Clinical Profile, Intensive Care Needs, and Short-Term Outcome of Toxic Shock Syndrome Among Children: A 10-Year Single-Centre Experience from North India

Objective To describe the clinical and laboratory profle, management, intensive care needs, and outcome of children with toxic shock syndrome (TSS) admitted to the pediatric intensive care unit (PICU) of a tertiary care center in North India. Methods This retrospective study was conducted in the PICU of a tertiary care hospital in North India over a period of 10 y (January 2011–December 2020) including children<12 y with TSS (n=63). Results The median (interquartile range, IQR) age was 5 (2–9) y, 58.7% were boys, and Pediatric Risk of Mortality III (PRISM-III) score was 15 (12–17). The primary focus of infection was identifed in 60.3% children, 44.5% had skin and soft tissue infections, and 17.5% (n=11) had growth of Staphylococcus aureus. Common manifestations were shock (100%), rash (95.2%), thrombocytopenia (79.4%), transaminitis (66.7%), coagulopathy (58.7%), and acute kidney injury (AKI) (52.4%); and involvement of gastrointestinal (61.9%), mucus membrane (55.5%), respiratory (47.6%), musculoskeletal (41.3%), and central nervous system (CNS) (31.7%). The treatment included fuid resuscitation (100%), vasoactive drugs (92.1%), clindamycin (96.8%), intravenous immunoglobulin (IVIG) (92.1%), blood products (74.6%), mechanical ventilation (58.7%), and renal replacement therapy (31.7%). The mortality was 27% (n=17). The duration of PICU and hopsital stay was 5 (4–10) and 7 (4–11) d, respectively. Higher proportion of nonsurvivors had CNS involvement, transaminitis, thrombocytopenia, coagulopathy, and AKI; required mechanical ventilation and blood products; and had higher vasoactive–inotropic score. Conclusion TSS is not uncommon in children in Indian setup. The management includes early recognition, intensive care, antibiotics, source control, and adjunctive therapy (IVIG and clindamycin). Multiorgan dysfunction and need for organ supportive therapies predicted mortality.

Genetic and evolutionary characteristics of clindamycin-resistant Staphylococcus aureus in Yangzhou / 公共卫生与预防医学

Objective To investigate the drug resistance phenotype, drug resistance genes and molecular characteristics of clinical isolates of Staphylococcus aureus in Yangzhou from 2016 to 2020. Methods A total of 71 strains of clindamycin resistant Staphylococcus aureus were collected. Molecular typing of the strains was performed using multilocus sequence typing (MLST) and SNP. Antimicrobial minimal inhibitory concentrations were detected by the method of microdilution broth. Different resistance genes were detected. Results A total of 71 strains of clindamycin resistant Staphylococcus aureus were collected in this study, of which 42 strains (59.15%) were inherently resistant and 29 strains (40.85%) were induced resistant ; 44 strains (61.97%) were found to be methicillin resistant Staphylococcus aureus (MRSA). Among the 71 strains , 18 ST types were found , and the detection rates of mecA and ermB in ST59 strain were higher than those in other ST types. Among the clustered strains, CC59 was inherently resistant. Conclusion The clinically isolated Staphylococcus aureus in Yangzhou has severe drug resistance, especially the resistance to clindamycin. CC59 clone group carries many drug resistance genes, and all of them are MRSA . This study provides reliable data for clinical selection of appropriate drugs and further investigation of the prevalence of clindamycin-resistant strains.

Treatment of Artemisinin-Resistant Plasmodium falciparum Malaria in India

Background: Treatment failure in P. falciparum malaria is a major dilemma that faces health care workers throughout the country. True drug resistance is one of the causes after ruling out compliance and drug quality issues. The other cause is re-infection with a new strain of the parasite during the treatment period. Objectives: To find out what are the antimalarials prescribed in India for the treatment of Artemisininresistant P. falciparum malaria. Methods: By reviewing documents published by the National Vector Borne Disease Control Programme. Results: It is found that a combination of oral Quinine and oral Clindamycin can be given for Artemisinin-resistant P. falciparum malaria. Conclusions: There is a lack of awareness among health care providers on how to treat artemisinin-resistant P. falciparum malaria. This paper addresses this concern.

