The epidemiology of melioidosis and its association with diabetes mellitus : a systematic review and meta-analysis

Melioidosis is an under-recognized fatal disease in humans, caused by the Gram-negative bacterium Burkholderia pseudomallei. Globally, more than 35,000 human melioidosis cases have been reported since 1911. Soil acts as the natural reservoir of B. pseudomallei. Humans may become infected by this pathogen through direct contact with contaminated soil and/or water. Melioidosis commonly occurs in patients with diabetes mellitus, who increase the occurrence of melioidosis in a population. We carried out a systematic review and meta-analysis to investigate to what extent diabetes mellitus affects the patient in getting melioidosis. We selected 39 articles for meta-analysis. This extensive review also provided the latest updates on the global distribution, clinical manifestation, preexisting underlying diseases, and risk factors of melioidosis. Diabetes mellitus was identified as the predominant predisposing factor for melioidosis in humans. The overall proportion of melioidosis cases having diabetes was 45.68% (95% CI: 44.8–46.57, p < 0.001). Patients with diabetes mellitus were three times more likely to develop melioidosis than patients with no diabetes (RR 3.40, 95% CI: 2.92–3.87, p < 0.001). The other potential risk factors included old age, exposure to soil and water, preexisting underlying diseases (chronic kidney disease, lung disease, heart disease, and thalassemia), and agricultural activities. Evidence-based clinical practice guidelines for melioidosis in patients with diabetes mellitus may be developed and shared with healthcare professionals of melioidosis endemic countries to reduce morbidity. © 2022 by the authors. Licensee MDPI, Basel, Switzerland

Activity of Mecillinam and Clavulanic Acid on ESBL Producing and Non- ESBL Producing Escherichia Coli Isolated From UTI Cases

Mecillinam is one of the very few oral antibacterial agents used against extended spectrum ?- lactamase (ESBL) producing Escherichia coli (E. coli) causing urinary tract infection (UTI)). It is reported that, resistance to mecillinam can be reversed to some extent by adding beta lactamase inhibitor like clavulanic acid. The present study was aimed to determine in-vitro activity of mecillinam and mecillinam-clavulanic acid combination on the susceptibility of ESBL producing and non-ESBL producing E. coli. Total 124 E. coli (78 ESBL positive and 46 ESBL negative) isolates from urine samples of patients with UTI were included in the study. Organisms were isolated from patients attending BIRDEM General Hospital from July 2012 to December 2012. ESBL production was tested by double disc synergy test. Minimum inhibitory concentration (MIC) of mecillinam and clavulanic acid against E. coli was determined by agar dilution method. Of the total E. coli isolates, 62.9% was ESBL positive and 37.1% was negative for ESBL. Out of ESBL positive isolates, 75.6% was sensitive to mecillinam while ESBL negative isolates showed the sensitivity as 67.4%. The sensitivity to mecillinam of ESBL positive and negative isolates increased to 85.9% and 86.9% respectively by addition of clavulanic acid with mecillinam. The MIC values of intermediate and resistant isolates converted to sensitive MIC range after addition of clavulanic acid with mecillinam. Conversion of resistance of ESBL producing isolates by adding clavulanic acid was also evident by the reduction of MIC50 and MIC90 from 4?g/ml to ?1 ?g/ml and from 128 ?g/ ml to 64 ?g/ml respectively. Similar trend of reduction of MICs was also observed in non-ESBLs. In conclusion, both ESBL positive and negative E. coli demonstrated considerable sensitivity to mecillinam and the sensitivity increased significantly (p&lt;0.05) by adding clavulanic acid with mecillinam.Ibrahim Med. Coll. J. 2014; 8(2): 56-60</jats:p

Trends Of Antibiotic Susceptibility Of Salmonella Enterica Serovar Typhi And Paratyphi In An Urban Hospital Of Dhaka City Over 6 Years Period

The antibiotic resistance pattern of salmonella is ever changing over time. The present study is a retrospective analysis of rate of isolation of Salmonella Typhi and Paratyphi and their antibiotic resistance pattern over 6 years period in an urban hospital of Dhaka city. Blood culture submitted in BIRDEM hospital from 2004-2009 were analyzed. Isolated Salmonella sp were identified and antimicrobial susceptibility testing was carried out by a standard disc diffusion method. Among 385 isolated Salmonella sp 304 (79%) were Salmonella enterica serovar Typhi and 81 (21%) were Salmonella enterica serover Paratyphi A. The rate of isolation of S. Paratyphi A has increased over 6 the year period from 14% to 24%. Resistance to individual first line anti-salmonella drugs has increased from 2004 to 2006 (42 to 63%) but has decreased thereafter. Similar pattern was found when simultaneous resistance to three first line antibiotics namely ampicillin, chloramphenicol and co-trimoxazole were considered. Out of total 304 S. Typhi, 117 (38%) were simultaneously resistant to all three first line drugs compared to only 1.8% S. Paratyphi A. Analysis showed that 80 to 90% of isolated S. Typhi was nalidixic acid resistant (NARST) with reduced susceptibility to ciprofloxacin while the rate for S. Paratyphi A was 71-94%. All S. Typhi and Paratyphi A were sensitive to ceftriaxone. The study showed that there was a gradual decline of resistance of S. Typhi to first line antibiotics but very high prevalence of nalidixic acid resistant S. Typhi and S. Paratyphi in Bangladesh. DOI: http://dx.doi.org/10.3329/imcj.v5i2.10097 IMCJ 2011; 5(2): 42-45</jats:p

