Perfil de sensibilidad antimicrobiana de microorganismos causantes de infecciones urinarias adquiridas en la comunidad en pacientes con diabetes mellitus en Colombia / Antimicrobial susceptibility profile in urinary pathogens causing community-acquired infections in diabetic patients in Colombia

Resumen Introducción. La infección de las vías urinarias es la más frecuente en pacientes diabéticos, y es un factor determinante de la morbilidad y la mortalidad en este grupo de pacientes. El aumento de la resistencia de los microorganismos adquiridos en la comunidad a los antibióticos comúnmente utilizados para combatirla es alarmante. Objetivo. Determinar el perfil de sensibilidad a los antibióticos de los microorganismos responsables de infecciones urinarias adquiridas en la comunidad en pacientes diabéticos atendidos en algunos hospitales de Colombia. Materiales y métodos. Se hizo un estudio descriptivo de un subgrupo de pacientes diabéticos en el marco de una investigación en adultos con infección de origen comunitario de las vías urinarias. Durante un año, se recolectaron aislamientos de Escherichia coli, Klebsiella spp. y Proteus mirabilis en nueve hospitales de Colombia y se determinó su perfil de sensibilidad mediante métodos microbiológicos y moleculares, para establecer la presencia de betalactamasas de espectro extendido del tipo AmpC y de carbapenemasas del tipo KPC. Resultados. Se recolectaron 68 aislamientos (58 de E. coli, nueve de Klebsiella spp. y uno de P. mirabilis). Cuatro (6,9 %) de los aislamientos de E. coli expresaron dichas betalactamasas, en dos (3,4 %) de ellos, pertenecientes al grupo filogenético B2 y al clon ST131, se detectaron las betalactamasas TEM-1 y CTM-X-15. En otros cuatro (6,9 %) aislamientos de E. coli se encontró el fenotipo AmpC, y en tres de ellos se produjeron las betalactamasas TEM-1 y CMY-2. Un aislamiento de K. pneumoniae expresó la carbapenemasa KPC-3. Conclusión. Se confirmó la presencia de cepas productoras de betalactamasas de espectro extendido y carbapenemasas en microorganismos responsables de infección urinaria adquirida en la comunidad en pacientes diabéticos.

Abstract Introduction: Urinary tract infection is the most common pathology in diabetic patients, and an important determinant of morbidity and mortality among them. The increasing resistance of uropathogens acquired in the community to commonly used antibiotics is alarming. Objective: To identify the profile of antibiotic susceptibility of uropathogens responsible for community-acquired infections among diabetic patients in hospitals in Colombia. Materials and methods: We conducted a descriptive study in a subgroup of diabetic patients in the framework of a larger study in adults with urinary tract infection acquired in the community. Over one year, we collected Escherichia coli, Klebsiella spp. and Proteus mirabilis isolates from nine hospitals in Colombia. Their susceptibility profile was determined using microbiological and molecular methods to establish the presence of extended-spectrum AmpC betalactamases and KPC carbapenemases. Results: We collected 68 isolates (58 E. coli, nineKlebsiella spp. and oneProteus mirabilis). Four (6.9%) of the E. coli isolates expressed extended spectrum betalactamases,two (3.4%) of thembelonged to the phylogenetic group B2 andto ST131 clone and expressed the TEM-1 and CTM-X-15 betalactamases. The AmpC phenotype was found in four(6.9%) of the E. coli isolates, three of which producedTEM-1 and CMY-2 betalactamases. One K. pneumoniaeisolate expressed the KPC-3 carbapenemase. Conclusion: The presence of extended spectrum betalactamases and carbapenemases in uropathogens responsible for community-acquired infection was confirmed in diabetic patients.

CTX-M extended-spectrum ß-lactamase-producing Klebsiella spp, Salmonella spp, Shigella spp and Escherichia coli isolates in Iranian hospitals

