A prospective study to analyse antibiotic susceptibility pattern of Pseudomonas aeruginosa in a tertiary care hospital

Background: Pseudomonas aeruginosa, a gram-negative pathogen is commonly associated with nosocomial infections. Infections caused by P. aeruginosa can range from superficial skin infections to fulminant sepsis. Antimicrobial resistance is an area of prime concern in pseudomonal infections. The objective of the study was to evaluate and analyse the antibiotic susceptibility pattern of P. aeruginosa at a tertiary care hospital in South India.Methods: The study was carried out at Kasturba Medical College and Hospital, Manipal, India from January 2011 to December 2011. Ten different types of specimens were collected from patients who were culture positive for Pseudomonas aeruginosa. Antibiotic susceptibility was confirmed by disk diffusion technique on Muller-Hinton medium and was performed according to the Clinical Laboratory Standard Institute (CLSI) guidelines.Results: Out of 200 samples of P. aeruginosa 69.5% and 30.5% were from male and female patients respectively. Majority of the specimen from which P. aeruginosa was isolated consisted of sputum, pus and urine. Among the antimicrobial drugs tested, organism was most sensitive to carbapenems (77.5%), piperacillin-tazobactam (77%) and cefoperazone-sulbactam (72%). Resistance rates were high for fluoroquinolones (FQs) (43.5%), gentamicin (40.5%), tobramycin (40.5%), ticarcillin-clavulanic acid (39%) and aztreonam (38%) when compared to cefepime (31.5%), ceftazidime (32.5%), netilmicin (34.5%) and amikacin (35%).Conclusions: Carbapenems and piperacillin-tazobactam were the best antipseudomonal agents with highest sensitivity to P. aeruginosa. FQs, gentamicin and tobramycin were the least effective drugs against P. aeruginosa as monotherapy

A Comparative Analysis of Bacterial Growth with Earphone Use

Background: Recently the worldwide usage of earphones has increased especially among the school and college students who have a high rate of sharing among them. Alike airline headsets, headphones and stethoscope ear-pieces, ear phones can easily be a vector of potential pathogens, which can give rise to otitis externa. Purpose: To compare the bacterial growth of the external ear in association with earphone and assess the role of earphones as vector or microorganisms. Material and Methods: 50 voluntary male subjects (age 18-25 years) were chosen and divided into two groups, A and B, according to the use of earphones. Swabs were taken from their left ear and the left earpiece of the earphone. Samples were processed as recommended. Results: In group A, bacteria were found in 20 (80%) ear and 14 (56%) earphone swabs. In group B, bacteria were found in 23 (92%) ear and 17 (68%) earphone swabs. Group B showed heavy growth and a significant increase in the number of bacterial growths after frequent and constant use. Conclusion: Frequent and constant use of earphones increases the bacterial growth in the ear and sharing of earphones might be a potential vector of commensals. It is therefore, always better not to share or else to clean the earphones before sharin

COLD ANTIBODY-MEDIATED AUTOIMMUNE HEMOLYTIC ANEMIA IN A PATIENT WITH OVERLAP SYNDROME OF SYSTEMIC LUPUS ERYTHEMATOSUS WITH SJOGREN’S SYNDROME

Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder commonly seen in females characterized by multisystem inflammation with the production of an array of antibodies. Hematological disturbances are common in SLE specifically autoimmune hemolytic anemia (AIHA) which results from the development of autoantibodies directed against antigens on the surface of patient’s own red blood cells. Here, we present a rare case of a 50-year-old female patient presenting with cold antibody-mediated AIHA

CLINICAL AND MICROBIOLOGICAL PROFILE OF CANDIDA ISOLATES FROM ORAL CANDIDIASIS IN PATIENTS UNDERGOING RADIOTHERAPY FOR HEAD AND NECK MALIGNANCY

