High Burden of Antibiotic Resistant Bacteria Isolated from Tracheal Culture in a Tertiary Care Institute

Introduction: Multidrug resistant bacteria is causing a veryserious problem in the proper treatment and management ofsick patients in ICU’s. Study aimed to find out antimicrobialsusceptibility pattern of bacterial isolates from trachealculture.Material and methods: This study was carried over a periodof 6 months from July to December 2017 in the departmentof microbiology. Total of 470 tracheal aspirates were studied.Each specimen was streaked on 5% sheep blood agar andMacConkey agar. After isolation and identification, sensitivityof selected organisms against different antibiotics was studiedResults: Out of 470 tracheal aspirates, 328 samples showedsingle bacterial growth, 76 were sterile; contaminants weregrown in 58 samples and in remaining 8 samples yeast weregrown. The incidence of positivity in our study was 83.8%,with gram negative bacteria outnumbering the gram positiveones. Of the 328 samples which showed bacterial growth,Acinetobacter spp 159(40.3) was the most common organismfollowed by Klebsiella pneumoniae 72(18.2), Pseudomonasspp 46(11.6), Escherichia coli 27(6.8), Staphylococcus aureus13(3.2), Klebsiella oxytoca 5(1.26), Enterococcus spp 3(0.76),Proteus spp, Citrobacter spp, Providencia stuartii 1(0.25)each. Also XDR (extensively drug resistant) bacteria wereisolated at a high frequency (67%) with Acinetobacter spp.being the most common 128(56.6)) followed by Klebsiellaspp. 39(17.2) Pseudomonas spp. 38(16.8), and E.coli 12(5.3).Conclusion: Gram negative were main organisms responsiblefor lower respiratory tract infections in hospitalized patientsand the majority of the isolates belong to XDR and MDRcategory.

Clinicoepidemiological Profile of Organophosphorus Poisoning in a Tertiary Care Center

Introduction: Organophosphorus compounds are widelyused as insecticides. Organophosphorus poisoning hasa significant morbidity and mortality and is a commonoccurrence due to their easy accessibility. Study aimed toassess clinicoepidemiological profile of organophosphoruspoisoning.Material and methods: Our study was a hospital basedprospective study conducted over a period of two yearsinvolving all the patients of organophosphorus (OP)poisoning, admitted in the medical emergency of the hospital.These patients were evaluated for demographic and clinicalprofile and followed till the time of discharge or death.Results: 102 cases of OP poisoning were admitted, majoritybelonged to the age group of 15-25 years (54.9%) and were ofrural origin (84.3%). Females (67.64%) outnumbered males.97 cases had taken it with suicidal intent. Miosis was themost consistent clinical feature (93.13%). 64 patients (62.7%)needed admission in ICU. Respiratory failure was the mostcommon complication. Mortality rate of 14.7% was observed.Conclusion: OP compounds are ingested mostly with suicidalintent due to their easy availability mostly by young andproductive population. Initial management and resuscitationin periphery is invaluable

Improved diagnosis of central nervous system tuberculosis by MPB64-Target PCR / Diagnóstico da tuberculose do sistema nervoso central por MPB64-Target PCR

Central nervous system (CNS) tuberculosis is a serious clinical problem, the treatment of which is sometimes hampered by delayed diagnosis. Clearly, prompt laboratory diagnosis is of vital importance as the spectrum of disease is wideand abnormalities of the cerebrospinal fluid (CSF) are incredibly variable. Since delayed hypersensitivity is the underlying immune response, bacterial load is very low. The conventional bacteriological methods rarely detect Mycobacterium tuberculosis in CSF and are of limited use in diagnosis of tuberculous meningitis (TBM). This double blind study was, therefore, directed to the molecular analysis of CNS tuberculosis by an in-house-developed PCR targeted for amplification of a 240bp nucleotidesequence coding for MPB64 protein specific for Mycobacterium tuberculosis. Based on the clinical criteria, 47 patients with CNS tuberculosis and a control group of 10 patients having non-tubercular lesions of the CNS were included in the study. Analyses were done in three groups; one group consisting of 27 patients of TBM, a second group of 20 patients with intracranial tuberculomas and a third group of 10 patients having non-tubercular lesions of the CNS acted as control. There were no false positive results by PCR and the specificity worked out to be 100 percent. In the three study groups, routine CSF analysis (cells and chemistry), CSF for AFB smear and culture were negative in all cases. PCR was positive for 21/27 patients (77.7 percent sensitivity) of the first group of TBM patients, 6/20 patients (30 percent sensitivity) of the second group with intracranial tuberculomas were positive by PCR and none was PCR-positive (100 percent specificity) in the third group. Thus, PCR was found to be more sensitive than any other conventional method in the diagnosis of clinically suspected tubercular meningitis.

A tuberculose do sistema nervoso central (CNS) é um problema clínico sério, cujo tratamento é dificultado pelo diagnóstico tardio. O diagnóstico laboratorial rápido é de importância vital considerando que o espectro da doença é amplo e as anormalidades do liquor são muito variáveis. Considerando que a hipersensibilidade tardia é a resposta imune fundamental, a carga bacteriana é muito baixa. Os métodos bacteriológicos convencionais raramente detectam Mycobacterium tuberculosis no liquor e são de uso limitado para diagnóstico da meningite tuberculosa (TBM). O presente estudo duplo-cego objetivou a análise molecular da tuberculose do CNS através de um PCR desenvolvido in-house direcionado para a amplificação de uma seqüência de nucleotídios de 240pb que codificam a proteína MPB64 especifica de Mycobacterium tuberculosis. Baseando-se em critérios clínicos, selecionou-se 47 pacientes com tuberculose do CNS e um grupo controle de 10 pacientes com lesões não-tuberculosas no CNS. As análises foram divididas em três grupos: um grupo de 27 pacientes com TBM, um segundo grupo com 20 pacientes com tuberculomas intracraniais e um terceiro grupo de 10 pacientes com lesões não-tuberculosas no CNS (controles). O PCR não forneceu nenhum resultado falso-positivo, com 100 por cento de especificidade. Em todos os três grupos de estudo, os resultados das análises de rotina do liquor por histologia, química e baciloscopia e também cultura foram negativos em todos os casos. No primeiro grupo de pacientes com TBM, PCR foi positivo em 21/27 pacientes (sensibilidade de 77,7 por cento). No segundo grupo de pacientes com tuberculomas intracraniais, 6/20 foram positivos (sensibilidade de 30 por cento). Nenhum dos pacientes do grupo controle foi positivo (100 por cento de especificidade). Dessa forma, o PCR mostrou-se mais sensível que os métodos convencionais no diagnóstico de casos suspeitos de meningite tuberculosa.