Comparison of efficacy of two topical drug therapy of acne vulgaris – 1% clindamycin versus 5% dapsone: A split face comparative study

Background: Acne vulgaris is common skin problem for adolescents and young adults. Topical clindamycin is an established treatment modality effective in mild-to-moderate acne. Dapsone has been used orally for the treatment of acne but used less due to its systemic side effects. Topical dapsone may offer new treatment option for acne vulgaris due to its dual anti-inflammatory and anti-microbial effect. Aim and Objective: The aim of the study was to compare the efficacy of 1% clindamycin gel with 5% dapsone gel in the patient of Grade II acne vulgaris. Materials and Methods: It was a prospective interventional study with split face comparative study design. Each patient was received a pair of labeled tubes of medication – Right (Rt) side containing clindamycin 1% and left (Lt) side containing dapsone gel 5%. The assessment was done by calculating the change from baseline, after 4, 8, and 12 weeks of the total lesion count and both inflammatory and non-inflammatory lesions using repeated measures analysis of variance. Results: A total of 40 patients were included in the study. Both inflammatory and non-inflammatory lesion count reduce significantly at the end of 4, 8, and 12 weeks on both side (P < 0.05). Mean reduction in total count of lesions after 12 weeks of therapy by dapsone 5% was 5.4 ± 5.05 (50.0%), while by clindamycin 1% gel was 5.0 ± 2.76 (50.5%). Conclusion: Dapsone 5% gel monotherapy and clindamycin 1% gel monotherapy have almost equal efficacy when compared after 12 weeks of therapy, but dapsone 5% gel therapy is slightly better effect on inflammatory lesions than clindamycin 1% gel.

Síndrome de Kounis, un infarto olvidado: reporte de caso / Kounis syndrome, a forgotten infarction: case report

La anafilaxia es una causa poco frecuente de síndrome coronario agudo por vasoespasmo con o sin la presencia de enfermedad coronaria subyacente. Presentamos el caso de un síndrome de Kounis en un paciente masculino sin factores de riesgo conocidos para enfermedad coronaria quien presentó un síndrome coronario agudo con elevación de ST que requirió manejo con adrenalina, soporte vital básico e ingreso a Unidad de Cuidados Intensivos; con arteriografía coronaria sin evidencia de enfermedad subyacente.

Anaphylaxis is a rare cause of vasospasm acute coronary syndrome with or without the presence of underlying coronary disease. We present the case of Kounis syndrome in a male patient with no known risk factors for coronary heart disease who presented with acute coronary syndrome with elevation of ST that required management with epinephrine, basic life support, and admission to the Intensive Care Unit; with coronary arteriography without evidence of underlying disease.

Phenotypic Characterization and Antibiotic Susceptibility Profile of Coagulase Positive Staphylococci from The External Surfaces of Hospital Cockroaches (Periplaneta americana)

A study to phenotypically characterize and determine the antibiogram of coagulase positive Staphylococci (CoPS) from the external surfaces of hospital cockroaches (Periplaneta americana) was conducted using standard microbiological methods. Out of the 50 cockroaches collected from various hospitals in Uyo, sixty-two percent (n = 31) had coagulase positive Staphylococci which consisted of Staphylococcus aureus (44.0 %; n = 22) and Staphylococcus intermedius (18.0 %; n = 9). The CoPS isolates showed 100% resistance to Penicillin, Tetracycline, Clindamycin and 80.6% sensitivity to Amoxicillin-clavulanate. The CoPS showed multiple antibiotic resistances to ≥ 3 antibiotics, with 60 % exhibiting resistance to 6 antibiotics. Out of the 80 % (n = 31) of the multidrug resistant CoPS that were sensitive to Amoxicillin-clavulanate, none of them showed production of beta lactamase. The cockroaches bore multiple antibiotic resistant CoPS on their external surfaces and their contact can initiate contamination of patients' food. Pest control measures in hospital are hereby recommended to minimize cockroach related infections

Antibiotic resistance profile in intrahospital pediatric services at third level centers in Dominican Republic / Perfil de resistencia a antibióticos en servicios pediátricos intrahospitalarios en centros de tercer nivel en República Dominicana

Objectives: The Dominican Republic lacks reliable information on antimicrobial resistance (AMR), which would allow physicians to prescribe the best treatment for common infectious diseases. This study aimed to define the antimicrobial resistance profiles of the more common pathogens from pediatric services, where data is even more important due to the vulnerability of the population. Methods: We collected data from patients admitted in the pediatric unit of three third level hospitals in the city of Santiago de los Caballeros, Dominican Republic, showing positive bacterial cultures, during a period of two years. Results: Half of the Gram negative pathogens exhibited third generation cephalosporins (3GC) resistance, 17% were resistant to carbapenems. Serratia marcescens presented an exceptionally high proportion of resistance to 3GC (95.9%). Staphylococcus aureus showed elevated resistance to methicillin (58.4%) and even to clindamycin (35.8%). Conclusion: There are elevated levels of antimicrobial resistance among the Enterobacteriaceae family and the Staphylococcus genus isolated from the pediatric population. Necessary measures should be taken to tackle AMR in the country.

