The prevalence of Mycoplasma hominis in Outpatients at a Tertiary Care Hospital in East India.

Introduction Mycoplasma hominis (M. hominis) is the first Mycoplasma isolated from humans in the year 1937. Though regarded as a commensal of the urogenital tract, it has been implicated in various genital and extra-genital infections namely bacterial vaginosis, cervicitis, pelvic inflammatory diseases, pyelonephritis, premature rupture of the membrane in pregnancy, infertility, sepsis in newborns, etc. The pathogenesis, prevalence, and epidemiology of genital mycoplasmas in general and M. hominis in particular in Indian women have been studied very minimally. This study aimed to study the prevalence of M. hominis carriage among symptomatic and asymptomatic sexually active women attending to the outpatient department of a tertiary care hospital in East India with or without clinically suspected genitourinary infections and to compare the detection of M. hominis by polymerase chain reaction (PCR) as compared to that of culture. Methods In this observational study, sterile Dacron swabs were used to collect two samples each from the genitourinary tract of 110 sexually active women aged 15-45 years (80 cases and 30 control). One sample was inoculated in mycoplasma broth for culture. The other was used for PCR to detect the presence of the M. hominis gene. Results Culture positivity for mycoplasma was seen in 4/80 (5%) patients clinically suspected of genitourinary infection (cases) based on their presenting signs and symptoms. In those without such suspicion (control), all cultures were negative (p=0.021). PCR was positive for M. hominis in 22 (20%) samples. Considering the PCR as the gold standard the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of culture are found to be 18.18%, 100%, 100%, and 88.25% respectively. The highest prevalence of M. hominis was in the age group 20-24 years (9/24) and 50% of all detections (11/22) were among 25-29 years. Detections were more frequent among patients with multiparity, multiple sexual partners, intrauterine contraceptive devices, lower socioeconomic status, and lower educational status. Conclusion Our study results showed that the presence of M. hominis is significantly higher in cases than in the control group. The study also indicates the need for continued research on this bacterium both in patients with genital symptoms and in asymptomatic patients.

High Prevalence of Biofilm-Forming MRSA in the Conjunctival Flora in Chronic Dacryocystitis.

OBJECTIVES: To report the microbiological spectrum of conjunctival flora and prevalence of biofilm-forming Methicillin-resistant Staphylococcus aureus (MRSA) in conjunctival flora in chronic dacryocystitis. DESIGN: Prospective, case-control study. METHODS: We included patients with unilateral chronic dacryocystitis, and their unaffected eyes as control. Microbiological profile and antibiotic susceptibility of the isolates was determined by standard microbiological procedures. S. aureus isolates were further evaluated for Methicillin resistance by Oxacillin resistance screening agar method and mecA polymerase chain reaction (PCR) and for biofilm synthesis by Congo red agar method, Microtitre plate (MTP) assay, and ica A and ica D PCR. RESULTS: We found 95 patients with unilateral chronic dacryocystitis. Aerobic Gram-positive isolates (74.2%, n = 72) were more than Gram-negative (25.7%, n = 25) or anaerobic isolates (20.5%, n = 25). S. aureus was most common (46.4%, n = 45), followed by Pseudomonas aeruginosa (10.3%, n = 10). Gram-positive isolates showed highest sensitivity to Linezolid (100%) and higher generation fluoroquinolones. Gram-negative isolates showed good sensitivity (>90%) to all tested antibiotics. S. aureus isolates showed MRSA prevalence as 93.5% and 96.9% by Oxacillin resistance screening agar method and mecA PCR, respectively. Biofilm formation was found in 71.8% MRSA isolates by MTP assay and 58.1% MRSA isolates were resistant to ≥3 classes of antibiotics. CONCLUSIONS: Gram-positive organisms, specifically S. aureus, are the major etiological agent in chronic dacryocystitis. There is high prevalence of MRSA in these isolates and concurrent biofilm formation.

