Spectrum of candidal species isolated from neonates admitted in an Intensive Care Unit of teaching hospital of Kashmir, North India

BACKGROUND: Candidal infections are an important cause of morbidity and mortality in Neonatal Intensive Care Unit. Neonatal candidiasis is increasing in frequency, mainly because of increase in the survival of babies with low-birth weight, preterm births, advancement in medical field, life support systems, relative immunodeficiency, and extensive use of broad-spectrum antibiotics. Over the past few decades, there has been a progressive shift from the predominance of Candida albicans to nonalbicans Candida species. AIMS AND OBJECTIVES: The objective of the current study was to know the prevalence of nonalbicans candidemia in neonates and their antifungal susceptibility pattern. Materials and Methods: In this study, a total of 424 samples from clinically diagnosed septicemic neonates were included. Identification of Candida isolates from these samples as well as their antifungal sensitivity testing was performed with Vitek 2 Compact (Biomerieux France) using Vitek 2 cards for identification of yeast and yeast-like organisms (ID-YST cards). Results: A total of 246/424 (58.01%) cases were blood culture positive. Out of these, 80/246 samples tested positive for candidemia (32.5%). Candida tropicalis (13.8%) was the predominant species isolated among the non-albicans Candida followed by Candida krusei (4.8%), Candida parapsilosis (3.2%), Candida guilliermondii (2.8%), and Candida dubliniensis (2.0%). We found an increase in the antifungal drug resistance, especially for the azole group of drugs, both in C. albicans and non-albicans Candida species. All the isolates were uniformly sensitive to micafungin, voriconazole, and caspofungin. Conclusions: Candidemia in neonates is an ominous prognostic sign and is an important entity in our region. The present study highlights the mycological shift of Candida species in neonatal candidemia with a preponderance of nonalbicans Candida species

Fluoroquinolone Resistance in the Clinical Isolates of Kashmir Valley and In-Vitro Efficacy of Fosfomycin in Multiple Infections

BACKGROUND: Antibacterial resistance is a major concern in healthcare associated infections. Longer hospital stay, empirical treatment without antimicrobial stewardship policy and ineffective infection control practices are making it difficult to treat infections. Kashmir valley lacks surveillance data and awareness about antibiotic resistance among clinicians, thus complicating patient care. The aim of this study was to investigate the prevalence of antibacterial resistance among various clinical isolates. METHODS: The study was conducted between February 2013 and April 2014 in the Srinagar city. Samples of urine, pus, and other body fluids (N=500) were examined for clinically important pathogens. Standard laboratory protocols were followed for the isolation, identification and susceptibility tests. Recent CLSI guidelines for antimicrobial susceptibility were followed using Kirby-Bauer method. RESULTS: Predominant pathogens identified in urine cultures were Escherichia coli (42.1%), Klebsiella pneumoniae (31.57%), Proteus species (7.8%), Pseudomonas aeruginosa (13.1%) and Enterococcus faecalis (5.26%). Methicillin resistant Staphylocoocus aureus (14.8%) and Methicillin sensitive Staphylococcus aureus (22.2%) were common isolates found in pus. Other frequent clinical isolates found in pus cultures were Proteus species (28.1%), Enterococcus faecalis (18.5%) and Pseudomonas aeruginosa (14.8%). Klebsiella pneumoniae and Staphylococcus aureus were prevalent isolates in semen cultures. All clinical isolates screened in this study were resistant to quinolones, aminoglycosides, cephalosporins, carbepenems and sulphonamides. Glycopeptide resistance was observed in one of the urinary isolates. All clinical isolates were sensitive to fosfomycin. CONCLUSION: We found high quinolone resistance in pathogens isolated from community acquired urinary tract infection (UTI) and nosocomial infections. Fosfomycin can be a good alternative choice in the treatment of urinary tract infection with greater efficacy & lesser antibiotic resistance. The drug has not been so far prescribed in routine clinical practice in the valley