EMERGENCE OF CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII IN THE INTENSIVE CARE UNIT OF A REFERRAL HOSPITAL OF EASTERN INDIA AND ITS THERAPEUTIC OPTION

Background and objective: Multidrug-resistant Acinetobacter baumannii has one of the most serious nosocomially acquired gram negative infection in Intensive Care Unit (ICU). The gradual increase in incidence of this pathogen reflects their de-novo selection due to antibiotic usages and its ability to spread between patients. This study was undertaken to detect resistance to carbapenems in clinical isolates of A. baumannii in our ICU set up and to assess the rate of carbapenemase and MBL production among the isolates with the therapeutic options available against them. Material and methods: A. baumannii was identified by conventional methodology and susceptibility profile was determined by disc diffusion method. Carbapenem resistant isolates were further checked for mettalo beta lactamases (MBL) assay by EDTA disc synergy test and Minimum inhibitory concentration determination by agar dilution method. Results: 71.87% (n=46) of isolates showed resistance to Imipenem by disc diffusion method. 82.6% (n=38) of isolates were MBL producer both by phenotypic EDTA disc synergy test and MIC determination test by agar dilution method. The susceptibility profiles of A. baumannii strains towards colistin, polymyxin B and tigecycline were 90.62%, 57.81% and 78.12% respectively.Conclusion: Detection as well as awareness of this MBL producing A. baumannii in a hospital set up, coupled with judicious antimicrobial therapy based on sensitivity profiles will help us fight against this deadly menace. KEYWORDS: Acinetobacter baumannii; Carbapenemases; Mettalo beta lactamases

EMERGENCE OF CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII IN THE INTENSIVE CARE UNIT OF A REFERRAL HOSPITAL OF EASTERN INDIA AND ITS THERAPEUTIC OPTION

Background and objective: Multidrug-resistant Acinetobacter baumannii has one of the most serious nosocomially acquired gram negative infection in Intensive Care Unit (ICU). The gradual increase in incidence of this pathogen reflects their de-novo selection due to antibiotic usages and its ability to spread between patients. This study was undertaken to detect resistance to carbapenems in clinical isolates of A. baumannii in our ICU set up and to assess the rate of carbapenemase and MBL production among the isolates with the therapeutic options available against them. Material and methods: A. baumannii was identified by conventional methodology and susceptibility profile was determined by disc diffusion method. Carbapenem resistant isolates were further checked for mettalo beta lactamases (MBL) assay by EDTA disc synergy test and Minimum inhibitory concentration determination by agar dilution method. Results: 71.87% (n=46) of isolates showed resistance to Imipenem by disc diffusion method. 82.6% (n=38) of isolates were MBL producer both by phenotypic EDTA disc synergy test and MIC determination test by agar dilution method. The susceptibility profiles of A. baumannii strains towards colistin, polymyxin B and tigecycline were 90.62%, 57.81% and 78.12% respectively.Conclusion: Detection as well as awareness of this MBL producing A. baumannii in a hospital set up, coupled with judicious antimicrobial therapy based on sensitivity profiles will help us fight against this deadly menace. KEYWORDS: Acinetobacter baumannii; Carbapenemases; Mettalo beta lactamases

A case report of Small Colony variant of Staphylococcus aureus isolated from a patient with chronic oesteomyelitis in a tertiary care hospital of eastern India

Small colony variants (SCVs) of Staphylococcus aureus often cause persistant and relapsing infections. SCVs are characterized by a strong reduction in growth rate, atypical colony morphology and unusual biochemical characteristics. We here report a case of chronic oesteomyelitis caused by SCV of Staphyloccous aureus in a middle aged male patient

Actinomycetoma-recurrence after amputation

Actinomycetoma is a chronic granulomatous infection of the subcutaneous tissue caused by fungus-like bacteria, that is, Nocardia sp, Actinomyces sp. This infection is common in tropical countries like India, though the disease is worldwide in distribution. A 22-year-old female who presented with multiple fistulas, sinus tracts, and pain and swelling over left foot following trauma 6 years back. A diagnosis of actinomycetoma was made based on clinical and microbiological ground. Two years after amputation there was recurrence and finally took multiple antibiotic therapies but was left without cure. Another case was that of a 37- year-old male who presented with multiple fistulas, sinus tracts, and pain and swelling on the right sole 6 months after prick of bamboo stick. There was a recurrence after amputation. Both the patients were treated with a Wallace regimen (Amikacin with Cotrimoxazole/Minocycline/Ciprofloxacin). Patient showed excellent response with healing of all sinuses after 2 months of therapy