Breast abscess due to salmonella enterica serovar typhi in ayoung diabetic female

Salmonella enterica serovar Typhi (S. Typhi) is occasionally associated with abscess formation in various organs of the body. But breast abscess by S. Typhi without the general and specific symptoms of typhoid fever is unusual. We report a case of breast abscess due to S. Typhi in a 20 year old non-lactating diabetic female without the features of typhoid fever. Ibrahim Med. Coll. J. 2013; 7(1): 16-1

A bacteriological study of diabetic foot infection in an urban tertiary care hospital of Dhaka city

Identification of organisms and effective antibiotic therapy is an important component of treatment of diabetic foot infections. This study was undertaken to determine the organisms associated with diabetic foot infection (DFI) and their antibiotic sensitivity pattern. A total of 75 patients having type 2 diabetes mellitus with Wagner’s grade 1-5 foot ulcers attending BIRDEM hospital were included in the study. Specimens were processed for aerobic culture. The bacteriological isolation and antimicrobial sensitivity tests of the isolates were done by standard microbiological methods. Gram negative bacilli were tested for extended spectrum b lactamase (ESBL) production by double disc diffusion method. Culture was positive in 92% of the cases which yielded 135 pathogens. Of the positive culture, 75.3% had multiple organisms. Polymicrobial infection was more in higher grade of foot ulcers. Gram negative organisms were most frequently isolated (80%) bacteria. Pseudomonas (48%) and Proteus sp.(33%) was the most common Gram negative organisms isolated. Staphylococcus aureus was the most commonly isolated gram positive organism (21.3%). ESBL production was noted in 31.5% Gram negative bacilli and methicillin resistance was noted in 43.8% of Staphylococcus aureus. Most of the Gram negative bacilli were resistant to various classes of antibiotics. Imepenem was the most effective agent against Gram negative organisms, while vancomycin was for staphylococcus. The present study has shown that infection with multidrug resistant Gram negative bacilli is the most common cause of DFI in BIRDEM hospital. Ibrahim Med. Coll. J. 2009; 3(2): 50-5

Melioidosis – Case Reports and Review of Cases Recorded Among Bangladeshi Population from 1988-2014

Melioidosis, caused by Burkholderia pseudomallei, is a potentially fatal infectious disease. Early and correct diagnosis is important, as mortality in untreated melioidosis is high. The first case of melioidosis from Bangladesh was reported in 1988. Since then a few cases have been reported from Bangladesh. We report here four culture confirmed cases of melioidosis diagnosed in BIRDEM Genaral Hospital during May 2009 to April 2010.The detail demographic data, clinical features and outcome are discussed. We have also reviewed all the melioidosis cases among Bangladeshi population recorded from 1988 to 2014. Ibrahim Med. Coll. J. 2014; 8(1): 25-3

High level gentamicine resistance and susceptibility to vancomycine in enterococci in a tertiary care hospital of Dhaka city

Vancomycin and high level gentamicin resistant enterococci detection is important for effective treatment and control of nosocomial infection. The present study was undertaken to determine the species distribution of Enterococcus and the rate of vancomycin and high level gentamicin resistant enterococci (HLGRE) in clinical samples in a tertiary care hospital of Dhaka city. Enterococci were identified to species level by standard biochemical and serological methods. Their susceptibilities to antibiotics were determined by disc diffusion method according to CLSI guideline. Minimum inhibitory concentration (MIC) of vancomycin and gentamicin were determined by agar dilution method. The study was conducted from July 2009 to February 2010. Among 80 isolates, 95% and 5% were identified as Enterococcus faecalis and Enterococcus faecium respectively. Out of 80 isolates 72 (90%) were sensitive and 8 (10%) were intermediate resistant to vancomycin (30µg) by disc diffusion method, but all isolates were susceptible by agar dilution MIC method. Out of 80 enterococci, 37 (46.25%) showed high level resistance to gentamicin (MIC: > 500 µg/ml) by MIC method but, initially six of which showed sensitive result to gentamicin by disc diffusion method using 120 µg disc. The study indicated high prevalence of HLGRE in our hospital population. MIC method was more accurate in detecting high level gentamycin resistant enterococci compared to disc diffusion method with 120 µg gentamicin disc. However, none of the enterococcal strains showed resistance to vancomycin. HLGRE should be monitored regularly in clinical samples as it is difficult to treat. Ibrahim Med. Coll. J. 2013; 7(2): 28-3

