Vancomycin Resistance among Enterococci: Further Limiting Our Therapeutic Options

Introduction: Enterococci are indigenous flora of theintestinal tract, oral cavity & genitourinary tract of human.Over recent years, there is increased interest in Enterococcinot only because of their serious infections but becauseof their increasing resistance to many antimicrobials.Vancomycin being the only alternative available. But over thetime, there has been increase in Vancomycin Resistance whichhas spread globally. The aim of this study was to determinethe prevalence of Vancomycin Resistant Enterococci (VRE)isolated from various clinical specimens in a tertiary carehospital in North India.Material and methods: A cross-sectional study was conductedin the Department of Microbiology, Government MedicalCollege, Amritsar from July 1st, 2018 to June 30th, 2019. Allthe samples received were processed and identification ofEnterococci was made by using standard microbiologicaltechniques. Antimicrobial susceptibility was performed byKirby Bauer disc diffusion method as per CLSI guidelines.Results: Out of total clinical samples (11,098), 3,551 (31.9%)were found to be culture positive. Among the culture positive,91 (2.56%) isolates were identified as Enterococcus speciescomprising of 37 E.faecalis (41%) and 54 E.faecium (59%).Maximum number of Enterococci were isolated from urinesamples (54.92%) followed by pus & body fluids (38.02%) andblood (7.04%). 9.52% of E.faecium isolates were found to beresistant to vancomycin. All the strains were 100% susceptibleto Linezolid, Teicoplanin & Quinupristin-dalfopristin.Conclusion: Enterococci have become the major pathogenicbacteria that cause hospital-acquired infections due tomultiple-antimicrobial resistance. VRE has emerged asimportant nosocomial pathogen and pose serious threat topatients. Vancomycin should be cautiously used else wewould be left with very few therapeutic options.

Bacteriological and Antimicrobial Susceptibility Profile of Orthopaedic Surgical Site Infections

Background: Orthopedic implant site infection is major component of surgical site infection associated with high morbidity and mortality. Implants are foreign to the body so that orthopedic surgery is at risk of microbiological contamination .The changes in pathogenic flora has lead to emergence of antibiotic resistance creating problems in the management of orthopedic diseases. The aim of this study was to determine the type of bacterial pathogens isolated from surgical site infection (SSI) in Guru Nanak Dev Hospital attached to Govt. Medical College, Amritsar and their antibiotic sensitivity profile. Methods: During this period of study from August 2018 to July 2019, 509 pus samples were sent to microbiology department suspected as surgical site infection, from orthopaedic department of Government Medical College, Amritsar. Standard microbiological techniques were used to identify the organisms and determine the antibiotic susceptibility pattern as per CLSI guidelines. Results: In the study, out of 397 (77.6%) positive cultures, 109 (27.45%) Gram positive organisms were isolated among whom Staphylococcus aureus 92 (23.17%) was most common and 288 (72.54%) Gram negative organisms were isolated among whom Klebsiella species 90 (22.67 %) was most common isolate. Conclusion: S. aureus is the most common organism responsible for SSIs. Antibiotic preference should be made according to local sensitivity pattern of the hospital.

Emerging Antimicrobial Resistance in Staphylococcus and Spectrum of Oral Oxazolidinone Linezolid in Multidrug Resistant Staphylococcus in a Tertiary Care Hospital

Introduction: Staphylococcus species is an asymptomaticcolonizer which has exhibited increasing resistance to variousantimicrobial agents in the recent times. Although, theorganism was naturally susceptible to all the antimicrobialagents, it has acquired multi drug resistance via variousmechanisms. In view of rising prevalence antimicrobialresistance, this study was undertaken to study the prevalenceof methicillin resistance and the emergence of linezolidresistance amongst the Staphylococcal isolates obtained fromvarious clinical samples in a tertiary care hospital.Material and Methods: This study was conducted from July2017 to December 2018 in a tertiary care hospital. Clinicalspecimens were processed, and Staphylococcal isolateswere identified using standard microbiological techniques.Antimicrobial resistance pattern of all the Staphylococcalisolates was determined and interpreted as per the latest CLSIguidelines.Results: A total of 989 Staphylococcal isolates were obtainedamongst which 498 (49.44%) were found to be methicillinresistant. Highest antimicrobial resistance was observedto beta lactam antibiotics followed by azithromycin andfluoroquinolones. 26 (2.628%) strains of Staphylococcalspecies were found to be resistant to linezolid while theyretained sensitivity to Vancomycin.Conclusion: The emergence of drug resistance in variousmicroorganisms has been a cause of global concern. Risingtrend of resistance has been observed to methicillin andlinezolid especially in indoor patients of the Intensive careunits. This study highlights the high prevalence of Methicillinresistance in both Staphylococcus aureus and Coagulasenegative Staphylococcus species in a tertiary care hospital inAmritsar, India. Although, linezolid resistance is emerging at aslow pace, adequate measures must be undertaken to preservethe therapeutic armoury.

Comparative Evaluation of Rose Bengal Plate test and ELISA in lab Diagnosis of Human Brucellosis

Human brucellosis is a major bacterial zoonosis reported worldwide. It is mainly an occupational disease reported in farmers, veterinarians, slaughterhouse workers, animal handlers and meat inspectors. Unavailability of automated blood culture systems makes isolation difficult and diagnosis mainly depends on serological and molecular methods. Materials and Methods: In a prospective study, a total of 127 serum samples, 28 from pyrexia of unknown origin (PUO) cases and 99 from high risk cases like veterinary personnel, butchers, nomads, farmers and gawalas, were serologically tested by Rose Bengal Plate Test (RBPT) and enzyme-linked immumosorbent assay (ELISA) and results were analyzed. Results: Out of 127 samples, 20 were tested positive by RBPT while 24 tested positive by ELISA. None of the PUO cases and veterinary personnel tested positive by RBPT or ELISA. Positivity was more among males, urban area, history of animal contact and consumption of raw milk. ELISA was found to be more sensitive and specific than RBPT. Conclusion: In our study significant prevalence of brucellosis was found among occupationally exposed persons. Most of the positive cases were found to be asymptomatic and those who were symptomatic had non-specific complaints. The findings signified silent presence of disease in our society. RBPT can be used as a rapid screening test in the peripheral resource poor labs and in absence of culture ELISA can be used for further confirmation.