Multidrug‑resistant acinetobacter infection and their susceptibility patterns in a tertiary care hospital

Background: Antibiotic‑resistant Acinetobacter nosocomial infection is a leading problem. It acts as an opportunistic pathogen to cause a wide spectrum of infection including nosocomial pneumonia, meningitis, endocarditis, skin and soft tissue infections, urinary tract infection, conjunctivitis, burn wound infection and bacteremia. Multidrug‑resistant Acinetobacter infection creates a great problem in hospital setting. Materials and Methods: The clinical specimens obtained from ICU and different surgical and medical wards were investigated using standard microbiological techniques to know the distribution of and their resistant profile. Antimicrobial resistance was studied using the modified Kirby Bauer disk diffusion technique following the CLSI protocol. Results: Major infections found in different medical wards, surgical wards and ICU were due to Acinetobacter baumannii (74.02%), A. lowfii (14.2%), A. haemolyticus (7.79%), A. junii (3.8%) among Acinetobacter spices. Acinetobacter showed increased resistant against majority of commercially available drugs imipenem (5.2%), meropenem (9.75%), piperacillin‑tazobactum (18.2%), netilmicin (16.24%), amikacin (14.29%), ceftazidime (74.1%), gentamicin (70.13%), ofloxacin (42.21%). Conclusion: A. baumannii was found to be associated with UTI, RTI, septicemia, bacteremia, and meningitis and wound infection. A. baumannii displayed higher resistance to more number of antibiotics than other nosocomial pathogens from ICU.Keywords: Acinetobacter, antibiotic resistance, nosocomial infectionNigerian Medical Journal | Vol. 53 | Issue 3 | July-September | 201

An unusual case of invasive rhinocerebral aspergillosis in an immunocompetent woman

Invasive rhinocerebral aspergillosis is very rare and commonly seen in immunocompromised individuals with a high rate of morbidity and mortality. It is an opportunistic infection and has a spectrum of presenting features from allergic sinusitis to active invasive disease. Here, we describe a case of invasive rhinocerebral aspergillosis in an immnunocompetent middle-aged woman. She was treated with systemic antifungal medications, but she ultimately succumbed to death

Methicillin-resistant Staphylococcus aureus, Cytomegalovirus, and mucosal Candida albicans coinfection in a postrenal transplant recipient

Here, we report a rare case of methicillin-resistant Staphylococcus aureus (MRSA), Cytomegalovirus (CMV), and mucosal Candida albicans coinfection in a post-renal transplant recipient. The patient presented with a cheek ulcer with nasal swelling after 2 months of immunosuppressive therapy following renal transplantation. Microbiological investigations revealed MRSA and C. albicans from the respective lesions and polymerase chain reaction for CMV from blood sample was positive. The patient was subsequently treated with appropriate regimen and is on regular follow-up

Adrenal histoplasmosis with disseminated cutaneous manifestations in an immunocompetent patient: A case report

This report describes a case of adrenal histoplasmosis along with disseminated cutaneous involvement in a 48-year-old immunocompetent male. The patient presented with multiple erythematous nodules on the skin of the scalp, face, back, thigh, abdomen, and soles. Abdominal computed tomography (CT) imaging revealed bilateral adrenomegaly, with hepatosplenomegaly. Histological examination of the biopsy specimen from both the skin lesion and CT-guided fine-needle aspiration cytology (FNAC) aspirates of the adrenal gland showed a granulomatous infiltrate with numerous intracellular Periodic Acid Schiff (PAS)-positive rounded yeast cells within the macrophages. Culturing of these materials, incubated in Sabouraud′s agar, showed growth of Histoplasma capsulatum. Treatment with itraconazole showed an excellent response