Search

Background: Coagulase Negative Satphylococci (CoNS) were once thought to be non-pathogenic skin contaminants when recovered from culture media, but the usage of intravenous and implantable devices and increase in the number of immune - compromised patients in hospitals, they have now emerged as a major contributor of hospital acquired infections. The number of CoNS with enhanced resistance to glycopeptides (especially vancomycin) has been observed to be on the rise in the recent decades. Therefore, this research was done to recognize the clinical isolates of CoNS and to recognize various drug resistance with distinct mention to Vancomycin. Aim: This study aimed to isolate Coagulase Negative Staphylococci from different clinical specimens and to determine antimicrobial susceptibility pattern of all the isolates. From January 2021 to December 2021, Methods: this study was conducted in the Department of Microbiology at the School of Medical Sciences & Research, SMSR, Sharda University, Greater Noida. Total 341 CoNS were recovered in 1 year duration time from various clinical samples. Descriptive statistics like frequency table, mean, proportions were used. Analysis was done by SPS software. A total of 341 isolates of coagulase negative staphylococci Results: (CoNS) were obtained from various specimens out of which 150 (44%) were found to be clinically signicant. Maximum number of clinically signicant CoNS were recovered in the age group 0-9 years 29 (19.3%) followed by age group, ≥ 60 years: 27 (18%). Clinically signicant CoNS were isolated in maximum number from blood samples (n=51, 34%) followed by pus (n=35, 23.3%). Samples received from patients housed in the neonatal intensive care unit yielded the maximum number of clinically signicant CoNS isolates, 31 (20.7%). Staphylococcus.epidermidis was found to be the most commonly associated clinically signicant CoNS with infection 72 (48%) followed by Staphylococcus haemolyticus 42 (28%). MIC by microbroth dilution and E test was also done on all clinically signicant isolates of CoNS for vancomycin, all isolates were within the susceptible range with none of the isolates being resistant to vancomycin(with MIC =

Background: The irrational use of antibiotics has led to the emergence of multi drug resistant pathogens. The phenomenon of MIC creeps occurs when organisms start showing raised MIC but within susceptible range giving an indication of the prevalence of rise in resistant pathogens in an area Methods: A cross sectional study in a large tertiary care hospital in North India to observe the susceptibility pattern among uropathogens and the possibility of MIC creeps. The Antimicrobial Susceptibility Testing (AST) and Minimum Inhibitory Concentration (MIC) were conducted by Vitek Compact 2. The identification of Extended Spectrum Beta Lactamase (ESBL) producers and Carbapenem Resistant Enterobacteriaceae (CRE) among Escherichia coli were noted. The MIC 50 and MIC 90 for Nitrofurantoin, the most widely used antibiotic for lower UTI, was calculated to investigate the phenomenon of MIC creep. Results: In our study, a total of 2522 urine samples were analyzed:1538 (61%) were positive with the commonest isolate being E. coli (n=736, 47.8%) followed by Klebsiella spp. (n=178, 11%). Less than 10% of resistance was observed for Fosfomycin, Amikacin, Nitrofurantoin, Imipenem, Meropenem and Colistin. ESBL producers and CRE E. coli were 528 (72% of 736) and 79 (11% of 736) respectively. Overall, 119/736 samples had an MIC ≥128. Amongst the ESBL producers, 96/528 had MIC ≥ 128 and amongst the CRE, 13/79 had MIC ≥ 128. Discussion: E. coli can be used to reflect the trends in development of resistance. In the current study, it was observed that E. coli showed a reduced susceptibility for Nitrofurantoin indicated by a creeping increase in MIC albeit within normal range. Conclusion: Trends in rising MIC should alert prescribers to use drugs such as Nitrofurantoin judiciously. Antimicrobial stewardship practices should be strongly implemented in hospitals to curb rising resistance and obtain better treatment outcomes for patients with infectious diseases.