Abstract This study was conducted in Iran in order to assess the distribution of CTX-M type ESBLs producing Enterobacteriaceae. From January 2012 to December 2013, totally 198 E. coli, 139 Klebsiella spp, 54 Salmonella spp and 52 Shigella spp from seven hospitals of six provinces in Iran were screened for resistance to extended-spectrum cephalosporins. After identification and susceptibility testing, isolates presenting multiple-drug resistance (MDR) were evaluated for ESBL production by the disk combination method and by Etest using (cefotaxime and cefotaxime plus clavulanic acid). All isolates were also screened for bla CTX-M using conventional PCR. A total of 42.92%, 33.81%, 14.81% and 7.69% of the E. coli, Klebsiella spp, Salmonella spp and Shigella spp isolates were MDR, respectively. The presence of CTX-M enzyme among ESBL-producing isolates was 85.18%, 77.7%, 50%, and 66.7%, in E. coli, Klebsiella spp, Salmonella spp and Shigella spp respectively. The overall presence of CTX-M genes in Enterobacteriaceae was 15.4% and among the resistant isolates was 47.6%. This study indicated that resistance to β-lactams mediated by CTX-M enzymes in Iran had similar pattern as in other parts of the world. In order to control the spread of resistance, comprehensive studies and programs are needed.

Analysis for the presence of determinants involved in the transport of mercury across bacterial membrane from polluted water bodies of India

Abstract Mercury, which is ubiquitous and recalcitrant to biodegradation processes, threatens human health by escaping to the environment via various natural and anthropogenic activities. Non-biodegradability of mercury pollutants has necessitated the development and implementation of economic alternatives with promising potential to remove metals from the environment. Enhancement of microbial based remediation strategies through genetic engineering approaches provides one such alternative with a promising future. In this study, bacterial isolates inhabiting polluted sites were screened for tolerance to varying concentrations of mercuric chloride. Following identification, several Pseudomonas and Klebsiella species were found to exhibit the highest tolerance to both organic and inorganic mercury. Screened bacterial isolates were examined for their genetic make-up in terms of the presence of genes (merP and merT) involved in the transport of mercury across the membrane either alone or in combination to deal with the toxic mercury. Gene sequence analysis revealed that the merP gene showed 86–99% homology, while the merT gene showed >98% homology with previously reported sequences. By exploring the genes involved in imparting metal resistance to bacteria, this study will serve to highlight the credentials that are particularly advantageous for their practical application to remediation of mercury from the environment.

Multidrug-resistant bacteria among patients with ventilator-associated pneumonia in an emergency intensive care unit, Egypt

Ventilator-associated pneumonia [VAP] is the most common hospital-acquired infection among mechanically ventilated patients. Our objectives were to determine the incidence of VAP, isolate multidrug-resistant bacteria, identify the most prevalent resistant strains and identify their antibiotic susceptibility pattern. The VAP rate was calculated. The isolated microbes were identified and tested for antibiotic susceptibilities. The minimum inhibitory concentrations were determined of imipenem, meropenem and ertapenem for Klebsiella isolates. Klebsiella isolates resistant to carbapenems were tested for the presence of the blaKPC gene. The VAP incidence density rate was 48.8 incidences/1 000 ventilator days. The most common Gram-positive organism was Staphylococcus aureus, of which 86.6% of isolates were resistant to cefoxitin, but 100% were sensitive to teicoplanin, linezolid and tigecycline. The most common Gram-negative bacillus was Klebsiella, of which 94.6% of isolates were resistant to cefotaxime, 70.2% to imipenem, and 64.9% to ertapenem, but 100% were sensitive to colistin and 94.6% were sensitive to tigecycline. Of the carbapenem-resistant Klebsiella strains, 23.1% had the blaKPC gene. The high rates of VAP and the high rates of resistance among isolated organisms point to improper implementation of infection control programmes

Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital

OBJECTIVE: To evaluate the impact of a clinical pharmacy program on health outcomes in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital in Brazil. METHOD: A randomized controlled trial with a 6-month follow-up period was performed in 70 adults, aged 45 years or older, with type 2 diabetes who were taking insulin and who had an HbA1c level ≥8%. Patients in the control group (CG) (n = 36) received standard care, patients in the intervention group (IG) (n = 34) received an individualized pharmacotherapeutic care plan and diabetes education. The primary outcome measure was change in HbA1c. Secondary outcomes included diabetes and medication knowledge, adherence to medication, insulin injection and home blood glucose monitoring techniques and diabetes-related quality of life. Outcomes were evaluated at baseline and 6 months using questionnaires. RESULTS: Diabetes knowledge, medication knowledge, adherence to medication and correct insulin injection and home blood glucose monitoring techniques significantly improved in the intervention group but remained unchanged in the control group. At the end of the study, mean HbA1c values in the control group remained unchanged but were significantly reduced in the intervention group. Diabetes-related quality of life significantly improved in the intervention group but worsened significantly in the control group. CONCLUSION: The program improved health outcomes and resulted in better glycemic control in patients with type 2 diabetes undergoing insulin therapy. .

