Staphylococcus aureus including MRSA nasal carriage among hospital exposed and unexposed medical students.

INTRODUCTION: Staphylococcus aureus is one of the most common human pathogen causing a wide range of infections. It is estimated that S.aureus colonizes the anterior nares in approximately 31% of the general population at any given time. The incidence of community acquired & hospital acquired S. aureus has been increasing over the past few decades, predominantly due to continuous upsurge in the drug resistant isolates. Moreover, globally the incidence of methicillin resistant S.aureus (MRSA) is progressively increasing. Hence, it would be imperative to screen all healthcare workers, interns and admitted patients for MRSA carriage and to treat all those who are found positive for the same. With the above background, the current study was undertaken to investigate the carrier rate of S. aureus (including MRSA) among hospital unexposed & exposed medical students. METHODS: A total of 181 medical students of Veer Chandra Singh Garhwali Government Institute of Medical Sciences & Research, Srinagar Garhwal, Uttarakhand. Study participants were broadly divided into two groups: hospital exposed group (n=107) and hospital unexposed group (n=74). Nasal swabs were obtained & cultured for the detection of S. aureus. Congo red agar and 0.1% Crystal Violet Assay were performed to observe the ability to form in vitro biofilm by S. aureus. RESULTS: Out of total 181 medical students 29.28% were found to be healthy carrier of S. aureus. Among the hospital exposed group 37.38% and among hospital unexposed group 17.57% were found to be healthy carrier of S. aureus. Only one student (hospital exposed group) was found to be positive for MRSA. Beta-lactamase production was noted in 90.57% strains of S. aureus while the significant rate of slime layer production was observed in 73.58% of strains. CONCLUSION: Prevalence of S. aureus nasal carriage increases with the duration of exposure to the hospital environment. The nasal carriage of S. aureus in medical students indicate the potential danger of dissemination of S. aureus including MRSA from them to the hospitalized patients which in turn complicates the treatment of same.

Cavernous sinus thrombosis following dental extraction: a rare case report and forgotten entity.

Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A computed tomography scan revealed venous dilatation of the right superior ophthalmic vein. The patient was immediately treated with incision and drainage, intravenous antibiotics, and heparin (low molecular weight). Unfortunately, the patient died two days after surgery due to complications from the disease. CST is a rare disease with a high mortality rate. Therefore, dental health education in rural areas, legal action against unregistered dental practitioners, early diagnosis, and aggressive antibiotic treatment can prevent future mortality resulting from CST.

Mobile phones: Reservoirs for the transmission of nosocomial pathogens.

BACKGROUND: Global burden of hospital-associated infection (HAI) is on the rise and contributes significantly to morbidity and mortality of the patients. Mobile phones are indispensible part of communication among doctors and other health care workers (HCWs) in hospitals. Hands of HCWs play an important role in transmission of HAI and mobile phones which are seldom cleaned and often touched during or after the examination of patients without hand washing can act as a reservoir for transmission of potent pathogens. This study aimed to investigate the rate of bacterial contamination of mobile phones among HCWs in our tertiary care hospital and to compare it with personal mobile phones of non-HCWs (control group). MATERIALS AND METHODS: The mobile phones and dominant hands of 386 participants were sampled from four different groups, hospital doctors and staff (132), college faculty and staff (54), medical students (100) and control group (100). Informed consent and questionnaire was duly signed by all the participants. Samples were processed according to standard guidelines. RESULTS: 316 mobile phones (81.8%) and 309 hand swab samples (80%) showed growth of bacterial pathogens. The most predominant isolates were Coagulase-negative Staphylococcus, Staphylococcus aureus, Acinetobacter species, Escherichia coli, Klebsiella pneumoniae, Pseudomonas species and Enterococcus species. CONCLUSION: Hundred percent contamination was found in mobile phones and hands of HCWs indicating mobile phones can be the potential source of nosocomial pathogens. Our study results suggest that use of mobile phones in health care setup should be restricted only for emergency calls. Strict adherence to infection control policies such as proper hand hygiene practices should be followed.

Does iodine excess lead to hypothyroidism? Evidence from a case-control study in India.

