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Background: Evaluation of urea and creatinine levels in vaginal wash fluid for the diagnosis of premature rupture of membranes.Methods: The study was conducted on150 pregnant patients, 50 in each group. Confirmed PROM and unconfirmed PROM. Per speculum examination was done to look for pooling, pH tested using the Pehanon paper and vaginal wash fluid was collected. Vaginal wash fluid urea and creatinine levels were tested by a kit based on spectrophotometry.Results: The mean urea levels were 26.35 mg/dl in the study Group 1 and 3.12 mg/dl in the control group. ROC curve was plotted and the cut off value of vaginal wash fluid urea was found to be 8.55 mg/dl. The vaginal wash fluid urea levels of >8.55 mg/dl detected PROM with a sensitivity, specificity, negative and positive predictive value of 100%. The mean creatinine levels were 0.62 mg/dl in study Group 1 and 0.20 mg/dl in the control group. ROC curve was plotted and the cut off value of vaginal wash fluid creatinine was found to be 0.405 mg/dl. Vaginal wash fluid creatinine levels detected PROM with a sensitivity of 76% and specificity of 100%. The negative predictive value and positive predictive values were 80.4% and 100%.Conclusions: Urea can be used as a definite marker of PROM and creatinine can be used as a supportive marker.
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Background: Tigecycline is used as a last line ofdefence against Multidrug Resistant (MDR) strains,and increasing rates of resistance are a growing concernglobally. Tigecycline resistance has been reported invarious pathogens including Acinetobacter spp.,Klebsiella spp., Enterobacter spp., E. faecalis, S.aureus, S. pneumoniae and Serratia marcescens. Aimand Objectives: To study Tigecycline susceptibilitypattern of isolates of Enterobacteriaceae andAcinetobacter spp. from Respiratory Tract Infections(RTI) in a tertiary care hospital. Material and Methods:A total of 7573 respiratory samples were received inMicrobiology Department of Govind Ballabh PantInstitute of Postgraduate Medical Education andst st Research (GIPMER) from 1 January 2018 to 31December 2018. The samples were processed as perstandard techniques. Identification and antimicrobialsusceptibility testing was done by VITEK-2 Compactautomated system and Kirby – Bauer Disc DiffusionMethod as per CLSI Guidelines. Results: Out of total7573 respiratory samples received in laboratory, 1017(13.42%) were culture positive for pathogens.Klebsiella pneumoniae 420(41.29%) waspredominantly isolated microorganism followed byPseudomonas aeruginosa 206(20.25%) andAcinetobacter spp. 193(18.97%). Most of Gramnegative organisms were resistant to commonly usedantibiotics. Carbapenem resistance was observed as67.25%. Conclusion: Overall Tigecycline resistanceamong Carbapenem Resistant Enterobacteriaceae(CRE) and Carbapenem Resistant Acinetobacter(CRA) was found to be 15.50% and 10.69%respectively. Although Tigecycline is a promisingantibiotic for the treatment of infections caused by drugresistant problematic pathogens, Tigecycline resistanceis most frequently observed in A. baumannii andEnterobacteriaceae, especially in MDR strains. Hence,we advocate judicious use of Tigecycline in MDRinfections and it should be kept as reserve.
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Increased mortality due to sepsis and bacteremia impacts health-care activities severely. Administration of broad-spectrum antibiotics empirically may lead to failure of treatment. Toxic effects of non-susceptible drugs can be harmful for the patients and lead
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Background & Objectives: Extended-Spectrum Beta-Lactamase (ESBL) producing members of the family Enterobacteriaceae are emerging worldwide The aim of this study was to evaluate risk factors, co-morbidity status and short term mortality rates among hospitalized patients with and without ESBL producing Enterobacteriaceae spp. urinary isolates. Methods: An analytical cross-sectional study conducted in a super-specialty hospital from December 2014 to July 2015. Urine samples from 100 patients which repeatedly yielded significant colony counts of Enterobacteriaceae spp. isolates were identified using standard biochemical tests. Antibiotic susceptibility testing of these isolates was carried out by modified Kirby Bauer disk diffusion method as per CLSI guidelines 2014. Isolates which were resistant to cefotaxime and/or ceftazidime were tested for the production of ESBL by phenotypic confirmatory disc diffusion test. Relevant clinico-epidemiological details of these patients were subsequently obtained from Medical records as per the proforma formulated. The original version of the Charlson Index (CI) was used to assess co-morbidity and short term mortality rates. Results & Interpretation: Escherichia coli followed by Klebsiella pneumonia were the predominant isolates. 40 isolates were confirmed as ESBL producers. All isolates had Multiple Antibiotic Resistance (MAR) index of >0.2. The p-value of difference in proportion of all the risk factors distributed among patients with and without ESBL producing urinary Enterobacteriaceae spp. isolates respectively was found to be >0.05. The p-value of difference in mean Charlson index scores between these two groups of patients was 0.45. Conclusions: The results obtained in our study are largely inconclusive. It is imperative that more number of multicentre studies should be conducted in order to generate conclusive evidence on this subject. [Mohit B NJIRM 2016; 7(5):40-45]