Six‑year susceptibility trends and effect of revised Clinical Laboratory Standards Institute breakpoints on ciprofloxacin susceptibility reporting in typhoidal Salmonellae in a tertiary care paediatric hospital in Northern India.

The antimicrobial trends over 6 years were studied, and the effect of revised Clinical Laboratory Standards Institute (CLSI) breakpoints (2012) for ciprofloxacin susceptibility reporting in typhoidal Salmonellae was determined. A total of 874 (95.4%) isolates were nalidixic acid‑resistant (NAR). Using the CLSI 2011 guidelines (M100‑S21), 585 (66.9%) isolates were ciprofloxacin susceptible. The susceptibility reduced to 11 (1.25%) isolates when interpreted using 2012 guidelines (M100‑S22). Among the forty nalidixic acid susceptible (NAS) Salmonellae, susceptibility to ciprofloxacin decreased from 37 isolates (M100‑S21) to 12 isolates (M100‑S22). The 25 cases which appeared resistant with newer guidelines had a minimum inhibitory concentration (MIC) range between 0.125 and 0.5 μg/ml. MIC50 for the third generation cephalosporins varied between 0.125 and 0.5 μg/ml over 6 years whereas MIC90 varied with a broader range of 0.19–1 μg/ml. The gap between NAR and ciprofloxacin‑resistant strains identified using 2011 guidelines has been reduced; however, it remains to be seen whether additional NAS, ciprofloxacin‑resistant isolates are truly resistant to ciprofloxacin by other mechanisms of resistance.

Bordetella trematum bacteremia in an infant: A cause to look for.

Bordetella trematum spp. nov. has been isolated from wounds, ear infections and diabetic ulcers. We report a case of a 7‑month‑old infant with fever, vomiting and abnormal body movements with bacteremia caused by this novel species. The infant responded to fluoroquinolone and macrolide combination therapy.

Evaluation of diclofenac sodium as a perioperative analgesic.

1. This study was undertaken to assess whether the analgesia conferred by Diclofenac sodium in the post operative period following general surgery is enhanced by preoperative administration of the drug. 2. Two groups of patients were studied. Group I patients received narcotic premedication and Group II patients received Diclofenac sodium as premedication. Post operatively both groups were administered intramuscular Diclofenac sodium 8 hourly for 48 hours. 3. Pain scoring using visual analogue scale indicated a better pain relief in Group II patients. In Group I, 75% patients had a pain score less than 3 whereas 85% in Group II had a pain score less than 3 (Figure 1). 4. Pulmonary function tests were done 24 hours after surgery and revealed improved values of all parameters in Group II patients. This indicates a greater degree of analgesia in Group II patients. 5. Preoperative administration of the drug reduces the initiation of pain in the periphery and decreases the inflammatory response after surgery. 6. NSAIDS do not have any central effect or any respiratory depression. Patients in our study were found to be awake, cooperative and pain free. The additional analgesia conferred by preoperative administration in conjunction with adequate postoperative therapy allows us to recommend Diclofenac sodium as a sole analgesic for perioperative pain relief except in those patients with a bleeding diathesis.

Efficacy & dose-response of intrathecal pentazocine for post-operative pain relief.

With a view to assess the efficacy of intrathecal pentazocine for post-operative pain relief, 60 patients randomly divided into 6 equal groups were administered graded doses (0, 1, 2, 3, 4 and 5 mg respectively) of pentazocine lactate, intrathecally along with 1 per cent bupivacaine. The duration of analgesia was found to be dose related till 3 mg. Higher doses did not increase the duration of analgesia nor were any untoward effects observed. It is concluded that intrathecal pentazocine is safe and effective for post-operative pain relief and 3 mg is the minimum effective dose without side effect.