β-Lactamase production and antimicrobial susceptibility pattern of Moraxella catarrhalis isolates: report from Pakistan

OBJECTIVE@#To assess the frequency of β-lactamase production and antimicrobial resistance in Moraxella catarrhalis isolated from clinical specimens in Pakistan.@*METHODS@#This cross sectional study (January to December 2010) was conducted in clinical microbiology laboratory of Aga Khan University Hospital. A total of 97 clinical respiratory specimens growing Moraxella catarrhalis were included. Frequency of β-lactamase production and antimicrobial resistance rates against ampicillin, erythromycin, ciprofloxacin and tetracycline were noted by performing minimum inhibitory concentration (MIC). MICs were calculated as MIC50 and MIC90.@*RESULTS@#β-Lactamase production was detected in 84% of isolates, which correlated well with high MIC of ampicillin. Majority of isolates were susceptible to erythromycin (97%) and tetracycline (96%) with MIC90=0.12 mg/L and MIC90=1 mg/L respectively. All isolates were found susceptible to ciprofloxacin (MIC90=0.06 mg/L).@*CONCLUSIONS@#Result suggests that empirical use of ampicillin should be discouraged while treating respiratory tract infections. This also emphasizes the importance of continuous surveillance in order to detect emerging resistance in Moraxella isolates.

Association of airborne Aspergillus with asthma exacerbation in Southern Pakistan

BACKGROUND: Exposure to airborne fungi has been related with exacerbation of asthma in adults and children leading to increased outpatient, emergency room visits, and hospitalizations. Hypersensitivity to these airborne fungi may be an important initial predisposing factor in the development and exacerbation of asthma. OBJECTIVE: This study was conducted to determine an association between fungal types and spore concentrations with the risk of asthma exacerbation in adults. METHODS: This cross-sectional study was conducted from May 2008 to August 2009 at the Aga Khan University Hospital Karachi, Pakistan. All adult (age≥16 years) patients presenting to the hospital with acute asthma exacerbation were enrolled after informed consent. A home survey was conducted for each patient to assess their environmental characteristics. Indoor air samples were also obtained from the patient's home to determine the type and spore concentration of fungi within the week of their enrollment in the study. RESULTS: Three hundred and ninety-one patients with an acute asthma exacerbation were enrolled during the study period. The mean age of participants was 46 years (standard deviation, ±18 years) and 247 (63.2%) were females. A trend of higher asthma enrollment associated with higher Aspergillus concentrations was found in two consecutive summers. A total of nineteen types of fungi were found in air samples. Aspergillus spp. was the most frequently isolated fungus with acute asthma exacerbation. CONCLUSION: An association of higher concentration of indoor Aspergillus spp. with asthma exacerbation in adults was observed in this study.

β-Lactamase production and antimicrobial susceptibility pattern of Moraxella catarrhalis isolates: Report from Pakistan

Objective: To assess the frequency of β-lactamase production and antimicrobial resistance in Moraxella catarrhalis isolated from clinical specimens in Pakistan. Methods: This cross sectional study (January to December 2010) was conducted in clinical microbiology laboratory of Aga Khan University Hospital. A total of 97 clinical respiratory specimens growing Moraxella catarrhalis were included. Frequency of β-lactamase production and antimicrobial resistance rates against ampicillin, erythromycin, ciprofloxacin and tetracycline were noted by performing minimum inhibitory concentration (MIC). MICs were calculated as MIC

comparison of disease caused by Shigella and Campylobacter species: 24 months community based surveillance in 4 slums of Karachi, Pakistan

Despite the efforts of the international community diarrheal diseases still pose a major threat to children in children less than five years of age. Bacterial diarrhea has also emerged as a public health concern due to the proliferation of drug resistant species in many parts of the world. There is a paucity of population-based data about the incidence of shigellosis and Campylobacter infections in Pakistan. We report country specific results for Shigella diarrhea that were derived from a multicenter study conducted in six Asian countries. Disease surveillance was conducted over a 24 month period in urban slums of Karachi, Pakistan, a city with a population of 59,584. Cases were detected through passive detection in study treatment centers. Stool specimens or rectal swabs were collected from all consenting patients. Between January 2002 and December 2003 10,540 enteric infection cases were detected. The incidence rate of treated diarrhea in children under 5 was 488/1000/year. In children, 5 years and older, the diarrhea rate was 22/1000/year. 576 [7%] Campylobacter isolates were detected. The pre-dominant Campylobacter species was C. jenuni with an increase of 29/1000 year in children under 5 years. Shigella species were isolated from 394 of 8032 children under 5 years of age. Shigella flexneri was the dominant species [10/1000/year in children under 5 years] followed by Shigella sonnei [3.9/1000/year], Shigella boydii [2.0/1000/year] and Shigella dysenteriae [1.3/1000/year]. Shigellosis and Campylobacter infection rates peaked during the second year of life. The incidence rate of shigellosis increased in old age but such a trend was not observed in Campylobacter infections. Of 394 shigellosis patients 123 [31%] presented with dysentery in contrast to only 54 [9%] of 576 patients with Campylobacter infections [p < 0.001]. Both Campylobacter infections and shigellosis are common in community settings of Pakistan but shigellosis presented more frequently with abdominal pain and dysentery than Campylobacter infections indicating that shigellosis may be a more severe illness than Campylobacter infections. Due to the increased and disease severity, drug resistant shigella have become a significant health problem; moreover it is a disease of poor and impoverished people who do not have the access to standard water and sanitary conditions, health care services or optimal treatment. In the face of these facts it is empirically important to develop a low cost effective vaccine that can protect these populations for a longer duration

