Comparison of disk susceptibility test of gram-negative rods with MIC for cefoperazone- sulbactam compination

Multi drug resistance [MDR] Acinetobacter to almost all antibiotics has now become a major problem in most hospitals world wide. Cefoperazone /sulbactam and Polymyxin are among the only antibiotics still sensitive against MDR Acinetobacter species. Since Clinical and Laboratory Standards Institute [CLSI] and British Society of Antimicrobial Chemotherapy [BSAC] working party have not included these antibiotics, most clinical laboratories are not performing in-vitro susceptibility against them. We performed a comparative study to find out the sensitivity and specificity of disk diffusion [DD] for in vitro susceptibility test of cefoperazone /subactam with MIC against isolates of Acinetobacter. In-vitro susceptibilities of a total of 42 isolates of Acinetobacter species were performed by MIC [Estrip method] and DD methods. Sensitivity and specificity of the DD was calculated with MIC as standard. Results were analyzed on SPSS version 13.0 and expressed as scattergram. A total of 42 Acinetobacter species were isolated. All were resistant to Cefoperazone alone when checked by DD method. Twenty two were sensitive to Cefoperazone/sulbactam by MIC [< 32/16 Mu g/ml] and 20 were resistant to Cefoperazone/sulbactam [> 32/16 Mu g/ml]. 19 [86%] of sensitive isolates were also sensitive by DD, 18 [86%] of resistant isolates were also resistant by DD. Sensitivity and Specificity of DD were 86% each. Correlation was significant at the 0.01 level [2-tailed]. Among 6/42 discrepancies, 5 were minor and 1 was major. DD method for reporting antimicrobial sensitivity of Acinetobacter species against Cefoperazone/Sulbactam is consistent with MIC with a sensitivity and specificity of 86% each

Subcutaneous phaeohyphomycosis caused by exophiala jeanselmei. A case report

Exophiala jeanselmei is a dematiaceous fungus causing black grain mycetoma, chromoblastomycosis and phaeohyphomycosis. It tends to involve cutaneous, subcutaneous tissues or visceral organs. We present a case of a previously healthy young male with a five year history of multiple soft tissue swellings of the body, as well as indolent soft tissue infection of his digits. He had received several courses of antibiotic and anti-tuberculous therapy without improvement. Two of the subcutaneous cystic masses were aspirated through fine needle and sent for histopathology and culture. Histopathology revealed acute on chronic inflammation with granuloma formation, and septate fungal hyphae with spores. The fungus was identified on culture as Exophiala jeanselmei and a diagnosis of subcutaneous phaeohyphomycosis was confirmed. He was treated with oral itraconazole along with incision and drainage and has shown marked clinical improvement. He continues to be on therapy at this time