Bacteriological Profile of Surgical Site Infections and Their Antibiogram: A Study From Resource Constrained Rural Setting of Uttarakhand State, India.

INTRODUCTION: Surgical site infections (SSI) constitute a major public health problem worldwide and are the second most frequently reported nosocomial infections. They are responsible for increasing the treatment cost, length of hospital stay and significant morbidity and mortality. AIM: To determine the incidence of SSIs and the prevalence of aerobic bacterial pathogens involved with their antibiogram. MATERIALS AND METHODS: Samples were collected using sterile cotton swabs from 137 patients clinically diagnosed of having SSIs and were processed as per standard microbiological techniques. Antimicrobial susceptibility testing was done using modified Kirby-Bauer disc diffusion method. This cross sectional study was conducted for a period of six months (January 2013 to June 2013) in the Department of Microbiology at a rural tertiary care hospital of Uttarakhand state, India. RESULTS: Out of 768 patients, 137 (17.8%) were found to have SSIs and samples were collected from them. Out of total 137 samples, 132 (96.4%) yielded bacterial growth and 139 bacterial isolates were obtained. Staphylococcus aureus (50.4%) was the commonest organism followed by Escherichia coli (23.02%), Pseudomonas aeruginosa (7.9%) and Citrobacter species (7.9%). Antimicrobial profile of gram positive isolates revealed maximum sensitivity to vancomycin, teicoplanin and linezolid, whereas among gram negative isolates meropenem, piperacillin-tazobactam, and amikacin were found to be most sensitive. CONCLUSION: The rate of SSI observed in this study was comparable to other similar studies, however we observed a higher degree of antimicrobial resistance. Adherence to strict infection control measures, maintenance of proper hand hygiene and optimal preoperative, intraoperative and postoperative patient care will surely reduce the incidence of SSIs.

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.

Epidemiological trends of cancer morbidity at a government medical college hospital, Chandigarh, India.

AIM: An epidemiological shift has resulted in increase in the prevalence of non-communicable diseases (NCD). Unlike other NCDs which are easily and definitely preventable, the knowledge of cancer prevention is still limited at present. Various aetiological factors are difficult to control since those are habit forming. Hence an available remedy remains its secondary and tertiary prevention for which appropriate planning is of paramount importance. Evidence based planning requires careful analysis of data with a view to prioritize various cancers. Keeping in view the fact that the adaptation of smoking free status in Chandigarh city might have a far reaching positive effect on the cancer related morbidity of the people, the following study was undertaken to provide base line data to be used for future comparisons. METHODS: The registers maintained in the Department of Radiotherapy were checked and those belonging to the years 1999 to 2009 were utilized to analyze the cancer morbidity in respect to age, sex, and year of presentation to health care facility. RESULTS: A total of 4,600 cancer patients (males=2276, females=2324) demonstrated a gradual increase in the number of cancer cases from 150 in the year 1999 to 783 in the year 2009. The most common cancers amongst males were cancer of gastro-intestinal tract (GIT) and lung (including larynx) constituting 37.3% and 27.1% of the total, respectively. In females these were cancers of breast and cervix representing 33.3% and 17.6% of total cancer cases, respectively, and lung cancer constituted 5.3%. The maximum cases of bone cancer (53.8% of all bone cancers) were observed amongst children aged less than 20 years and lung cancer (48.2% of all lung cancers) among the elderly aged 60-69 years.

Epidemiological study of risk factors for oral, laryngeal and esophageal cancers at a tertiary care hospital in India.

UNLABELLED: BACKGROUND AND AIS: An epidemiological shift in the form of increase in the incidence of cancer and decrease in the incidence of smoking is universally realized today. This study was conducted to observe an association of smoking, use of alcohol and tobacco and cancers of the oral cavity, larynx and esophagus MATERIAL AND METHODS: it was a case control study conducted at Deptt. of Radiotherapy at GMCH, Chandigarh. The registers from radiology department were utilized and studied for the presence of history of alcohol consumption, smoking and tobacco intake. Statistical analysis was done by calculating Odds ratio along with 95% confidence interval. RESULTS: Out of 363 cases with the diagnosis of Laryngeal, Esophageal and Oral Cancer along with 568 controls studied, 42 (11.6%) were in the age group of 30-44 years, 153 (42.1%) in the age group of 45-59 years and rest 171 (47.1%) in the age group of 60+ years. Among cases, the percentage of tobacco use, smoking and alcohol consumption was 10.5, 60.6 and 33.6 respectively as against the similar percentages among controls 1.4, 9.0 and 6.3. The odds ratio for tobacco use in relation to patients aged 60+ years was 2.39, in the age group of 45-59 years was 11.19 and increased to 55.35 in the age group 30-44 years. Similarly the overall odds ratio for alcohol consumption was 7.48 and it was 4.98 in the age group 60+ years, 6.30 in the age group 45-59 years and increasing to 17.00 in the age group of 30-44 years. CONCLUSION: Finding suggests that risk of cancer of the upper respiratory and alimentary tracts is higher with tobacco and alcohol use. Further studies are required.