Knowledge and beliefs among health care workers regarding hepatitis B infection and needle stick injuries at a tertiary care hospital, Karachi

Hepatitis B virus [HBV] infection is a recognized occupational risk for health care workers [HCWs]. This study aimed to assess the knowledge and beliefs of HCWs regarding HBV transmission and needle stick injuries [NSIs]. A cross-sectional questionnaire based KAP study was conducted at Civil Hospital, Karachi, during the period of January to September 2006. HCWs were inquired about possible modes of HBV transimission and association with NSIs. Data were entered using Epilnfo 6.04d software. Statistical analysis was performed using SPSS 12.5 software. A total of 343 HCWs participated, and those answered at least 5 correct modes of HBV transmission were considered knowledgeable. Knowledgeable group was more likely to report NSIs [p<0.006], more vaccinated [p<0.001] and were also more likely to attend awareness session [p< 0.009]. Overall knowledge were inadequate and behaviour and attitude towards clinical practices were found compromised. To reduce the occupational risk, effort should be focused to establish effective infection control program and training of staff

Plant Root Hair in Tap Water: A Potential Cause for Diagnostic Confusion / 대한진단검사의학회지

Plant root hairs are commonly found artifacts in parasitology specimens and may be confused with helminthes by an untrained eye. We report a case of brain tuberculoma where the tissue sample was contaminated with root hair derived from tap water; the presence of this root hair, which mimicked a larva, led to diagnostic confusion. Therefore, tap water should be considered a source of root hair and vegetable matter.

Antibiotic susceptibility of pathogens isolated from patients with community-acquired respiratory tract infections in Pakistan-the active study

Respiratory tract infections [RTIs] are amongst the most wide spread and serious infections, accounting for over 50 million deaths globally each year. In developing countries, infants under 4 years of age are at greatest risk of lower RTIs, whereas in developed countries the severity of infection and rate of mortality are greater in elderly. The objective of the survey was to determine the in vitro susceptibility of antibiotics commonly prescribed RTIs against Streptococcus pneumoniae [SP], Haemophilus influenzae [HI] and Streptococcus pyogenes, isolated from patients with communityacquired RTIs globally. This survey involved 9 countries. In this study we present the results from Pakistan where SP and HI only were tested. A total of 200 isolates were included in the study. Both SP and HI were in equal number. Antibiotic susceptibility testing was performed by using Clinical and Laboratory Standards Institute guidelines and E test for determination of the minimal inhibitory concentration. For non-US products the Committee of the Antibiogram of the French Society of Microbiology Breakpoints was used. All SP were found susceptible to amoxicillin, coamoxiclave and cefixime, 72% isolates were found sensitive to macrolide and 97% to levofloxacin. All HI were found sensitive to co-amoxiclave and to cefixime, 97% to ampicillin, 98% to clarithromycin and 99% to levofloxacin. In isolates collected from Pakistan, SP resistance rate was elevated for macrolide. SP and HI remain susceptible to beta-lactams as well as to levofloxacin

Primary drug resistance to anti-tuberculous drugs in Karachi

To assess the frequency of primary drug resistance among newly diagnosed tuberculosis cases in Karachi. Multicentric study involving various TB clinics and treatment centres of Karachi between. April to December 2005. The frequency of drug resistance among new TB patients was evaluated using a non-probability convenient sampling methodology. Sputum sample was obtained from 140 newly diagnosed sputum smear-positive patients of pulmonary tuberculosis from various centres of Karachi. Sensitivities were performed by proportion method. Fifteen [11.5%] samples in 130 eligible patients showed primary resistance to one or more drugs. Ten [7.6%] of the isolates tested were resistant to a single drug, none were resistant to 2 drugs, 4 [3.0%] to 3 drugs and 1 [0.76%] to 4 drugs while 1 [0.76%] to all 5 first line agents. Resistance to streptomycin [10 ug/ml] was seen in 8 [6.1%], isoniazid [1ug/ml] in 12 [9.2%], Rifampicin [5 ug/ml] in 4 [3.0%], ethambutol [10 ug/ml] in 1 [0.76%] and pyrazinamide in 6 [4.6%] samples. Primary Multi-Drug Resistance [PMDR] was found in 2 [1.5%] patients. [Isoniazid 1 ug/ml, rifampicin 5 ug/ml with or without other drugs]. In the studied patients, primary drug resistance to at least one anti-tuberculosis drug was 11.5%. It requires an efficiently working anti-tuberculosis programme to prevent escalation including resistance

