Comparative evaluation of different culture media for the isolation and identification of common urinary pathogens

Background: Urinary tracts infections (UTIs) are one of the most common infections encountered in hospital as well as community settings. There is continuous increase in incidence of this infection leading to more consumption of antimicrobial drugs. Urine cultures occupy most of the workload of routine microbiology laboratories in developing country like India. Accurate and rapid identification of pathogens is the primary responsibility of a clinical microbiology laboratory.Methods: Mid-stream urine and catheterized samples were collected. Cultures were plated on blood agar, MacConkey agar and cysteine lactose electrolyte deficient media and incubated overnight at 35°C-37°C in ambient air. Colonies on the MacConkey agar, CLED agar and blood agar were also identified. The final identification of the isolates was done using standard identification protocol.  Antimicrobial susceptibility was performed by Kirby- Bauer disc diffusion test according to the CLSI guidelines.Results: Out of 500 urine samples processed, 211 samples showed significant growth, 24 samples showed polymicrobial growth and 265 samples were reported sterile.  Out of these 211, 199 showed pure growth and 12 showed mixed growths. Out of 199 pure growths, 126 were gram negative bacilli, 56 were gram positive cocci and 17 were yeast. All the gram-negative bacilli grown on all the media but most of the gram-positive cocci and yeast were unable to grow on Mac-Conkey agar and blood agar but grew successfully on CLED agar.Conclusions: So, in resource constrain laboratories, CLED agar can be used as media of choice for isolation of common uropathogens because it is user friendly, cost effective and decreases work load of the laboratories

UROPATHOGENS: ISOLATION AND ANTIBACTERIAL SUSCEPTIBILITY PATTERN

Objective: To find the antibiotic sensitivity pattern of uropathogens. Methods: A total of 100 urine samples of clinically suspected urinary tract infection were collected from May 2016 to July 2016. The samples were inoculated on cystine lactose electrolyte deficient agar and incubated at 37°C for 24 hrs. Results: A total of 77 (77%) samples were positive showing microbial growth. Among all isolates, Escherichia coli was 36.36%, followed by Klebsiella spp. (35.06%), Citrobacter spp. (6.49%), Staphylococcus aureus (6.49%), Pseudomonas spp. (5.19%), Enterococcus faecalis (3.90%), and Acinetobacter spp. (1.30%). For Gram-positive isolates, the most effective antibiotic was nitrofurantoin followed by sulphafurazole. For Gram-negative isolates, the most effective antibiotic was nitrofurantoin followed by gentamicin and piperacillin/tazobactam. Conclusion: In this study, nitrofurantoin was the most effective antibiotic for Gram-positive and Gram-negative uropathogen

Antibiotic susceptibility profile and extended spectrum β-lactamases production by uropathogenic Escherichia coli from tertiary care hospital of rural settings

Background: Escherichia coli are the most common cause of urinary tract infections in community as well as hospital settings. Emergence of drug resistance in Escherichia coli due to various mechanisms makes the treatment options very limited. This study was undertaken to detect ESBLs in uropathogenic Escherichia coli isolates and to determine their antimicrobial susceptibility pattern in rural setting.Methods: A prospective study was done on 502 E. coli isolates from clinically suspected cases of urinary tract infections (UTI) patients of all age groups. All samples were inoculated on Cysteine Lactose Electrolyte Deficient Agar (CLED). Organisms grown in pure culture were identified by standard biochemical tests. Antibiotic susceptibility test was done by the Kirby Bauer Disc diffusion method on Muller Hinton agar. ESBL detection was done as per CLSI guidelines.Results: Of the 502 isolates of Escherichia coli, nitrofurantoin (82%) was found be most sensitive antimicrobial followed by amikacin (73%), gentamycin (71%) and imipenem (64%). Common empirically used antibiotics like fluroquinolones and Cotrimoxazole drugs showed alarming rate of resistance. 60% isolates were found to be multidrug resistant. ESBL production was detected in 31% isolates. ESBL producing strains were found to be more drug resistant than non ESBL producing strains.Conclusions: So, drug resistance due to production of ESBLs in Escherichia coli is a serious threat for clinicians. Strict infection control measures and early detection of beta lactamase producing isolates are the need of the hour to contain the emergence of this type of resistance

Costochondral Grafts in the treatment of Temporomandibular joint ankylosis: a Clinical Study

Background: Treatment of temporomandibular joint (TMJ) ankylosis usually requires adequate excision of the involved ankylotic block (arthroplasty) without interposing any material (gap arthroplasty) or interpositional arthroplasty using autogenous or alloplastic materials. The objective of this paper was to note the potential of the costochondral graft (CCGs) as an interpositional material and to see whether they induce normal growth potential in the reconstructed mandible. Materials and method: The ankylosed temporomandibular joint was reached by a preauricular incision with or without angulation and exposed. In the first 4 cases, arthroplasty was done using a bur. The bony mass was detached of its muscle attachments and removed. In the 5th case, condylectomy was performed. In all cases, this was followed by immediate costochondral grafting. Results: The maximal incisal opening in the pre-operative period ranged from 0- 2mm and in the immediate post- operative period from 15- 20mm. at the end of the follow up period it ranged from 20- 35 mm. The increase in SNB angle, SND angle, ramus length and mandibular body length all showed linear growth of mandible on the side where costochondral grafting was done. Conclusion: The articular reconstruction with costochondral grafts for the treatment of TMJ ankylosis is efficient in relation to post- operative maximal incisal opening, recurrence and articular function

