Speciation of Enterococcus species: better way to deal with clinical infections at resource limited settings

Background: Enterococcus species are well known for its intrinsic resistance pattern to several antibiotics. Hence, appropriate management and prevention is essential in any healthcare facility. Present study was conducted to establish an accessible biochemical tests to differentiate Enterococcus species at resource limited settings.Methods: Enterococci isolated from various clinical specimens were speciated using an array of biochemical reactions and antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. Results were interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines.Results: Out of 107 enterococcal isolates, 63(59%) were E. faecium, 40(37%) were E. fecalis, 2(2%) were E. hirae, 1(0.9%) was E. raffinosus and 1(0.9%) was E. gallinarum. E. faecium and E. fecalis showed 23% and 7% vancomycin resistance respectively, while E. gallinarum showed low level vancomycin resistance.Conclusions: Enterococcus speciation can be done using simple biochemical reactions and its susceptibility pattern enables to distinguish Van phenotypes too. Hence, it is helpful for management of infections in resource limited settings to a greater extent.

Study on reproductive tract infection among the female patients attending the gynecology OPD in a teaching hospitals of Gujarat- India.

Background: Reproductive tract infections (RTIs) often go unnoticed and sexually active young women are particularly susceptible to sexually transmitted Infections (STIs). STIs are among the top five disease categories and about one third of STIs globally occur among people younger than 25 years of age. Present study was carried out to know the socio demographic profile of women suffering from RTI/STI. Sensitivity and specificity of syndromic approach was also found. Aims & Objective: (1) To know the socio-demographic profile of female patients attending the gynecology OPD with complaints of RTIs. (2) To find out the sensitivity and specificity of various diagnostic tests used for diagnosing RTIs. Material and Methods: A cross sectional study was carried out among 150 female patients who have attended the Gynecology OPD with complains suggesting Reproductive Tract Infection (RTI) during March-September 2005. After taking Medical and Obstetric History, vaginal and cervical specimens were collected during pelvic examination for laboratory investigation to confirm the diagnosis of genital tract infection. 5 ml blood was drawn in sterile vacutainer for serology. Various laboratory tests were carried out to confirm the diagnosis of RTI. Results: Out of 150 females patients of reproductive tract infection, 68 (45.3%) were less than 25 yrs. Mean age of the study population was 27.37 ± 5.52 yrs. Majority (133, 88.7%) of the females were housewives. The most common symptom reported was vaginal discharge (147, 98%), followed by lower abdominal pain (114, 76%) Findings of present study revealed that sensitivity of Homogenous white discharge (compared with gram stain) to detect the Bacterial vaginosis was 69.4%. Similarly correlation of Green Yellow frothy (GYF) discharge with culture examination for detection of trichomoniasis revealed, sensitivity of 68.8% and specificity of 99%, which means that all the cases labelled as “not having GYF discharge” also tested negative for trichomoniasis by culture. Sensitivity of curdy white discharge in detecting candidiasis was 69.1% and specificity was 99.1%. Conclusion: Young married women are more prone to Reproductive Tract Infection (RTI). Abnormal vaginal discharge is the most common presenting feature among the sufferers of RTI/STI. Syndromic approach is highly specific in diagnosing RTI.

Assessment of biofilm formation in device-associated clinical bacterial isolates in a tertiary level hospital.

Background: Biofilm formation is a developmental process with intercellular signals that regulate growth. Biofilms contaminate catheters, ventilators, and medical implants; they act as a source of disease for humans, animals, and plants. Aim: In this study we have done quantitative assessment of biofilm formation in device-associated clinical bacterial isolates in response to various concentrations of glucose in tryptic soya broth and with different incubation time. Materials and Methods: The study was carried out on 100 positive bacteriological cultures of medical devices, which were inserted in hospitalized patients. The bacterial isolates were processed as per microtitre plate method with tryptic soya broth alone and with varying concentrations of glucose and were observed in response to time. Results: Majority of catheter cultures were positive. Out of the total 100 bacterial isolates tested, 88 of them were biofilm formers. Incubation period of 16-20 h was found to be optimum for biofilm development. Conclusions: Availability of nutrition in the form of glucose enhances the biofilm formation by bacteria. Biofilm formation depends on adherence of bacteria to various surfaces. Time and availability of glucose are important factors for assessment of biofilm progress.

Sexually transmitted infections and reproductive tract infections in female sex workers.

The present study was conducted in 300 female sex workers (FSWs) from Surat city in 2005-2006. Vaginal swabs, endocervical swabs and serum samples were collected from each of these FSWs. Vaginal samples were screened for bacterial vaginosis (BV), candidiasis and Trichomonas vaginalis . Endocervical swabs were screened for gonococcal infection. Serological tests for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg) and syphilis were performed. From a total of 300 FSWs, BV was detected in 40 (13.33%), trichomoniasis in six (2%), candidiasis in 31 (10.33%), HIV seropositivity in 35 (11.66%), HBsAg reactivity in 10 (3.33%) and rapid plasma regain (RPR) reactivity in 20 (6.66%) cases. RPR-positive serum samples were confirmed by the treponema pallidum hemaglutination test. Gonococcal infection was not found in any of the FSWs. Of the total of 35 HIV-positive patients, 20 patients had associated coinfection. Of the 35 HIV-seropositive FSWs, BV was detected in six (17.14%), candidiasis in six (17.14%), syphilis in five (14.28%) and HBsAg in two (5.71%). One (2.85%) HIV-positive FSW was positive for both candidiasis and syphilis.

Diagnosis of leptospirosis and comparison of ELISA and MAT techniques.

Leptospirosis is perhaps the most common, most wide spread yet under diagnosed zoonosis in the world, Inada et al identified the causal agent in Japan in 1916. Microscopic agglutination test (MAT) developed initially by Martin and Pettit (1918) is the reference method that was successively done after ELISA test to evaluate and compare and make a reliable diagnosis. Blood samples were collected from August 2004 to September 2004 from hospitalized patients of South Gujarat region who were clinically suspected cases of leptospirosis according to WHO case definition. In our setup we separated the sera and carried out ELISA for detection of IgM antibodies and rest of the sera were stored at -20 degrees C. As we do not have the facility for performing MAT test in our centre, we personally carried these sera to Chennai for performing the MAT and identified the serovars prevalent in South Gujarat region. Out of 30 samples tested 16 samples (53.3%) were positive by ELISA and 12 samples (40%) were negative by ELISA. By MAT, 17 samples (56.67%) were found positive and 13 samples (43.33%) were negative. 2 samples were borderline by ELISA and these turned out to be negative by MAT. Cosidering MATas the gold standard the sensitivity of IgM ELISA in this study was 88% and specificity 90.90%. We concluded that IgM ELISA is rapid test and its results are quite similar to MAT. The most common serovars isolated and identified are L. hebdomadis, L. pyrogenes, L. autumnalis and L. grippotyphosa in this part of the country.