Study Of Antibiotic Resistance Pattern Among Gram Positive Isolates Of Diabetic Foot Ulcer, With Special Reference To Methicillin Resistance And Inducible Clindamycin Resistance

One of the important factors contributing to emergence of resistant strains in diabetic foot ulcers (DFUs) is inappropriate and widespread use of antimicrobials, either by patients themselves or primary care providers. So routine testing of antibiotic sensitivity plays a crucial role. Also routine test fails to detect Methicillin resistance (MR) which is mediated by mecA, encoding the PBP 2a and inducible Clindamycin resistance (ICR) due to erm genes. Hence, it is advisable to perform MR testing and D test for detection of inducible Clindamycin resistance routinely during the primary antibiotic testing for the knowledge of their prevalence and measures to be taken to control their spread. The present study included 212 diabetic foot ulcer patients, from which 94 (31.33%) gram positive isolates were obtained, of which 75 (25.0%) were Staphylococcus aureus, 9 (3.0%) were Coagulase negative Staphylococci (CoNS) and 10 (3.33%) were Enteroccocus species. Among the Staphylococcal isolates, Methicillin resistance was seen in 25.33% S. aureus and 33.33% CoNS species. Inducible Clindamycin resistance was seen in 20.0% S. aureus and 33.33% CoNS isolates

Study Of Bacterial Colonization Of Mobile Phones And Writing Pens In Tertiary Care Hospital.

Background and Aim: Health care workers accessories like mobile and pen have become important fomites in spread of health care infections and when used at the patient’s point of care may be responsible for cross contamination. Aim is to determine whether mobile phones and pens could play a role in the spread of bacterial pathogens. Methodology: Swabs from from mobile phones and pens were taken and inoculated on blood agar and MacConkey agar plates and the isolates were identified by standard microbiological procedures. Results: 28 /74(37.83%) mobile phone and 22/74(29.73%) pens showed bacterial contamination. Coagulase negative staphylococcus accounted for the majority of positive isolates. Conclusion: Mobiles and pens are potential reservoir for bacteria. They might be a vector in the transmission of potential pathogenic microorganisms. The risk can be reduced by using alcohol-based sanitizing agents for wiping mobile and pen.

Seroprevalence of HIV-2 in and around Nagpur.

Abstracts: Backround: Human immunodeficiency virus type 2 (HIV- 2) belongs to the family Retroviridae and is morphologically similar to HIV-1. Reliable and up-to- date information on the HIV-2 epidemic in India is still lacking. Methodology: We conducted this study to know the seroprevalence of HIV-2 in our region. Results: A total 15046 samples were screened at ICTC that includes 6343 from ANC mothers and 8703 samples from direct walk-in clients and referred patients.for HIV-2 antibodies. Also, we found 9 (0.10%) samples positive for HIV-2. One patient was coinfected with HIV-1 and HIV-2. There were no HIV-2 positive cases in ANC and paediatric age group. Conclusion: As HIV-2 is being reported from various parts of the country and its treatment modalities differ from HIV-1 hence screening for HIV-2 should be carried out routinely.

A Case-control Study Examining Association between Infectious Agents and Acute Myocardial Infarction.

Background: Coronary heart disease is multi-factorial in origin and its burden is expected to rise in developing countries, including India. Evidence suggests that the inflammation caused by infection is associated with the development of atherosclerosis and heart disease. An increasing number of clinical and experimental studies point to a contribution of various infectious organisms to the development of atherosclerosis in humans. Acute myocardial infarction (AMI) is associated with atherosclerosis. Objectives: The objective of the following study is to study the association between Helicobacter pylori, Chlamydia pneumoniae and C-reactive protein (CRP) with AMI. Materials and Methods: This group-matched case-control study was carried out in Government Medical College, Nagpur, Maharashtra, India. The study compared the risk of occurrence of AMI (outcome) if subjects were ever-infected with H. pylori or C. pneumoniae; and their CRP positivity (exposure). Incident cases of myocardial infarctions in a tertiary care hospital were included as cases. Results: The study recruited 265 cases and 265 controls and detected an odds ratio (OR) of 2.50 (95% confidence interval [CI]: 1.69-3.70) and an OR of 2.50 (95% CI: 1.71-3.65) for C. pneumoniae and H. pylori, respectively. Raised CRP levels had an OR of 3.85 (95% CI: 2.54-5.87). Conclusion: Although our study indicates the role of infections in the etiology of AMI in study population, the relative public health impact of these agents in the overall prevalence of AMI needs urgent research attention.

Effect of mass drug administration on lymphatic filariasis: economic and social impact.

Introduction: Lymphatic filariasis, the second most common vector borne parasitic disease after malaria. According to WHO, lymphatic filariasis is the second most common cause of long term disability after mental illness. The Government of India has accorded a high priority for elimination of this infection through mass chemotherapy programme (MDA). Material and Methods: This study was conducted to see the effect of MDAon lymphatic filariasis. As lymphatic filariasis control programme is a national programme and it is controlled and monitored by health services, we collected and analyzed the data from four sentinel centers from Nagpur district from 2004 to 2012. Result and Conclusion: We observed that after repeated administration of MDA the Mf rate has declined over a period of time and helped to reduce the transmission from one person to other. It also prevents the chronic disability and increases the marriage prospectus in young females in endemic area. The cost of preventing one case of chronic disease is very low as compared to other chronic diseases. So we concluded that repeated subsequent rounds of MDA is effective. It is economical with social benefits.

Epidemiology of pandemic H1N1 strains in a tertiary hospital of Maharashtra.