Author: Reshu Chauhan., Tarana Sarwat and Dalip K Kakru Background: Enterococcal infection has emerged as a major therapeutic challenge. Exposure of High- Level Aminoglycoside Resistance (HLAR) and Vancomycin-Resistant among Enterococcus species has further limited the drug in Enterococcal infections. Objective: To estimate the prevalence of High- Level Aminoglycoside Resistant (HLAR), i.e HLG and HLS resistance and Vancomycin-Resistant among Enterococcus species at a tertiary care hospital in Greater Noida. Material & Methods: A total of 80 isolates identified by morphological and biochemical characteristics were tested for antibiotic susceptibility using Kirby- Bauer disc diffusion method and the Epsilometer test (E- test) and Vitek automated as per standard protocol. Results: Eighty out of 13,639 culture-positive clinical samples comprising of 48 urine, 15 from pus, 6 blood, 5 vaginal swabs, 2 ETT, 1 BAL, and 1 tissue fluid(Pleural fluid) isolates were identified as Enterococcus faecalis (57.5%), Enterococcus faecium (35%), Enterococcus durans (5%), and Enterococcus gallinarum (2.5%). The majority of the isolates (61.25%) were from a urine specimen. While High-Level Aminoglycoside Resistance was seen in 71.62% of the isolates. Vancomycin-Resistant Enterococci were found to be majorly in urine isolates. Conclusions: The petrifying rise in the prevalence of Vancomycin and multidrug resistance strains authorize immediate, sufficient, and efficient surveillance programs to prevent and control its spread.

The increasingly frequent application of carbapenemases induces a selective pressure on bacteria to acquire resistance against carbapenems. A large variety of carbapenemases have been identified in Enterobacteriaceae. The emergence of carbapenemases in E. coli and Klebsiella species possess a serious therapeutic problem in hospitals because carbapenems are often antibiotics of last resort for the treatment of serious infections caused by multidrug-resistant bacteria. The main aim of this study to determine the carbapenem-resistant strains of Escherichia coli and Klebsiella species. Detection of carbapenemase enzyme in the carbapenem-resistant Escherichia coli and Klebsiella species. This is a cross-sectional study, performed in the bacteriological laboratory. A total of 204 strains of Escherichia coli and 122 strains of Klebsiella species were isolated from patients admitted & attending the OPD at Sharda Hospital during the study period. The identification of the clinical isolates was based on morphological and biochemicals characterization. Result: Among the total number of bacterial growth received during the study period, the E. coli (204) was more in number as compared to other bacterial strains followed by Klebsiella species (122), Pseudomonas species (117), Staphylococcus aureus (100) and Enterococcus species (80). Among the following specimen i.e, urine (58.8%), was highly received during the study period followed by pus (15.3%) and sputum (7.5%). Colistin (100%) and Polymyxin B (100%) is found to be the most sensitive drug. Gentamicin (19.6%) and Cefuroxime (12.2%) are the least sensitive drugs. In the present study, we found that the Klebsiella species (75%) and Escherichia coli (64%) was the major reason of carbapenemase production but the organisms incidentally were susceptible to colistin and polymyxins (100%) followed by other antibiotics. This is a welcome finding in times of increasing carbapenem resistance & is reason enough to suggest the use of Polymyxins in the health care settings where the carbapenems to be used for the treatment of infections caused by Enterobacteriaceae.

Background: Coronavirus disease-2019 (COVID-19) is a recently emerged viral disease, for which there’s currently no definitive treatment. It is, therefore, necessary to determine biomarkers to know the extent of disease severity so that timely action can be taken to reduce mortality. We aimed to determine the usefulness of C-reactive protein (CRP) levels in assessing COVID-19 disease severity and correlate them with mortality due to the same. Methods: Data for COVID-19 were retrospectively collected and analyzed from May 2020 to October 2020. The CRP value was correlated with disease severity using Karl Pearson’s correlation coefficient. A logistic regression model was adopted to analyze the association between mortality and related factors. Results: Out of 642 patients enrolled, 22 died while 620 recovered. Most of the non-survivors were male. Multivariate analysis showed that age, diabetes, hypertension, and CRP values were significantly associated with mortality. CRP showed a strong positive correlation with disease severity and, hence, mortality. Conclusion: In patients with COVID-19, CRP correlated with disease severity and tended to be a good predictor of adverse outcome.

