Resistance Pattern in Mostly Gram-negative Bacteria Causing Urinary Tract Infections.

PURPOSE: The antimicrobial prescription in urinary tract infections (UTI) is driven by local data on its pathogenic spectrum and the resistance pattern exhibited by the disease-causing pathogens. We aimed to determine the bacteriological diversity of UTI causing pathogens and antimicrobial resistance in mostly gram-negative bacteria. METHODS: This retrospective hospital-based cross-sectional study analyzed the culture and sensitivity reports of urine samples from a referral centre in the Aljouf region of Saudi Arabia. All the antibiograms from January 1, 2020, to December 31st 2020, were included. The bacterial identification and antimicrobial testing were carried out by the BD Phoenix system (BD Diagnostics, Sparks, MD, USA). Antimicrobial testing was performed as per the Clinical and Laboratory Standard Institute recommendations. Frequencies of multidrug- and extensive drug resistance were calculated. RESULTS: Of the 1334 non-duplicate urine samples received, 422 (31.6%) bacterial growths were observed. Of these, 383 (90.8%) and 39 (9.2%) were gram-negative and gram-positive bacterial isolations, respectively. E. coli 161 (38.1%), K. pneumoniae 97 (23.0%), and E. faecalis 18 (4.3%) were frequent aetiologies of UTI. 309 (80.7%) of gram-negative bacteria were multidrug-resistant including 88 (23.0%) extensively drug-resistant. Overall, a resistance rate of > 55 % to 1st through 4th generation cephalosporins was observed except for cefoxitin (43.7%). A resistance rate of 37.6% was observed towards carbapenems, with the lowest rate (34.0%) to meropenem. CONCLUSION: Multi-drug resistant gram-negative bacteria dominate the pathogenic spectrum of UTI in the region. A high resistance rate to cephalosporins and carbapenems exists in gram-negative organisms, causing UTI.

Clinical characteristics among patients with COVID­19: A single­center retrospective study.

The aim of the present study was to investigate the clinical features and laboratory parameters of hospitalized patients with coronavirus disease 2019 (COVID-19) and assess the characteristics between severe and non-severe cases. The study retrospectively analyzed the clinical data of 1,096 patients, of which, 626 (57.11%) and 470 (42.89%) were categorized into severe and non-severe groups, respectively. Clinical parameters such as signs and symptoms, comorbidities, levels of D-dimer, C-reactive protein (CRP), interleukin 6 (IL-6) and lactate dehydrogenase were analyzed. The data are presented as frequencies, means and standard deviations. The chi-square test and Mann-Whitney U test were used to assess any significant differences between the severe and non-severe COVID-19 groups. The clinical symptoms in severe COVID-19 cases included anosmia (P≤0.01), sore throat (P≤0.01), fatigue (P≤0.01), headache (P≤0.01), and shortness of breath (P≤0.01). Laboratory findings showed a significant increase in CRP (21.90±40.23 vs. 16.13±21.82; P≤0.01) and IL-6 levels (58.92±55.07 vs. 41.41±38.30; P≤0.01). Patients with severe COVID-19 had significant lymphopenia compared with that in non-severe cases. Among the comorbidities, hypertension (P≤0.01) was significantly more frequent in patients with severe COVID-19. In conclusion, major derangements in laboratory parameters were observed in patients with severe COVID-19 infection.

Diagnostic utility and performance of rapid antigen test in SARS CoV- 2 in symptomatic and asymptomatic patients during the second pandemic wave in Kashmir, North India.

PURPOSE: Real time reverse transcriptase PCR (rRT PCR) although gold standard test for the diagnosis of SARS CoV-2, carries disadvantages of a sophisticated set up, long time to results and centralized services. The rapid antigen tests (RAT) can be used as a primary screening tool with the advantages of rapid turnaround time and ease of use. The study was conducted to determine the performance of rapid antigen test (standard Q COVID 19 Ag) in comparison to rRT PCR in symptomatic patients and asymptomatic contacts and asymptomatic patients with no apparent contact history. METHODS: Nasopharyngeal swabs taken in duplicate from 1034 patients were collected over a 5 months period. These included 248 (23.98%) symptomatic, 386 (37.34%) asymptomatic contacts and 400 (38.68%) asymptomatic subjects who were routinely screened in pre-operative period, as a prerequisite for travel, or pregnant females. Both rRT PCR and RAT were performed as per manufacturers' instructions. Performance of test in different subgroups of patients was evaluated. Performance of RAT test on basis of duration of illness and Ct values was also analyzed. RESULTS: In this study, 445 (43.04%) were rRT PCR positive, out of which 374 samples were RAT positive as well. 31 samples were RAT positive but PCR negative. The sensitivity, specificity, PPV and NPV of the rapid antigen test was 84.04%, 94.74%, 92.35% and 88.71% respectively. The negative predictive value of the test in asymptomatic patients without any significant contact history was 97.07%. CONCLUSIONS: This study recommends the use of the antigen test as a method of diagnosis for SARS CoV-2. However a negative result with RAT in suspected patients and their contacts should be viewed with caution. This study also finds the utility of using RAT test in the community settings as a screening test in schools, colleges and mass gatherings.