BACKGROUND: Iodine deficiency disorders have been known to mankind since antiquity and various researchers elucidated the role of iodine in its causation. However, recent evidence shows that the entire control program ignored multi-causality and association of increased iodine intake with hypothyroidism. This study was conducted to assess differences of iodine intake as measured by urinary iodine excretion (UIE) between cases of hypothyroidism and healthy controls. METHODS: A case-control study was conducted with three groups (cases, hospital controls and community controls) in two cities of India. Patients with overt hypothyroidism were cases (n = 150) and were compared with age, sex and socioeconomic status-matched hospital (n = 154) and community (n = 488) controls. Thyroid function tests (T3, T4, TSH) were used as diagnostic and inclusion criteria. TPOAb and UIE estimation were carried out for all study participants. RESULTS: Mean values of TPOAb and UIE were higher in cases as compared to hospital controls as well as community controls (p <0.05). With a cut off of 34 IU/mL for TPOAb, more cases had an anti-TPO level >34 as compared to hospital controls (p <0.001) as well as community controls (p <0.001); OR, 0.06 (95% CI, 0.03, 0.12) and 0.08 (0.05, 0.12), respectively. For UIE cut-off of 300 µg/L, more cases than hospital controls (p = 0.090) and community controls (p = 0.001) had higher levels; OR, 0.671, (0.422, 1.066) and 0.509, (0.348, 0.744), respectively. CONCLUSION: The study has clearly shown that cases of hypothyroidism are associated with excess iodine intake. Cohort studies to generate further evidence and an eco-social epidemiological approach have been suggested as the way forward.

Microbiology of chronic suppurative otitis media in a tertiary care setup of uttarakhand state, India.

BACKGROUND: Chronic suppurative otitis media (CSOM) is a notorious infection and a major health problem in developing countries causing serious local damage and threatening complications. Early and effective treatment based on the knowledge of causative micro-organisms and their antimicrobial sensitivity ensures prompt clinical recovery and possible complications can thus be avoided. AIMS: The aim of this study was to isolate the organisms associated with CSOM and to detect the antibiogram of the aerobic isolates. MATERIALS AND METHODS: A total of 204 patients clinically diagnosed of CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and cultured for microbial flora. Drug susceptibility testing for aerobic isolates was conducted using Kirby-Bauer disc diffusion method. RESULTS: The most common causative organisms isolated were Staphylococcus aureus (48.69%) and Pseudomonas aeruginosa (19.89%) amongst the 191 aerobic isolates. Anaerobes accounted for 29.41% of the isolates while 12.25% were fungi. Antimicrobial profile of aerobic isolates revealed maximum sensitivity to amikacin (95.5%), ceftriaxone (83.4%) and gentamicin (82.7%). CONCLUSION: Knowing the etiological agents of CSOM and their antimicrobial susceptibility is of essential importance for an efficient treatment, prevention of both complications and development of antibiotic resistance and finally, the reduction of the treatment costs.

The baseline widal titre among the healthy individuals of the hilly areas in the garhwal region of uttarakhand, India.

INTRODUCTION: Typhoid fever is endemic in all parts of India and the Widal test is widely used for its diagnosis. In the endemic areas, the healthy people may contain antibodies which are capable of reacting upto a variable titre in the Widal test, due to a past exposure, TAB vaccination and cross reacting antigens. Therefore it varies widely from place to place and is referred to as the baseline titre of that area. The aim of this study was to determine the average baseline titre of the apparently healthy population in the Garhwal region of Uttarakhand, India. MATERIAL AND METHODS: Blood samples were collected from healthy volunteers over the period from February 2011 to January 2012 and they were analyzed for the presence of the Salmonella antibodies by carrying out the Widal tube agglutination test. RESULTS: Among the 2164 serum specimens which were tested, 922 (42.6%) sera were found to be positive for the Widal test and 1242 were negative. The most frequently recorded titre of the reactive sera was 1:40 for the anti-O antibodies and it was 1:80 for the anti-H antibodies and this was the baseline titre for this region. CONCLUSION: Based on the above results of our study, it has been recommended that the cut-off titre of 1:80 for the anti-O antibodies and of 1:160 for the anti-H antibodies may be considered as diagnostic for enteric fever in the Garhwal region of Uttarakhand, India.

The prevalence of inducible clindamycin resistance among staphylococci in a tertiary care hospital - a study from the garhwal hills of uttarakhand, India.