BACKGROUND Pseudomonas aeruginosa is the most common gram-negative bacterium associated with nosocomial infections. Active observation of changes in antibiotic resistance of Pseudomonas aeruginosa is necessary for the selection of appropriate antimicrobial agent for empirical therapy. This study was conducted to determine the antibiotic susceptibility pattern of Pseudomonas aeruginosa isolated from various clinical samples collected from patients admitted in critical and non-critical areas. METHODS Pseudomonas aeruginosa isolates obtained from various samples in critical and non-critical areas during one-year period were included in the study. The isolates were identified using standard laboratory procedures, and the susceptibility was checked using the Kirby-Bauer disk-diffusion assay according to Clinical and Laboratory Standard Institute (CLSI) guidelines-2019. RESULTS During one-year period, 224 Pseudomonas aeruginosa isolates were isolated from patients admitted to various units, out of which 143 (63.8 %) were from noncritical areas and 81 (36.1 %) were from critical areas. Highest isolation from noncritical area was observed from pus sample 49 (34.26 %) followed by sputum and urine samples 46 (32.16 %) and 27 (16.78 %) respectively. Pseudomonas aeruginosa isolated from critical areas were mainly from endotracheal aspirates 36 (44.4 %) and all were multidrug resistant (MDR) (36.3 %). CONCLUSIONS The present study helps in understanding the emergence of MDR strains in intensive care units (ICUs). Thus, regular surveillance of antibiotic susceptibility pattern is important for reducing the healthcare associated infection (HAI) rates and antimicrobial resistance. KEYWORDS Antibiotic Susceptibility Pattern, Pseudomonas aeruginosa, Critical and Non-Critical Areas

Non-fermenting Gram-negative bacilli (NFGNB) are emerging as important cause of blood stream infections. We aimed to determine the prevalence and antibiotic susceptibility pattern of NFGNB isolated from blood of patients with sepsis. We found, in 176 patients, the most common to be Pseudomonas aeruginosa (74) and Acinetobacter baumanii complex (39) followed by Stenotrophomonas maltophilia (16), Sphingomonas paucimobilis (6), Burkholderia cepacia (5) and Ochrobactrum anthropic (1). Generally, organisms showed a good sensitivity towards colistin, carbapenems and fluoroquinolones, whereas cephalosporins were ineffective.

Introduction: Bloodstream Infections (BSIs) are one of the major cause of morbidity and mortality worldwide. To decrease the mortality from septicaemia early diagnosis and appropriate treatment of BSIs is most important. Early diagnosis of a BSI will markedly improve patient management. Aim: To identify various pathogenic organisms causing BSIs and determine their susceptibility to various antibiotics. Materials and Methods: A total of 1367 blood samples were received in the bacteriology laboratory for culture out of which 274 samples showed culture positivity. Among the positive cases 32 cases of Multidrug Resistance (MDR) were found. MDR cases show resistance to ≥3 classes of antibiotics. Enterobacteriaceaefamily showed highest MDR cases. Blood cultures were repeated for confirmation of results. Simple descriptive analysis of data was done and results presented in frequencies and percentages. Results: Out of 274 positive samples obtained, Coagulase Negative Staphylococci (CoNS) constituted maximum proportion of isolates (66%) followed by Pseudomonas species(12%),Escherachia coli(6.2%),Klebsiella species(3.2%),Citrobacter spp.(2.9%),Staphylococcus aureus(2.9%) andEnterococcus(2.9%). Conclusion: The present study highlighted the bacteriological aetiology of BSIs along with their antibiogram that may provide necessary information for the formulation of antibiotic policy in effective management of such cases.