Resistance pattern of clinical isolates involved in surgical site infections

Wound infections due to the incursion of microbes need to be averted or to heal the wounds by antibiotics. Antibiotics are not only aid in cure of infections but also help to prevent the flourishing and production of one or more species of microorganism, resultant in purulent discharge. This current study was carried out to evaluate the resistance pattern of clinical isolates from surgical site infections by the Kirby Bauer disc diffusion method. A total of 257 clinical isolates were collected from different hospitals in Karachi and evaluated by using fifteen antibiotics belonging to different groups. Staphylococcus aureus [n=87], Escherichia coli [n=76], Pseudomonas aeruginosa [n=56], Proteus [n=21] and Klebsiella [n=17] species are the most common clinical isolates of surgical site infections. Among the semi-synthetic penicillins, ampicillin was found to be resistant to nearly all clinical isolates but amoxicillin was moderately sensitive to S. aureus. Combinations of semi-synthetic penicillins are more sensitive than the penicillin alone. Co-amoxiclave exhibits superior sensitivity to all the surgical infection isolates except Pseudomonas aeruginosa which showed 68.75% resistance. Pseudomonas aeruginosa was highly resistant to cephalosporin except ceftraixone which showed 21.88% resistance. S. aureus was slightly responsive to cefazolin, cephradine, cefaclor, ceftizoxime, cefuroxime and ceftriaxone. E. coli, Gram-negative clinical isolate was showed 25% and 31.25% resistance to ceftriaxone and cefuroxime. In the Klebsiella species, 71.42% and 64.29% resistance to cefazolin and cefuroxime respectively, was observed. Aminoglycosides such as gentamycin and tobramycin were found to be more susceptible to all the clinical isolates. Quinolones like ofloxacin and enoxacin were showed good sensitivity to nearly all the clinical isolates. On the basis of the present study, it is recommended to adopt a rational use of antibiotics in prophylaxis and the utilization of a coordinated scheme of surgical wound inspections.

Perfil etiológico y susceptibilidad antimicrobiana del primer episodio de infección urinaria febril / Etiologic and antibiotic susceptibility profile of the first episode of febrile urinary tract infection

Urinary tract infection (UTI) is a common infection in childhood; its diagnosis involves performing a urine culture. Aim: To describe the etiology and bacterial susceptibility of the first episode of UTI in children presenting with fever to the emergency room. Patients and Methods : One hundred and five children (2 months -5 years old) seen at the Hospital Dr. Sotero del Rio in Santiago, between November 2009 and November 2010 were evaluated. A urine specimen was obtained by transurethral catheterization. Urine was cultured and microorganisms were identified and tested for antimicrobial susceptibility. Results: 76.2% (80) of patients were women and 80% (84) were under 18 months. Urine sediment was abnormal in 82.5%. The most frequently isolated microorganism was Escherichia coli (96.1%) showing high susceptibility to aminoglycosides (near 100%), third generation cephalosporins, ciprofloxacin and nitrofurantoin; and low susceptibility to cephalothin (69%) and trimethoprim/sulfamethoxazole (66%). We found one ESBL-producing strain. Conclusion: The most common uropathogen was E. coli with good in vitro susceptibility to aminoglycosides and third generation cephalosporins, which are the recommended initial empirical therapy. E. coli ESBL-producing strains appear as emerging pathogens in community acquired UTIs in children.

La infección del tracto urinario (ITU) es muy frecuente en la niñez y su diagnóstico implica la realización de urocultivo. Objetivo: Describir la etiología y susceptibilidad bacteriana del primer episodio de ITU en niños que consultaron por fiebre en una unidad de emergencia. PacientesyMétodos: Se evaluaron 105 niños (2 meses -5 años) consultantes en la Unidad de Emergencia Infantil del Hospital Sótero del Río del área sur-oriente de Santiago entre noviembre de 2009 y noviembre de 2010, con muestra de orina tomada por cateterismo trans-uretral para sedimento de orina, urocultivo y antibiograma. Resultados: El 76,2% (80) de los pacientes fueron mujeres y 80% (84) tenía menos de 18 meses. El sedimento de orina resultó alterado en 82,5%. El microorganismo aislado con mayor frecuencia fue Escherichia coli (96,1%) que mostró buena susceptibilidad in vitro (cercana a 100%) para aminoglucósidos, cefalosporinas de tercera generación, quinolonas y nitrofurantoína, y baja susceptibilidad para cefalotina (69%) y cotrimoxazol (66%). Una cepa era productora de β-lactamasa de expectro extendido (bLEE). Conclusión: El uropatógeno más frecuente fue E. coli que demostró buena susceptibilidad in vitro a aminoglucósidos y cefalosporinas de tercera generación, antimicrobianos parenterales recomendados como tratamiento empírico inicial para este grupo de pacientes. Las cepas de E. coli productoras de bLEE aparecen como patógenos emergentes en las ITUs adquiridas por niños en la comunidad.