Objetivos: La República Dominicana carece de información confiable sobre las resistencias antimicrobianas en el país, lo que permitiría al personal médico prescribir los mejores tratamientos para infecciones comunes. El objetivo de este estudio es definir los perfiles de resistencia antimicrobiana de los patógenos más comunes en servicios pediátricos, donde esta información es esencial, debido a la vulnerabilidad de la población. Métodos: Se tomaron los datos de reportes microbiológicos con cultivo bacteriano positivo procedentes de pacientes admitidos en la unidad pediátrica de tres hospitales de tercer nivel en la ciudad de Santiago de los Caballeros, República Dominicana, durante un periodo de dos años. Resultados: La mitad de los patógenos Gram negativos mostraron resistencia a cefalosporinas de tercera generación (3GC), 17% eran resistentes a carbapenémicos. Serratia marcescens presentó una resistencia excepcionalmente elevada a 3GC (95.9%). Staphylococcus aureus mostró alta resistencia a meticilina (58.4%) e incluso a clindamicina (35.8%). Conclusión: Existen elevados niveles de resistencia antimicrobiana entre las enterobacterias y los estafilococos en la población pediátrica dominicana. Es necesario tomar medidas para abordar este problema en el país.

Pharmacokinetic drug–drug interaction study between clindamycin and cyclosporin in rabbits

Cyclosporine A (CSA) is an immunosuppressant drug, metabolized mainly by CYP3A4 that is one of the CytochromeP450 enzymes. Clindamycin (CLN) is a lincosamide antibiotic, inducing CYP3A4 activity in vitro, and thereby mayalter CSA pharmacokinetics (PK). The current research was performed to investigate the PK parameters changes ofCSA up on co-administrating with CLN in healthy male rabbits. Twelve healthy male rabbits randomly were selectedand divided into two groups: Control set (n = 6) in which the rabbits were received oral normal saline CSA solution(10 mg/kg/day), meanwhile rabbits in the test group (n = 6) were treated with oral normal saline CSA solution (10 mg/kg/day) concomitantly with normal saline solution of CLN (8 mg/kg/day) at the same time for 7 days. Blood samples(2 ml) were collected and CSA concentrations were measured in whole blood at the predetermined time points byusing Chemiluminescent Immunoassay (CLIA) detection kit. PK profiles of CSA for both groups in the control andtest groups including Cmax, tmax, AUC0-24, the area under the blood concentration–time curve from 0 hour to infinity(AUC0-∞), t½, and Ke were compared. The results showed a statistically insignificant differences in the PK parametersof CSA alone or combined with CLN with p > 0.05. In conclusion, it has been found that CLN does not affect the CSAPK. Further confirmation of our findings is requiered in humans before these results can be applied in patient care.

Antimicrobial efficacy of a new tri-antibiotic combination against resistant endodontic pathogens: an in-vitro study / Eficácia antimicrobiana de uma nova combinação tripla de antibióticos contra patógenos endodônticos resistentes: um estudo in vitro

Antecedentes: A remoção de todas as bactérias patogênicas do sistema de canais radiculares é de primordial importância para o sucesso da terapia endodôntica. Objetivo: O estudo teve como objetivo determinar a eficácia antimicrobiana de três antibióticos e sua nova combinação contra patógenos endodônticos selecionados. Métodos: Neste estudo in vitro, foram utilizadas cepas bacterianas associadas à condição endodôntica refratária e determinado CIM e MBC de Clindamicina (C), Metronidazol (M), Doxiciclina (D), bem como sua combinação de DMC. Cultivamos Candida Albicans, Pseudomonas Aeruginosa, Escherichia Coli, Enterococcus Faecalis, Streptococcus Mutans, Bacillus Subtilis subsp. spizizenii, Actinomyces Actinomycetemcomitans em meios de cultura seletivos. Analisamos os dados usando o teste 't' emparelhado, ANOVA unidirecional e o teste post hoc HSD de Tuckey. Resultados: A clindamicina inibiu significativamente o crescimento de C. Albicans (90%) e S. Mutans (90%) e P. Aeruginosa, E. Coli, E. Coli, E. Faecalis, B. Subtilis e A. Actinomycetemcomitans eram resistentes a ele. O metronidazol não inibiu nenhuma das bactérias. A doxiciclina inibiu significativamente C. Albicans (90%),P. Aeruginosa (90%) e S. Mutans (90%), enquanto E.Coli, E. Faecalis, B. Subtilis e A. Actinomycetemcomitanseram resistentes a ela. A combinação de CMD inibiu significativamente todos os micróbios. Entretanto, em concentrações bactericidas de CMD, E. Faecalis (p = 0,024),B. Subtilis (p = 0,021) e A. Actinomycetemcomitans (p =0,041) foram eliminados significativamente, enquanto C.Albicans (p = 0,164), P. Aeruginosa (p = 0,489), E. Coli (p= 0,106) e S. Mutans (p = 0,121) apresentaram resistência. Conclusão: O CMD combinado pode ser usado contra patógenos endodônticos resistentes para obter resultados endodônticos previsíveis. (AU)