Introduction: Carbapenem resistant Enterobacteriacea (CRE) has created a remarkable health distress. Definitive detection of Carbapenemase producing CRE is the first step in combating this problem. Objective: To detect and compare CP- CRE both by phenotypic and molecular methods. Materials and Methods: A total of 52 carbapenem resistant clinical isolates were screened for the presence of carbapenemase genes by routine phenotypic methods like modified hodge test and combined disc test as well by multiplex PCR. Results: Out of the total 52 meropenem resistant isolates, 35 were modified hodge test positive and 33 were combined disc test positive. 42 isolates were found harbouring one or more than one gene. blaKPC alone was present in 38 isolates, while as blaKPC with blaNDM were present in 1 isolate and blaKPC with blaIMP was seen in 1 isolate. blaNDM alone in 2 isoates, blaIMP and blaVIM alone in none of the isolates. Conclusion: Accurate detection of carbapenemase producing genes by molecular methods overcomes the problem related to CRE. Though there is no signal method that is ideal for all situations. Keywords: Modified hodge test, Combined disc test, Multiplex PCR, Carbapenem resistant Enterobacteriaecae.

Background As there are no data available regarding the strains of Mycobacterium tuberculosis circulating in Kashmir Valley, India, the current study aimed at describing the genetic diversity of M. tuberculosis strains in this region, by spoligotyping and 12-locus-based MIRU-VNTR typing (Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat). Methods Sputa from 207 smear positive cases with newly diagnosed pulmonary tuberculosis were subjected to culture for M. tuberculosis . Eighty-five isolates confirmed as M. tuberculosis were subjected to drug susceptibility testing and molecular typing by spoligotyping and MIRU-VNTRs. Results Drug susceptibility results of 72 isolates revealed 76.3% as fully sensitive while 5.5% as multidrug resistant (MDR). Spoligotyping of 85 isolates detected 42 spoligotypes with 50 isolates (58.8%) clustered into seven spoligotypes. SIT26/CAS1_Del was the major spoligotype (23, 27%) followed by SIT127/H4 (12, 14.1%); CAS lineage (37.6%) was predominant, followed by Haarlem (25.8%) and ill-defined T clade (23.5%). MIRU-VNTR analysis displayed 82 MIRU patterns from 85 strains, including 3 small clusters and 79 unique. MIRU 26 was found to be the most discriminatory locus. Conclusions Kashmir Valley has CAS as the predominant lineage of M. tuberculosis similar to the rest of the Indian sub-continent, while it is peculiar in having Euro American lineages such as Haarlem and ill-defined T clade.

Title: Lower respiratory tract infections in intensive care units. A four year study from North India. Study Design: Prospective study Place and Duration of Study: Sher-i-Kashmir Institute of Medical Sciences, Srinagar Kashmir. Four years (July 2010 and June 2014). Methodology: A prospective analysis of respiratory specimens from various intensive care units (ICUs) was done over a period of four years. Antimicrobial susceptibility of culture positive isolates to various antibiotics was performed as per Clinical Laboratory Standards Institute (CLSI) guidelines. Original Research Article Bali et al.; BJMMR, 11(7): 1-9, 2016; Article no.BJMMR.21636 2 Gram-negative bacteria (GNB) were screened for extended spectrum β-lactamase (ESBL) and metallo-β-lactamase (MBL) production; whereas methicillin and vancomycin resistance was searched in staphylococci and enterococci isolates respectively. Results: The frequencies of Gram-positive and Gram-negative bacteria were 26% and 68% respectively with yeast recovered in 8% of the specimens. K. pneumoniae and Acinetobacter spp were the most common Gram-negative bacteria and S. aureus the most common Gram-positive one. High level resistance to all the antimicrobials was seen; with K. pneumoniae being the most multidrug resistant GNB isolated in the ICU setting. ESBL production was also highest in K. pneumoniae isolates (67.1%). Also 59.6% of Acinetobacter isolates were found to be MBL producers. Methicillin resistance was seen in 48% of S. aureus and 85.5% of coagulase negative staphylococci (CoNS) isolates with vancomycin resistance seen in 6.7% of enterococcal isolates. Conclusion: An increasing trend over the years in the antibiotic resistance of respiratory pathogens in ICUs of this north Indian state was seen that calls for urgent measures to limit their continued rise.