Frequency and sensitivity pattern of extended spectrum beta lactamase producing isolates in a tertiary care hospital laboratory of Pakistan

To determine frequency, distribution and sensitivity pattern of Extended-Spectrum 6 Lactamase [EBSL] producing organism at a tertiary care hospital in Pakistan. All members of enterobacteriacae isolated between April and August 2002 were studied. Isolates were speciated according to standard biochemical tests. Susceptibility testing was performed by Kirby-Bauer method. ESBL was detected using double disc method using cefotaxime versus cefotaxime plus clavulanate according to NCCLS. Statistical analysis was performed by SPSS version 10. Test of significance were calculated using chi-square test. Results : During the study period, 1137/2840 [40%] of the isolates tested were found to be ESBL producing. ESBL positivity was detected in 50% Enterobacter sp., 41% E.coli and 36% K.pneumoniae. ESBL production was noted in 52% of nosocomial isolates tested [415/799]. ESBL was more frequent in patients at the extremes of ages [under 5 years and more than 60 years]. Cross-resistance to non-beta lactam antibiotics [flouoroquinolones, aminoglycosides and co-trimoxazole] was also more frequent in ESBL producing organisms [p<0.05]. A high frequency of ESBL positivity amongst our isolates is documented which is alarming in low-income settings where expensive second line agents are unavailable. Our data supports urgent need for regular screening and surveillance for these organisms

Frequency of isolation of Shigella Serogroups/Serotypes and their antimicrobial susceptibility pattern in children from slum areas in Karachi

To assess the frequency of serogroups and serotypes, as well as the antimicrobial susceptibility pattern of Shigella species isolated from known cases of diarrhoea and dysentery from Karachi, Pakistan. A cross-sectional study was conducted between January 2002 and March 2003 at Aga Khan University on stool samples received from children with diarrhoea and dysentery from four low socio-economic areas [Sultanabad, Rehri Goth, Hijrat and Sherpao colony] of Karachi. Stool samples yielding growth of Shigella species, were further identified for serotypes by slide agglutination. Antibiotics susceptibility was performed by Kirby Bauer disk diffusion method. Out of 4688 stool samples received, 193 [4.1%] were positive for Shigella species. Shigella flexneri was the predominant serogroup [58%] followed by Shigella sonnei [16%], Shigella boydii [15%] and Shigella dysentriae being the least common [11%]. A number of serotypes were isolated in each serogroup, 8 serotypes in S. flexneri, 8 serotypes in S. dysenteriae, 9 serotypes in S. boydii, and Phase 1 and 2 were found in S. sonnei. 17% isolates remained non-serotypeable. All isolates were susceptible to Ofloxacin and Ceftriaxone, high rate of resistance was observed in Cotrimoxazole [87.75%] and Ampicillin [55.5%]. Emerging resistance against Nalidixic acid [39%] was observed. Shigella still accounts for a significant proportion of bacillary dysentery in many tropical and subtropical countries. Serotype identification can help in devising strategies such as development of effective vaccine for controlling this problem. Increasing antibiotic resistance against commonly prescribed drugs signify that treatment options have become difficult in cases of severe dysentery [JPMA 55:184;2005]

Nalidixic acid screening test in detection of decreased fluoroquinolone susceptibility in stalmonella typhi isolated from blood

To determine the validity of nalidixic acid screening test in the detection of high MICs of fluoroquinolone against Salmonella[S.] typhi isolated from blood and correlate zone diameters of ofloxacin with that of MIC value for nalidixic acid sensitive and resistant strains. Cross-sectional analytical study. Clinical Microbiology Laboratory of the Aga Khan Hospital, Karachi from January 2002 to December 2003. Two hundred S. typhi isolates from blood were included for nalidixic acid screening and ofloxacin susceptibility. Antibiotic susceptibilities for both the antibiotics were obtained by disc diffusion method whereas MICs were determined by standard agar dilution method as recommended by NCCLS guidelines. Sensitivity, specificity and correlation between both antimicrobial susceptibility methods were calculated and results expressed as scattergrams. The results broadly classify S. typhi isolates into nalidixic acid resistant strains with no zone of inhibition around 30 micro g nalidixic acid disc and nalidixic acid sensitive strains with mean zone of inhibition of 24.9mm. All S. typhi isolates with ofloxacin MIC of >/= 0.125 micro g/ml were found to be nalidixic acid resistant [MIC >/= 32 micro g/ml] whereas the isolates with ofloxacin MIC /= 0.125 micro g/ml]. Nalidixic acid resistance as a screening method is proved to be significant in identifying S. typhi isolates with reduced susceptibility to fluoroquinolones. It is also suggested that inhibition zone of

