ACINETOBACTER MAIN CAUSE OF HOSPITAL ACQUIRED INFECTIONS: A REVIEW

Hospital acquired infections (HAIs) are mostly caused by Gram-negative organisms and is one of the major issues in patient safety. These infectionsare often associated with the medical processes of hospitals such as invasive medical devices and various surgical procedures. Gram-negativeorganisms account for most infections in the hospital environment because of their ability to acquire resistant against multiple antibiotics. Throughdifferent mechanisms including the synthesis of β- lactamases, overexpression of transmembrane efflux pump, loss of porins, synthesis of antibiotic modifying enzymes, target mutations, ribosomal mutation or modifications, mutations in lipopolysaccharide structure etc. these organisms have developed drug-resistant property and the genes encoded in plasmids play a vital role in developing the resistant. Among all Gram-negative bacteria, Acinetobacter baumannii is an emerging pathogen that accounts for about 80% of all reported infections. Although other species of Acinetobacter are also often associated with HAIs. Acinetobacter is non-motile, obligate aerobic Gram-negative coccobacillus and are ubiquitous free-living saprophytes in soil and water. It is commonly transmitted through medical devices such as ventilators, urinary catheters and other invasive devices in hospitals but its ability to colonize on the skin of individuals often increases the rate of transmission through person to person contact. Patients admitted to Intensive Care Unit (ICU) are at the major risk of getting infected by A. baumannii and these includes pneumonia/ ventilator associated pneumonia(VAP), bloodstream infections, wound abscesses, urinary tract infections etc.Â

EMERGENCE AND ANTIBIOTIC SENSITIVITY PATTERN OF ACINETOBACTER BAUMANNII IN HOSPITAL FACILITY

ABSTRACTObjective: Nosocomial infections or Hospital acquired infection (HAI) are one of the major threats to hospitalized patients as well as for the hospitalassociated personnel. In last few years there is a gross change in causative agents, new organisms have come out with great threat to hospitals as theypossess antibiotic resistance property e.g. production of biofilm, production of enzymes such as β- lactamases. Among many organisms, Acinetobacterbaumannii has emerged as a potent nosocomial pathogen. Our objective of this study was to find the burden of Acinetobacter baumannii infectionswhich are associated as nosocomial infections and to determine the drug of choice for an effective treatment.Methods: Clinical specimens were collected from patients of different unit of the hospital by maintaining universal precautions and standardmicrobiological protocols. All the respective specimens were cultured in respective culture medium i.e. MacConkey agar, blood agar, chocolate agar,cysteine lactose electrolyte deficient (CLED) agar and, fluid thioglycolate (TG) medium at 37˚C for 24-48 hours. After incubation of 24-48 hours cultureplates were examined for bacterial growth and identification and antibiotic sensitivity test was made by Vitek2 compact.Result: The study was conducted at the department of microbiology from January 2016 to April 2016. A total of 2582 specimens were collected andprocessed for identification and sensitivity testing. Specimens of all age group (2 days- 93 years) and both sexes were processed for identificationof A. baumannii and antibiotic sensitivity testing. A total of 119 isolates (4.60%) of A. baumannii were obtained from 2582 clinical specimens. Themost common infection A. baumannii was found as lower respiratory tract infection (89.07%) followed by abscess (6.72%), septicaemia (2.52%),urinary tract infections (0.84%), and soft tissue infections (0.84%). The maximum sensitivity of A. baumannii isolates were seen to Colistin (CL) (119,100%), followed by Tigecycline (TGC) (63, 52.94%) and Minocycline (MIN) (27, 22.69%). The maximum resistant was observed for Imipenem (IMI),Aztreonam (AZT) and Ticarcillin- clavulanic acid (TIC) (119, 100%).Conclusion: The Gram- negative coccobacillus, Acinetobacter baumannii poses a formidable threat to patients. It has emerged as a superbug inhospital environment particularly in ICU units. The chances of A. baumannii infections increase in the presence of iatrogenic factors like inadequatelong- term antibiotic therapy and new interventions in a medical facility. To control the burden of Acinetobacter infections new therapies suchas combine therapy must be obtained and followed with proper dose as recommend by physicians; along with awareness of the importance ofthis infection should be implicated. Proper sanitation, good housekeeping, sterilization of equipment, hand hygiene, water purification, isolationprocedures and maintaining of the hospital environment, use of infection control practices are some of the measures to control the transmission ofAcinetobacter spp. among hospital personnel.Keywords: Acinetobacter baumannii, Biofilm, β-lactamases, Hospital acquired infection

MIPOMERSEN: A NOVEL THERAPEUTIC DRUG FOR THE TREATMENT OF FAMILIAL HYPERCHOLESTEROLEMIA, HYPERLIPIDAEMIA, AND HYPERCHOLESTEROLEMIA

Familial Hypercholesterolemia (FH) is one of the most common autosomal dominant disorders which exist in either heterozygous form or a homozygous form. These two forms are prevalent in1 in500 and1 ina million population respectively. FH results in premature atherosclerosis; as early as childhood in case of homozygous (HoFH) form and in adults in case of heterozygous (HeFH) form. In case of HoFH both the alleles forLDL-receptor are defective, whereas the mutation in the single allele is the cause for HeFH. Both the forms of the disease are associated with high levels ofLDL-C and lipoprotein (a) in plasma, with high morbidity and mortality rate caused by cardiovascular disease. In several past years, different lipid-lowering drugs like Statins (HMG-coenzyme-A reductase inhibitor), MTTP inhibitor, CETP inhibitors, PCSK9 inhibitor, thyroid mimetics, niacin, bile acid sequestrants and lipid apheresis were administered to patients with FH, to achieve the goal of reducing plasmaLDL-C and lipoprotein (a). However, such drugs proved inefficient to achieve the goals because of several reasons. Mipomersen is a 20 nucleotide antisense oligonucleotide; a novel lipid-lowering therapeutic drug currently enrolled in the treatment of patients with HoFH, HeFH and other forms of hypercholesterolemia. It arrests the synthesis of Apo B100 by targeting Apo B100 mRNA and thus inhibiting the synthesis and release of all Apo B-containing lipoproteins, such as very low-density lipoprotein (VLDL), intermediate density lipoprotein (IDL), low-density lipoprotein (LDL), and non-high-density lipoprotein. It also lowers lipoprotein (a), and ultimately reduces the severity of coronary artery disease and cardiovascular disease.Keywords: Hypercholesterolemia, Low-density lipoprotein, Mipomersen, Cholesterol, Lipoprotein, Antisense oligonucleotideÂ