Current efficacy of antibiotics against Klebsiella isolates from urine samples - A multi-centric experience in Karachi

Due to emergence of bacterial resistant strains, the effectiveness of current antibiotic treatment without culture/sensitivity testing is questionable. Our study aims to assess the present sensitivity profiles of Klebsiella isolates from urine samples and provide options for empiric prescription in critically ill patients. Klebsiella pneumoniae isolates collected over a period of 28 months till January 2011 from 1, 617 urine samples of subjects presenting with Urinary Tract Infections were identified at a local diagnostic lab using standard protocol and subjected to Kirby-Bauer disk diffusion sensitivity testing. MICs were also estimated by E-nephelometry. Among 20 drugs used, low sensitivity was found to amoxicillin [0.1%], doxycycline [11.5%], nitrofurantoin [15.5%], amoxiclav [18.2%], gentamicin [35.4%], pipemidic acid, cephradine [40.3%] and cotrimoxazole [43.1%]. The isolates were more sensitive to cefuroxime [55.9%], cefixime [57.7%], ciprofloxacin [62.5%], ofloxacin [63%], ceftriaxone [66.2%], ceftazidime [66.4%], cefotaxime [66.6%], fosfomycin [77.5%] and amikacin [89.4]. Most effective were cefroperazone.sulbactam [95.8%], piperacillin.tazobactam [95.7%] and imipenem [97.7%]. Self-medication, lack of awareness, and the misuse of antibiotics by doctors has exacerbated the menace of microbial resistance. The study warrants the prudent choice of drugs in adherence with prevailing sensitivity profiles

[ study of the effect of silver nanoparticles on extended spectrum beta-lactamase producing Klebsiella strains]

Wide use of beta-lactam antibiotics increases bacterial resistance to these groups of antibiotics in pathogen bacteria through production of beta-lactamase enzyme. The present study was carried out with the aim of evaluating the isolation of ESBL producing Klebsiella spp. in clinical specimens and investigating the effect of silver nanoparticles on them. A total of 61 clinical Klebsiella isolates were examined in terms of production of extended spectrum beta-lactamase [ESBL] through disk diffusion method using the antibiotics cefixime, ceftriaxone, ceftazidime, as well as beta-lactamase inhibitor clavulanic acid, and the antibiotics' minimal inhibitory concentration [MIC] values were determined by agar dilution method. Then, ESBL production was examined using standard ESBL disk for detection of deta-lactamase through DDT [double disk approximation test] method. Subsequently, the effect of different concentrations of nanosilver solution on isolated bacteria was studied. Student t-test was used for analysis of the data. Out of 61 multidrug resistant Klebsiella isolates, 51 [60.83%] Klebsiella pneumonea and 10 [39.16%] Klebsiella oxytoca were recognized. All samples were demonstrated to be positive in double disk method for proving ESBL production, and were sensitive to the nanosilver solution with a concentration of 500ppm. The obtained findings showed that increase in the concentration of nanosilver solutions had a direct correlation with inhibition zone diameter of ESBL producing Klebsiella spp in vitro and in completely aseptic condition. If it is proved that nanosilver solutions are non-toxic in vivo, they could be used as a new effective alternative to antibiotics

Phenotypic & molecular characterization of AmpC β-lactamases among Escherichia coli, Klebsiella spp. & Enterobacter spp. from five Indian Medical Centers.