Frequency and sensitivity pattern of extended spectrum beta lactamase producing isolates in a tertiary care hospital laboratory of Pakistan

To determine frequency, distribution and sensitivity pattern of Extended-Spectrum

Cephalosporin resistant shigella flexneri from a clinical isolate - a rare finding

Shigellosis is an important public health problem, especially in developing countries. Antibiotic treatment of dysentery aimed at resolving diarrhea or reducing its duration, and to prevent transmission to other close contacts. Isolates with resistance to first line drugs have been reported throughout world, third generation cephalosporins and quinolones are mainstay of treatment. Shigella flexneri resistant to third generation cephalosporins in a clinical isolate is a rare finding, and this has been reported for the first time in Pakistan

Apache II score as a predictor of the type or virulence of sepsis

A variety of systems for assessing severity of illness in critically ill patients have been described. The APACHE II [acute physiology and chronic health evaluation] is used widely for predicting probability of hospital mortality. We have looked, in our retrospective review, at the correlation between APACHE II scores of patients admitted to our Intensive care unit [ICU] within twenty four hours and the development and type of infection as well as evidence of hemodynamic involvement [i.e. presence of sepsis] as outlined by the criteria described for systemic inflammatory response syndrome [SIRS]. As evidenced by following these patients with increased APACHE II scores and their cultures, we found that many of them had moderate to severe signs and symptoms of sepsis including hemodynamic complications, increased respiratory rate, temperature changes and mental status changes. They were also eventually found to be culture positive for organisms like Candida, Methicillin-resistant Staphylococcus aureus [MRSA], Pseudomonas sp., E. coli, and Klebsiella sp. in the blood, tracheal cultures and urine -organisms possibly virulent in compromised patients even though these patients were intubated and catheterized

Reduction in ventilator - associated pneumonia using bacterial filters: a prospective, observational study

Nosocomial pneumonias related to mechanical ventilation in patients admitted to intensive care units occur in 25-33% of all hospitalized patients. They are responsible for a growing number of deaths in the ICU and represent enormous costs annually. Although they form only 5-15% of hospitalized beds, ICUs account for 10-25% of health care costs internationally. A large amount of this cost goes in treatment and care of patients with ventilator-associated pneumonia [VAT's]. We undertook a prospective observational study in our intensive care unit where a simple bacterial filter was used in the ventilator circuit of each patient and changed daily. The incidence of VAPs occurring over a period of three months [prior and after the intervention] was observed. This study was carried out in our twelve-bedded multidisciplinary ICU in an urban tertiary care hospital. This is an urban referral center where the incidence of VAPs in the quarter prior to the intervention, Oct-Dec 2002, was 13.6 per 1000 patients. Positive VAP was diagnosed based on results of tracheal secretions correlated with clinical findings. A light weight filter [HME] was used in the ventilator circuit and changed on a daily basis. The incidence of VAP dropped to 2/1000 patients in the next quarter, Jan-Mar 2003. Ventilator associated pneumonias contribute to a great deal of the morbidity, cost and mortality as well as duration of stay in ICU patients. The introduction of bacterial filters [at the minimal cost of Rs. 100 or $1.6 daily] has significantly reduced this incidence, thereby pointing towards a positive trend at a minimal cost. This promising intervention should be tested in a larger cohort of patients

Prevalent nosocomial gram negative aerobic bacilli and their antimicrobial susceptibility pattern in intensive care unit

OBJECTIVE: To determine the type of prevalent aerobic gram-negative bacilli and their sensitivity pattern among nosocomial isolates. DESIGN: Prospective collection of clinically significant nosocomial gram negative bacilli. SETTING: Tertiary care hospital in Karachi. METHOD: One hundred isolates were identified by standard methods and minimum inhibitory concentration was checked by epsilometer test. The most frequent isolates were Eschericia coli [43%] followed by Klebsiella pneumoniae [18%] Acinetobacter spp. [7%] Enterobacter spp. [7%] and Klebsiella spp. other than pneumoniae [7%]. Most of the isolates of dominant species [E. coli and Klebsiella pneumoniae] were multiresistant including third generation cephalosporins. This study indicates that most effective antibiotics imipenem and amikacin inhibited most of the isolates. Imipenem alone or amikacin in combination with one broad spectrum beta-lactam drug should be used in initial empiric therapy in any life threatening nosocomial infection