OBJECTIVE: This study was undertaken to assess the frequency of the phenotypic expression of the inducible resistance to clindamycin which was due to the expression of the erm genes in various clinical isolates of the Staphylococcus species. MATERIALS AND METHODS: This was a cross sectional study conducted in the Dept. of Microbiology and Immunology, Veer Chandra Singh Garhwali Govt. Medical Sciences and Research Institute, Srikot, Uttarakhand, from July 2010 to December 2011. A total of 373 consecutive, non duplicate strains of Staphylococci isolated from various clinical samples like pus, wound swab, blood, urine and other body fluids, were tested. The isolates which had a discordant resistance pattern (clindamycin-sensitive and erythromycin-resistant) by Kirby Bauer Disk Diffusion method were selected and subjected to the D-test for inducible clindamycin resistance, as per the Clinical and Laboratory Standards Institutes (CLSI) guidelines. RESULTS: Among the 373 clinical isolates of Staphylococci which were studied, 134 isolates showed a discordant resistance pattern. Among these discordant strains, 45 (33.6%) isolates were D-test positive, which had inducible clindamycin resistance and belonged to the inducible macrolide lincosamide streptogramin- B phenotype (MLSBi). 89 (66.4%) isolates were D-test negative and they belonged to the macrolide streptogramin phenotype (MS). Among the MLSBi phenotypes, 6 (13.3%) isolates were methicillin-resistant Staphylococcus aureus (MRSA), 13 (28.9%) were Methicillin-sensitive S.aureus (MSSA) and 26 (57.8%) were coagulase negative staphylococci (CONS). CONCLUSION: The D-test is a simple, effective and an important method for the phenotypic detection of inducible clindamycin resistance and it should be used routinely, as it will help in guiding the empirical therapy. The possible clinical failures can thus be avoided.

Chronic suppurative otitis media: optimizing initial antibiotic therapy in a tertiary care setup.

A prospective study was done to determine the clinico-microbiological profile and the antibiogram of patients with chronic suppurative otitis media. Ninety-four patients presenting with tympanic perforation and ear discharge of more than 3 months were studied. Middle ear swabs obtained aseptically were processed for culture and the isolates identified by standard procedures. Antimicrobial susceptibility testing of the aerobic bacterial isolates was performed by disc diffusion method according to clinical laboratory standards institute guidelines. Patients in the age group of 21-30 years were more commonly affected (22.3%). Male:Female ratio was 2:1.4. Of the 94 patients, 64 (68.1%) had tubo-tympanic disease and rest 30 (31.9%) presented with attico-antral disease. Monomicrobial flora was seen in 55 (58.5%) samples, 28 (29.8%) yielded polymicrobial growth and 11 (11.7%) samples were sterile. A total of 115 microbial isolates (86 aerobic bacteria, 18 anaerobic bacteria and 11 fungi) were obtained. Pseudomonas aeruginosa (32.2%) was the most common isolate followed by Staphylococcus aureus (17.4%). Amongst anaerobes, gram positive cocci were more commonly isolated (38.9%). Aspergillus spp. (72.7%) were the most common fungus isolated. Most of the Pseudomonas aeruginosa isolates (25, 67.6%) were susceptible to all the antibiotics. Among the commonly used topical agents in the treatment of CSOM, tobramycin was the most effective (83.8%), followed by gentamicin (78.1%), ciprofloxacin (75.6%) and neomycin (3.5%). Periodic monitoring of the microbiological profile along with their sensitivity pattern is essential for formulating an effective antibiotic policy for CSOM.

Application of a cardiac arrest score in patients with sudden death and ST segment elevation for triage to angiography and intervention.

The aim of this study was to test a previously validated, prognostic, cardiac arrest score in patients with ST segment elevation acute myocardial infarction (AMI) who suffered a witnessed cardiac arrest and survived to emergency department admission. A consecutive series constructed retrospectively from a sudden death database (n = 22) of patients with ST segment elevation AMI resuscitated from cardiac arrest underwent angiography and angioplasty of the culprit vessel within 24 hours of presentation. A cardiac arrest score was assigned to each case by explicit criteria present on evaluation. Primary outcomes were survival to hospital discharge and the degree of neurological recovery during the hospitalization. All patients underwent successful coronary angioplasty and 77% received adjunctive intraaortic balloon counterpulsation. The overall rate of survival to discharge was 41%. For cardiac arrest scores of 0, 1, 2, and 3, respectively, the rates of neurologic recovery were 0 (0%) of 4 (95% CI 0-53%), 3 (50%) of 6 (95% CI 15-85%), 2 (67%) of 3 (95% CI 13-98%), and 9 (100%) of 9 (95% CI 72-100%), and the rates of survival to discharge were 0 (0%) of 4, (95% CI 0-53%), 2 (33%) of 6 (95% CI 6-74%), 2 (67%) of 3 (95% CI 13-98%), and 9 (100%) of 9 (95% CI 72-100%), P < 0.01 for both outcomes over ascending scores. These results suggest appropriate patients for primary angioplasty after cardiac arrest are those with ST segment elevation AMI and an emergency department cardiac arrest score of > or = 2, thus predicting a 11 (92%) of 12 (95% CI 65-100%) chance of survival to discharge.