Background: Removal of all the pathogenic bacteria from the root canal system is of prime importance for the success of endodontic therapy. Objective: The study aimed to determine the antimicrobial efficacy of three antibiotics and their new combination against selected endodontic pathogens. Methods: In this in-vitro study, we used bacterial strains associated with the refractory endodontic condition and determined MIC and MBC of Clindamycin (C), Metronidazole (M), Doxycycline (D) as well as their combination CMD. We cultured Candida Albicans, Pseudomonas Aeruginosa, Escherichia Coli, Enterococcus Faecalis, Streptococcus Mutans, Bacillus Subtilis subsp. spizizenii, Actinomyces Actinomycetemcomitans on selective culture media. We analyzed the data using paired 't' test, one-way ANOVA, and Tuckey's HSD post hoc test. Results: Clindamycininhibited the growth of C. Albicans (90%) and S. Mutans (90%) significantly and P. Aeruginosa, E. Coli, E. Faecalis, B. Subtilis, and A. Actinomycetemcomitans were resistantto it. Metronidazole did not inhibit any of the bacteria. Doxycycline inhibited C. Albicans (90%), P. Aeruginosa(90%), and S. Mutans (90%) significantly while E. Coli,E. Faecalis, B. Subtilis, and A. Actinomycetemcomitans were resistant to it. The combination of CMD inhibited all the microbes significantly. However, at bactericidal concentrations of CMD, E. Faecalis (p = 0.024), B. Subtilis (p = 0.021) and A. Actinomycetemcomitans(p = 0.041) were eliminated significantly, while C. Albicans (p = 0.164), P. Aeruginosa (p = 0.489), E. Coli (p = 0.106) and S. Mutans (p = 0.121) showed resistance. Conclusion: Combination CMD can be used against resistant endodontic pathogens to achieve predictable endodontic results. (AU)

Determination of Clindamycin Phosphate and Clindamycin in Long-Circulating Autologous Erythrocyte-Based Drug by HPLC / 中国药学杂志

OBJECTIVE: To establish a high performance liquid chromatography (HPLC) method to determine the contents of clindamycin phosphate and clindamycin in long-circulating autologous erythrocyte-based drug. METHODS: Clindamycin phosphate and clindamycin were determined by HPLC with Shimadzu Shim-pack VP-ODS chromatographic column (4.6 mm×250 mm, 5 μm) and Waters Symmetry C18 precolumn(3.9 mm×22 mm, 5 μm). The internal standard was nipagin ester. The mobile phase was composed of 0.062 5 mol•L-1 KH2PO4 and acetonitrile at 65∶35 (V/V) at a flow rate of 1.0 mL•min-1. The column temperature was maintained at 25 ℃ and the detection wavelength was set at 210 nm. RESULTS: The calibration curve of clindamycin phosphate showed good linearity in the range of 0.253-506 μg•mL-1, and the calibration curve of clindamycin showed good linearity in the range of 0.251-502 μg•mL-1. The average recovery was more than 98%. The test solution was stable at 4 ℃ and room temperature for 24 h, and the precision met requirements. CONCLUSION: The method is simple, specific, accurate and stable, which is suitable for the determination of clindamycin phosphate and clindamycin in long-circulating autologous erythrocyte-based drug.