ABSTRACTObjective: To study the clinico-microbiological profile of oral candidiasis in head and neck squamous cell cancer (HNSCC) patients undergoingcurative radiotherapy (cRT).Methods: Patients undergoing cRT and developing oral candidiasis were enrolled. Clinical features such as pain and xerostomia were recorded.Candida isolates from lesions were speciated using CHROMagar (Himedia Inc.), and antifungal susceptibility was determined using microbrothdilution (MBD). Patients were followed up to study the clinical course of infection.Results: Of the 100 patients undergoing cRT, 79 developed oral candidiasis. Median duration to development of infection was 4 weeks (range:1-6.5 weeks). Mucositis was observed in 76 (96.2%) and xerostomia in 53 (67.1%) patients; 61 patients (77.2%) had symptoms attributable tocandidiasis. However, there was no correlation between severity of infection and mucositis (p=0.84) or xerostomia (p=0.51). Candida albicans was themost frequent (47 patients, 59.4%) isolate, followed by Candida tropicalis (23 patients; 29.1%). All isolates were sensitive to nystatin, but fluconazoleresistance/dose-dependent susceptibility was noted in 26 (32.9%) isolates. Both Candida krusei and two of four Candida glabrata isolate exhibitedfluconazole resistance. All patients received treatment for Candidiasis. On follow-up, 1 month after cRT, oral candidiasis resolved with gradualrecovery of mucositis in all patients.Conclusion: Candida albicans was the most common cause of oral Candidiasis in HNSCC cRT, and all isolates were susceptible to nystatin in-vitro.All lesions resolved with recovery from mucositis. In addition, as no patient developed systemic candidiasis, it appears that oral candidiasis thoughtroublesome is curable with treatment.Keywords: Radiation mucositis, CHROMagar, Microbroth dilution, Antifungal susceptibility

Risk factors of acute respiratory distress syndrome in Scrub typhus

Background: Scrub typhus is a common tropical infection presenting as acute febrile illness. Acute Respiratory Distress Syndrome (ARDS) is a serious complication of scrub typhus and is often associated with high mortality. This study was aimed to analyse risk factors of ARDS in Scrub typhus patients.Methods: This study was a prospective observational case control study conducted from June 2012 to June 2015 in Kasturba Hospital, Manipal, Karnataka, India. ARDS was diagnosed as per Berlin criteria.Results: During the study period, a total of 320 patients were diagnosed to have scrub typhus as per our criteria. All the patients were from state of Karnataka except for 1 patient, who was from state of Kerala. A total of 20 (6.25%) patients (cases) were diagnosed to have ARDS and 300 (93.75%) patients (controls) did not have ARDS. After multivariate analysis of the risk factors only two risk factors had significant association with development of ARDS: sepsis (OR 4.34,95% CI 0.51,36.76) and septic shock (OR 16.57 95% CI 1.64,166.76).Conclusions: ARDS is a common and serious complication of scrub typhus. It often occurs along with other complications. Presence of dyspnoea, sepsis, septic shock, hypoalbuminemia should alert clinicians about ARDS. ARDS due to scrub typhus is associated with high mortality. Early recognition and prompt therapy can reduce mortality

Incidence of multidrug-resistant organisms causing ventilator-associated pneumonia in a tertiary care hospital: A nine months′ prospective study

