RESUMEN
This study was designed to assess the significance of pyuria as a marker of urinary tract infections [UTIs] in haemodialysis patients and renal tuberculosis as a common a etiology of sterile pyuria. The study was conducted on 50 patients with end stage renal disease [ESRD] on regular haemodialysis [group I], as well as 10 healthy controls [group II]. Fresh urine samples were cultured, examined microscopically for pyuria and tested by Bayer reagent strips for protein, blood, nitrite and leucocyte esterase [LE]. Gram stain of colonies and their identification to the species level using API 20 E system were performed. Ziehl-Neelson [ZN] staining for acid alcohol fast bacilli and Polymerase chain reaction [PCR] for detection of Mycobacterium tuberculosis [MTB] DNA were performed on 24 hours collected urine samples. All patients had pyuria [>/= 5 WBCs/hpf]. Protein, blood, LE and nitrite were significantly higher in patients than in controls [P value <0.01, <0.01, <0.001 and <0.05 respectively]. A significant correlation was found between patients' symptoms and bacterial growth [p<0.1]. Thirty one patients had sterile pyuria; three out of them [10%] were proved to be tuberculous by ZN or PCR. To conclude, pyuria is a common finding in haemodialysis patients and is proved to be a valuable parameter of UTIs in these patients. In symptomatic patients with sterile pyuria, renal tuberculosis should be excluded by ZN staining and/or PCR. In asymptomatic patients, periodic urine culture should be performed to confirm presence or absence of UTIs
RESUMEN
Considering the recent increase in infections caused by non-C. albicans Candida species and the changing spectrum and susceptibility profile of Candida species around the world, this study was undertaken. In this communication, we present data on five major Candida species isolated from candidaemic patients and their antifungal susceptibility profiles. Over a 4-year period, 120 adult inpatients with candidemia, as evidenced by positive blood cultures, were enrolled in the study. Peripheral blood samples were collected for culture, isolation and identification of Candida species by using Bactec automated 9240 system, germ tube test, API 20C sugar assimilation strip test and Vitek 2 cards for yeast identification. All the isolates were checked for purity and speciated by CHROMagar Candida as also by PCR amplification of rDNA. MICs were determined on RPMI agar supplemented with 2% glucose by using E-test strips for amphotericin B, 5-flucytosine, fluconazole and voriconazole. The MIC breakpoints for resistance were based on Clinical and Laboratory Standards Institute [CLSI] criteria and were as follows: amphotericin B, > 1 [micro]g ml-1; 5-flucytosine, > 32 [micro]g ml-1; fluconazole, > 64 [micro]g ml-1 and voriconazole, > 4 [micro]g ml-1. During the study period, a total of 120 bloodstream Candida species were identified. The predominant species isolated was C.albicans [39.2%] followed by C.parapsilosis [29.2%], C.tropicalis [15.8%], C.glabrata [8.3%] and C.krusei [2.5%]. Other yeast species represent 5% . The ratio of C.albicans to non-albicans isolates was 47:73. Except for one [2.9%] isolate of Candida parapsilosis [MIC of >/= 1 [micro]g ml-1], all Candida isolates were susceptible to amphotericin B. Resistance against 5- flucytosine was observed in 2.1% of C.albicans isolates, 2.9% of C.parapsilosis isolates, 10.5% of C.tropicalis isolates and all 3 [100%] C.krusei isolates. Two [4.3%] C.albicans isolates, one [10%] C.glabrata isolate and one [33.3%] C.krusei isolate exhibited resistance to fluconazole. None of the isolates was found to be resistant to voriconazole, including those that showed resistance to fluconazole. It is concluded that, although, amphotericin B and fluconazole are widely used in clinical practice, there was no evidence of enhanced resistance. Interestingly, Candida species isolates exhibiting resistance to fluconazole were not resistant to voriconazole. Hence voriconazole, due to its wider species coverage, could be used in treatment of candidemia cases caused by fluconazole resistant strains of C.krusei
RESUMEN
C.difficile is an important cause of nosocomial diarrhoea and pseudomembranous colitis [PMC], has a mortality rate that ranges from 15 to 30%. Therefore, in this study we investigated the incidence rate, toxigenicity and susceptibility pattern of C.difficile isolates to anti-anaerobic agents. We have also investigated the genotypes of clinical isolates by PCR ribotyping. The study was conducted on 80 patients [40 diarrhoeic and 40 non diarrhoeic] who had history of antibiotic exposure in the previous four weeks as well as on 20 healthy control subjects. The overall incidence rate of C.difficile was 35%. None of the healthy controls had positive culture. Analysis of the cytotoxin producing C.difficile strains showed that 40% of symptomatic and 20% of asymptomatic patients were infected by the cytotoxigenic strains [p<0.05]. A total of 35 C.difficile isolates were investigated for their susceptibility to 15 antibiotics using the E test. Amoxycillin/clavulanic acid, ampicillin, meropenem, metronidazole, penicillin, piperacillin, piperacillin/tazobactam, teicoplanin and vancomycin had excellent activity against all isolates of C.difficile. Multiple resistance to two or more antibiotics was observed in toxigenic, more than the non-toxigenic strains [ratio, 2.75:1] and in symptomatic than the asymptomatic patients [ratio, 2.5: 1]. Interestingly, the 35 C.difficile culture positive patients harboured 10 different, highly diverse PCR ribotypes. Ribotypes 097 [23%] and 078 [17%] were the most prevalent toxigenic ribotypes responsible for over one-third of the cases of C.difficile associated diarrhoea [CDAD] seen. In conclusion, we believe that the extent of C.difficile involvement in diarrhoeal diseases would be better judged by direct comparison with the isolation rates of other enteric pathogens in antibioticassociated diarrhoea. In addition, our finding suggest that metronidazole should remain the drug of choice for the therapy of CDAD. It is also concluded that the prevalent PCR ribotypes of C.difficile strains isolated in our study are different from those found in Europe