Detection of inducible clindamycin resistance in Staphylococcus aureus from various samples in a tertiary care hospital

Background: The increasing frequency of MRSA infections and rapidly changing patterns in antimicrobial resistance, led to renewed interest in the usage of Macrolides-Lincosamide-Streptogramin B (MLSB) antibiotics to treat Staphylococcus aureus infection. Clindamycin is an important drug used in the treatment of MRSA and MSSA infection. The aim of this study was to determine inducible and constitutive clindamycin resistance among clinical isolates of Staphylococcus aureus by D-test.Methods: During a period of 6 months from July 2018 to December 2018, a total of 100 Staphylococcus aureus isolated from different clinical samples were subjected to routine antibiotic sensitivity testing by Kirby Bauer’s disc diffusion method. Methicillin-resistance was determined by using the cefoxitin (30 µg) disc. Incidence of MLSBc and MLSBi in Staphylococcus aureus isolates by D-test as per CLSI guidelines.Results: Out of 100 isolates of Staphylococcus aureus obtained from 350 clinical samples, 70(70%) were found to be MRSA and 30(30%) were MSSA. Among 100 Staphylococcus aureus isolates, 40% isolates showed MLSBi resistance, 28% isolates showed MLSBc resistance, 6% isolates showed MS phenotype and 26% isolates showed Sensitive phenotype. MLSBc and MLSBi were found to be higher in MRSA as compared to MSSA (21%, 27% and 7%, 10% respectively). All clinical isolates showed 100% sensitivity to Vancomycin and Linezolid in routine antibiotic susceptibility testing.Conclusions: Continuous surveillance of the MLSB resistance is important and required before the prescription of clindamycin to treat MRSA infections.

Determine Constitutive and Inducible Clindamycin Resistance among Clinical Isolates of Staphylococcus Aureus Isolates from Tertiary Care Hospital, Bettiah, India

Introduction: Clindamycin has been used to treat pneumoniaand soft tissue and musculoskeletal infections due to MRSA.One important problem in Clindamycin treatment is the riskof clinical failure during therapy caused by MLSB inducibleresistance. The Clinical and Laboratory Standards Institute(CLSI) suggest D-test, which is a phenotypic showingtechnique for inducible Clindamycin resistance.Material and Methods: We analyzed antimicrobialsusceptibility testing by Kirby Bauer disk diffusion method.Methicillin resistance was detected with cefoxitin (30 µg) diskand inducible clindamycin resistance was unwavering in allerythromycin resistant isolate by using D-zone test.Results: 100 S. aureus isolate 37 (36.6%) were methicillinresistant (MRSA) and 63 (63.4%) were methicillin-sensitiveS. aureus (MSSA). Although, mainstream of the MRSAisolates were imitative from pus samples 15, however, the S.aureus isolates imitative from post-operative wound infectionwere mainly MRSA 7. A total of 21 S. aureus isolates withiMLSB phenotype shown that they were 100% susceptible tovancomycin and linezolid, with modest sensitivity (71.14%) togentamicin, cefuroxime and slightest sensitivity to (23.81%)doxycycline, (20.95%) ciprofloxacin.Conclusion: Outstanding to high happening of erythromycinresistance amongst S. aureus isolates, we recommend thatD-zone test have to be regularly done in all laboratories forsuitable recommendation of clindamycin and thus preventingappearance of inducible resistant strains and managementfailure.

Prevalence of Inducible Clindamycin Resistance and Methicillin Resistance among Staphylococcus Species from Various Clinical Samples in a Tertiary Care Hospital of Eastern India

Staphylococcus species is an important cause of nosocomial and community acquired infections worldwide. Clindamycin is an alternative agents used to treat erythromycin resistant Staphylococcal infections. Clinical failure also reported due to various mechanisms of resistance to MLSB antibiotics. Accurate identification of clindamycin resistance is important to prevent therapeutic failure. Unfortunately, inducible Clindamycin resistance is not detected by standard susceptibility tests. Aims: The aim of the present study was to detect the prevalence of inducible clindamycin and methicillin resistance among clinical isolates of Staphylococcal species via antibiotic sensitivity test form various clinical samples. Methods: Total 153 Staphylococcal isolates were tested for antimicrobial susceptibility testing by as per guidelines. For detection of MRSA cefoxitin disc and for inducible clindamycin resistance, D test was performed. Results: Out of 153 samples, 119 were Staphylococcus aureus and 34 were Coagulase negative Staphylococcus (CoNS). Out of which 62.18 % were MRSA and 37.81 % were MSSA. Inducible MLSB phenotype was detected in 31.09 %, MS phenotype and constitutive MLSB phenotype in 42.85 % and 10.08 %. Conclusion: So it can be concluded from our study that D-test should be routinely performed in microbiology laboratory for every Staphylococcal isolates otherwise clindamycin resistance may misinterpreted as clindamycin sensitive resulting in therapeutic failure.