Background & objectives: AmpC β-lactamases which are often plasmid mediated hydrolyze all β-lactam antibiotics except cefepime and carbapenems. We evaluated the presence of AmpC β-lactamases among Enterobacteriaceae strains recovered prospectively from patients at five Indian tertiary care centres. Methods: The study included 909 consecutive Gram-negative isolates recovered from clinically significant specimens during June 2007 - May 2008 as part of an ICMR-ESBL study. Among the study isolates, 312 were found to be cefoxitin resistant by disc diffusion test (DDT). Minimum inhibitory concentration (MIC) determination by E test was done against amikacin, levofloxacin, impinem, meropenem, ertapenem, tigecycline and piperacillin-tazobactam. Combined DDT using phenyl boronic acid as inhibitor with cefoxitin was used for phenotypic confirmation of AmpC phenotype. The common Amp C genotypes ACC, FOX, MOX, DHA, CIT and EBC were detected by multiplex PCR. Results: Plasmid mediated Amp C phenotype was confirmed in 114 of the 312 (36.5%) cefoxitin resistant isolates with 255 (81.7%) showing multidrug resistance. Susceptibility to tigecycline was highest (99%) followed by imipenem, meropenem (97%), ertapenem (89%), amikacin (85%), and piperacillin-tazobactam (74.6%). Levofloxacin resistance was 82 per cent. ESBL co carriage was observed among 92 per cent of Amp C producers. Among 114 Amp C producers, 48 could be assigned a genotype, this included CIT- FOX (n=25), EBC (n=10), FOX (n = 4), CIT (n=3), EBC-ACC (n=2) and one each of DHA, EBC-DHA, FOX -DHA and FOX-EBC-DHA. Interpretation & Conclusions: Overall, AmpC phenotypes were found in 12.5 per cent isolates, multidrug resistance and ESBL co-carriage among them was high suggesting plasmid mediated spread. The study results have implications in rational antimicrobial therapy and continued surveillance of mechanisms of resistance among nosocomial pathogens.

Nosocomial and community infections due to class A extended-spectrum β-lactamase (ESBLA)-producing Escherichia coli and Klebsiella spp. in southern Brazil

OBJECTIVES: To determine the prevalence of class A extended spectrum β-lactamases (ESBL)-producing Escherichia coli and Klebsiella spp., and to investigate clonality among ESBL-producing isolates of nosocomial and community infections. METHODS: The study involved 354 nosocomial infections samples and 992 community infections samples, obtained between 2003 and 2006 at Caxias do Sul, RS. The detection of ESBL was performed by the disk-diffusion test. Presence of blaCTX-M, blaSHV and blaTEM β-lactamase genes was evaluated by PCR, and genomic typing was determined by pulsed-field gel electrophoresis analysis. RESULTS: Higher frequency of ESBL-producing isolates were detected among nosocomial samples of E. coli (6.7 percent) and Klebsiella (43.7 percent), than those obtained from community infections (0.4 percent and 2.6 percent). blaTEM and blaCTX were the most prevalent ESBL gene families in both E. coli and Klebsiella isolates. Different pulsotypes were obtained among ESBL-producing E. coli and 11 clones for Klebsiella spp., which occurred over the years and in different hospital wards. Among ESBL-producing K. pneumoniae, 74.3 percent transferred ESBL genes by conjugation and exhibited concomitant decreased aminoglycosides susceptibility. CONCLUSION: ESBL-producing E. coli, and especially K. pneumoniae are essentially a nosocomial problem, and their dissemination to the community is relatively limited. The great genetic variability observed among ESBL-producing bacteria indicates polyclonal spread and high transference of ESBL genes between bacteria in the hospital environment. This information is of paramount importance for nosocomial infection control.

Antimicrobial activity of erythromycin and clarithromycin against clinical isolates of Escherichia coli, Staphylococcus aureus, klebsiella and proteus by disc diffusion method

Fifty clinical isolates comprising of Escherichia coli, Staphylococcus aureus, Klebsiella and Proteus were collected from different local pathological laboratories and their resistant pattern against two well known macrolides; erythromycin and clarithromycin were studied using disc diffusion method. Klebsiella [41.67% against erythromycin and 58.34% against clarithromycin] and Proteus [66.67% against erythromycin and clarithromycin] species were found to be more resistant against the studied macrolides as compared to the rest of organisms. In case of Staphylococcus aureus and Escherichia.coli, resistant found were 27.78% and 23.54% against erythromycin and 22.23% and 35.30% against clarithromycin respectively. It is concluded from these figures that microbial resistance against these macrolides are increasing in our population which is alarming and therefore it is recommended to physicians to prescribe these antibiotics unless no other substitute is available in clinical practices

