Brachyspira species blood stream infection

The spirochetes inhabiting the large intestines of humans and animals consist of a diverse group of related organisms. Intestinal spirochetosis caused by Brachyspira pilosicoli is a newly recognized enteric disease of human being and animals manifest as mild colitis and diarrhoea. Few cases have been reported of spirochetaemia especially in critically ill and immunocomprised patients. This is another case of spirochetaemia in a patient diagnosed as a case of chronic liver disease secondary to hepatitis C virus, presented in emergency room with history of fever, abdominal pain and slightly altered mental state. Brachyspira pilosicoli was isolated in anaerobic blood culture bottle

Evaluation of prevalence of low and high level mupirocin resistance in methicillin resistant Staphylococcus aureus isolates at a tertiary care hospital

OBJECTIVE: To evaluate the trend of mupirocin resistance in MRSA, isolated at the Clinical Microbiology Laboratory of a tertiary care hospital. METHODS: A total of 200 MRSA strains recovered over a 2 year period from various body sites were tested using the 5 and 200 microg discs of mupirocin to detect its resistance. RESULTS: High level and low level mupirocin resistance were detected in zero and 1% of MRSA strains, respectively. Resistance to other non beta lactam antibiotics was also high. No MRSA strains were found to be resistant to vancomycin and tegicycline. CONCLUSION: Mupirocin resistance was found to be very low among local clinical isolates of MRSA. Its judicious use to decolonize nasal carriers should be promoted among hospitalized patients to avoid further transmission and infections due to prevalent endemic MRSA strains in any health care setting. Concomitantly, regular surveillance and effective infection control initiatives are desirable to reduce the incidence of health care associated infections due to MRSA and also of mupirocin resistance

Diagnostic accuracy and agreement between four phenotypic carbapenemase detection tests among enterobacterales

Introduction: Carbapenem-resistant Enterobacterales (CREs) are becoming increasingly popular as a cause of hospital-acquired infections that are difficult to treat and are frequently reported as causes of outbreaks in various hospitals. Conventional culturing techniques take at least 2 days to report a case as carbapenem resistant, and it is therefore important to detect such resistance mechanisms as early as possible.Methods: This study aimed to compare the diagnostic performance of Carba NP, modified Hodge test (MHT), ethylenediaminetetraacetic acid (EDTA) disk synergy test (DST), and the modified carbapenem inactivation method (mCIM). This study was done at Microbiology Laboratory, Aga Khan University Hospital, Karachi. It was an observational study. Carba NP, MHT, EDTA DST, and the mCIM were performed on consecutive isolates of Enterobacterales. Sensitivity, specificity, and agreement between the four tests were calculated.Results: Of 207 Enterobacterales isolated, 127 were resistant to carbapenems. One hundred and fourteen of these were tested by a polymerase chain reaction, and the sensitivities of the Carba NP, MHT, EDTA DST, and the mCIM were found to be 94.34%, 75.47%, 79.25%, and 98.11%, respectively.Conclusions: Due to increased rates of carbapenem resistance, there is a need to employ mechanisms in hospitals that can identify such organisms as early as possible, both from clinical and epidemiological standpoints. The Carba NP test is a rapid, cost-effective, and reliable method and mCIM is more accurate but time consuming and both can be safely used for the screening of CREs

Assessment of resistance in multi drug resistant tuberculosis patients

Objective: To study MDR-TB isolates and to identify primary and secondary resistance at microbiology laboratory Aga Khan University, Karachi, Pakistan. Methods: All samples positive for Mycobacterium tuberculosis (MTB) received during January - September 2004 were reviewed for drug resistance pattern as well as for history of previous antituberculous drugs exposure. Results: Out of 216 Mycobacterium tuberculosis cultures, 138 (64%) showed resistance to one or more agents. Multi drug resistance (MDR) was observed in 102 (47%) isolates. Of 138 drug resistant isolates; primary resistance to any one or more agent was noted in 31(39%) and secondary (acquired) resistance in 107 (79%) isolates. On analysis of the 102 MDR-TB strains 8 (10%) showed primary resistance while 94 (69%) showed secondary resistance. CONCLUSION: In this group MDR-TB was mainly associated with previous anti-tuberculous treatment. However, primary MDR was also observed and reflects dissemination of MDR cases within the community

Antimicrobial sensitivity pattern, demographic findings and risk factors amongst meningitis and non-meningitis invasive streptococcus pneumoniae at aga khan university hospital clinical laboratory, Karachi, Pakistan

