Injection practices among practitioners in private medical clinics of Karachi, Pakistan

The aim of this study was to determine the frequency and determinants of sharps injuries among private health practitioners in slum areas of Karachi, Pakistan. All practitioners with at least 1 year of experience in a private medical clinic were asked to complete a self-administered, structured questionnaire [317/397 responded]. Only 7.9% of practitioners were qualified from medical school, 12.3% were registered nurses and 8.8% lacked any professional qualifications. At least 1 sharps injury in the previous 12 months was reported by 26.7%, mostly due to needle recapping. Only 25.2% reported using a new syringe for each patient. In multivariate regression analysis shorter work experience, < 14 years of schooling, > 20 patients per day, administering ? 30 injections per day, reuse of syringes and needle recapping after use were significantly associated with sharps injury in the past year. Better awareness and training on standard precautions is needed for private practitioners in slum areas of Karachi

Comparative antibacterial activity of meropenem, a new carbapenem antibacterial agent

Three hundred ninety three isolates from clinical specimens were tested in-vitro to determine their susceptibility pattern against meropenem and other common antimicrobials.of the 191strains of enterobacteriaceae tested [100%] were susceptible to the new carbapenem. Ninety-two% of the 60 strains of pseudomonas aeruginosa were inhibited by meropenem as compared to 85% for imipenem, and 83%each for gentamicin. Ceftazidime and piperacillin. All the methicillinsuscrptible staphylococci, all pneumococci and 96% of enterococci tested were susceptible to meropenem. The new carbapenem showed excellent activity against all bacteria isolated from clinical specimen at this tertiary care center

Serodiagnosis of parasitic infections at a tertiary care centre in Saudi Arabia

The application of control measures, particularly population based chemotherapy has in many countries greatly reduced the incidence of serious parasitic disease manifestations. Therefore, a restrospective study was carried out to determine the prevalence of parasitic infections, as detected by serological markers at a referral center in Riyadh. A total of 1179 were tested for the following parasitic diseases; 172 for E. histolytica, 219 for echinococcus, 81 for leishmania, 624 for schistosoma and 83 patients for malaria. The prevalence rate for these infections were found to be 24.7% for echinococcus,.2.3% for E. histolytica, 4.9% for leishmania, 38.9% for schistosoma, and 30% for malaria

Hospital based incidence of clostridium difficile enterocolitis and cross reactivity of the latex agglutination test

In order to determine the prevalence and characteristics of antibiotic-associated Clostridium difficile enterocolitis, a total of 2476 specimens from 2356 patients were examined. Of these 224 [9.5%] were positive, 158 [70%] of them occurring in organ transplant, bone marrow transplant or neutropenic patients. Antibiotic-associated colitis due to enterotoxigenic C. difficile was diagnosed by use of cytotoxin assay [CTA]. During a previous study, CTA was compared with a commercial latex agglutination [LA] test and gave a high frequency of false positives. Sixteen of these 31 false positive specimens also had a bacterial pathogen or parasite present. Since a wide range of microbial pathogens/parasites are found in Saudi patients, we also tested stool supernatants from a further 107 patients harboring enteric microbial pathogens/parasites to determine the cross-reactivity of a rapid latex agglutination kit [LA] with these organisms. Only one specimen which grew Salmonella enteritidis gave a false-positive reaction. Since the reagents in the LA test also react with non-toxigenic strains of C. difficile and other anaerobes, the method could be used only as a rapid screening procedure and positive findings should be confirmed by a specific test. Running title: C. difficile toxin enterocolitis

Antibacterial activity of tazocin TM [piperacillin/trazobactam] against 1296 clinical isolates from a tertiary care center

The antibacterial activity of the recently developed Beta-lactamase inhibitor tazobactam with and without piperacillin was studied in recent clinical isolates from patients at a tertiary care center. Although tazobactam by itself had little or no antibacterial activity, the combination with piperacillin was highly effective against piperacillin-resistant Staphylococcus aureus and Enterococci. It was also significantly more inhibitory than piperacillin towards almost all members of Enterobacteriaceae and Pseudomonas aeruginosa tested. The activity was compared with another commercially available combination of penicillin [amoxicillin and Beta-lactamase inhibitor, clavulanic acid], and other drugs commonly used in clinical practice

Laboratory diagnosis of viral diseases-fact, fiction and clinical relevance

After many years of limited use, diagnostic virology has entered the main stream of clinical medicine. Recent developments in tissue transplantation, cancer chemotherapy, and the development of antiviral therapy have greatly augmented the need for rapid and accurate diagnosis of viral infection. Many health care professionals lack clear understanding of the utilization of viral diagnostic facilities as well the methodology used in analysing clinical specimens. This article will give an overview of clinical situations where viral diagnosis is useful, then discuss a number of misconceptions by attending physicians that often preclude viral diagnostic studies. It will then review current methods available for recognition of virus in clinical specimens with emphasis on rapid viral diagnostic tests and their clinical relevance

In-vitro activity of azithromycin: a long-acting azalide

The in vitro activity of azithromycin, an orally active azalide, was compared with that of erythromycin and oral beta-lactams against 893 clinical isolates of staphylococci, streptococci, enterococci, Haemophilus influenzae and Salmonella typhi. MIC[90] of azithromycin for streptococci was 0.12 mg/L, 0.5 mg/L for H. influenzae, 8.0 mg/L for Salmonella typhi and methicillin-susceptible Staphylococcus aureus. Like erythromycin and the beta-lactams tested, it had little or no activity against enterococci, methicillin-resistant S. aureus and coagulase negative staphylococci

