Prevalence and Risk Factors for Vancomycin Resistant Enterococci Isolated from Clinical Samples in Kashmir, North India: A Hospital Based Study.

Aims: To find out the prevalence and risk factors for vancomycin resistant Enterococci in a leading tertiary care center of north India. Design: Cross sectional study. Place and Duration of Study: Sher-I-Kashmir Institute of Medical Sciences, Srinagar. Kashmir. One year study. Methodology: A total of 400 isolates of Enterococci from patients admitted to our hospital were recovered using standard microbiological procedures, during a period of one year. Antimicrobial susceptibility of these isolates to various antibiotics was performed according to Clinical Laboratory Standard Institute (CLSI) guidelines. Minimum inhibitory concentration (MIC) of isolates found to be resistant to vancomycin on disc diffusion was done by microbroth dilution method. Various risk factors like placement of IV line catheter, urinary catheter, hospital stay and prior use of antimicrobial agents was noted for all the patients. Results: A total of 25 (6.3%) isolates of Enterococci were found to be vancomycin resistant, most of them recovered from the blood samples. E. faecium 16 (64%) was the predominant VRE isolated followed by E. faecalis 9 (36%). Factors like stay in an ICU, prior use of antimicrobials, placement of IV line and urinary catheter were associated with vancomycin resistant Enterococci (VRE) acquisition. Conclusion: VRE were recovered from our hospital and strict adherence to infection control guidelines needs to be followed to control their dissemination.

Lower Respiratory Tract Infections in Intensive Care Units. A Four Year Study from North India.

Title: Lower respiratory tract infections in intensive care units. A four year study from North India. Study Design: Prospective study Place and Duration of Study: Sher-i-Kashmir Institute of Medical Sciences, Srinagar Kashmir. Four years (July 2010 and June 2014). Methodology: A prospective analysis of respiratory specimens from various intensive care units (ICUs) was done over a period of four years. Antimicrobial susceptibility of culture positive isolates to various antibiotics was performed as per Clinical Laboratory Standards Institute (CLSI) guidelines. Gram-negative bacteria (GNB) were screened for extended spectrum β-lactamase (ESBL) and metallo-β-lactamase (MBL) production; whereas methicillin and vancomycin resistance was searched in staphylococci and enterococci isolates respectively. Results: The frequencies of Gram-positive and Gram-negative bacteria were 26% and 68% respectively with yeast recovered in 8% of the specimens. K. pneumoniae and Acinetobacter spp were the most common Gram-negative bacteria and S. aureus the most common Gram-positive one. High level resistance to all the antimicrobials was seen; with K. pneumoniae being the most multidrug resistant GNB isolated in the ICU setting. ESBL production was also highest in K. pneumoniae isolates (67.1%). Also 59.6% of Acinetobacter isolates were found to be MBL producers. Methicillin resistance was seen in 48% of S. aureus and 85.5% of coagulase negative staphylococci (CoNS) isolates with vancomycin resistance seen in 6.7% of enterococcal isolates. Conclusion: An increasing trend over the years in the antibiotic resistance of respiratory pathogens in ICUs of this north Indian state was seen that calls for urgent measures to limit their continued rise.

Novel route of infection in experimental model of hydatid disease.

Viable protoscolices of Echinococcus granulosus injected into Swiss-albino mice by two different routes, viz. intraperitoneal and subcutaneous and in two different concentrations of 2000 and 1000 scolices, to observe the development of cysts have shown that subcutaneous route of infecting a mouse model is superior because of its low infecting dose and longer survival period of mouse. This finding should be helpful in experiments to observe the effect of drugs for the treatment of hydatidosis, in vivo, without the need of killing the mouse.

Methicillin-resistant Staphylococcus aureus: need for constant surveillance,stringent control and vigorous treatment measures.

Staphylococcus aureus has shown a disconcerting propensity to develop resistance to antimicrobial agents and an increasing proportion of these have become resistant to methicillin as well. Regular surveillance should be carried out in every hospital and stringent infection control measures and vigorous treatment should be employed to prevent the nosocomial spread of MRSA. A total of 1056 MRSA were isolated from various specimens received in bacteriology division of SKIMS Srinagar out of which 46.32% were from inpatients and 31.87% from outpatients. None of these strains showed resistance to vancomycin and a good proportion were sensitive to amikacin (80.75%) gentamicin (69%) or ciprofloxacin (63.25%).