Antibiobitc susceptibility pattern of bacterial isolates from patients admitted to a tertiary care hospital in Lahore

To determine the antimicrobial sensitivity pattern of bacterial isolates from patients admitted in a tertiary care hospital of Lahore. The study was carried out in Department of Pathology, Postgraduate Medical Institute, Lahore from January 2010 to June 2010. The samples from the hospital were sent to microbiology laboratory for bacteriological examination. They were cultured onto Blood and MacConkey agar plates; organisms were identified by their colonial morphology, Gram Staining and appropriate biochemical tests using standard recommended protocol. Antimicrobial susceptibility pattern of the bacterial isolates recovered from different clinical specimens against penicillins,, cephalosporins, fluoroquinolones, carbapenems, aminoglycosides and trimethoprim sulphmethoxazole was determined using modified Kirby Bauer method. Among the 925 different clinical samples, 379 organisms were isolated. Escherichia coli and Klebsiella species were the most prevalent isolates followed by Pseudomonas and Staphylococcus spp. High degree of resistance was observed among gram negative organisms to all groups of antibiotics. Resistance to amikacin ranged from 12- 18% among different species of Gram negative isolates whereas the range of carbapenem resistance was 1.4 - 9.5%. The percentage of oxacillin resistance among staphylococcal isolates was 33.1%, but all were sensitive to vancomycin. High frequency of resistance observed in the present study indicates that antibiotic resistance among nosocomial isolates is a serious problem. There is a continuous need of surveillance of sensitivity patterns of antimicrobial agents in our set up to know about the trend of this problem

Detección de cepas productoras de b-lactamasas de espectro extendido por el sistema DIRAMIC: Comparación con los métodos doble difusión con discos y E-test / Detection of expanded-espectrum-betalactamases by DIRAMIC system: Comparison with the double-disk synergy test and E-test

The capacity of the DIRAMIC system to detect strains producing extended-spectrum-betalactamase (ESBL) was evaluated through the comparison with two phenotypic confirmatory tests: double-disk synergy test and E-test. Ninety seven clinical isolates of Escherichia coli y Klebsiella spp. previously characterized; not repeated and suspected of being ESBL producers were studied by the three methods. In comparison with E-test and double-disk synergy test, DIRAMIC system showed a sensitivity of 85.7 percent and 92.7 percent as well as specificity of 100 percent and 92.9 percent; respectively. The values found have a very high degree of concordance (kappa index > 0.80). The results obtained vouch for the utility of the DIRAMIC as a rapid method to alert about the presence of strains producing ESBL enzymes.

Se evaluó la capacidad del sistema DIRAMIC-Cuba para detectar cepas productoras de p-lactamasas de espectro extendido (BLEE), mediante la comparación con dos métodos fenotípicos confirmatorios: doble difusión con discos y E-test. Noventa y siete aislados clínicos de Escherichia coli y Klebsieüa spp previamente caracterizados, no repetidos, sospechosos de producir BLEE se estudiaron por los tres procedimientos para determinar sensibilidad, especificidad y concordancia entre los resultados. Para el sistema DIRAMIC se encontró una sensibilidad de 85,7 y 92,7 por ciento y una especificidad de 100 y 92,9 por ciento en comparación con E-test y doble difusión con discos, respectivamente. Los valores de concordancia encontrados fueron muy altos (índice kappa > 0,80). Los resultados obtenidos avalan la utilidad del sistema DIRAMIC como vía rápida, para alertar al médico acerca de la presencia de cepas productoras de BLEE, aunque es necesario profundizar y ampliar el estudio a modo de emitir resultados más precisos.

Cephalosporins susceptibility test in urinary tract infections

This study was conducted at the Al Kindy Teaching Hospital to determine the resistance patterns tocephalosporins of members of the family Enterobacteriaceae isolated from urinary tract infections [UTIS]. A total of 270 urine specimens were collected from February, 2008 to May, 2008. Determination the Resistance patterns to cephalosporins in Enterobacteriaceae isolated from urinary tract infection. Urine specimens were processed for culture, and susceptibility testing using Kirby-Bauer method. The minimum inhibitory concentration [MIC] was determined by twofold dilution. Escherichia coli was found to be the most organism, followed by Klebsiella spp. The results of susceptibility of isolates under study to different cephalosporins were moderately or highly resistant to many of the test agents. The observations on the minimum inhibitory concentrations [MICs] and minimum bactericaidal concentrations [MBCs] for the cephalosporins explained the high level of resistance to cephalothin and cefaclor, and a moderate level of resistance to cefotaxime, ceftazidime and cefixime. The increasing MIC of cephalosporins, especially third generation, indicates decreasing susceptibility of these organisms to these types of beta-lactam agents due to the production of extended spectrum beta-lactamases [ESBLs]

