Search

This study was conducted in Rama Medical College Hospital & Research Centre. The inclusion and exclusion criteria were applied. The study was conducted from January 2016 to December 2016. A total 50 high vaginal swabs were collected from pregnant women admitted to the labour room after gestation. Vaginal swabs collected from high vagina using sterile cotton swabs (Himedia, Mumbai) and transported to the laboratory and inoculated into enrichment broth, (Todd Hewitt Broth) and incubated at 370 C for 18-24 hours. After incubation sample were plated onto Blood agar and MacConkey agar (Himedia, Mumbai) and incubated aerobically at 370 C for 18-24 hours. The isolates were identified based on colony appearance, gram stain, and standard biochemical test obtained from (Himedia, Mumbai). Out of 50 women, 16 (32%) were primigravida 34 (68%) were multigravida. Number of pathogenic growth were 31 (62%). The maximum number of aerobic vaginitis cases fell in the age group of 20-25 years followed by 26-30 and 30-35. The common pathogenic isolates in this study Candida, Escherichia coli, Klebsiella species, Coagulase negative Staphylococcus and Enterococcus species. The results of present study showed a high occurrence of Candida among pregnant women. There was a high prevalence of vaginal candidiasis among multigravida, women at the third trimester and those between age group 20 to 25 and 3 samples of aerobic vaginitis with polymicrobial growth. This study did not show any Group B Streptococcus. In this study were found most common sensitive drugs among all microbes– Gentamycin, Amikacin, Netilmicin, Amoxycillin/clavulanic acid, Piperacillin/tazobactam, Imipenem, Meropenem, Tigecycline, Colistin, Polymyxin B. Cotrimoxazole, Ceftriaxone, Ceftazidime, Cefoxitine, Teicoplanin, Levofloxacin, Vancomycin, Ampicillin, Penicillin, Tetracyclin, Aztreonam.

Background: Asymptomatic bacteriuria is common and can lead to adverse foetal and maternal outcomes. Aims and Objective: The current study aimed to estimate the prevalence of asymptomatic bacteriuria (ABU), its associated risk factors, bacterial isolates and antimicrobial sensitivity pattern in pregnant women attending Outpatient department (services in a tertiary hospital in India. Materials and Methods: This was a hospital-based cross-sectional study among asymptomatic women coming for routine antenatal check-ups to obstetrics OPD of a teaching hospital in Northern India. Samples were collected, processed and antimicrobial sensitivity done as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Data was analysed and p value below 0.05 was considered as statistically significant. Results: Overall 247 pregnant women were included in the study with a mean age of 25.9 ± 3.1. The overall prevalence of asymptomatic bacteriuria was 18.6%. The most common isolates responsible for ABU were E. Coli (48%), S Aureus (23%), K. pneumonia (12%), Pseudomonas (6%), Enterococcus (6%), Proteus (5%). Gram-negative isolates were mostly sensitive to Fosfomycin, Meropenem, Piperacillin + Tazobactum whereas gram-positive isolates were usually sensitive to Fosfomycin, Vancomycin and Linezolid Most isolates were resistant to Co-amoxiclav, Ciprofloxacin, and Nitrofurantoin. Conclusion: Considering the high prevalence of ABU and its association with adverse maternal and foetal outcomes, urine culture should be included in routine investigations being offered to pregnant women. Gram-negative bacteria were the primary causative agents with Fosfomycin, Meropenem and Ceftazidime showing high level of efficacy against the pathogens.

Objective: To determine frequency of gram negative bacterial isolates and their antibiotic sensitivity pattern among patients with chronic suppurative otitis media. Study Design: Descriptive Cross Sectional study. Setting: Department of Pathology Sahara Medical College Narowal. Period: January 2020 to June 2020. Material & Methods: Total 126 bacterial isolates were taken from the patients having unilateral or bilateral ear discharge reporting to OPD or emergency department during study period. After taking detailed history, examination and baseline investigations diagnosis was confirmed. Specimens of ear discharge were taken from all patients and sent to the pathology department of study institution to determine culture and sensitivity pattern of Gram-negative bacterial isolates. Consent was taken from ethical review committee. Data was analyzed on SPSS-24. Chi square test was applied on collected data. Results: Bacterial isolates were taken from 126 cases having age 2-54 years with mean age of 11.45±5.73 years of either gender. Mostly children less than 8 years of age were found with otitis media. Gram positive bacteria were detected in 41.3% and gram negative in 55.6% and candida albicans in 3.2% out of total 126 bacterial cultures. Out of gram negative cultures, pseudomonas aeruginosa was found in 41.4%, proteus mirabilus in 44.3% and E.coli in 14.3% specimens. Conclusion: Gram negative bacteria are common cause of chronic suppurative otitis media in our region, mostly affecting young children. There is variable antibiotic sensitivity pattern depending on cultural, climate changes and previously taken antibiotics.