Objective: To determine the resistance rate of penicillin and ceftriaxone amongst invasive meningitis and nonmeningitis isolates of streptococcus pneumoniae. Methods: The prospective cross-sectional study was conducted from January 2011 to March 2014 at the Clinical Microbiology Laboratory of Aga Khan University, Karachi, and comprised all invasive strains of streptococcus pneumoniae. Penicillin and ceftriaxone susceptibilities were performed and interpreted based on minimum inhibitory concentration breakpoints recommended by Clinical and Laboratory Standards Institute guidelines. Data was analysed using Stata 12. Result: There were 163 strains isolated from sterile body fluids of 109 patients. Of the total, 46(28%) samples were meningitic while 117(72%) were non-meningitic. Of the meningeal isolates, 12(26%) were resistant to penicillin, while none was resistant to ceftriaxone and vancomycin. None of non meningeal isolates showed resistance to penicillin, ceftriaxone or vancomycin. Conclusions: There was considerable penicillin resistance among meningeal strains of streptococcus pneumoniae, but here appeared to be no need to add vancomycin for empirical treatment of invasive streptococcus pneumonia infection

Comparison of antimicrobial efficacy of calcipex and metapex in endodontic treatment of chronic apical periodontitis: A randomised controlled trial study protocol

Introduction: Various intracanal medicaments have been used in cases of chronic apical periodontitis for appropriate disinfection of the root canal system to eliminate microbes especially from the inaccessible areas. Calcium hydroxide is the most common intracanal medicament available in various forms, but its effectiveness with or without iodoform using microbial culture is unknown. Therefore, our aim is to compare the antimicrobial efficacy of Calcipex and Metapex in endodontic treatment of teeth presenting with chronic apical periodontitis by assessing the bacterial load reduction.Method and analysis: 60 single rooted teeth of patients with diagnosis of chronic apical periodontitis will be selected and the canals debrided chemomechanically. The patients will be randomised into two groups: Calcipex and Metapex. The first sample (S1) for bacterial culture will be taken before placement of intracanal medicament and the second sample (S2) will be taken after 7 days, before final obturation from the canal and sent to lab for culture. Colony-forming unit will be evaluated. Paired t-test will be used to assess difference between antimicrobial efficacies within the group of medicaments. Independent sample t-test will be used to assess antimicrobial efficacies between groups. Level of significance will be kept at 0.05.Ethics and dissemination: Approval from Aga Khan University Hospital Ethical review committee is taken. Findings will be reported according to the Standard Protocol Items for Randomised Trials guidelines. Research findings will be disseminated through annual reports, peer-reviewed journals and conferences.Trial registration number: NCT04336709

A fatal case of gram negative bacterial sepsis associated with disseminated strongyloidiasis in an immunocompromised patient

We report a fatal case of disseminated strongyloidiasis in a patient with multiple myeloma receiving chemrotherapy. A fifty-seven years old man presented with severe diarrhoea and vomiting, fever, weight loss and dysphagia,due to mouth ulcers. Despite broad-spectrum intravenous antibiotics, albendazole (anti protozoal) and supportive treatment, the patient died of Gram-negative sepsis

β-lactamase production and antimicrobial susceptibility pattern of moraxella catarrhalis isolates: report from Pakistan

Objective: To assess the frequency of β-lactamase production and antimicrobial resistance in Moraxella catarrhalis isolated from clinical specimens in Pakistan. Methods: This cross sectional study (January to December 2010) was conducted in clinical microbiology laboratory of Aga Khan University Hospital. A total of 97 clinical respiratory specimens growing Moraxella catarrhalis were included. Frequency of β-lactamase production and antimicrobial resistance rates against ampicillin, erythromycin, ciprofloxacin and tetracycline were noted by performing minimum inhibitory concentration (MIC). MICs were calculated as MIC50 and MIC90. Results: β-Lactamase production was detected in 84% of isolates, which correlated well with high MIC of ampicillin. Majority of isolates were susceptible to erythromycin (97%) and tetracycline (96%) with MIC90=0.12 mg/L and MIC90=1 mg/L respectively. All isolates were found susceptible to ciprofloxacin (MIC90=0.06 mg/L). Conclusions: Result suggests that empirical use of ampicillin should be discouraged while treating respiratory tract infections. This also emphasizes the importance of continuous surveillance in order to detect emerging resistance in Moraxella isolates

Microbiological safety of areca nut-containing, ready-to-eat chewing substances common among Pakistani paediatric population: A pilot study

Objective: To evaluate microbiological contamination of areca nut-containing, ready-to-eat chewing substances easily accessible to vulnerable paediatric population.Methods: A pilot study was conducted at the Aga Khan University Medical College from June to October 2016 on twelve samples of areca nut-containing chewing substances (four supari, paan masala and gutka each) collected from various localities of Karachi. These were evaluated individually for total colony counts, hygiene indicator organisms, pathogenic organisms, and levels of aflatoxin. Microbial contamination was analysed using pour-plate method. Fungal aflatoxin levels were measured by enzyme-linked immunosorbent assay (ELISA)..Results: Wet gutka preparations were contaminated by Escherichia coli and Enterobacteriacaea. High levels of fungal aflatoxin (range: 0.43-1.84 mg/kg), a proven carcinogen, were identified in all the 12(100%) products. No sample contained pathogenic bacteria. However, 1(8.33%) sample did not meet hygiene criteria cut-off.Conclusions: Habitual use of unhygienic chewing substances containing fungal toxins is a public health concern that needs to be addressed through a preventative, behaviour-changing strategy.