The study was designed to investigate the seroprevalence of haemoparasites ( Babesia , Anaplasma and Theileria ) among ruminants from Kashmir valley for a period of two years. A total of 585 blood samples were collected from selected small holders and private livestock farms using multistage cluster random sampling technique. EDTA containing, methanol fixed and Giemsa (1:10) stained thin peripheral blood smears were microscopically examined. Microscopic examinations showed the overall 74(29.83%), 9(4.29%) and 3(2.27%) seroprevalence of haemoparasitic infection in cattle, sheep and goats respectively. Prevalence of Babesia , Anaplasma and Theileria in cattle were 33(13.30%), 18(7.25%) and 23(9.27%) and in sheep 5(2.43%), 1(0.487%) and 3(1.46%) respectively. In goats the prevalence of Babesia and Theileria was 1(0.75%) and 2(1.51%). Age-wise epidemiological observations revealed highest prevalence rate in 1-5 years age group in cattle Overall gender-wise prevalence was not much prominent but female hosts were found to be more infected than males. The highest 56.71% prevalence of haemoparasitic diseases was found in exotic cattle with zero prevalence in local sheep.

Background & objectives: Dengue virus infection is endemic in India with all the four serotypes of dengue virus in circulation. This study was aimed to determine the geographic distribution of the primary and secondary dengue cases in India. Methods: A multicentre cross-sectional study was conducted at Department of Health Research / Indian Council of Medical Research (DHR)/(ICMR) viral research and diagnostic laboratories (VRDLs) and selected ICMR institutes located in India. Only laboratory-confirmed dengue cases with date of onset of illness less than or equal to seven days were included between September and October 2017. Dengue NS1 antigen ELISA and anti-dengue IgM capture ELISA were used to diagnose dengue cases while anti-dengue IgG capture ELISA was used for identifying the secondary dengue cases. Results: Of the 1372 dengue cases, 897 (65%) were classified as primary dengue and 475 (35%) as secondary dengue cases. However, the proportion varied widely geographically, with Theni, Tamil Nadu; Tirupati, Andhra Pradesh and Udupi-Manipal, Karnataka reporting more than 65 per cent secondary dengue cases while Srinagar, Jammu and Kashmir reporting as low as 10 per cent of the same. The median age of primary dengue cases was 25 yr [interquartile range (IQR 17-35] while that of secondary dengue cases was 23 yr (IQR 13.5-34). Secondary dengue was around 50 per cent among the children belonging to the age group 6-10 yr while it ranged between 20-43 per cent among other age groups. Interpretation & conclusions: Our findings showed a wide geographical variation in the distribution of primary and secondary dengue cases in India. It would prove beneficial to include primary and secondary dengue differentiation protocol in the national dengue surveillance programme.

Invasive listeriosis predominantly affects pregnant women, neonates, elderly and people with a compromised immune function. For more than 80 years since the discovery of Listeria in 1924, only a few reports of invasive listeriosis in humans have emerged from India, with all of them in patients having an underlying predisposition. We, however, report Listeria monocytogenes meningoencephalitis in an immunocompetent, previously healthy, 20-month-old female child with no underlying predisposition. The patient showed poor response to empirical treatment with vancomycin and ceftriaxone but improved dramatically after substitution with ampicillin and amikacin. She had a complete recovery other than left lateral rectus palsy that persisted.

