Antibiotic Susceptibility Pattern of the Potential Pathogens of Ventilator Associated Pneumonia in the Endotracheal Tubes of Critically Ill Patients

An endotracheal (ET) tube offers surface for potential pathogens to attach and produce biofilm. These potential pathogens are typically hospital flora with a broad range of antibiotic resistance. The study aimed to characterize the biofilm-producing flora in ET tube of critically ill patients. Following extubation, ET tubes were retrieved aseptically from 100 different patients and promptly transported in a sterile ziplock bag. Each ET tube was cut into three different sections; inner lumen was scraped out and inoculated on Blood agar, MacConkey agar, and Chocolate agar. Colonies produced on media were tested for antibiotic susceptibility testing by applying disc diffusion and Colistin minimum inhibitory concentration (MIC). Out of 100 ET tubes, monomicrobial growth was observed in 62, polymicrobial growth in 14, and no growth in 24 specimens. A total of 93 potential pathogens were isolated including 25 (26.89%) Acinetobacter species, 23 (24.73%) Klebsiella species, 15(16.12%) Pseudomonas species, 13 (13.98%) E. coli, 6 (6.45%), Staphylococcus aureus, 4 (4.3%) Coagulase Negative Staphylococcus species (CoNS), 2 (2.15%) Proteus species, 1 (1.07%) Enterobacter species and 4 (4.3%) Candida species. Imipenem and Colistin proved to be among the most successful antibiotics against gram negative isolates. Only 1 out of 25 Acinetobacter species was resistant to Colistin. Methicillin resistance emerged in two S. aureus and three CoNS strains. Microorganisms usually adhere themselves to the surface of ET tubes. They may act as potential pathogens for the onset of Ventilator Associated Pneumonia (VAP) and are resistant to commonly administered antibiotics in hospitals. A technique to reduce or prevent the risk of biofilm development is crucial

Antimicrobial Susceptibility Pattern and In-vitro Biofilm Forming Abilities of Potential Pathogens Isolated from Inner Lumen of Endotracheal Tubes of Patients Admitted in Critical Care Units

Introduction: The potential pathogens of ventilator associated pneumonia (VAP) have the ability to form biofilm within the endotracheal (ET) tube inserted in a patient. These pathogens can lead to onset of VAP once they are flushed into the lungs during mechanical ventilation. Methodology: A prospective study was conducted where ETtubes were collected from the patients in ICU after more than 48 hours of intubation. ET tube was cut into sections and inner lumen was scrapped. The material was inoculated on 5% sheep blood agar and MacConkey agar. The isolated pathogens were tested for identification and antibiotic susceptibility testing. Bacterial isolates were also tested for in-vitro biofilm formation in microtiter plate by 1% crystal violet assay. Results: Among the 100 ET tubes, 93 microorganisms were isolated which include 79 (84.9%) gram negative bacilli (GNB), 10 (10.8%) gram positive cocci (GPC), and 4 (4.3%) yeasts. Most common isolates were Acinetobacter species, Klebsiella species, Pseudomonas species, and E coli. Out of 10 GPC isolates, six were identified as Methicillin resistant strains including 4 (66.7%) coagulase negative Staphylococcus species and 2 (33.3%) S aureus. Out of 79 GNBs, 16 (20.3%) were extended spectrum beta lactomase (ESBL) producers, 14 (17.7%) AmpC, and 16 (20.3%) were carbapenemase producers. Carbapenemase production was further identified as metallo beta lactamase (MBL) producers (n=10) and serine carbapenemase producers (n=6). Out of 89 bacterial isolates, 82 (92.1%) were tested positive for in-vitro biofilm production while 07 (7.9%) were identified as non-adherent. Conclusion: Most of the ET tubes inserted for more than 48 hours inside a patient have a high risk of getting infested with potential biofilm producing pathogen. There is high rate of multi drug resistant (MDR) strains among these potential pathogens. The biofilm formed inside the ETtube possess the risk of onset of VAP

Fosfomycin Sensitivity Pattern among Uropathogens Isolated from Patients Visiting Day Care Facility of Sushila Tiwari Hospital in Kumaun Region, Uttarakhand, India