Etiology and antimicrobial susceptibility pattern of bacterial conjunctivitis in children at Princess Rahmah Hospital in Jordan

bacterial conjunctivitis, chiefly affecting young children, is generally caused by different pathogens. Therefore, this study aims to investigate microorganisms causing bacterial conjunctivitis in children and to assess their sensitivity to various groups of antimicrobial. A retrospective study was conducted on positive cultures taken from 39 children aged below 15 years, who attended as outpatient or inpatient at Princess Rahmah Hospital between January and December/ 2008. The obtained data were analyzed and the results were tabulated. A total of 39 isolates were recovered from cultures obtained from children patients. The male and female isolates ratio was [1.6: 1.0]. The most frequent pathogen found was S. aureus [56.4%], followed by Klebsielia spp. [18.0%], Streptococcus spp. [12.8%], Pseudomonas spp [5.1%], E. coli [5.1%] and Moraxella was found in only one culture [2.6%]. Ciprofloxacin had the highest susceptibility rate [90.4%] for all the tested isolates, followed by cefotaxime [72.7%] and vancomycin [71.4%]. Whereas, cefixime showed the lowest susceptibility rate [0.0%] for all the tested isolates. S. aureus was the main isolate of conjunctivitis in children, which almost all isolates were susceptible to ciprofloxacin, cefotaxime, and vancomycin. Overall cefixime resistance rate was 100%. This information should be considered when empirical therapy is recommended or prescribed for children with bacterial conjunctivitis

Etiology and antimicrobial susceptibility pattern of otitis media in children at Princess Rhamah Hospital in Jordan

Otitis media is one of the most common infections in children. Recently it was noticed that there is a marked increase in relapse of otitis media in children. Therefore, this study conducted to investigate microorganisms causing otitis media in children and to assess their sensitivity to various groups of antimicrobial. A retrospective study was conducted on positive cultures taken from 173 children aged below 15 years, who attended as outpatient or inpatient at Princess Rahmah Hospital between January and December/ 2008. The obtained data were analyzed and the results were tabulated. A total of 173 isolates were recovered from cultures obtained from children patients. The male and female isolates ratio was [1.24:1.0]. The most frequent pathogen found was S. aureus [68.2%], followed by Streptococcus spp. [12.1%], H. influenzae [9.3%], Psudomonas spp [6.9%] and Klebsiella spp. [3.9%]. The susceptibility rate of S. aureus was recorded the highest [95.9%] for vancomycin, and the lowest susceptibility rate [31.8%] was recorded for oxacillin. S. aureus was the main isolate of otitis media in children, which almost all isolates were susceptible to cefotaxime, ciprofloxacin and vancomycin. Overall oxacillin resistance was near 67%. This information should be considered when empirical therapy is recommended or prescribed for children with otitis media

Avaliação da ação antimicrobiana de soluções multiuso para desinfecção de lentes de contato hidrofílicas, in vitro / Antimicrobial efficacy assessment of multi-use solution to disinfect hydrophilic contact lens, in vitro

OBJETIVO: Avaliar a influência da ação antimicrobiana das soluções multiuso para desinfecção de lentes de contato hidrofílicas. MÉTODOS: Duas soluções multiuso denominadas solução A (poliquaternário-1 a 0,001 por cento e miristamidopropil dimetilamina a 0,0005 por cento) e solução B (poliaminopropil biguanida a 0,0001 por cento) foram testadas em lentes de contato hidrofílicas contaminadas com Pseudomonas aeruginosa (ATCC27583), Staphylococcus epidermidis (ATCC1226), Klebsiella pneumoniae (ATCC13883), Staphylococcus aureus (ATCC25923) e Candida albicans (ATCC 10231) para verificar a quantidade de redução do crescimento dos microrganismos após o enxágue com as soluções. Foram seguidas as instruções preconizadas pelos fabricantes. RESULTADOS: Houve redução de 90 por cento do crescimento de Pseudomonas aeruginosa, Staphylococcus epidermidis, Staphylococcus aureus e Candida albicans. Não houve crescimento de Klebsiella pneumoniae. CONCLUSÃO: As soluções testadas neste trabalho mostraram redução do número de microrganismos testados.

