicalprofile of pediatric enteric fever and the sensitivity pattern ofthe disease to drugs in this region.Methodology: This prospective observational study conductedin a tertiary care hospital at Dhaka from March to December2016 among suspected case of Enteric fever as per casedefinition. Among 212 suspected enteric fever 117 childrenwere diagnosed as enteric fever by blood culture and/or Widaltest.Results: During the study, Male: female were 1.3: 1. Maximum(70%) children were in age group 5 years or more. Most of thechildren were from urban slum area (53.6%) of Dhaka city.Cases were admitted throughout the year. Commonpresentation were fever (100%), anorexia (100%), painabdomen (74.4%) and loose motions (46.1%). The commonsigns were hepatomegaly (41.9%), hepatosplenomegaly(5.1%) coated tongue (64.9%), pallor (74.4%). Thecomplications rate was 35.9% and commonest being UTI andpneumonia. The overall positivity of Widal test was 89.7% andthe culture positivity was 32.5%. Among isolates, 94.7%wereSalmonella typhi and 5.3% Salmonella paratyphi A. Amongthem18.1% isolates were multi drug resistant.Conclusion: Enteric fever is most prevalent during summer &rainy session. WASA supplied water may play a role.Hepatomegaly is common. UTI and pneumonia are thecommonest complication. Multidrug resistant cases are not soas high as other countries. Cefixime, Ceftriaxone. Meropenamand Ofloxacine are the drugs of choice. Ciprofloxacin is stillcould be chosen for the treatment of enteric fever. Higher rateof resistant to Azithromycin is alarming.

Prevalence of Urinary Tract Infection and the Antibiotic Sensitivity Pattern of the Most Common Uropathogen from a Tertiary Care Hospital of Jamshedpur

Introduction: Urinary tract infections are one of the mostcommon infections encountered and pose a major threat topublic health. Strict antibiotic policies based upon theknowledge of regional susceptibility pattern, may be of greathelp for the clinicians and also prevent emergence of resistantstrains of pathogens.Aim: The aim of this study was to observe the prevalence andanalyse the antibiotic sensitivity pattern of the most commonlyisolated uropathogen in urinary tract infection.Materials and Methods: In this study a total of 338 urinarysamples of suspected urinary tract infections were collectedfrom the microbiology laboratory of M.G.M. Medical Collegeand Hospital, a tertiary care hospital. The age and sex ofpatients, the organisms isolated and antimicrobial susceptibilityprofile of the most frequently isolated uropathogens wasobserved.Results: Out of 338 samples suspected of UTI 118samples showed positive growth in MacConkey agar.Antibiotic susceptibility test was done by disc diffusion method.The most frequently isolated uropathogen was E.coli ie 51%and the antibiotic susceptibility pattern of E.coli was observed.Resistance to the commonly used drugs was high.Conclusion: Drug resistance has become a global problemthese days so proper surveillance and coordinance with theclinicians is required for the judicious selection of effectiveempirical treatment of UTI.

Clinical and Bacteriologic profile of Neonatal Sepsis in a tertiary care hospital: A 5-year review

Background@#Neonatal sepsis, a clinical syndrome characterized by non-specific signs and symptoms, is the most common cause of neonatal mortality and morbidity. It is classified into early or late-onset depending on the onset of symptoms, if within the first 72 hours or later. Early onset sepsis (EOS) occurs due to ascending infection following rupture of membranes or during passage through an infected birth canal. Late onset sepsis (LOS) can be nosocomial or community-acquired. A high index of suspicion and timely and judicious use of antibiotics are needed to achieve good outcomes. @*Objective@#This study looked into the clinical and bacteriologic profile of neonatal sepsis in a tertiary care hospital from January 2013 to December 2017. @*Methodology@#This was a retrospective observational study. Data on maternal risk factors, mode of delivery, gestational age, birth weight, birth setting, clinical manifestations, and blood culture and sensitivity were gathered. Descriptive statistics was used to analyze the data.@*Results@#Majority of cases were late onset sepsis with an equal distribution in those born via normal spontaneous delivery (NSD) and cesarean section (CS). There were more culture- positives in low birth weight (LBW) infants and those not delivered within a hospital. The most common maternal risk factor was UTI. Majority of culture-positive newborns presented with respiratory distress, poor feeding, fever, and irritability with respiratory distress being the most common manifestation for both EOS and LOS. Predominant isolates were CONS, E. coli and Klebsiella sp. Both E. coli and Klebsiella were resistant to both first-line empiric antibiotics – ampicillin and gentamicin but highly sensitive to piperacillin-tazobactam and imipenem.@*Conclusion@#Clinical signs and symptoms of neonatal sepsis are non-specific. The presence of respiratory distress, fever, poor feeding, and irritability together with other risk factors should raise suspicion for sepsis and prompt investigation and treatment. Predominant isolates seen were CONS, E. coli and Klebsiella sp. with resistance to first-line empiric antibiotics.

Pattern of clinical manifestation and antibiotics sensitivity of Burkholderia Cepacia sepsis in Neonatal Intensive Care Unit of tertiary care centre of North India

Background: Neonatal sepsis is a major cause of morbidity and mortality worldwide. Now a days, neonatal sepsis due to Burkholderia cepacia is on rise. This study was conducted to delineate clinical presentation and antibiotic sensitivity pattern from blood culture proven Burkholderia sepsis. Methods: In this retrospective analytical study, thirty-six neonates admitted to Neonatal Intensive Care Unit of a tertiary care hospital with blood culture proven Burkholderia sepsis were included. Clinical manifestation, laboratory findings and antibiotic sensitivity patterns of blood culture proven Burkholderia sepsis were analyzed.Results: : All neonates were inborn and were admitted within 24 hours of birth. Difficulty in breathing was most common presenting symptom and seizure was second in number. There was no association with mode of delivery. Male to female ratio is 1.4:1. Progressive thrombocytopenia was the most consistent feature and in 6 patients also associated with anaemia. Average hospital stay was increased and more in preterm neonates. In this setup piperacillin + tazobactem was found to be most sensitive against Burkholderia cepacia and cotrimoxazole was 2nd in sensitivity.Conclusions: Proper and timely identification of Non Fermentative Gram Negative Bacilli (NFGNB) other than Pseudomonas can help confine morbidity due to such infections. High degree of suspicion helps in early recognition. Efficient housekeeping is necessary to prevent nosocomial infections due to these pathogens.