To Determine the Frequency of Successful Outcome of Multi-Drug Resistant Tuberculosis Treated as Outpatient in a Tertiary Care Center

Objectives: To determine the frequency of successful outcome of multidrug-resistant tuberculosis treated as outpatient in a tertiary care center. Subject and methods: This was a descriptive cross-sectional study done from 13 April, 2018 to 13 Oct, 2018. All the patients fulfilling inclusion criteria having age 20-60 years of either gender under treatment of MDR-TB for more than six months were enrolled in study the from Programmatic Management of Drug Resistance Tuberculosis (PMDT) site at Department of Pulmonology. Informed consent was taken from patients. Strictly exclusion criteria i.e. patients having neurological or psychological problems before diagnoses of MDR-TB (as per medical record in history), co-infection with HIV, was followed to exclude potential confounder and biases. Education status was evaluated and the response of treatment was checked in matriculate & under matric patients, also socioeconomic status was evaluated by asking about monthly salary whether below or above 12000, and subsequently their effect on treatment outcome. HIV screening is done through ICT method and DST for tuberculosis done on sputum of the patients in the Provincial Reference Lab in Hayat Abad Medical Complex Peshawar for diagnosis. Results: A total of 151 patients were included in this study, among which males were 94, and females were 57. The mean age was 41 years and S.D 10.82. As per the results, 110 (72.84%) patients were having a successful outcome. Conclusion: This study concludes that the out-patient treatment strategy success rate was 72.84% and it is feasible and safe for the treatment of MDR-TB patients.

Study of microbial pattern and antibiotic sensitivity pattern in hospitalised acute exacerbation of COPD patients

Background: Most of the acute exacerbations of COPD are preventable and curable. More than 50% of them are infectious in nature and strain of the pathogen causing them is quite variable from place to place and often determines the severity of exacerbation. Antibiotic resistance has created a bigger challenge for the treating physicians to have a better treatment outcome. Our objective was to study the bacterial profile and antibiotic sensitivity pattern in all acute exacerbation of hospitalized COPD patients.Methods: All patients admitted for COPD exacerbation were evaluated for their sputum culture and sensitivity and followed up.Results: Totally 148 patients were included in the study and organisms were isolated 72 patients. Important organisms isolated were Klebsiella (20), Pseudomonas (16), Streptococci (8), Staphylococcus aureus (8), MTB (4) etc. Many MDR strains were noted. Resistance to newer antibiotics were also noted.64 patients out of 148 required a change in antibiotic (40 in culture positive group, 24 in culture negative group) and there were 12 deaths noted in study. Mortality and morbidity were more in culture negative group and in those who had MDR strains.Conclusions: Gradual shift to gram negative bacilli was observed in infective exacerbation of COPD. Multiple resistant strains were noted and often responsible for poor recovery. Early diagnosis and proper antibiotic selection is the key for a good treatment outcome.

Study of Colistin Sensitivity Pattern of Pseudomonas Aeruginosa in a Tertiary Care Hospital

Introduction: Pseudomonas is an invasive organism thatcauses severe Hospital Acquired Infections in immunecompromised hosts and it exhibits a high degree of resistanceto broad spectrum antibiotics. In recent years Colistin is thedrug of choice for use against MDR strains. The aim wasto study the antibiotic susceptibility and Colistin sensitivitypattern of Pseudomonas isolates from various samples.Material and methods: 100 Pseudomonas aeruginosaisolates from various samples (exudates, bloods and urines)were included and other isolates were excluded in the study.The samples were collected under aseptic precautions.Isolation and identification of the isolates was done as per thestandard guidelines in the lab and AST was done by KirbyBauer disc diffusion method and interpretation was done asper CLSI guidelines.Results: Out of 100 isolates, 36 were from the surgicalwards;30, 20 and 14 were from medical wards, OBG andGHCCD respectively. 83%of isolates were sensitive toColistin and 17% were resistant. MDR strains (both ESBL’sand MBL’s) were detected in 33% and out of these 15.2%were also resistant to Colistin.Conclusion: Colistin is one of the first antibiotics withsignificant activity against MDR Gram negative pathogensand its usefulness has been documented that it will be the “lastline” therapeutic drug in the 21st century. In the present studyit is showing that resistance to Colistin is also increasing,recommending regular monitoring of AST for propermanagement and to limit its use routinely

Zoonotic potential of multidrug-resistant extraintestinal pathogenic Escherichia coli obtained from healthy poultry carcasses in Salvador, Brazil

The zoonotic potential to cause human and/or animal infections among multidrug-resistant extraintestinal pathogenic Escherichia coli from avian origin was investigated. Twenty-seven extraintestinal pathogenic E. coli isolates containing the increased survival gene (iss) were obtained from the livers of healthy and diseased poultry carcasses at two slaughterhouses in Salvador, northeastern Brazil. The antimicrobial resistance-susceptibility profiles were conducted with antibiotics of avian and/or human use by the standardized disc-diffusion method. Antimicrobial resistance was higher for levofloxacin (51.8%), amoxicillin/clavulanic acid (70.4%), ampicillin (81.5%), cefalotin (88.8%), tetracycline (100%) and streptomycin (100%). The minimum inhibitory concentrations above the resistance breakpoints of doxycycline, neomycin, oxytetracycline and enrofloxacin reached, respectively, 88.0%, 100%, 75% and 91.7% of the isolates. Strains with high and low antimicrobial resistance were i.p. administered to Swiss mice, and histopathological examination was carried out seven days after infection. Resistance to goat and human serum complement was also evaluated. The results show that Swiss mice challenged with strain 2B (resistant to 11 antimicrobials) provoked a severe degeneration of hepatocytes besides lymphocytic infiltration in the liver, whereas the spleen showed areas of degeneration of the white and red pulp. Conversely, the spleen and liver of mice challenged with strain 4A (resistant to two antimicrobials) were morphologically preserved. In addition, complement resistance to goat and human serum was high for strain 2B and low for strain 4A. Our data show that multidrug resistance and pathogenesis can be correlated in extraintestinal pathogenic E. coli strains obtained from apparently healthy poultry carcasses, increasing the risk for human public healthy.