Resistencia inducible a clindamicina en Staphylococcus aureus resistentes a meticilina aislados de pacientes pediátricos en Paraguay / Inducible resistance to clindamycin in methicillin-resistant Staphylococcus aureus isolated from Paraguayan children

Resumen Introducción: El método de difusión de doble disco se presenta como una alternativa diagnóstica que permite identificar aislados de Staphylococcus aureus susceptibles a clindamicina, ante el aumento de resistencia a meticilina, reduciendo así la posibilidad de fallo en el tratamiento. Objetivo: Determinar la frecuencia de resistencia a clindamicina inducida por eritromicina en S. aureus resistentes a meticilina (SARM) aislados de niños paraguayos. Materiales y Métodos: Estudio observacional, descriptivo, de corte transversal. Se colectaron 145 aislados S. aureus que causaron infecciones de piel y tejidos blandos y osteo-articulares en pacientes pediátricos del Hospital Central del Instituto de Previsión Social en el período de diciembre-2012 a noviembre-2013. La resistencia a clindamicina se determinó por métodos automatizados y de difusión de doble disco. Se realizó reacción de polimerasa en cadena para genes ermA, ermB, ermC y msrA de aislados representativos. Resultados: La resistencia global a meticilina y clindamicina fue de 67 y 13%, respectivamente (11% atribuible al mecanismo de resistencia a clindamicina inducible). Los genes ermC y msrA fueron detectados individualmente en 25 y 17% de los aislados, respectivamente, mientras que un aislado presentó ambos genes en simultáneo. Discusión: La frecuencia de mecanismo de resistencia inducible a clindamicina señala la importancia de los métodos de difusión de doble disco en la práctica microbiológica, así como se encuentran en los límites de puntos de cortes considerados como aceptables para el uso de este antimicrobiano para infecciones cutáneas y osteo-articulares causadas por SARM.

Background: The double disc diffusion method is an alternative diagnostic that allows the identification of Staphylococcus aureus isolates apparently susceptible to clindamycin but that may develop resistance due to an induction phenomena, mainly asociated to the increase in resistance to methicillin, thus increasing the possibility of failure in the treatment. Aim: To determine the frequency of induced clindamycin resistance in methicillin-resistant S. aureus (MRSA) isolated from Paraguayan children. Materials and Methods: In this cross sectional study, we collected 145 S. aureus isolates that caused skin and soft tissue and osteoarticular infections in pediatric patients of the Central Hospital I.P.S. in the period from December-2012 to November-2013. Resistance to clindamycin was determined by automated methods and double disc diffusion. PCR was performed for ermA, ermB, ermC and msrA genes from representative isolates. Results: The global resistance to methicillin and clindamycin was 67 and 13%, respectively (11% attributable to the inducible mechanism). The ermC and msrA genes were detected individually in 25 and 17% of the isolates respectively while an isolate presented both genes simultaneously. Discussion: The frequency of inducible resistance to clindamycin indicates the importance of double disc diffusion methods in microbiological practice, as well as being within the cut off points considered acceptable for the use of this antibiotic for skin infections. and osteoarticular caused by MRSA.

Inducible Clindamycin Resistance in Gram Positive Isolates Obtained from Clinical Samples in a Tertiary Care Hospital in Mumbai.

Background: Infections by Gram positive isolates are increasing due to which their antibiotic sensitivity pattern is changing. This has revived interest in Macrolide-Lincosamide Streptogramin Group B (MLSB) antibiotics. Misuse of MLSB antibiotics hasincreased resistance in Gram-positive organisms especially Staphylococcus species to these drugs. Clindamycin is an important drug for treatment of Gram-positive isolates. Hence detection of inducible clindamycin resistance in these clinical isolates is required to prevent therapeutic failure and avoid inadvertent use of this drug. Aim and Objectives: To detect inducible clindamycin resistance among Gram positive isolates obtained from clinical samples. Material and Methods: The study was carried out over a period of one year (Jan-Dec 2018). A total of 461 Gram positive isolates of Staphylococcus species, Streptococcus pneumoniae and Beta-haemolytic Streptococcus were identified from various clinical samples and antibiotic susceptibility done on Vitek2 Compact usi g GP ID, and 628 and ST01 cards respectively. According to CLSI 2017, D-zone test was performed for detection of inducible clindamycin resistance for strains resistant to erythromycin. Results: Staphylococcus aureus (SA) isolates were 59%, Staphylococcus epidermidis (SE) 21%, other Coagulase Negative Staphylococcus (CONS) 16%, Streptococcus pyogenes (Group A-beta haemolytic) 2%, Streptococcus agalactiae (Group B betahaemolytic) 1% and Streptococcus pneumoniae (alpha haemolytic) 1%. Isolates of Methicillin Sensitive Staphylococcus aureus (MSSA) were 58% and Methicillin Resistant Staphylococcus aureus (MRSA) were 42%. Frequencies of MS (clindamycin sensitive) phenotypes, inducible clindamycin resistance (MLSBi) phenotypes and phenotypes showing constitutive resistance (MLSBc) were 44%, 12% and 3% respectively among MSSA and 34%, 39% and 8% respectively among MRSA. Among SE, MS, MLSBc and MLSBi phenotypes were 39%, 24% and 12% respectively and 8%, 44% and 30% respectively among other CONS. One isolate of S. pyogenes was of MLSBi phenotype and none among S. agalactiae and S. pneumoniae. Conclusion: The study emphasizes the significance of conducting D-zone test along with routine antimicrobial susceptibility testing to guide in therapy and avoid treatment failures.