Bacteriological Aspect of Bile in Cholecystectomy Patients

Cholecystectomy is currently a frequent performed operation. The presence of gallstones within either the gallbladder or biliary tree is associated with the bacterial colonization of the bile. Acute cholangitis spans a continuous clinical spectrum and can progress from a local biliary infection to advanced disease with sepsis and multiple organ dysfunction syndrome. Therefore, it is important to know the microbiological flora of the gallbladder before prophylactic antibiotics are given. Aim and objectives: 1.To evaluate the bacteriological profile of bile in patients undergoing cholecystectomy. 2. To determine the appropriate antibiotics for prophylaxis in cholecystectomy patients based on the bacteriological profile of bile in our study. Methods: The study was a prospective study carried out in Guru Nanak Dev Hospital, Amritsar. A total of 100 patients undergone cholecystectomy who met the inclusion criteria were included in the study. Bile was aspirated from all patients, this collected bile from gallbladder was transported to the Microbiology Department in 5cc sterile syringe. The specimen was evaluated to find out whether it is sterile or has any bacteria present. Sensitivity of isolated organisms was done against antibiotics. Results: 25 patients showed positive bile culture (25%), whereas bile was sterile in 75 patients (75%). E.Coli was the most common isolated bacteria (60%) followed by Enterococcus (20%), Staph Aureus (8%), Salmonella (8%) and Pseudomonas (4%). Postoperative wound infection was more common (20%) in group of patients with isolated organisms from bile. Conclusion: 25% of bile samples were culture positive. E coli was the most common aerobic bacteria to be isolated from the bile culture . E. coli, salmonella and pseudomonas were most sensitive to piperacillin + tazobactum and imipenum (100%). E. coli also showed sensitivity to amikacin and gentamicin (73.33% each). Enterococcus was most sensitive to linezolid and ampicillin + salbactum (100%) followed by gentamicin and amoxicillin + clavulanate (80% each). Staphylococcus was most sensitive to linezolid (100%). Antimicrobial susceptibility of potential causative organisms and the local susceptibility pattern must be taken into consideration when prescribing drugs to patients with biliary disease.

Microbial Etiology and Antibiogram of SSIs following LSCS in a Tertiary Care Hospital in Amritsar

Surgical Site Infections (SSIs) are the second most commonly reported nosocomial infections after Urinary tract infection following a delivery by caesarean section. They add significantly to the morbidity, mortality and socioeconomic consequences in both patients as well as health care systems. Aim: To study the microbial etiology and antibiogram of post caesarean SSIs. Methods: This prospective study was conducted on pregnant women undergoing elective/emergency caesarean section irrespective of the indication during a study period from Jan 2017 to June 2018. 250 pregnant women undergoing LSCS developing signs and symptoms suggestive of SSI till the 30th post-operative day were included as cases. Under all aseptic precautions, two pus swabs were collected from every post caesarean women enrolled in the study. The first swab was used for gram staining while the other was inoculated on 5% blood agar and Macconkey agar. The isolates were identified by their colony characters and their standard biochemical tests. Antimicrobial susceptibility pattern was performed on Mueller Hinton agar plates by Kirby Bauer disc diffusion methods and interpreted as per latest CLSI guidelines. Results: Among 250 cases suspected of having SSIs, 93 aerobic isolates were obtained. Staphylococcus aureus (41.9%) was the most common organism isolated followed by Acinetobacter baumanii (15.1%), Escherichia coli(11.8%) Klebsiella pneumoniae(9.7%). 15/39(38.4%) of Staphylococcus aureus were observed to be Methicillin resistant. 15/45 (33.3%) of Gram negative isolates were Extended Spectrum Beta- Lactamase producers. Conclusion: Since MRSA is the leading cause of post caesarean SSI and the incidence of multidrug resistant pathogens as a cause of post-operative wound infections is rising with the increased prevalence of ESBL, therefore rational and judicious use of antimicrobials, active surveillance and reporting of SSI, enforcement of aseptic measures, implementation of infection control strategies and their periodic review is the need of an hour to reduce the rate of post caesarean SSIs.

Cellphones A Modern Stayhouse For Bacterial Pathogens.

Cellphones are increasingly used by health care personnels for communication. These can harbour various potential pathogens and become an exogenous source of nosocomial infections. A total of 160 cellphones belonging to doctors and paramedical staff working in various departments at govt. medical college and hospital, Amritsar were screened for bacterial isolates. Sterile swabs moistened with nutrient broth were used to swab the front, back and the sides of the cellphones and were subjected to culture and sensitivity. The same procedure was repeated after decontamination with 70% iso propyl alcohol.Out of total 160 cellphones growth was obtained in 65(40.62%) cellphones. 31(19.37%) from clinical workers and 34(21.25%) from non clinical workers. Coagulase negative staphylococcus was the most commonly isolated organism.The efficacy of decontamination with 70% isopropyl alcohol was found to be 98% as only 5 cellphones showed growth after decontamination.It was found that around 40% of the cellphones of health care workers were contaminated and thus acted as a potential source of nosocomial infections. Simple measures like decontamination with 70% isopropyl alcohol was found to be 98% effective.