Pulmonary pseudallescheriasis in an immunocompetent patient without a pre-existing cavity or cyst is a rare phenomenon. We report a case of invasive pulmonary pseudallescheriasis in a lobectomised patient treated for tuberculosis. Filamentous fungi with pyriform conidia were seen in the bronchoalveolar lavage fluid . The fungus was identified as Pseudallescheria boydii on culture.

Background: The aim of this study was to assess the pattern of periurethral bacterial flora in uncircumcised boys and to evaluate the effect of circumcision on alteration of periurethral uropathogenic bacterial flora. Materials and Methods: Pattern of periurethral bacterial flora before and after circumcision was studied prospectively in 124 boys. The results were analysed to compare change in bacterial colonisation before and after circumcision. Results: The age range was 6 weeks to 96 months. Most (94.3%) of the boys had religious indication and 5.7% had medical indication for circumcision. E. coli, Proteus and Klebsiella were most common periurethral bacterial flora in uncircumcised subjects. Coagulase-negative staphylococcus and Staphylococcus aureus was most common periurethral bacterial flora in circumcised subjects. In 66.1% of circumcised subjects, no bacteria were grown from periurethral region. Conclusion: We conclude that presence of prepuce is associated with great quantity of periurethral bacteria, greater likelihood of the presence of high concentration of uropathogens and high incidence of urinary tract infection (UTI). This study provides circumstantial evidence supporting the idea that early circumcision may be beneficial for prevention of UTI.Key words: Circumcision, periurethral bacterial flora, uropathogen

Linezolid, a viable alternative to vancomycin against methicillin resistant staphylococcal isolates, has been in use for a decade around the globe. However, resistance against staphylococci remains extremely rare and unreported from most of the Asian countries. Herein, we report two cases of linezolid resistant, coagulase negative staphylococcal sepsis for the first time from India. The first case was an 18-year-old burn patient, who, after a major graft surgery, landed in sepsis, and linezolid resistant Staphylococcus cohnii with an minimum inhibitory concentration (MIC) of >256 μg/ml by both broth microdilution and Etest, was isolated from multiple blood cultures. The second patient was a 60-year-old male with an intracranial bleed and sepsis, from whose blood cultures, linezolid resistant Staphylococcus kloosii was repeatedly isolated. Linezolid MIC was >32 μg/ml by broth microdilution and >16 μg/ml by Etest.

Viable protoscolices of Echinococcus granulosus injected into Swiss-albino mice by two different routes, viz. intraperitoneal and subcutaneous and in two different concentrations of 2000 and 1000 scolices, to observe the development of cysts have shown that subcutaneous route of infecting a mouse model is superior because of its low infecting dose and longer survival period of mouse. This finding should be helpful in experiments to observe the effect of drugs for the treatment of hydatidosis, in vivo, without the need of killing the mouse.

One hundred and twenty methicillin resistant Staphylococcus aureus (MRSA) strains were checked for minimum inhibitory concenteration (MIC) of vancomycin. The results showed that 98 strains (81.7 %) had MIC4microg/mL, 18 strains (15 %) had MIC 8 microg/mL, and 4 (03.3%) had MIC 16 microg/mL which being borderline between sensitive (4microg/mL) and resistant (32 microg/mL) values points towards possible emergence of low level vancomycin resistance in the organisms and may explain the reasons of delayed therapeutic success of vancomycin in S. aureus bacteraemia in some situations.

Staphylococcus aureus has shown a disconcerting propensity to develop resistance to antimicrobial agents and an increasing proportion of these have become resistant to methicillin as well. Regular surveillance should be carried out in every hospital and stringent infection control measures and vigorous treatment should be employed to prevent the nosocomial spread of MRSA. A total of 1056 MRSA were isolated from various specimens received in bacteriology division of SKIMS Srinagar out of which 46.32% were from inpatients and 31.87% from outpatients. None of these strains showed resistance to vancomycin and a good proportion were sensitive to amikacin (80.75%) gentamicin (69%) or ciprofloxacin (63.25%).