Serological Evidence of Scrub Typhus among Cases of PUO in the Kashmir Valley- A Hospital Based Study.

INTRODUCTION: Rickettsial infections are being increasingly recognized as a cause of acute febrile illnesses and should be considered a distinct possibility in patients presenting with suggestive clinical features. Their diagnosis remains a challenge in a country like ours where tests like immunofluorescence assay cannot be routinely done. Results of serological tests, when correlated with patients clinical profile can aid in the timely diagnosis of scrub typhus. AIM: To find out the extent to which scrub typhus contributes to Pyrexia of Unknown Origin (PUO) in patients admitted to or attending the OPD of our hospital using simple tests like Weil-Felix Agglutination Test (WFT) and Enzyme Linked Immunosorbent Assay (ELISA). MATERIALS AND METHODS: A cross-sectional study was carried out in the Department of Microbiology, Government Medical College and Hospital, Srinagar, over a period of eight months (1(st) March to 31(st) October 2015). Serum samples from patients suffering from Pyrexia of Unknown Origin (PUO) were processed for the detection of Scrub typhus. A total of 162 samples were included in the study. These were subjected to WFT using OX-K strain. The serum samples were diluted 1/20 to 1/640 and a titre of ≥ 1:160 was considered as positive. The samples were also tested for IgM and IgG antibodies for scrub typhus by ELISA and tube agglutination test was done to detect typhoid fever and brucellosis. RESULTS: Of the 162 serum samples tested 22.8% tested positive scrub typhus by WFT. IgM ELISA and IgG was positive in 8 (4.9%) and 15 (9.3%) samples respectively. Sensitivity, specificity, positive and negative predictive values of WFT; taking IgM ELISA as a reference standard were 75%, 79.9%, 16.2% and 98.4% respectively. CONCLUSION: Scrub typhus is prevalent in our state and the results of WFT supplemented by those of ELISA can aid in its diagnosis. However the results of these tests should always be regarded in light of the clinical condition of the patient.

Diagnostic value of Tzanck smear in various erosive, vesicular, and bullous skin lesions.

BACKGROUND: Cutaneous cytology has long been shown to be useful in the diagnosis of several erosive, vesicular, and bullous skin lesions. The Tzanck smear although an old tool, still remains a simple, rapid, easily applied, and inexpensive test for these skin lesions. AIMS AND OBJECTIVES: The aim of this study was to evaluate the diagnostic value of Tzanck smear by determining its sensitivity and specificity in various erosive, vesicular, and bullous skin lesions. MATERIALS AND METHODS: One hundred and forty-two patients with erosive, vesicular, and/or bullous skin lesions were included in the study. Four groups of disorders were identified: infections, immunologic disorders, genodermatosis, and spongiotic dermatitis. All the study cases were evaluated by Tzanck smear. Definitive diagnosis was established by standard diagnostic techniques (including when appropriate, viral serology, bacterial culture, histopathology, direct immunoflourescence). RESULTS: The sensitivity and specificity of cytologic findings was respectively 86.36% and 91.30% for viral infections; for bacterial infections, it was 85.7% and 66.6%. The sensitivity and specificity of Tzanck smear was respectively 85.0% and 83.33% for pemphigus; for bullous pemhigoid it was 11.11% and 100.0%. Tzanck smear sensitivity in genodermatoses was 100%. The sensitivity and specificity of the test in spongiotic dermatitis could not be calculated due to an insufficient number of patients. CONCLUSION: The Tzanck smear is a quick and reliable tool for the evaluation of various erosive and vesiculobullous skin lesions.