Swine-flu is a viral fever caused by a new mutated strain Influenza A virus subtype H1N1, which infects humans. Pandemic H1N1 (pH1N1/2009) virus was detected in the first quarter of 2009 in the west coastal region of North America and spread very rapidly to the other countries during April-June, 2009. This study was conducted to assess the epidemiology of pandemic H1N1 strains using a cross-sectional study design in a tertiary hospital. The symptomatic patients attending the flu outpatient department (OPD)/emergency from August 2009 to April 2011 at Indira Gandhi Government Medical College, Nagpur were included using a standard case definition. A total of 67 (27.01%) samples from 247 patients were pandemic influenza A/H1N1 positive. None of the patients had a history of foreign travel, whereas 23.88% of the patients gave history of travel to an endemic area. Overall, 22.38% of the patients came in contact with proven cases of pandemic H1N1. pH1N1 transmission activity has increased since May 2010.

The geographic location (latitude) of studies evaluating protective effect of BCG vaccine and it's efficacy/effectiveness against tuberculosis.

OBJECTIVE: To study association between the geographic location (latitude) of studies evaluating protective effect of BCG vaccine and it's efficacy / effectiveness against tuberculosis. METHODS: A comprehensive literature search was carried out to identify relevant studies. Data extraction from these studies included place of study (geographic latitude), study design and reported point estimate of protective effect of BCG vaccine against tuberculosis. Information on latitude was obtained from Oxford School Atlas for World Geography. A spearman rank correlation coefficient was estimated to study the association between the latitude of studies and protective effect of BCG vaccine. RESULTS: The Spearman's rank correlation coefficient was significant for all studies grouped together & trials and marginally non-significant for other observational studies. However it was not statistically significant for case-control studies and cohort studies. Overall rho (for 80 studies) between latitude and protective effect of BCG was calculated to be 0.3853 (p = 0.0004). The results thus demonstrated that, in general BCG appeared to provide greater protection at higher latitudes. Thus a correlation coefficient of 0.3853 between latitude and protective effect would indicate that (0.3853)(2) or 15% of the variance in protective effect was accounted for by latitude. CONCLUSION: The study recognized an association between geographic locations of studies and reported protective effects of BCG vaccine against tuberculosis.

Scar size and effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of tuberculosis and leprosy: a case-control study.

BACKGROUND: The study was undertaken to estimate the effectiveness of BCG vaccination in relation to scar size in the prevention of tuberculosis and leprosy. METHODS: The present study was designed as hospital-based pair-matched case-control study and was carried out at Government Medical College Hospital, Nagpur, Maharashtra, India. It included 877 cases of tuberculosis and 292 cases of leprosy (diagnosed by WHO criteria), born onwards 1962. Each case was pair-matched with one control for age, sex and socio-economic status. BCG vaccination status was assessed by examination for the presence of BCG scar, immunisation records if available and information from subjects/parents of children. Subjects uncertain about BCG vaccination were not included. The diameter of the BCG scar was measured both across and along the arm in millimeters using a plastic ruler. The average was then calculated. RESULTS: A significant protective association between BCG vaccination and tuberculosis (OR=0.38, 95% CI 0.31-0.47) and leprosy (OR = 0.38, 95% CI 0.26-0.55) was observed. The overall vaccine effectiveness (VE) was 62% (95% CI 53-69) against tuberculosis and 62% (95% CI 45- against leprosy. Vaccine effectiveness against tuberculosis and leprosy was non-significantly greater in the group who had BCG scar size < or =5 mm as compared to subjects who had BCG scar size > 5 mm. Thus there was no clear association between BCG scar size and its effectiveness. CONCLUSION: The current study did not identify any significant association between BCG scar size and its effectiveness against tuberculosis or leprosy.

Change in antimicrobial resistance pattern of Salmonella Typhi in central India.

BACKGROUND & OBJECTIVES: Multidrug resistant Salmonella Typhi infections have been reported worldwide in the last decade. In a study from central India in 1991 multidrug resistant S. Typhi were reported to account for 91 per cent of patients of enteric fever. The present study was planned to study the antimicrobial susceptibility pattern, phage types and biotypes of strains of S. Typhi prevalent in this region. METHODS: A total of 54 isolates of Salmonella were recovered from 1468 blood samples of patients suspected to have enteric fever and admitted in the Government Medical College and Hospital, Nagpur. Antimicrobial susceptibility pattern of these isolates was studied by disc diffusion test. Phage typing and biotyping of the first 33 strains was done at the National Salmonella Phage Typing Center, New Delhi. Minimum inhibitory concentration of chloramphenicol was determined by agar dilution method. RESULTS: Of 54 isolates of Salmonella, 51(94%) were S. Typhi and 3 (6%) were S. paratyphi A serotype. Of the 30 isolates of S. Typhi subjected to phage typing, two phage types E1 23 (77%) and A 7 (23%) were found to be prevalent in this region. Multidrug resistance was observed in 12 (22%) strains of S. Typhi. Thirty five (68%) strains were sensitive to chloramphenicol, ampicillin, gentamicin, cotrimoxazole, cefotaxime and ciprofloxacin. Resistance to two antibiotics was observed in 4 (8%) strains. Cefotaxime resistance was observed in one isolate and gentamycin resistance in two, while none of the isolates was found to be ciprofloxacin resistant. INTERPRETATION & CONCLUSION: Multidrug resistance in S. Typhi has decreased from that reported in 1991 though there is a still a small percentage of strains which continue to be multidrug resistant.