Study on Metallo-Beta Lactamase Producing Pseudomonas Species in Clinical Isolates of a Tertiary Care Hospital of Western Odisha.

Pseudomonas species are responsible for 10% of hospital acquired infection especially in an ICU set up and in burn patients. Metallo-beta lactamase production is the most common mechanism of resistance to carbapenem which is the most commonly used drug to treat Pseudomonas. Local prevalence of MBL producing Pseudomonas is important information to both microbiologist and clinician to formulate hospital infection control strategy. This cross-sectional descriptive study was conducted in a tertiary care hospital of western Odisha to detect MBL prevalence among clinical isolates of Pseudomonas species.METHODS187 Pseudomonas strains (165 P. aeruginosa and 22 P. putida) isolated in different clinical samples in Vitek 2 system were checked for imipenem resistance (MIC>8 µl/ml). All imipenem resistance strains were checked for MBL production by combined disc test with imipenem, and MBL production was confirmed by MBL E test.RESULTSAmong 187 Pseudomonas strains 12.20% were carbapenem resistant and 9% were MBL producing. About 74% of carbapenem resistant Pseudomonas strains were MBL positive. MBL positivity rate was much higher in Pseudomonas putida (27.20%) compared to Pseudomonas aeruginosa (7%) and in ICU (14.20%) compared to IPD (9.20%) or OPD (6.80%). Colistin was the most effective (97%) antibiotic against MBL producing Pseudomonas.CONCLUSIONSIt is better to prevent MBL Pseudomonas than to cure it as most of the antibiotics were found to be ineffective against it. In our study MBL production rate in clinical isolate of Pseudomonas was low (9%) compared to other studies in India.

Microbial Profile and Antibiogram of Pus Isolate in a Tertiary Care Hospital of Western Odisha.

Pus sample is one of the major samples received in Microbiology laboratory. Overall incidence of wound sepsis in India is 10-33%. A predictable microbial profile in wound infection is very much important for clinician to start empirical therapy and also to combat drug resistance. We wanted to assess the microbial profile and antibiogram in pus isolates causing wound infection in a tertiary care centre of Western Odisha.METHODSThis is a cross-sectional descriptive study. 287 pus samples in total received from different departments of Hitech Medical College, Rourkela, from June 2019 to Dec. 2019 were processed using standard microbial culture methods and antibiotic sensitivity was done as per CLSI guideline.RESULTSAmong 287 samples, 187 (65%) showed positive growth. Among 187 positive samples, 64% were from male population. Middle age group (21-40 and 41-60) was most affected age group (36% and 37.4% respectively). Most commonly isolated bacteria were Staphylococcus aureus (38%) followed by Pseudomonas species (17.10%). Least common bacteria were Streptococcus pyogenes (0.5%). Most of the gram-negative bacilli showed high sensitivity towards imipenem (53-93%), meropenem (80-100%), piperacillin tazobactam (67-100%) and amikacin (67-88%) but lower sensitivity to 3rd generation cephalosporins (36-73%), cotrimoxazole (60-80%), amoxiclav (20-75%) and fluoroquinolones (42-73%). Staphylococcus aureus showed high sensitivity to linezolid (92%), aminoglycoside (84%), clindamycin (88%) and cotrimoxazole (72%) but lower sensitivity to erythromycin (25%), amoxiclav (40%) and fluoroquinolones (44%).CONCLUSIONSStaphylococcus aureus and Pseudomonas species were the most common bacteria isolated in our study with variable antibiogram. Pus aspirate was better sample than pus swab. A continuous inspection should be carried out to monitor the antibiogram of wound isolate to formulate and implement antibiotic policy in our hospital.

Aetiological Profile and Antibiogram of Urinary Isolates Causing UTI in Patients Attending a Tertiary Care Hospital of Western Odisha

Although UTI is a female disease, males are also susceptible during the neonatal period and old age. Asymptomatic bacteriuria, cystitis and acute urethral syndrome are the most common clinical type. Etiological profile is variable in different geographical areas, but E. coli is the most common agent worldwide. Klebsiella, Proteus, Pseudomonas are important causes of hospital acquired UTI. Culture sensitivity of early morning mid-stream urine collected by clean catch technique is the gold standard method of diagnosis of UTI. Sensitivity to 3rd generation cephalosporins and cotrimoxazole is variable in different areas but aminoglycoside, nitrofurantoin and carbapenem are almost sensitive worldwide. Resistance to nitrofurantoin and carbapenem has been reported in many areas of world. Before starting empirical therapy, physician should know the local etiological profile and antibiotic sensitivity pattern of uropathogens. We wanted to study the etiological profile and antibiotic sensitivity pattern of urinary isolates in a tertiary care hospital of Western Odisha.METHODSEarly morning mid-stream urine samples of 730 clinically suspected UTI patients were collected by clean catch technique and sent to microbiology department. Cysteine lactose electrolyte deficient (CLED) agar media was seeded with urine with the help of 0.01 ml (4 mm) loop. After incubation for 24 hrs at 370C growth was observed and identified by Gram stain and biochemical tests. Antibiotic sensitivity was performed by disc diffusion method as per CLSI guidelines. Antibiotic sensitivity was performed for all Gram-negative bacteria, Enterococci and Staphylococcus.RESULTSAmong 730 samples, 238 (33%) showed significant bacteriuria and 63 % of significant bacteriuria samples were from female. Middle age females (36-50 yrs.) were more affected (38%) followed by old age (>50 yrs.) male (19%) and old age (>50 yrs.) female (18%). E. coli was the most common bacteria (31%) followed by Enterococci (18%). Fluoroquinolones like nalidixic acid and norfloxacin showed high resistance rate (31%, 42% in case of Gram-negative bacteria and 12%, 25% in case of Staphylococcus species respectively). Nitrofurantoin showed excellent sensitivity to both Gram-positive cocci and Gram-negative bacilli. (80% for gram-negative bacilli and 87 % for Staphylococcus species and 78% for enterococci species). Aminoglycoside and carbapenem showed excellent sensitivity to Gram-negative bacteria (81% and 92% respectively). Third generation cephalosporins showed poor sensitivity (48% to 53%).CONCLUSIONSEnterococci rather than Klebsiella species was the 2nd most common uropathogen in our study. Aminoglycoside was still useful for UTI. Nitrofurantoin was the best option for empirical therapy.