Study Of Antibiotic Resistance Pattern Among Gram Positive Isolates Of Diabetic Foot Ulcer, With Special Reference To Methicillin Resistance And Inducible Clindamycin Resistance

One of the important factors contributing to emergence of resistant strains in diabetic foot ulcers (DFUs) is inappropriate and widespread use of antimicrobials, either by patients themselves or primary care providers. So routine testing of antibiotic sensitivity plays a crucial role. Also routine test fails to detect Methicillin resistance (MR) which is mediated by mecA, encoding the PBP 2a and inducible Clindamycin resistance (ICR) due to erm genes. Hence, it is advisable to perform MR testing and D test for detection of inducible Clindamycin resistance routinely during the primary antibiotic testing for the knowledge of their prevalence and measures to be taken to control their spread. The present study included 212 diabetic foot ulcer patients, from which 94 (31.33%) gram positive isolates were obtained, of which 75 (25.0%) were Staphylococcus aureus, 9 (3.0%) were Coagulase negative Staphylococci (CoNS) and 10 (3.33%) were Enteroccocus species. Among the Staphylococcal isolates, Methicillin resistance was seen in 25.33% S. aureus and 33.33% CoNS species. Inducible Clindamycin resistance was seen in 20.0% S. aureus and 33.33% CoNS isolates

Identificación de microorganismos vaginales en pacientes en trabajo de parto pretérmino / Identification of vaginal microorganisms of patients in preterm labor

Resumen OBJETIVO: Identificar los microorganismos vaginales más frecuentes en pacientes en trabajo de parto pretérmino, mediante el A.F. Genital System-Liofilchem®. MATERIALES Y MÉTODOS: Estudio descriptivo, prospectivo y transversal llevado a cabo en pacientes en trabajo de parto pretérmino atendidas en el servicio de Ginecología y Obstetricia de la Fundación Hospital Infantil Universitario de San José de Bogotá, entre julio de 2015 y febrero de 2016 de quienes se obtuvieron muestras de flujo del introito vaginal y se sembraron en el panel del A.F. Genital System-Liofilchem®, de acuerdo con las instrucciones del fabricante. Para el análisis de los datos se utilizó el programa estadístico Stata versión 13 (StataCorp®) y se implementó la prueba no paramétrica de Wilcoxon. RESULTADOS: Los microorganismos aislados con mayor frecuencia fueron: Staphylococcus aureus (89.1%), Ureaplasma urealyticum (43.4%) y Mycoplasma hominis (19.5%). De las muestras positivas para especies de micoplasma, 52.2% tuvo concentración mayor de 105 UFC/mL. De los agentes aislados, Ureaplasma urealyticum y Mycoplasma hominis mostraron resistencia de 100% para clindamicina y eritromicina, respectivamente. CONCLUSIONES: Los microorganismos vaginales representan un factor de riesgo de parto pretérmino. Ureaplasma urealyticum y Mycoplasma hominis muestran resistencia total a clindamicina y eritromicina.

Abstract OBJECTIVE: Determine the frequency of microorganisms present in the vagina of women in preterm labor. MATERIALS AND METHODS: Descriptive, prospective, cross-sectional study of a series of cases of 46 patients treated at the Fundación Hospital Infantil Universitario de San José de Bogotá for preterm labor, who were sampled from the vaginal introitus and planted on the A.F. Genital System-Liofilchem® panel. Genital System by Liofilchem®, according to the manufacturer's instructions. The statistical package Stata version 13 (StataCorp®) was used. The statistical analysis was descriptive, the nonparametric Wilcoxon test was run. RESULTS: The most isolated microorganism was Staphylococcus aureus with a frequency of 89.13%. Ureaplasma urealyticum was detected in 43.48% and Mycoplasma hominis in 19.57 Of the positive samples for genital Mycoplasmas, 52.2% showed a concentration >105 CFU/mL. Ureaplasma urealyticum isolates showed 100% resistance to clindamycin and 100% Mycoplasma hominis for erythromycin. CONCLUSIONS: Microorganisms that have been identified as risk factors for preterm delivery were identified in 93.5% of the vaginal discharge samples. For Ureaplasma urealyticum and Mycoplasma hominis, 100% resistance for clindamycin and erythromycin is identified.

