Isolation of Enterococcus spp. in various clinical sample and their antimicrobial resistant pattern with MIC of vancomycin in patient attending tertiary care centre, RIMS, Ranchi, Jharkhand

Introduction- Enterococci are part of normal intestinal flora of humans and animals but have also emerged as important pathogens responsible for serious infections in hospital and community acquired infections.it is second most common cause of nosocomial infections in gastrointestinal tract, wound and genitourinary tract. To process all the clinicalAim- samples from various department in our hospital, for isolation of Enterococci spp. To speciate the isolates & to have resistance pattern of the isolates of vancomycin total 926 sample were collected from both outMaterial & Methods- patients and in patient in all clinical departments and transported to microbiology laboratory. specimens were processed by inoculating on to blood agar, MacConkey Agar, nutrient agar, potassium tellurite agar and incubated at 37°C for24-48 hr. Enterococci were identified by their typical arrangement in and salt tolerance test Gram stain, bile esculin test and biochemical tests. Antimicrobial susceptibility patterns were determined by performing Kirby-Bauer disc diffusion method and Minimum inhibitory concentration (MIC) values were identified by tube dilution methods. Result- a total of 926 sample, 645 (69.72%) were culture positive and 281 (30.28%) were culture negative. Among 645 culture positive cases, 81(12.55%) were Enterococcus faecalis. Antimicrobial susceptibility & MIC done as per standard protocols. The E. Faecalis showed 99% sensitive to Vancomycin. the resistance to vancomycin was 1% & further confirmed by MIC via tube dilution methods. In which MIC was ?32 ?g/ml in one isolate. About 8 of Enterococcal strains showed MIC of 0.0125?g/ml. species level identification of Enterococcus is important forConclusions- epidemiological study and also for analysis of drug resistant pattern. Effective detection of vancomycin resistance helps in reducing the morbidity and mortality of VRE in hospitalized patients

Evaluating The Changing Trends In Emergence Of Multidrug Resistance Among Gram Positive Organisms Isolated From Skin And Soft Tissue Infections From A Tertiary Care Hospital, Jharkhand

Drug resistance among gram positive aerobic cocci poses a significant problem in management of patients with skin and soft tissue infections (SSTI's). S. aureus is the most common organism that causes mild skin and soft tissue infections to serious infections such as sepsis and toxic shock syndrome. Enterococcus and Streptococcus species have also emerged as a cause of skin and soft tissue infections and health care associated infections (HAI's). SSTI's is an inflammatory microbial invasion of epidermis, dermis and subcutaneous tissue. It is classified according to the layer of infection, severity of infection and microbiologic etiology. The practice guidelines of the Infectious Disease Society of America (IDSA) for the diagnosis and management of skin and soft tissue infection classifies SSTI's into five categories comprising superficial and complicated infections which include impetigo, erysipelas, cellulitis, necrotizing fasciitis, surgical site infection. Risk factors associated with development of SSTI's include poor hygiene, overcrowding, co- morbidities like diabetes, immunocompromised state, overuse of antibiotics, prolonged hospital stay, burn patients etc. Prompt recognition, timely surgical debridement or drainage with appropriate antibiotic therapy is the mainstay treatment for SSTI's. Empirical therapy includes penicillin, cephalosporins, clindamycin and cotrimoxazole. Multi-Drug resistance is of major concern commonly caused by MRSA (Methicillin resistant staphylococcus aureus) which includes CA-MRSA (Community acquired methicillin resistant Staphylococcus aureus), HA-MRSA (hospital acquired methicillin resistant Staphylococcus aureus), VRSA (vancomycin resistant staphylococcus aureus) & VRE (vancomycin resistant Enterococci). HA-MRSA is generally susceptible to clindamycin, vancomycin, Linezolid & trimethoprim- sulfamethoxazole. In contrast, CA-MRSA is usually sensitive to these former antibiotics as well as broader range of oral antimicrobial agents like clindamycin, linezolid, quinolones, daptomycin, tigecycline etc. These empirical therapeutic agents provide coverage for both S. aureus, Streptococcus species and Enterococcus species. Therefore, demographic knowledge of antimicrobial agents and their resistance pattern plays a significant role in management of SSTI's

Surgical management of varicose veins: a comparative analysis between radiofrequency ablation and open surgery with venous stripping