Serodiagnosis of adenovirus infections at a tertiary care centre in Saudi Arabia

To determine the seroprevalence of adenovirus infection in tertiary care patients. Retrospective analysis of adenovirus infections by serology. King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. 565 patients treated at a referral centre during January 1987 to January 1992.Results: 13 patients had titres > 1 : 16 in the absence of other pathogens; 11 patients were immunocompromised with five deaths; seven patients experienced pulmonary distress and two had persistent diarrhoea. Adenovirus infection should be considered in the aetiology of severe illness in immunocompromised children

Comparative in vitro activity of newer cephalosporins

To determine the in vitro activity of six new cephalosporins. Determination of minimum inhibitory concentration of new drugs and their comparison with commercially available cephalosporins in clinical use against recent clinical isolates. King Faisal Specialist Hospital and Research Centre, Riyadh [KFSH and RC], Saudi Arabia. 897 bacteria recently isolated from clinical specimens of patients at KFSH and RC. Cefepime, cefpirome, GR 691 53 and Ro 09-1428 were the most active agents against Enterobacteriaceae and Aeromonas hydrophila, inhibiting >90% of them at

Prevalence of intestinal parasites among food handlers in Al-Medinah

Fecal specimens from 13,216 food handlers [male] adults, representing 21 different nationalities, were analyzed for the presence of intestinal parasites at King Abdul Azeez Hospital, Al-Medinah. Approximately 14% of these individuals harbored potentially pathogenic parasites, the most common organism being Giardia lamblia [33%], followed by Entamoeba histolytica [23%], Trichuris trichiura [12.3%], Ascaris lumbricoides [11.8%] and others. The highest incidence of parasitic load was found in Sri Lankans [40.7%]. Although G. lamblia and E. histolytica were found in almost all the nationalities, preponderance of metazoan parasites with complicated life cycles occurred in individuals from tropical countries where optimal conditions of temperature and humidity are favorable for the survival and development of these organisms

Antibacterial activity of fluoroquinolones local clinical isolates from a referral centre in Riyadh

A total of 1,034 clinical isolates from a tertiary care center were tested against six fluoroquinolones, namely norfloxacin, ciprofloxacin, lomefloxacin, sparfloxacin, temafloxacin, and CI-960. Bacteria tested consisted of 579 strains of Enter obacteriaceae, 98 pseudomonads, 51 Acinetebacter, 56 enterococci and 250 isolates of staphylococci. All six fluoroquinolones showed excellent in vitro activity inhibiting >90% of Escherichia coli at an MIC of < 0.03-0.5 mg/L, Klebsiella pneumoniae at 0.12-2.0 mg/L, Enterobacter at 0.12-2.0 mg/L, Serratia marcescens at 0.12-2.0 mg/L, Pseudomonas aeruginosa at 0.5-2.0 mg/L, Staphylococus aureus at < 0.03-1.0 mg/L, and coagulase negative staphylococci at an MIC of 0.12-2.0 mg/L Xanthomonas maltophilia showed some resistance to norfloxacin, ciprofloxacin, lomefloxacin and temafloxacin, but was inhibited by sparfloxacin and CI-960. A majority of isolates of enterococci were resistant to norfloxacin, ciprofloxacin, lomefloxacin and CI-960, but sparfloxacin and temafloxacin inhibited 92% and 82% of these strains, respectively

Etiology of bacterial diarrhea in a major referral center in Saudi Arabia

A total of 34,856 stool specimens from 19,437 patients with symptoms of gastroenteritis were analyzed for bacterial enteropathogens during the period of January 1, 1985, to December 31, 1989, at a major tertiary care referral hospital in Saudi Arabia. Bacterial pathogens were isolated from 1426 [7.3%] patients, with Salmonella being the most frequent [3.8%], followed by Campylobacter [2.0%] Shigella [1.1%], and Aeromonas hydrophila [0.34%]. Salmonella serogroups B and C and Shigella B and D constituted the majority of isolates in these two groups. Major clinical symptoms associated with bacterial gastroenteritis included mild to moderate diarrhea, abdominal discomfort, tenesmus, vomiting, fever, and dehydration. Bloody diarrhea was more common in patients with shigellosis [32%] than in those infected with other bacteria. Stool specimens from 80% of the patients with Shigella gastroenteritis had leukocytes, compared with about 40% of the patients with Salmonella or Campylobacter

Intestinal parasites: incidence and etiology in over 1,000 patients at King Faisal Specialist Hospital in Riyadh

Stool specimens from 3, 817 patients were examined for presence of intestinal parasites during the calendar year 1985 at the King Faisal Specialist Hospital and Research Centre, Riyadh. Protozoan or metazoan parasites were found in 1, 036 [27.8%] patients, yielding a total of 1, 411 organisms. Incidence of potentially pathogenic parasites was 22.9% of the total and commensal was 77.1%. Of the first group, Giardia lamblia was most common, constituting over half of all the parasites within this group, followed by Hymenolepis nana. Among the commensals, Entamoeba coli was encountered most frequently, followed by Endolimax nana and Blastocystis hominis. Although over 77% of the parasites observed were considered non-pathogenic, their presence in the stool strongly suggests the possibility of patient's exposure to environmental conditions that may result in the ingestion of contaminated food or water containing pathogenic parasites