Study the antimicrobial agents sensitivity of methicillin resistant Staphylococcus aureus isolated from patients admitted in RIMS, Ranchi

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of hospital-acquired infections that are becoming increasingly difficult to combat because of emerging resistance to all current antibiotic classes. For this, study of MRSA isolated from admitted patients were carried out. These strains were separately tested for their sensitivity to different antibiotics to know which group of antibiotics are most effective particularly for cases of RIMS, Ranchi. Material & Methods: The present study was carried out in the Department of Microbiology, Rajendra Institute of Medical Sciences (RIMS), Ranchi clinical isolates of MRSA strains were obtained from admitted patients of RIMS, Ranchi. The sources of isolate included pus from infected surgical wounds, infected burn wounds, conjunctival swab, aural swab, throat swab, vaginal swab, urine etc for microbiological analysis and antimicrobial sensitivity of MRSA. Disc diffusion method was employed. Results: All the 264 cases of staphylococcal species isolated from different clinical specimens were subjected to coagulase test. It was observed that out of 264 strains of staphylococci isolated from different sites 165 strains (62.5%) were coagulase positive and 99 strains (37.5%) were coagulase negative by tube method. It was observed that out of 165 strains of staph. aureus isolated from different clinical samples 64 strains of staph. aureus were resistant to methicillin (38.78%). Maximum isolation of MRSA were from pus 38 (51.35%), followed by throat swab 19 (36.36%), aural swab (14.28%) and conjunctival swab (44.44%). It was observed that out of 165 strains of s. aureus isolated only 64 strains were resistant to methicillin. All strains of MRSA were 100% sensitive to Vancomycin & linezolid. Similarly 92.3% were sensitive to netilmicin, 89.7% to clindamycin, 82.1% to ciprofloxacin, 74.4% to cephotaxime, 69.2% to azithromycin, 56.4% to roxithromycin & clarithromycin, 17.9% to piperacillin/tazobactam. The most effective antibiotic against MRSA was vancomycin, linezolid, netilmicin & clindamycin. Conclusion: After comparing the effectiveness of antibiotics against MRSA infection it can be concluded that piperacillin/tazobactam, clarithromycin, roxithromycin azithromycin, cefotaxime & ciprofloxacin are of little value in treating the MRSA infection. They should not be used indiscriminately and in a haphazard manner otherwise increment in emergence of resistant strains may not be checked

Clinicopathological observations on incidental appendicectomy in a tertiary care teaching hospital, Ranchi

Background: Incidental appendectomy is defined as the removal of a clinically normal appendix during non-appendiceal surgery.  This study was conducted at RIMS, Ranchi to document effects of incidental appendicectomy on overall morbidity and mortality while performing the intra-abdominal operation and also to study the frequency of pathological findings in incidentally removed appendices and the correlation between the pathology in the appendix with known aetiological factors for acute appendicitis. Materials & Methods: The diagnosis of the primary intra-abdominal pathology was made on the basis of a detailed history through clinical examination, supported by laboratory investigations and confirmed during operation besides, the patients. The clinical setting-emergency or elective laparotomy in which the appendix was removed was noted. Laparotomy incision used was noted with regard to the case with which the appendix could be approached. The naked eye examination of the appendix was noted. A piece of appendix was collected for histopathological examination. Results: About 42% of patients were below 30 years of age. Approximately 68% of female patients were below 40 years of age. Diseases of the extra-hepatic biliary tree were the most frequent indications for operation in female patients (91%).  Contaminated operations formed 88% of abdominal operations. Appendix could be easily approached and removed in 90% of the laparotomies. Operative time (length of anaesthesia) was increased by an average of 7.7 minutes. Retrocaecal position was the commonest site of appendix (68%). Length of appendices varied between 2.5-15 cms, majority being about 5-10 cms in length. Fibrotic changes with luminal obliteration were observed in 15% of appendices. Faecoliths alone or with bands, kings, adhesions or thickening of wall of appendix were present in 12% cases. Evidence of focal or catarrhal appendicitis was evident in 3% cases. Post-operative hospital stay was 12 days or less in the majority of patients (93%). Conclusion: An incidental appendicectoy should be performed when operating in abdomen for the surgical treatment of some other diseases, where no contraindication exists. The added procedure does not increase either intra-operative risk or post-operative complications and spares the patient from the possible subsequent development of acute appendicitis

