A Study Of Bacteriological Profile And Their Antibiotic Susceptibility Patterns Of Isolated Organisms From ICU's With Special Reference To Multi-Drug Resistant Organisms.

Background and Aim: Microbes are notorious for rapidly develop drugs resistant due to gene transfer and spontaneous mutation. So their continues surveillance of antibiogram pattern is necessary to detect muti-drugs resistant organisms to improve patients outcome admitted in ICUs. Objective is to detect bacterial organisms causing infection in different ICUs and to know their antibiotic resistance pattern. Methodology: Total 602 different samples were collected from different ICUs and processed for culture, bacterial identification and antibiotic susceptibility testing done according to CLSI recommendation. Results: Out of total 602 samples, 248 (41.02%) were culture positive. The number of isolated Gram negative and Gram positive organisms were 196 (79.03%) and 52 (20.97%) respectively. Most common isolated of Gram negative organism was Pseudomonas spp. 58(23.38%), followed by Acinetobacter spp. 46 (18.55%). While, most common isolated gram positive cocci was coagulase negative staphylococcus spp. 32 (12.95%), followed by Enterococcus spp 8 (3.24%). From total 196 isolates of gram negative, 71.43% were MDROs, 7.14% were XDROs. Out of total 52 gram positive isolates, 40.38% were MDRO, 3.85% were XDRO. Conclusion: Routine Microbiological surveillance helps to guide in implementing better antibiotic policies to improve patient’s morbidity and mortality suffering from multi-drug resistant infections in ICUs.

Prevalence of metallo-β-lactamase producing pseudomonas spp.(in Tertiary Care Hospital).

Background: Metallo-β-lactamase (MBL) mediated resistance to carbapenem is an emerging threat in Pseudomonas isolates. The aim of this study is to detect metallo-β-lactamase producing isolates of Pseudomonas spp. from various clinical samples from indoor patients in a teaching hospital. Materials and Methods: Total 900 bacterial strains were isolated from different clinical samples from indoor patients. The bacterial strains were isolated and identified as per the standard guidelines. Amongst them 100 isolates of Pseudomonas were taken for the present study. All pseudomonas isolates were subjected to antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method (CLSIs). In all imipenem resistant isolates of Pseudomonas spp., MBL detection was carried out by Imipenem-EDTA combined-disc synergy test (CDST). Results: Out of 100 isolates of Pseudomonas, 44 (44%) were imipenem resistant. Of these 44 isolates, 30 were producing MBL enzyme. 30 MBL positive isolate included 12 (40%) from surgical wards, 10 (33.33%) from tuberculosis ward, 4 (13%) from medicine ward, 2 (7%) from paediatric ward, 1 (3%) from urology ward and 1 (3%) from neonatal ICU. All MBL positive strains were resistant to β-lactams, aminoglycosides and fluoroquinolones. Conclusion: Prevalence of MBL producing Pseudomonas spp. is 30%. The MBL producing Pseudomonas spp. isolates were multidrug resistant. It is important to identify MBL producing pseudomonas isolates in laboratory as may cause serious infections and may cause a nosocomial outbreak.

Candida prevalence and its antifungal susceptibility in various clinical specimens in tertiary care center.

Background: The purpose of this study was to isolate the Candida spp. & examine their susceptibility to antifungal drugs from various clinical specimens. One hundred fifty isolates of Candida spp. were included in this study. Clinical history revealed that all patients were on systemic broad spectrum antibacterial drugs. Materials and Methods: Candida spp. was differentiated by germ tube test, culture characteristics on special media for fungus, sugar fermentation, sugar assimilation and growth on corn meal agar. Antifungal drug susceptibility testing against Fluconazole, Ketoconazole, Itraconazole, Voriconazole, Nystatin and Amphotericin B were done on basis of CLSI guidelines on Methylene blue containing Mueller Hinton Agar by disk diffusion method. Result: We found 52% and 48%, C.albicans & Non albicans candida spp., respectively. There were no resistance to Nystatin and Amphotericin B. C.albicans was more susceptible than Non albicans candida. Nystatin & Amphotericin B were susceptible to all isolated Candida spp. In present scenario, Fluconazole is most commonly used empirical antifungal drug, which is more effective to C.albicans than Non albicans Candida. Conclusion: Due to emergence of resistance in Azole group of antifungal among Non albicans candida, it should be mandatory to use antifungal drugs as per the susceptibility testing.

Epidemiological and microbiological profile of infective keratitis in Ahmedabad.