Effect of denture wearing on occurrence of fungal isolates in the oral cavity: a pilot study

Objectives: An attempt was made to evaluate effect of denture wearing on occurrence of fungal isolates in the oral cavity before and after complete denture insertion. Method: Twenty five completely edentulous patients were selected; swab samples were collected intraorally before fabrication of complete dentures from labial vestibular area and after complete denture fabrication (one and four days after denture insertion). Further these samples were inoculated and incubated. Results: In nineteen patients no isolate of fungus before denture insertion as well as 4 days after denture insertion was found. In two subject results were false positive (contamination from environment), and in four patients there was increase in growth but not much significant increase of growth of fungal isolates was seen (mild growth of fungus only after denture insertion). One of the major finding of this study was overall occurrence of fungal isolates (before and after denture insertion) in the oral cavity were not significant

Efficacy of combined phenotypic methods for methicillin-resistant Staphylococcus aureus detection and antibiotic susceptibility

Background: The main aim of our study is to demonstrate comparative evaluation of oxacillin disc diffusion (ODD), oxacillin screen agar (OSA), CHROM agar (CA) with cefoxitin disc diffusion (CDD) method for the detection of methicillin-resistant Staphylococcus aureus obtained from various clinical samples.Methods: This prospective study was conducted to detect Methicillin resistance among staphylococcus aureus by four phenotypic methods isolated from various clinical samples received in the Department of microbiology MMIMSR, Mullana.Results: The data was statistically analyzed, compiled in form of tables, graphs, percentage and test of significance will also be done wherever necessary (using Microsoft Excel, 2008 version) CDD+ODD+OSA+CA proved to be 100% followed by ODD+OSA+CA and CDD+OSA+CA 82.07% and CDD+ODD+OSA 80.1%.Conclusions: Combined phenotypic methods are better in evaluating and studying MRSA infections in hospitals as compared to tests done in isolation for proper diagnosis and timely treatment of infections

Differential, Tissue-specific, Transcriptional Regulation of Apolipoprotein B Secretion by Transforming Growth Factor β

n/

Extended-spectrum β-lactamase and AmpC β-lactamase Production among Gram-negative Bacilli Isolates Obtained from Urinary Tract Infections and Wound Infections

Extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases continue to be a major problem in healthcare settings. Due to the scarcity of information regarding the antibiotic susceptibility patterns particularly from urinary tract infection (UTI) and wound infections, the current study was carried out to assist the clinicians to prescribe appropriate antibiotics against Gram-negative clinical isolates. In the current study, urine (n = 620) and pus (n = 228) samples were collected from different sites (at various clinical departments) and subjected to direct microscopic examination, culture and antibiotic susceptibility testing (AST). In the AST testings, the isolates that exhibited reduced zone of inhibition to one or more of the antibiotics such as cefotaxime (≤27 mm), ceftriaxone (≤25 mm), ceftazidime (≤22 mm), cefpodoxime (≤17 mm) and aztreonam (≤27 mm) were considered as potential ESBL producers and the ESBL production was confirmed using phenotypic screening test (double-disk synergy test) and phenotypic confirmatory test (combined-disk test). However, isolates showing resistance or decreased sensitivity to cefoxitin, cefotaxime, ceftriaxone, ceftazidime, cefpodoxime or aztreonam and sensitive to cefepime were considered as a screen positive AmpC producer and subjected to AmpC disk tests. The current study concluded that 72.41% and 21.76% of ESBL and AmpC producers were detected, respectively in our hospital. It was also observed that the double-disk synergy and combined-disk tests were equally effective for ESBL detection. Further, AmpC disk test is simple, easy to perform and interpret, requiring less expertise for the rapid detection of AmpC isolates

Effect of Short-Term Placebo-Controlled Consumption of Probiotic Yoghurt and Indian Curd on the Streptococcus mutans Level in Children Undergoing Fixed Interceptive Orthodontic Therapy

Objective:To examine the effect of short-term consumption of probiotic yoghurt, Indian curd, and ultra-heated yoghurt as placebo on the levels of salivary and plaque Streptococcus mutans (S. mutans) in children undergoing fixed interceptive orthodontic therapy.Methods:A placebo-controlled double-blind study was carried out in a total of 30 children (8-15 years). The S. mutans level in the plaque and saliva were taken at the baseline and 2 weeks after the initiation of fixed orthodontic treatment by Dentocult SM kits. An equal number of participants randomized in three groups were asked to ingest 200 g of yoghurt containing Lactobacillus acidophilus La-1 and La-2 (>1×109 cfu/mL) once daily, Indian curd, or ultra-heated control yoghurt without viable bacteria and were followed for the S. mutans level after 2 weeks.Results:A significant reduction in salivary S. mutans levels was recorded after probiotic yoghurt ingestion (p=0.001) in addition to a reduction in the plaque S. mutans, which was observed after Indian curd consumption (p=0.026).Conclusion:Our findings suggest that short-term daily consumption of probiotic yoghurt along with Indian curd may help to reduce the levels of S. mutans in the saliva and plaque in children undergoing interceptive fixed orthodontic therapy