Introduction: Urinary Tract Infections (UTI) are one of the most common infections responsible for antibiotic resistance. There are limited antibiotics options for treating the cases due to Multi Drug Resistant (MDR) bacteria. Fosfomycin is being used for treating UTIs and has shown promising results even against MDR pathogens. Aim: To determine the fosfomycin sensitivity pattern along with Minimum Inhibitory Concentration (MIC) against uropathogens by agar dilution method. Materials and Methods: The present cross-sectional study was conducted in the Department of Microbiology, Government Medical College Haldwani, Uttarakhand, India, between August 2017 to September 2019. Clean catch, mid stream urine samples were inoculated on Cystine Lactose Electrolyte Deficient (CLED) agar and incubated. The significant growths of pathogenic bacteria were subjected to antibiotic susceptibility testing. Fosfomycin (30 mg) disc was used in Kirby-Bauer disc diffusion testing. Fosfomycin trometamol MIC was determined by agar dilution method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. The data collected in the study were analysed by using Statistical Package for the Social Science (SPSS) software version 20.0. Results: Significant growth of pathogenic bacteria was observed in 365 out of total 2725 urine samples. E.coli (72.32%) was the leading isolate followed by Enterococcus species (10.41%). Fosfomycin was recorded as the most active antibiotic against all the bacterial pathogen with 85-100% susceptibility except Proteus species (40%) in disc diffusion method. The MIC of fosfomycin was recorded between 4-64 against most of the isolates by agar dilution method. Conclusion: Fosfomycin is the most active antibiotic against all the uropathogens in the study setup and can be included in empirical treatment of day care patients along with nitrofurantoin

Symmetrical peripheral gangrene and tuberculosis: A rare kinship

Symmetrical peripheral gangrene (SPG) is a rare clinical syndrome characterized by ischemic necrosis of 2 or more limbs, without involvement of large vessels. It is often associated with disseminated intravascular coagulation and septic shock. Usually caused by Gram-positive and Gram-negative organisms, tuberculosis as a cause is extremely rare. We present the case of a 46-year-old man, who initially presented with signs and symptoms suggestive of tuberculosis but later developed SPG along with septic shock after his initial visit. The case highlights the progression of this dreaded complication and touches upon recent developments in its etiology as well as pathogenesis

Prevalence of Hepatitis A Virus and Hepatitis E Virus in Western Thar Region

Introduction: Hepatitis A Virus (HAV) and Hepatitis E Virus (HEV) pose major health problems in India. Both viruses are enterically transmitted, resulting in Acute Viral Hepatitis (AVH) in developing countries. This study was done to determine prevalence of HAV and HEV and their co-infection in patients presenting with AVH in a tertiary care hospital. Aim: To determine the prevalence of HAV and HEV and their co-infection among patients attending a Tertiary Care Hospital in Jodhpur presenting with symptoms of acute hepatitis. Materials and Methods: A cross-sectional study of one year duration was conducted in the Department of Microbiology, Dr S.N. Medical College, Jodhpur. A non random sampling of 174 patients presenting with AVH was considered in the study. On the basis of history, serum samples were analyzed for IgM anti-HAV and IgM anti-HEV for the detection of HAV and HEV, respectively using commercially available ELISA kits. Data collected was analysed by using Statistical Package for the Social Sciences (SPSS) version 11 and p-value <0.05 was considered significant. Results: The seroprevalence of HAV and HEV positive patients were 13.79% and 4.02%, respectively. The seroprevalence of both HAV and HEV in patients with AVH was 1.15%. The prevalence of HAV and HEV among males (58.3% and 41.6%) was higher than in females (7.97% and 14.28%). Conclusion: The prevalence of HAV is higher than that of HEV but screening of HEV should be done as there are cases of coinfections. In this region of country, these data will play a role in planning of vaccination strategies and for better sanitation programme in future

Disseminated trichosporonosis due to Trichosporon asahii in a diabetic patient

Trichosporon asahii (formerly known as Trichosporon beigelii) is an emerging, life-threatening opportunistic pathogen and has been found to be invariably associated with disseminated or deep-seated trichosporonosis, more so among the patients with granulocytopenia or hematological malignancies. We here report a successfully treated case of disseminated trichosporonosis in a known diabetic, 14-year-old girl, admitted to our hospital with chief complaints of fever, chills, and burning micturition since 3 weeks. Disseminated trichosporonosis is usually an insidious disease with poor prognosis. Early diagnosis is crucial for successful treatment. High index of clinical suspicion and extensive microbiological investigations can clinch the diagnosis