Nosocomial Klebsiella infection in neonates in a tertiary care hospital: protein profile by SDS-page and klebocin typing as epidemiological markers.

PURPOSE: To find out the prevalence of Klebsiella in hospital acquired neonatal infections in a tertiary care set up and to evaluate the role of klebocin typing and protein profile by SDS-PAGE in epidemiological typing of the isolates. METHODS: Hospital born neonates transferred to the neonatal unit after birth and available in the unit 48 hours later comprised the study group. Two hundred and three neonates were found eligible for inclusion in the study. Repeated blood cultures, other relevant clinical specimens and environmental samples were collected and identified according to the standard techniques. Isolated clinical and environmental Klebsiella pneumoniae strains were subjected to klebocin typing and protein profiling by SDS-PAGE at regular intervals. RESULTS: Multi drug resistant K. pneumoniae were the commonest organism isolated in 30 neonates leading to the incidence of Klebsiella nosocomial infection to be 14.7%. Klebocin typing of the K. pneumoniae isolates showed four patterns with type 312 being the commonest (43.4%). Whole cell protein analysis by SDS-PAGE of K. pneumoniae isolates revealed four types of banding pattern. Analysis of the typing method showed that the typeability and reproducibility of klebocin was 83.3% and 73.3% respectively whereas typeability and reproducibility of SDS-PAGE was 100%. CONCLUSIONS: Based on the present study it is concluded that SDS-PAGE typing method is better than klebocin typing in neonatal nosocomial infection. It is also suggested that protein profile by SDS-PAGE may be used as a tool for epidemiological typing of Klebsiella pneumoniae isolates in laboratories where genomic based molecular typing technique is not available.

Childhood obesity and hypertension.

Using the criteria of weight(g)/height(cm)2 greater than or equal to 2.26 as cut off point, 292 (7.56%) of the 3,861 school children in the age group 5-15 years were identified as obese. The mean blood pressure levels, both systolic and diastolic, were found to be significantly higher in the obese subjects compared to the controls (p less than 0.001). Further, 10 (3.4%) of the 292 obese subjects were detected to have sustained elevations in BP levels (BP greater than mean + 2 SD for age-sex) on monthly follow-up for 6 months. On the contrary, persistent hypertension was detected in only six (0.16%) of the 3,569 controls. None of these hypertensive children had any symptoms attributable to raised blood pressures and all had only mild elevations in BP levels. Baseline investigations, carried out in 9/16 subjects, failed to document any underlying cause for hypertension. Serum cholesterol levels, however, were elevated in six subjects. This suggests a close association between childhood obesity and essential hypertension.

Normal blood pressures and the evaluation of sustained blood pressure elevation in childhood.

A total of 3,861 school children in the age group 5-15 years were examined to establish the normative values for auscultatory blood pressure and to study the prevalence of sustained elevation of blood pressure in Indian children. Age-sex specific norms of systolic and diastolic blood pressure in the right upper limb were worked out. When the influence of age was minimised, the systolic and diastolic pressure still showed a positive correlation with height and weight. Two hundred and fifty five (6.60%) of the children screened were detected to have blood pressure level in excess of +2 SD of the mean for age and sex on first contact. The number declined to only 16 (0.41%) on re-evaluation 2 months after the initial contact. These 16 children continued to remain hypertensive during monthly follow up for 5 months. Family history of obesity, hypertension, or myocardial-infarction and/or stroke was met with in significantly higher (p less than 0.001) number of children with sustained hypertension as compared to normotensive students.