Analysis of Resistance to Macrolide–Lincosamide–Streptogramin B Among mecA-Positive Staphylococcus Aureus Isolates

OBJECTIVES: Genetic determinants conferring resistance to macrolide, lincosamide, and streptogramin B (MLSB) via ribosomal modification such as, erm, msrA/B and ereA/B genes are distributed in bacteria. The main goals of this work were to evaluate the dissemination of MLSB resistance phenotypes and genotypes in methicillin-resistant Staphylococcus aureus (MRSA) isolates collected from clinical samples. METHODS: A total of 106 MRSA isolates were studied. Isolates were recovered from 3 hospitals in Tehran between May 2016 to July 2017. The prevalence of MLSB-resistant strains were determined by D-test, and then M-PCR was performed to identify genes encoding resistance to macrolides, lincosamides, and streptogramins in the tested isolates. RESULTS: The frequency of constitutive resistance MLSB, inducible resistance MLSB and MSB resistance were 56.2%, 22.9%, and 16.6%, respectively. Of 11 isolates with the inducible resistance MLSB phenotype, ermC, ermB, ermA and ereA were positive in 81.8%, 63.6%, 54.5% and 18.2% of these isolates, respectively. In isolates with the constitutive resistance MLSB phenotype, the prevalence of ermA, ermB, ermC, msrA, msrB, ereA and ereB were 25.9%, 18.5%, 44.4%, 0.0%, 0.0%, 11.1% and 0.0%, respectively. CONCLUSION: Clindamycin is commonly administered in severe MRSA infections depending upon the antimicrobial susceptibility findings. This study showed that the D-test should be used as an obligatory method in routine disk diffusion assay to detect inducible clindamycin resistance in MRSA so that effective antibiotic treatment can be provided.

Synergistic effect of α-mangostin on antibacterial activity of tetracycline, erythromycin, and clindamycin against acne involved bacteria / 中草药·英文版

Objective: To evaluate the synergistic effect of α-mangostin with tetracycline, erythromycin, and clindamycin against bacteria involved in acne production. Methods: A broth microdilution method was used to determine the minimum inhibitory concentration (MIC) of α-mangostin and a range of antibiotics. Synergistic effects on antibacterial activity were determined based on their own MIC, and then using a checkerboard method and a time-kill assay at 37 °C for 24 h. Results: α-Mangostin exhibited antibacterial activity against Propionibacterium acnes, Staphylococcus aureus, S. epidermidis and S. pyogenes with MIC values of 0.78, 3.13, 0.78, and 6.25 µg/mL, respectively. The results of the checkerboard assay showed that α-mangostin produced synergistic effects with tetracycline, erythromycin, and clindamycin against all tested bacteria, with a fractional inhibitory concentration index (FICI) between 0.09 and 0.32. Moreover, time-kill curve data indicated that α-mangostin increased the antibacterial activity of tetracycline, erythromycin, and clindamycin. Conclusion: These findings suggested that α-mangostin may be used to enhance the antibacterial activity of some antibiotics against bacteria involved in acne production.

Comparison of Spinal Anaesthesia Vs General Anaesthesia for Lower Spinal Surgeries

Background: Both General and Regional anaesthesia can be   used for lower Lumbar Disc surgery but SPINAL ANAESTHESIA is also a better alternative as it is accompanies by less blood loss and haemodynamics instability. Materials & Methods: 60 patients were randomly assigned to receive either General Anaesthesia( GA group) or Spinal Anaesthesia(SA group).  Patients were supplemented with i.v. Propofol sedation in Spinal anaesthesia  group. The values were recorded preoperative, intraoperative & postoperative. HR, MAP, amount of blood less, surgeon Satisfaction were noted. The severity of nausea, vomiting, duration of recovery and total analgesic use was also recorded. Results: Total anaesthesia, surgical time and blood loss is less in spinal anaesthesia group as compared to general Anaesthesia group. Intraoperative hypertension and tachycardia is more in GA group. Surgeon satisfaction and cost effectiveness is more in SA group. Postoperative nausea ,vomiting is more in GA group. Conclusion: Spinal  anaesthesia is better ,safe and economical alternative to general anaesthesia for lower spinal surgery