PURPOSE: To evaluate the efficacy of disinfecting solutions in hydrophilic contact lenses (CL). METHODS: Two multi-use solutions denominated solution A (0.001 percent polyquaternium-1 and 0.0005 percent myristamidopropyl dimethylamine) and solution B (0.0001 percent polyaminopropyl biguanide) were used. The solutions were tested in hydrophilic contact lenses infected with Pseudomonas aeruginosa (ATCC27583), Staphylococcus epidermidis (ATCC1226), Klebsiella pneumoniae (ATCC13883), Staphylococcus aureus (ATCC25923) and Candida albicans (ATCC 10231) and the decrease in microorganisms growth after the hydrophilic contact lenses were cleaned with the respective solutions was verified. The manufacture's instructions were followed. RESULTS: A decrease of 90 percent of Pseudomonas aeruginosa, Staphylococcus epidermidis, Staphylococcus aureus, Candida albicans and a decrease 100 percent of Klebsiella pneumoniae was observed. CONCLUSION: The solutions decreased the amount of microorganisms tested.

[Prevalence of pathogens and antimicrobial susceptibility patterns in urine cultures of patients referred to Avesina medical center in Qazvin]

Knowledge of antimicrobial susceptibility is a suitable method in empirical use of antimicrobial agents. This study was designed to detect the prevalence and antimicrobial susceptibility patterns of urinary tract infections. This prospective study investigated the positive urine cultures of out-patients and inpatient of Avesina Teaching hospital in Qazvin during 3 months from July to September 2007. The antimicrobial Susceptibility Testing was performed by disk diffusion method. Among 224 urine samples, E coli was the most common species [61.2%] followed by Pseudomonas [10.3%], Kelebsiella [8.9%], and coagulase negative staphylococci [6.3%]. Nitrofurantoin [72.4%] and Amikacin [77%] were shown to be the most effective drugs on E coli species with Amikacin showing the highest efficacy on Pseudomonas species [50%]. E coli was the most common pathogen with maximum susceptibility to Nitrofurantoin. Hence, the administration of this drug in treatment of indoor and uncomplicated forms of UTI is recommended. Intravenously, Amikacin was found to be the most effective agent for such clinical complications

TEM & SHV genes in extended spectrum beta-lactamase producing Klebsiella species beta their antimicrobial resistance pattern.

BACKGROUND & OBJECTIVES: Extended spectrum beta-lactamases (ESBLs) are often plasmid mediated derived from mutations in the classic TEM and SHV genes by one or more amino acid substitution around the active site. Detection of TEM and SHV genes by molecular methods in ESBL producing bacteria and their pattern of antimicrobial resistance can provide useful information about its epidemiology and risk factors associated with these infections. We investigated the presence of TEM and SHV genes in ESBL producing Klebsiella spp. and their antimicrobial resistance pattern in cases of neonatal septicaemia in a tertiary care hospital. METHODS: A total of 130 clinical isolates of Klebsiella spp. isolated from septicaemic neonates of a neonatal intensive care unit (NICU) from a tertiary care hospital in north India, were screened for ESBL production by combined disk diffusion method. PCR was used to detect TEM and SHV genes in ESBL positive isolates. Isoelectric points of ESBL enzymes from a few isolates (n = 6) were noted for typing of ESBL by isoelectric focusing. RESULTS: Of the 64 ESBL producing Klebsiella spp. isolates, 17 (26.5%) had both TEM and SHV genes, 31 (48.4%) had TEM alone and 13 (20.3%) had SHV gene alone. Three (4.6%) ESBL positive isolates were negative for both TEM and SHV. Isolates with both TEM and SHV genes were highly resistant to antibiotics used. Degree of resistance for 3(rd) generation cephalosporins was also high in these isolates. Six randomly selected isolates were subjected to isoelectric focussing. Results of isoelectric focussing were comparable with PCR. INTERPRETATION & CONCLUSION: Presence of TEM gene in ESBL producing Klebsiella spp. was more common than SHV gene. Frequency of antibiotic resistance was high in isolates having both TEM and SHV genes.