Background: Varicose veins are a common condition affecting the lower limbs. Apart from having cosmetic problem, if not treated in time it can have some serious complications and are difficult to treat. Multiple modes of surgical management exist for the disease.Methods: This is a prospective clinical study, done over a period of 5-years, between February 2015 to February 2020. Patients were divided into 2 groups: group I (n=103) included those who underwent open surgical to treatment with venous stripping. Group II (n=104) included those who subjected to Radiofrequency ablation (RFA). Groups were selected with comparable physical parameters. Various parameters like bleeding, hematoma, blood requirement, postoperative inflammation, pain, numbness, mobilization, date of discharge and resuming duties were compared. All patients were followed up for 1y ear.Results: Majority of our patients belongs to age group 20-40 years with mean age of 35year in both groups. Male has dominance over female with male to female ratio 4:1. We noticed significant complication in group I than group II, such as bleeding (20:1), hematoma (5:0), inflammation (60:1) and blood requirement (1:0). In group II, we noticed early mobilization of patient (1day v/s 3 days), discharge from hospital (1day v/s 5 days) and resuming duties (5 days v/s 2 weeks).Conclusion: RFA keeps an edge over open surgical treatment with venous stripping.

Prevalence of Non Fermenting Gram Negative Bacilli with Their in vitro Antibiotic Sensitivity Profile in RIMS, Ranchi

Background: Non fermenting Gram Negative Bacilli arediverse and complex group of bacteria that possess very fewdefined characteristics. They are aerobic, non-fermentingGram negative bacilli which were initially considered ascontaminants but have come up with life threatening infectionsin hospitals as multidrug resistant organisms posing a threatbecause of their inherent and acquired drug resistance nature.Aims: Isolation and identification of NFGNB in clinical samplesand determination of their antibiotic sensitivity profile.Materials and Methods: The study was conducted in theDepartment of Microbiology, RIMS, Ranchi from February2017-July 2017. Various clinical samples reaching theBacteriology section of the Department of Microbiology wereprocessed and NFGNB were isolated and identified usingstandard procedure and their antibiotic susceptibility wasperformed.Results: A total of 3581 samples were received out of which2246 were culture positive and 217 were identified as NFGNB.The isolation rate of NFGNB was 9.6%. Number of malesaffected by NFGNB was 121 and that of females was 96.Analysed by specimen NFGNB were isolated from 91 urine, 74pus, 11 ear swab, 6 sputum, 8 body fluid, 21 blood culture and6 catheter tip samples. Urine was most common specimenaccounting for 42% followed by pus (34%), blood (9%), earswab (5%), body fluid (4%), sputum and catheter tip (3%each).The clinical samples from indoor patients yielded highestpercentage of NFGNB (38%) followed by ICU patients (36%)and outdoor patients (26%). Among the NFGNB isolatedPseudomonaas aeruginosa (51%) was the most commonfollowed by Acinetobacter baumanii (22%), Pseudomonas spp(19%), Acinetobacter spp, Stenotrophomonas maltophila,Burkholderia cepacia (2% each), Ralstonia spp &Sphingobacterium spp (1%). Non fermenters were highlysensitive to Imipenem accounting for 91.5% followed byPiperacillin-tazobactam (71.5%), cefoperazone sulbactam(67.7%) & Amikacin (55.6%) on an average.Conclusion: NFGNB considered being contaminants in thepast have now emerged as important health care associatedinfections. In our setting Imipenem can be used for thepreliminary treatment of infections caused by nonfermenters.As these organisms are important opportunistic andnosocomial pathogens causing infections inimmunocompromised patients, better infection control policiesin our settings and its implementation is a must.

Bacteriological Profile and Antibiogram of Bloodstream Infection in a Tertiary Care Hospital, India

Purpose: Blood stream infections (BSIs) are an importantcause of morbidity and mortality worldwide. Continuous orintermittent presence of microorganisms in the circulating bloodis a danger to every organ in the body. BSIs range from selflimiting infections to life threatening sepsis requiring rapid andaggressive antimicrobial treatment.[1] Culture of blood is a vitaltool to diagnose such infections. Antibiotic susceptibilitypatterns help in rationalizing therapy.Objective: The objective of this study was to determine thebacteriological profile and their antibiotic sensitivity patterns ofisolates from blood stream infections.Materials and Methods: This is a retrospective studyconducted from February 2018 to January 2019 at a tertiarycare hospital, RIMS, India. Blood samples were asepticallycollected and incubated in BD Bactec system, a fullyautomated blood culture system for detection of aerobic growthand incubated for 7 days at 37°C. Identification of microbialgrowth was done by standard methods (biochemical tests) andantibiotic sensitivity test was carried out by Kirby-Baur discdiffusion method as per Clinical Laboratory Standards Instituteguidelines (CLSI guidelines).Results: A total of 82 (28%) pathogens were isolated from 289bacteremia suspect patient blood specimens. Gram‑positivecocci (65.85%) were predominant organisms recoveredfollowed by Gram‑negative bacilli (34.15%). Staphylococcusaureus, Klebsiella spp and CoNS, were the primary pathogensisolated. Staphylococcus aureus (48%) was the predominantamong all. Glycopeptides, aminoglycosides, and carbapenems,were the most effective drugs for treating bacteremia.Conclusions: Early diagnosis and appropriate antimicrobialtreatment is the basis for the successful treatment of sepsis.The understanding of local bacteriological profile andantimicrobial susceptibility patterns may help the clinician inrationalizing the empirical treatment strategies.