Objective: To study the pattern of existing common pathogen of Urinary Tract Infection and their drug sensitivity pattern. Methods: It was a cross sectional study held in Medical Unit-I, CMC Teaching Hospital, Shaheed Mohtarma Benazir Bhutto Medical University(SMBBMU), Larkana with collaboration of Pathology Laboratory CMC Larkana, Aga Khan University Hospital Lab, Rahila Research Lab and Chughtai Lab. All the participants meeting inclusion criteria were enrolled. The reports of Urine culture were collected from above mentioned laboratories which include bio data, causative organism, their count and drug sensitivity pattern. The results were copied on proforma by researcher himself. SPSS version 25 was applied for data analysis. Results: Total 302 participants were registered in the study. Out of them 75.8% of them were female and 24.2% were male. Mean age of the patients was 40 ± 9 years. E-coli was found in 52.3%, Enterococcus in 13.2% and Klebsiella pneumonia in 9.6% cases. Meropenem was found sensitive in 92.4%, while cefoperazone sulbactam, Amikacin and Fosfomycin were found to be sensitive in 86.6%, 85%, 76.2% respectively. Ampicillin and Vancomycin was used in 50 cases for Enterococci. Ampicillin was found sensitive in 70% of cases where as vancomycin was found sensitive in 100% of cases with no vancomycin resistant Enterococci. For Enterobacteria Moxifloxacin was found resistant in 84.4% of cases, Ampicillin in 83.5%, Nalidix acid in 78% cases. While Ceftazidime and Amoxiclav was found resistant in 71.1% and 54.1% respectively. Conclusion: E-coli, Enterococcus and klabsella were the most pathogens found in this study. The drug sensitivity pattern showed that Meropenem, Cefoperazone Sulbactam, Amikacin, Fosfomycin and Vancomycin were found commonly sensitive while Moxifloxacin, Ampicillin, Ceftazidime and Amoxiclav was found resistant. Keywords: Urinary Tract Infection, Culture and Sensitivity, Meropenem, Vancomycin, Cefoperazone Sulbactam CMC @ SMBBMU, Larkana.

The present study was designed to reintroduce an older antimicrobial nitrofurantoin to treat uncomplicated urinary tract infection and to explore the relationship between the reintroduction and corresponding shift in sensitivity pattern of the microbes. The microbial sensitivity against ciprofloxacin before intervention was 46.6%, which significantly increased after intervention (51.8%). Treatment with nitrofurantoin resulted in a total clinical cure rate of 80.6%, of which rate of clinical cure achieved in expected time was 66.1% and delayed was 14.5%. The rate of total clinical cure with nitrofurantoin corresponded closely with the proportion of urinary isolates sensitive to nitrofurantoin. i.e., 86.3%. This preliminary study revealed that revival might be an effective strategy to increase the sensitivity and to delay the emergence of resistance.

Introduction: Neonatal sepsis (NS) is one of the important causesof neonatal morbidity anddeath in neonatal ward and neonatal medical care unit,especiallyin emergent nations. Frequent monitoring on pathogens with recent updates and their antimicrobial sensitivity pattern is compulsory for more satisfactory management. Methods: This cross sectionalstudy was outlined to evaluate the bacteriological profile and antimicrobialsensitivity pattern of NS in neonatal ward and neonatal intensive care unit (NICU)of Sylhet Women’s Medical College and Hospital, Sylhet, Bangladeshfrom October 2019 to December 2020. Blood samples from 90 clinically suspected neonatal sepsis cases were accumulated and processed in the microbiological protocol and their antimicrobial sensitivity pattern were determined. Results: Among the90 cases, two third (61, 67.78%) showed positive blood culture. Among the positive blood culture, 38(62.29%) were gram positive isolates and gram negative isolates were 23(37.7%). This study showed Staphylococcus aureuswas the most common organism (59.01%) followed by Escherichia coli (E. Coli)(27.87%), Klebsiella pneumonia (9.87%) and Streptococcus pneumonia (3.28%) among the isolates. Gram positive isolates were highly reactive to Amikacin and Amoxicillin and Clavulenic acid whereas gram negative isolates were highly reactive to Gentamicin and Meropenem. Conclusion: Gram positive organism are the predominant source of NS which was highlighted in our study,though gram negative organism also plays an important role in the mortality cause by neonatal sepsis.