<b>Background: </b> Ventilator-associated pneumonia (VAP) is an important intensive care unit (ICU) infection in mechanically ventilated patients. VAP occurs approximately in 9-27&#x0025; of all intubated patients. Due to the increasing incidence of multidrug-resistant organisms in ICUs, early and correct diagnosis of VAP is an urgent challenge for an optimal antibiotic treatment. <b> Aim of the Study: </b> The aim of the study was to assess the incidence of VAP caused by multidrug-resistant organisms in the multidisciplinary intensive care unit (MICU) of our tertiary care 1,400-bedded hospital. <b> Materials and Methods: </b> This prospective study was done in the period from December 2005 to August 2006, enrolling patients undergoing mechanical ventilation (MV) for&#62; 48 h. Endotracheal aspirates (ETA) were collected from patients with suspected VAP, and quantitative cultures were performed on all samples. VAP was diagnosed by the growth of pathogenic organism _10⁵ cfu/ml. <b> Results: </b> Incidence of VAP was found to be 45.4&#x0025; among the mechanically ventilated patients, out of which 47.7&#x0025; had early-onset (&#60; 5 days MV) VAP and 52.3&#x0025; had late-onset (>5 days MV) VAP. Multiresistant bacteria, mainly <i> Acinetobacter spp. </i> (47.9&#x0025;) and <i> Pseudomonas aeruginosa (27&#x0025;), </i> were the most commonly isolated pathogens in both types of VAP. Most of the isolates of <i> Escherichia coli </i> (80&#x0025;) and Klebsiella <i> pneumoniae (100&#x0025;) </i> produced extended-spectrum beta lactamases (ESBLs). As many as 30.43&#x0025; isolates of <i>Acinetobacter spp. </i>showed production of AmpC beta lactamases among all types of isolates. Metallo-beta lactamases (MBLs) were produced by 50&#x0025; of <i>Pseudomonas aeruginosa </i>and 21.74&#x0025; of Acinetobacter spp. <b> Conclusion</b> : High incidence (45.4&#x0025;) of VAP and the potential multidrug-resistant organisms are the real threat in our MICU. This study highlighted high incidence of VAP in our setup, emphasizing injudicious use of antimicrobial therapy. Combined approaches of rotational antibiotic therapy and education programs might be beneficial to fight against these MDR pathogens and will also help to decrease the incidence of VAP

Incidence of multidrug-resistant organisms causing ventilator-associated pneumonia in a tertiary care hospital: A nine months' prospective study

BACKGROUND: Ventilator-associated pneumonia (VAP) is an important intensive care unit (ICU) infection in mechanically ventilated patients. VAP occurs approximately in 9-27% of all intubated patients. Due to the increasing incidence of multidrug-resistant organisms in ICUs, early and correct diagnosis of VAP is an urgent challenge for an optimal antibiotic treatment. AIM OF THE STUDY: The aim of the study was to assess the incidence of VAP caused by multidrug-resistant organisms in the multidisciplinary intensive care unit (MICU) of our tertiary care 1,400-bedded hospital. MATERIALS AND METHODS: This prospective study was done in the period from December 2005 to August 2006, enrolling patients undergoing mechanical ventilation (MV) for >48 h. Endotracheal aspirates (ETA) were collected from patients with suspected VAP, and quantitative cultures were performed on all samples. VAP was diagnosed by the growth of pathogenic organism ≥10(5) cfu/ml. RESULTS: Incidence of VAP was found to be 45.4% among the mechanically ventilated patients, out of which 47.7% had early-onset (<5 days MV) VAP and 52.3% had late-onset (>5 days MV) VAP. Multiresistant bacteria, mainly Acinetobacter spp. (47.9%) and Pseudomonas aeruginosa (27%), were the most commonly isolated pathogens in both types of VAP. Most of the isolates of Escherichia coli (80%) and Klebsiella pneumoniae (100%) produced extended-spectrum beta lactamases (ESBLs). As many as 30.43% isolates of Acinetobacter spp. showed production of AmpC beta lactamases among all types of isolates. Metallo-beta lactamases (MBLs) were produced by 50% of Pseudomonas aeruginosa and 21.74% of Acinetobacter spp. CONCLUSION: High incidence (45.4%) of VAP and the potential multidrug-resistant organisms are the real threat in our MICU. This study highlighted high incidence of VAP in our setup, emphasizing injudicious use of antimicrobial therapy. Combined approaches of rotational antibiotic therapy and education programs might be beneficial to fight against these MDR pathogens and will also help to decrease the incidence of VAP