Context: Study of patients attending tertiary care ophthalmology institute at Ahmedabad. Aims: To study the microbiological etiology and epidemiological factors associated with suppurative keratitis. Settings and Design: A total of 150 corneal scrapings were evaluated from patients presenting with corneal ulcers at a tertiary ophthalmology center, Ahmedabad from July 2007 to June 2008. Materials and Methods: Scrapings were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. Socio-demographic data and risk factors were recorded. Results: Ninety percent (135/150) people with corneal ulcers had trauma as predisposing factor for keratitis. Trauma due to wooden objects was the leading cause (46/135) followed by vegetable matter and stone injury (23/135). Microbial etiology was established in 59.3% (89/150) of scrapings. Out of 89 positive isolates, 65.1% (58/89) were bacterial while 34.9% (31/89) were fungal. Among the bacterial isolates, 60.3% (35/58) were Gram-positive cocci while 39.7% (23/58) were Gram-negative bacilli. The most common bacterial isolate was Staphylococus aureus (32.7%, 19/58) followed by coagulase-negative Staphylococci (25.8%, 15/58) and Pseudomonas (18.9%, 11/58). Among the 31 fungal pathogens, Aspergillus species was the most common (35.4%11/31), followed by Fusarium species (22.5%, 7/31). Conclusion: Trauma with wooden material is the most common predisposing factor for suppurative keratitis. Males were more affected than females. Bacterial ulcers were more common than fungal in areas in and around Ahmedabad. Staphylococcus aureus and Aspergillus were the commonest bacterial and fungal isolates respectively. Geographical variation persists in microbial etiology of suppurative keratitis.

Seroprevalence of sporadic acute viral hepatitis with their co-infection at tertiary care hospital.

Background: Viral hepatitis is one of the major causes of mortality & morbidity in developing countries. Present study was aimed to know the seroprevalence and co infection of the acute viral hepatitis caused by hepatitis A, hepatitis B, hepatitis C and hepatitis E virus from patient attending one of the largest tertiary care hospitals. Material and Methods: Study was carried out from May 2009 to June 2010 at our hospital. A total of 556 serum samples were tested for HBsAg, antibody for HCV, IgM antibody of HAV and HEV by ELISA method from the patients having clinical signs & symptoms of acute viral hepatitis. Statistical analysis: Chi square test was done and the association was considered to be statistically significant if p < 0.05. Results: Out of 556 suspected cases of acute hepatitis 281 were positive. Among the total positive cases, IgM anti HAV antibodies was 70 (24.91%), IgM anti HEV antibodies was 141 (50.18 %), HBsAg was 65 (23.13%) and HCV was 5 (1.78 %). Dual infection was seen in 14 (4.98 %) cases with 6 children cases. Among the HAV positive patients, 80% were children, In contrast to that HEV infection (63.1%) and HBsAg infection (61.5%) was common in young adult. HCV infection was found common in adults more than 20 years of age. Overall male was affected more than female. Conclusion: Sporadic HEV infection constitutes significant cause of the acute viral hepatitis. In the light of this result a nationwide survey is recommended to confirm this pattern in the other areas. As vaccine for HEV is not available, prevention in form of improvement of socio - economic and hygienic standards of the population is the better option.

“Seroprevalence of transfusion associated hepatitis c virus (Hcv) in multi-transfused thalassemic children of the tertiary care hospital.”

Aim: To know the seroprevalence of Hepatitis C Virus (HCV) in Multi-transfused Thalassemic Children attending a tertiary care hospital, Ahmedabad, Gujarat. Material and Methods: Serum sample were tested by Enzyme Linked Immuno Sorbent Assay (ELISA) test for Anti HCV antibody from the thalassemic children over a period of 4 years from January 2006 to December 2009. Result: A total of 163 thalassemic children were tested for antibody of HCV. Out of these HCV antibodies were positive in 38 (23.31 %) patients. Conclusion: Prevalence of HCV infection among the thalassemic cases is much higher than the routine blood donors. in the light of this result a nationwide survey is recommended to confirm this pattern in the other areas and more sophisticated diagnostic tool should be employed to rule out window period of these Transfusion Associated infections.

Salmonella paratyphi-B meningitis, isolated from CSF.

We report a case of meningitis due to Salmonella paratyphi-B, in an 11 month old male infant. The child was admitted in Emergency department with the complains of generalized convulsion and vomiting. On examination patient appearance of child was lethargic and irritable, had marked neck stiffness, with bulging fontanelle, lumbar puncture was done and sent for routine investigation, microscopy, culture and sensitivity. Later on Salmonella paratyphi-B was isolated from CSF.