Multi-drug-resistant tuberculosis: the experience of an urban tertiary care hospital in South India using automated BACTEC 460 TB.

The emergence of multi-drug-resistant (MDR) strains has been a major obstacle in the tuberculosis (TB) control programme. In the present study we looked into the prevalence of MDR-TB in an urban tertiary care hospital in South India over four years (2007-2010). During this period, 641 clinical specimens (317 respiratory specimens and 324 non-respiratory specimens) were received for mycobacteriological culture and drug susceptibility testing for first-line drugs, using the BACTEC 460 TB system. Mycobacterium tuberculosis (MTB) was isolated in 34.8% (n = 223) specimens. Of the total 223 MTB isolates 83 (37.2%) were MDR. Forty-two percent of the pulmonary MTB isolates (n = 72) and 20.4% of the extra-pulmonary isolates (n = 10) were MDR. Although we observed a high percentage of drug resistance, the prevalence of MDR was not observed to vary significantly within the four years which suggested good management.

Ceftriaxone resistant Shigella flexneri, an emerging problem.

Shigellosis is a disease of public health importance in developing countries. It may cause self-limited diarrhea to severe dysentery. Emergence of multi drug resistant (MDR) strains is a growing concern globally. Ceftriaxone and ciprofloxacin are the drugs of choice for MDR cases. Here, we report a case of MDR Shigella flexneri from an immunocompromised patient. The strain was resistant to ceftriaxone [minimum inhibitory concentration (MIC) ≥ 64 µg/ml], limiting the treatment option. Simultaneously, the strain was also found to be resistant to ciprofloxacin (MIC ≥ 4 µg/ml). However, it was susceptible to ceftazidime (MIC 4 µg/ml). This is the first case of ceftriaxone resistant Shigella spp. reported from our hospital.

Direct drug susceptibility testing of Mycobacterium tuberculosis to primary anti-tubercular drugs by nitrate reductase assay.

OBJECTIVES: Traditional drug susceptibility testing for Mycobacterium tuberculosis takes weeks and/or expensive. In this study, we evaluated nitrate reductase assay for drug susceptibility testing which is faster than the visual detection of colonies. MATERIALS AND METHODS: 32 clinical specimens (direct microscopy positive for AFB with 1+, 2+ or 3+ grading) were decontaminated and the sediment was inoculated onto the L-J medium with INH or Rifampicin incorporated with Potassium nitrate and the same medium without antibiotics at 1;10 dilution as control. After 2 weeks, the control was first tested for color change with addition of nitrate reductase reagents. If found positive, the media with antibiotics were tested and compared. Futher incubation was done if the control was found to be negative. The results obtained was compared with standard direct proportion method for drug susceptibility testing. RESULTS: Resistance of isolates as shown by both methods for INH and Rifampicin was 37.5% and 31.3% respectively. The results showed that NRA and proportion method do not differ significantly ( P < 0.05 for both drugs). Thus an excellent agreement between the results of NRA and proportion method was found for two primary anti-tubercular drugs, 87.5% for INH and 97% for Rifampicin. CONCLUSION: Nitrate reductase assay is a rapid and inexpensive method for susceptibility testing of M. tuberculosis for primary anti-tubercular drugs and could be an alternative to existing methods, particularly in resource poor settings.