Comparison of proximal femur locking compression plate with dynamic hip screw in management of inter-trochanteric fracture

Background: Intertrochanteric fractures are common in elderly population and pose a significant financial burden to the patients and family. Anatomically contoured proximal femur locking compression plate (PFLCP) is the latest addition to deal with these fractures, which creates an angular stable construct. It will theoretically lessen the risk of failure by screw cut-out and varus collapse, the common mode of DHS failure. Materials & Methods: This study was done to prospectively compare, the rate of union, complications, operative risks and functional outcomes in inter-trochanteric fractures treated with dynamic hip screw [DHS] and Proximal femur locking compression plate [PFLCP]. It also determined the effectiveness of PF-LCP in comparison to DHS in treatment of inter-trochanteric fractures. The data collected during the study of 30 cases of inter-trochanteric fractures, 15 cases were treated using PFLCP and other 15 group of cases were treated using DHS in the Department of Orthopaedics in Rajendra Institute of Medical Sciences, Ranchi from December 2012 to December 2014.Results: The functional outcome was measured with Harris Hip Score. In PFLCP group 7 (46.67%) cases had excellent result, 5 (33.33%) cases had good result, and 3 (20%) cases had fair result with no poor result. The mean score in PFLCP group was 86.4. In DHS group 7 (46.67%) cases had excellent result, 4 (26.67%) cases had good result, 2 (13.33%) cases had fair result and 2 (13.33%) cases had poor result. Conclusion: PFLCP is a good option for the management of inter-trochanteric fracture with high union rate and low rate of complication with high functional outcome and with a possibility that it can be done without C-Arm

Microbiological and Biochemical Analysis of Methicillin-resistant Staphylococcus aureus Isolated from Patients Admitted in RIMS, Ranchi

Background: Since methicillin-resistant Staphylococcus aureus strains are resistant to multiple antibiotics, there is a possibility of extensive outbreaks which may be difficult to control. Early detection of methicillin-resistant Staphylococcus is important from patients and hospitals point of view. Materials and Methods: The present study was carried out in the Department of Microbiology, Rajendra Institute of Medical Sciences, Ranchi, clinical isolates of methicillin-resistant S. aureus strains were obtained from admitted patients of Rajendra Institute of Medical Sciences, Ranchi. The sources of isolate included pus from infected surgical wounds, infected burn wounds, conjunctival swab, aural swab, throat swab, vaginal swab, and urine for microbiological and biochemical analysis of methicillin-resistant S. aureus. Results: All the 264 cases of staphylococcal species isolated from different clinical specimens were subjected to coagulase test. It was observed that out of 264 strains of staphylococci isolated from different sites, 165 strains (62.5%) were coagulase positive and 99 strains (37.5%) were coagulase negative by tube method. Out of the 165 strains of coagulase-positive staphylococci, maximum isolation was obtained from pus 74 followed by throat swab 55, aural swab 21, vaginal 4, conjunctival swab 9, and urine 2. All the 165 cases of coagulase-positive Staphylococcus isolated from different clinical specimens were studied for hemolysis, mannitol fermentation, pigment production, and phosphatase production. Out of these 165 strains, 162 (98%) strains produced β-hemolysis on blood agar medium. Pigment production was noted in 160 (97%) of cases. Majority of strains produced characteristic golden yellow pigment on nutrient agar plate. A total of 155 (94%) strains of staphylococci fermented mannitol with the production of acid only. Phosphatase production was observed in 157 (95%) strains of pathogenic staphylococci. Conclusion: Considering the above-mentioned pathogenicity test, it was observed that coagulase test was the single most reliable test, though coagulase-negative staphylococci are sometimes pathogenic too