Disseminated melioidosis involving skin and joint: a case report

Melioidosis is an infectious disease that can cause serious morbidity and may result in death if not treated early. Its causative organism, Burkholderia pseudomallei is present in soil and water. Here, we report a case of disseminated melioidosis involving skin and joint in a farmer residing in an area where the organism has been found in the soil. Ibrahim Med. Coll. J. 2015; 9(2): 55-5

Activity of Mecillinam and Clavulanic Acid on ESBL Producing and Non- ESBL Producing Escherichia Coli Isolated From UTI Cases

Mecillinam is one of the very few oral antibacterial agents used against extended spectrum b-lactamase (ESBL) producing Escherichia coli (E. coli) causing urinary tract infection (UTI)). It is reported that, resistance to mecillinam can be reversed to some extent by adding beta lactamase inhibitor like clavulanic acid. The present study was aimed to determine in-vitro activity of mecillinam and mecillinam-clavulanic acid combination on the susceptibility of ESBL producing and non-ESBL producing E. coli. Total 124 E. coli (78 ESBL positive and 46 ESBL negative) isolates from urine samples of patients with UTI were included in the study. Organisms were isolated from patients attending BIRDEM General Hospital from July 2012 to December 2012. ESBL production was tested by double disc synergy test. Minimum inhibitory concentration (MIC) of mecillinam and clavulanic acid against E. coli was determined by agar dilution method. Of the total E. coli isolates, 62.9% was ESBL positive and 37.1% was negative for ESBL. Out of ESBL positive isolates, 75.6% was sensitive to mecillinam while ESBL negative isolates showed the sensitivity as 67.4%. The sensitivity to mecillinam of ESBL positive and negative isolates increased to 85.9% and 86.9% respectively by addition of clavulanic acid with mecillinam. The MIC values of intermediate and resistant isolates converted to sensitive MIC range after addition of clavulanic acid with mecillinam. Conversion of resistance of ESBL producing isolates by adding clavulanic acid was also evident by the reduction of MIC50 and MIC90 from 4µg/ml to £1 µg/ml and from 128 µg/ml to 64 µg/ml respectively. Similar trend of reduction of MICs was also observed in non-ESBLs. In conclusion, both ESBL positive and negative E. coli demonstrated considerable sensitivity to mecillinam and the sensitivity increased significantly (p<0.05) by adding clavulanic acid with mecillinam. Ibrahim Med. Coll. J. 2014; 8(2): 56-6

Modified MacConkey agar: a simple selective medium for isolation of Burkholderia pseudomallei from soil

Background and objectives:A selective medium is required for isolation of Burkholderia pseudomallei from soil. The present study aimed to develop an easy to prepare selective media by modifying MacConkey agar medium for improved isolation of B. pseudomallei from soil. Materials and methods: The media was prepared by using commercially available MacConkey agar as the basal medium and incorporating it with 4% glycerol and four antimicrobials namely vancomycin, amphotericin B, gentamicin and colistin at a concentration of 2.5 mg/L, 1 mg/L, 5 mg/L and 10 mg/L respectively. The media was initially optimized for growth of B. pseudomallei by addition of 100 organisms/plate of B. pseudomallei and ATCC strains of Gram negative and Gram positive bacteria. Sterile and unsterile soils were spiked with graded concentration (1x106 to 1x101 CFU/gm of soil) of B. pseudomallei and other clinical and saprophytic Gram negative organisms and cultured on MacConkey, Ashdown and modified MacConkey media after enrichment in Ashdown broth. Growth of B. pseudomallei in the three media was compared. The newly devised media was termed as - Modified MacConkey agar for Burkholderia (MMB media). Results: Culture of supernatant from spiked sterile soil after enrichment showed equivalent isolation of B. pseudomallei on MMB and Ashdown’s media and there was 100% inhibition of Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa on MMB medium. Almost similar inhibition of Comamonas testosteroni, Aeromonas salmonicida and Burkholderia cepacia was observed on both MMB and Ashdown’s media. Culture of sterile soil seeded with different concentrations of P. aeruginosa showed no growth in MMB media. But there was growth of P. aeruginosa when sterile soil samples spiked with 1x106 to 1x103 CFU of P. aeruginosa were cultured in Ashdown media. When unsterile soil was seeded with graded concentration of B. pseudomallei, the colony count of this bacterium gradually declined in all three medium with decreased spiking concentrations. Growth of other soil organisms was less in MMB media compared to other two media. Conclusion: The newly devised MMB media is selective and easy to prepare for the detection of B. pseudomallei from soil. IMC J Med Sci. 2024; 18(1):011. DOI: https://doi.org/10.55010/imcjms.18.011 *Correspondence:Md. Shariful Alam Jilani, Department of Microbiology, Ibrahim Medical College, 1/A Ibrahim Sarani, Segun Bagicha, Dhaka-1000, Bangladesh. Email: [email protected]