Seroprevalence of Human Immunodeficiency Virus among Antenatal Women in a Tertiary Care Hospital, India

Introduction: Human immunodeficiency virus (HIV) infection israpidly increasing in world as well as in India since thedetection of first acquired immune deficiency syndrome (AIDS)case in Chennai in 1986. Having seroprevalence rate of lessthan 1%, India is considered as low prevalence country but dueto large population this low prevalence convert in a hugesubset of HIV positive people. Unfortunately India shares onethird of total HIV positive cases of the world. Estimating the HIVseroprevalence in a low risk population of pregnant womenprovides vital information for the successful implementation ofAIDS control program and also for monitoring trend of HIV ingeneral population. Therefore, screening of pregnant women inearly pregnancy may help in prompt counselling and therapy,thereby bringing down the mother to child transmission of HIVinfection.Objective: To determine the rate and trends of seroprevalenceof HIV among antenatal women.Materials and Methods: It is a retrospective study conductedat PPTCT centre, Rajendra Institute of Medical Sciences(RIMS), Ranchi, a tertiary care referral hospital in Jharkhandstate of India from January 2014 to December 2016.The testswere done as per NACO guidelines using COMBAIDS-RSAdvantage-ST, HIV-1/2 TRISPOT and MERISCREEN HIV 1-2WB tests.Results: 19266 antenatal women were included in this study.Out of this 57 women were detected to be positive for HIV,accounting for 0.32% prevalence rate. HIV seroprevalenceamongst antenatal women is 0.32% which is in agreement withthe national projection (0.29% as per NACO annual report2014-2015). HIV seroprevalence rates showed a decreasingtrend from 0.32% in 2014 to 0.16% in 2016.Conclusion: Every antenatal woman should be screened forHIV. Appropriate antenatal screening, interventions andpreventive strategies might bring down the mother to childtransmission of HIV.

Ertugliflozin: a novel anti-diabetic drug

Diabetes Mellitus is a disorder of global proportion. Despite various treatment modalities presently being available, yet the desired glycaemic control and patient outcomes have not been achieved completely. Sodium glucose co-transporter type 2 inhibitors (SGLT2 inhibitors) are one such promising group of emerging drugs in diabetes treatment. Ertugliflozin prevents the reabsorption of glucose by inhibiting sodium-glucose cotransporter-2 (SGLT2) at proximal convoluted tubules. Ertugliflozin is available as 5mg and 15mg tablets. Ertugliflozin has been related to genital mycotic infections and urinary tract infections. Benefits of Ertugliflozin include better control on blood glucose, body weight and blood pressure.

Comparison of drug advertisements published in Indian and foreign journals.

Background: Drug advertisements form one of the major sources for updating drug information by the medical professionals. It has been observed that Indian drug advertisements provide incomplete and poor quality of essential information. However, existing information on comparison of drug advertisements in Indian and foreign journals is limited. Hence, this study was planned to compare the drug advertisements published in Indian and foreign journals. Methods: A total of 200 drug advertisements, 100 each from Indian and foreign journals, were randomly selected excluding those of medical devices, surgical appliances, nutritional supplements and ayurvedic drugs. The drug advertisements from two sources were compared for drug groups, compliance to „Ethical criteria for medicinal drug promotion‟ of World Health Organization (WHO), retrievability of cited reference(s) and mention of any additional information. Results: Drug groups advertised frequently in the Indian journals were those used for chronic diseases whereas chemotherapeutic agents topped the list in foreign journals. Brand names were mentioned in 100% advertisements in both categories of journals whereas information on other ingredients known to cause problems was not mentioned in any of the studied advertisements. Overall, compliance to WHO guidelines by advertisements was 54.6% in Indian journals and 68.2% in foreign journals. The two categories of journals didn‟t differ significantly in retrievability of cited reference(s) and additional information except for information on drug storage which was significantly more mentioned in Indian journals. Conclusions: Drug advertisements in both Indian and foreign journals were incomplete for updating drug information by medical professionals