Current efficacy of antibiotics against Klebsiella isolates from urine samples - A multi-centric experience in Karachi

Due to emergence of bacterial resistant strains, the effectiveness of current antibiotic treatment without culture/sensitivity testing is questionable. Our study aims to assess the present sensitivity profiles of Klebsiella isolates from urine samples and provide options for empiric prescription in critically ill patients. Klebsiella pneumoniae isolates collected over a period of 28 months till January 2011 from 1, 617 urine samples of subjects presenting with Urinary Tract Infections were identified at a local diagnostic lab using standard protocol and subjected to Kirby-Bauer disk diffusion sensitivity testing. MICs were also estimated by E-nephelometry. Among 20 drugs used, low sensitivity was found to amoxicillin [0.1%], doxycycline [11.5%], nitrofurantoin [15.5%], amoxiclav [18.2%], gentamicin [35.4%], pipemidic acid, cephradine [40.3%] and cotrimoxazole [43.1%]. The isolates were more sensitive to cefuroxime [55.9%], cefixime [57.7%], ciprofloxacin [62.5%], ofloxacin [63%], ceftriaxone [66.2%], ceftazidime [66.4%], cefotaxime [66.6%], fosfomycin [77.5%] and amikacin [89.4]. Most effective were cefroperazone.sulbactam [95.8%], piperacillin.tazobactam [95.7%] and imipenem [97.7%]. Self-medication, lack of awareness, and the misuse of antibiotics by doctors has exacerbated the menace of microbial resistance. The study warrants the prudent choice of drugs in adherence with prevailing sensitivity profiles

Pulmonary arteriovenous malformation in cryptogenic liver cirrhosis

The cause in 10 - 20% cases of liver cirrhosis [LC] cannot be elucidated, and are thus termed cryptogenic. Pulmonary arteriovenous malformations [PAVMs] are relatively rare, but the most common anomaly involving the pulmonary tree. Although the rare correlation between LC and PAVM is well-known, there have been no reports of PAVMs occurring in cryptogenic LC. We report a case of PAVM that occurred in cryptogenic liver cirrhosis in a 3 years old male child. The child presented with complaints of malena, hematemesis and variceal bleed. The examination revealed a child with respiratory distress, irritability, tachycardia, clubbing and abdominal distention. He was worked up for recurrent variceal bleeding secondary to portal hypertension but the oxygen saturation during hospital stay kept deteriorating. The diagnosis of hepatopulmonary syndrome as the cause of persistent hypoxemia in the absence of other cardio-pulmonary causes was then made by enhanced echocardiogram using agitated saline. He improved significantly after liver transplantation performed abroad. At a 6 months follow-up, the child was stable with no evidence of intrapulmonary shunting on repeat echo