In vitro evaluation of a new cefixime-clavulanic acid combination for gram-negative bacteria.

The study was conducted to evaluate a new cefixime-clavulanic acid combination for in vitro susceptibility towards gram-negative bacteria. A total of 220 isolates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeroginosa, Acinetobacter spp, Salmonella enterica serovar Typhi and Salmonella enterica serovar Typhimurium were included in the study. The isolates were tested for susceptibility towards the new combination antimicrobial molecule cefixime with clavulanic acid by disk diffusion and Epsilometer strip (E-strip) Minimum Inhibitary Concentration (MIC) method. Of the 101 E. coli and K. pneumoniae isolates, 62.4% were found to be extended spectrum beta-lactamase (ESBL) producers. Almost half of these were from the community and 55.6% were hospital isolates. Of the ESBL isolates, 19% were AmpC (cephalosporinases that are poorly inhibited by beta lactamase inhibitor) producers while the remaining 81% were non AmpC ESBL producers. The AmpC producers were resistant to both cefixime and the combination, while the non-AmpC producers were sensitive to the combination. The addition of clavulanate to cefixime did not improve the sensitivities of P. aeruginosa and Acinetobacter isolates. There were no ESBL isolates among the S. Typhi isolates, all of which were sensitive to cefixime. Of the S. Typhimurium, 88.9% were ESBL producers and all of these were resistant to cefixime but sensitive to the combination. The combination of cefixime with clavulanic acid offers the advantage of oral administration and appears to be a viable option for the treatment of uncomplicated community acquired infections caused by non-AmpC ESBL producing gram-negative bacteria.

Typhoid fever: narrowing therapeutic options in India.

Typhoid fever remains an important public health problem in India. One thousand four hundred fifty-eight blood cultures were screened, 178 grew out Salmonella enterica serovar Typhi. On agar dilution minimum inhibitory concentration (MIC) testing, 0.6% of the isolates were resistant to ciprofloxacin, 2% to cefotaxime and 1% to cefepime. Nalidixic acid resistance was observed in 51% isolates, of which 98.9% had decreased susceptibility (MIC > or = 0.125-4 microg/ml) to ciprofloxacin. One strain of nalidixic acid sensitive S. Typhi (NASST) also had a decreased MIC (0.125 microg/ml) to ciprofloxacin. Resistance to third and fourth generation cephalosporins is emerging in India and will gain significance in the coming decade. The molecular basis of resistance to cephalosporinsand ciprofloxacin resistance in NASST strains need to be further evaluated for S. Typhi.

Antibody levels against polioviruses in children following Pulse Polio Immunization Program.

This cross sectional study was performed in a tertiary level teaching hospital to evaluate and compare the antibody levels in children below 6 years who had received oral polio vaccination through Pulse Polio Immunization (PPI) with those children who had received both routine immunization as well as PPI. Detail history of polio immunization was taken. Serum samples were then collected for antibody determination by neutralization tests with standard polio viruses using Vero cell lines. Total 400 children were studied; 14 were found unvaccinated. Out of the remaining 386 (96.5%) vaccinated children, 292 (75%) had received both routine and pulse polio immunization, 68 (17%) had only PPI while 26 (6.7%) had received only routine immunization. The seropositivity was lowest for P3 and highest for P2. Overall seroprevalence for PI, P2 and P3 in vaccinated children was 89.1%, 93% and 80.6% respectively, and did not differ significantly between the three vaccinated subgroups. However, children who were immunized by both routine and PPI had higher geometric mean titers (315.5, 484.7 and 187.4 for PI, P2 and P3 respectively) when compared with those who had received only PPI (P<0.001 for each PI, P2 and P3), as well as those who had received only routine immunization with OPV (P<0.05 for PI, p<0.001 for P2, and P<0.01 for P3). Despite the reasonable immunization coverage in study population, there were 29 (7.25%) triple negative cases. Hence other causes of low seroconversion should also be considered to achieve polio free India.

Tuberculosis of the sternoclavicular joint.

A rare case of tuberculosis of the stemoclavicular joint in a 13-year-old girl is presented. The occurrence of tubercular infection in the sternoclavicular joint is extremely rare.