Isolation of bacteriophages to multi-drug resistant Enterococci obtained from diabetic foot: A novel antimicrobial agent waiting in the shelf.

Introduction: While foot infections in persons with diabetes are initially treated empirically, therapy directed at known causative organisms may improve the outcome. Many studies have reported on the bacteriology of diabetic foot infections (DFIs), but the results have varied and have often been contradictory. The purpose of the research work is to call attention to a frightening twist in the antibiotic-resistant Enterococci problem in diabetic foot that has not received adequate attention from the medical fraternity and also the pharmaceutical pipeline for new antibiotics is drying up. Materials and Methods: Adult diabetic patients admitted for lower extremity infections from July 2008 to December 2009 in the medical wards and intensive care unit of medical teaching hospitals were included in the study. The extent of the lower extremity infection on admission was assessed based on Wagner's classification from grades I to V. Specimens were collected from the lesions upon admission prior to the initiation of antibiotic therapy or within the first 48 h of admission. Results: During the 18-month prospective study, 32 strains of Enterococcus spp. (26 Enterococcus faecalis and 06 E. faecium) were recovered. Antibiotic sensitivity testing was done by Kirby-Bauer's disk diffusion method. Isolates were screened for high-level aminoglycoside resistance (HLAR). A total of 65.6% of Enterococcus species showed HLAR. Multidrug resistance and concomitant resistance of HLAR strains to other antibiotics were quite high. None of the Enterococcus species was resistant to vancomycin. Conclusion: Multidrug-resistant Enterococci are a real problem and continuous surveillance is necessary. Today, resistance has rendered most of the original antibiotics obsolete for many infections, mandating the development of alternative anti-infection modalities. One of such alternatives stemming up from an old idea is the bacteriophage therapy. In the present study, we could able to demonstrate the viable phages against MDR E. faecalis.

Detection of extended spectrum beta-lactamase from clinical isolates in Davangere.

Extended spectrum beta-lactamase enzymes (ESBLs) are enzymes that have the ability to hydrolyze oxyiminocephalosporins and infections by isolates producing them are often difficult to treat. A study to detect the presence of these enzymes in isolates was conducted by our hospital. A total of 207 non repetitive isolates were screened for resistance to any of five screening agents. Those with suspicious profiles were checked for ESBL production by double-disk approximation or a synergy test. The isolates were also subjected to a phenotypic confirmation test as recommended by CLSI (formerly NCCLS). Various cephalosporins-beta-lactamase inhibitor combinations were also tested. Of the 204 (98.5%) screen-positive isolates, only 126 (61.7%) were identified as ESBL producers. Of these, 26.1% of the isolates were positive by using the double-disk synergy test (DDST) method alone, 13.4% were positive using the method recommended by CLSI, and 60.3% of the isolates were positive by both the DDST and CLSI methods. We also report a high percentage of resistance to cefoxitin (96.8%) indicating changes in porins.

Study of bacterial, fungal, and parasitic contaminaiton of currency notes in circulation.

A total of 100 currency notes of various denominations in circulation were randomly studied for bacterial, fungal and protozoal contamination. All except four notes yielded one or more bacteria. Bacterial culture yielded single isolate in 33 notes, two in 44 notes, three in 12 notes and four in 7 notes. The predominant bacterial isolate was Bacillus sps followed by Coagulase negative Staphylococci and Micrococcus sps. Other bacteria that are either potential or confirmed pathogens included K. pneumoniae, E. coli, S. aureus, Pseudomonas sps and S. typhi. Only two notes were positive for Acid fast bacilli. 28 samples did not yield any fungal growth. Overall 118 fungal isolates were isolated, of which 34 could not be identified. All the fungi isolated were saprophytes. Saline and Iodine wet mount did not reveal any parasitic forms. We recommend that currency notes must be handled with caution.