Bacteriological profile of ventilator-associated pneumonia in a tertiary care hospital.

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection. The etiology of VAP and their antimicrobial susceptibility pattern varies with different patient populations and types of ICUs. MATERIALS AND METHODS: An observational cross-sectional study was performed over a period of 2 years in a tertiary care hospital to determine the various etiological agents causing VAP and to detect the presence of multidrug-resistant (MDR) pathogens in these VAP patients. Combination disk method, Modified Hodge test, ethylenediaminetetraacetic acid disk synergy test, and AmpC disk test were performed for the detection of extended-spectrum beta-lactamase (ESBL), carbapenemases, metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively. RESULTS: The prevalence of VAP was 35%. Enterobacteriaceae (66.66%) and Staphylococcus aureus (20%) were common in early-onset VAP, while nonfermenters (50%) and Enterobacteriaceae (40.61%) were predominant from late-onset VAP. Nearly 60.87% of the bacterial pathogens were MDR. ESBL was produced by 21.74% of Enterobacteriaceae. AmpC ß-lactamase was positive in 35.29% nonfermenters and 26.08% Enterobacteriaceae. MBL was positive in 17.64% nonfermenters and 17.39% Enterobacteriaceae. Among the S. aureus isolates, 75% were cefoxitin resistant. Prior antibiotic therapy (P = 0.001) and hospitalization of 5 days or more (P = 0.001) were independent risk factors for VAP by MDR pathogens. polymyxin B, tigecycline, and vancomycin were the most sensitive drugs for Gram-negative and positive isolates respectively from VAP. STATISTICAL ANALYSIS: SPSS for Windows Version SPSS 17.0 (SPSS Inc., Chicago, IL, USA) and Chi-square with Yates correction. CONCLUSION: Late-onset VAP is increasingly associated with MDR pathogens. Treatment with polymyxin B, tigecycline, and vancomycin should be kept as last-line reserve drugs against most of the MDR pathogens.

Detection of inducible and constitutive clindamycin resistance among Staphylococcus aureus isolates in a tertiary care hospital, Eastern India.

INTRODUCTION: Clindamycin is an excellent drug for skin and soft tissue Staphylococcus aureus infections, but resistance mediated by inducible macrolide-lincosamide-streptogramin B (iMLSB) phenotype leads to in vivo therapeutic failure even though they may be in vitro susceptible in Kirby-Bauer disk diffusion method. OBJECTIVE: The study was aimed to detect the prevalence of iMLSB phenotype among S. aureus isolates by double disk approximation test (D-test) in a tertiary care hospital, Eastern India. MATERIALS AND METHODS: A total of 209 consecutive S. aureus isolates were identified by conventional methods and subjected to antimicrobial susceptibility testing by Kirby-Bauer disk diffusion method. Erythromycin-resistant isolates were tested for D-test. RESULTS: From 1282 clinical specimens, 209 nonrepeated S. aureus isolates were obtained. Majority of isolates 129 (61.7%) were methicillin-resistant S. aureus (MRSA). There was statistically significant difference between outpatients 60.1% and inpatients 39.9% (P < 0.0001). From 209 S. aureus isolates, 46 (22%) were D-test positive (iMLSB phenotype), 41 (19.6%) were D-test negative (methicillin sensitive [MS] phenotype), and 37 (17.7%) were constitutively resistant (constitutive macrolide-lincosamide-streptogramin B phenotype). The incidence of inducible, constitutive, and MS phenotype was higher in MRSA isolates compared to MS S. aureus (MSSA). The constitutive clindamycin resistance difference between MSSA and MRSA isolates were found to be statistically significant (P = 0.0086). CONCLUSION: The study revealed 22% of S. aureus isolates were inducible clindamycin resistant, which could be easily misidentified as clindamycin susceptible in Kirby-Bauer disk diffusion method. Therefore, clinical microbiology laboratory should routinely perform D-test in all clinically isolated S. aureus to guide clinicians for the appropriate use of clindamycin.