Objective: To determine frequency, molecular characterization and sensitivity of bacterial isolates against commonly used antibiotics in neonatal sepsis. Study Design: Cross Sectional study. Setting: Department of Pathology Sahara Medical College Narowal. Period: October 2019 to March 2020. Material & Methods: Neonates admitted in neonatal intensive care unit (NICU) of study institution having signs and symptoms of neonatal symptoms such as fever, irritability, seizures, anorexia and lethargy, were included in the study using consecutive sampling technique. Blood sample from all study patients taken and sent for culture to determine bacterial isolates and antibiotic sensitivity against commonly used antibiotics for neonatal sepsis. Bacterial isolates identification was done using standard bacteriological technique performed by modified Kirby & Bauer disc diffuse method as per Clinical and Laboratory standards institute (CLSI) guidelines. Results: Total 200 cases were studied having neonatal sepsis and admitted in NICU including 58% female and 42% male children. Bacterial growth occurred in 10.5% samples and in 89.5% samples no bacterial growth seen. There were 1% samples with gram positive and 9.5% samples with gram negative bacterial isolates. Klebsiella was the commonest organism isolated in 38.1% cases out of total positive isolates. There were 72.5% neonates having age 1-14 days and 27.5% neonates having age 15-28 days. Conclusion: Gram negative bacteria are common cause of neonatal sepsis, out of which Klebsiella is the commonest organism. Antimicrobial drug resistance in different infections is a serious emerging issue.

BACKGROUND Stenotrophomonas maltophilia is a gram-negative bacillus, multidrug resistant (MDR) opportunistic pathogen, which is normally present in hospital surroundings. It has been one of the leading causes of nosocomial infections due to risk factors such as extended intensive care unit (ICU) stays and multiple invasive procedures. In this study we wanted to assess the antibiotic sensitivity pattern with various antimicrobial agents i.e. levofloxacin, minocycline, ceftazidime, chloramphenicol, & ticarcillin-clavulanic acid with special focus on trimethoprim-sulfamethoxazole (TMP-SMX). METHODS In vitro analysis was conducted on 164 Stenotrophomonas maltophilia strains isolated from blood and respiratory tract from January 2016 to November 2020. Antibiotic susceptibility and minimum inhibitory concentration (MIC) testing for trimethoprim-sulfamethoxazole (TMP-SMX), levofloxacin (LVX), ticarcillin - clavulanic acid (TIM), and minocycline (MIN) were performed using Vitek 2, as per clinical and laboratory standards institute (CLSI) guideline. RESULTS A total of 164 S. maltophilia were isolated. Out of the 164 S. maltophilia isolates, 26 (16 %) were isolated from blood, 114 (70 %) were isolated from respiratory samples, 20 (12 %) from pus & tissue, and 4 (2 %) from urine. Out of the 164 patients, 130 (80 %) were males and 32 (20 %) were females. Maximum patients were above 50 years of age 93 (56 %) followed by 20 - 50 years 55 (34 %). Out of the 164 patients, 67 (40 %) were admitted to wards, 92 (56 %) were in ICU and 5 (3 %) were seen in out-patient department (OPD). A total of 90 % strains were sensitive to trimethoprim-sulfamethoxazole (TMP-SMX). Total 91 % strains were sensitive to levofloxacin. CONCLUSIONS S. maltophilia is emerging as a significant nosocomial pathogen, with a growing rate of isolation. Trimethoprim- sulfamethoxazole (TMP-SMX) is still the drug of choice, but resistance to it has been reported. KEYWORDS Minimum Inhibitory Concentration, Trimethoprim-Sulfamethoxazole (TMP-SMX), Levofloxacin

Background: Sepsis in neonates by resistant strains remains a significant cause of mortality and morbidity in developing countries. This study attempted to find out the organisms responsible for early onset sepsis (EOS) and late onset sepsis (LOS) and determine their antimicrobial sensitivity pattern. Materials & Methods: This prospective observational single centre study was conducted on 1000 neonates during January to September 2018, that were investigated for rule out sepsis, at the Neonatal Intensive Care Unit of Ad-din Medical College Hospital, Dhaka. Results: Fifty-four neonates were found with culture proven sepsis.Coagulase-negative Staphylococci (CONS) (68.42%)was the commonest and followed by Acinetobacter (18.42%) were found on culture isolates in EOS. In LOS, CONS (75%) is the most predominant organism. Among the gram negative Acinetobacter (50%) was the most prevalent bacteria followed by E.coli (28.57%). None of the gram positive isolates were sensitive to Amikacin. Majority of the gram positive showed susceptibilities to Vancomycin (83%) and Linezolid (78%). Among gram negative isolates 93% were sensitive to Colistin, 63% to Gentamicin & 54% to Levofloxacin. Conclusion: Present study indicated that gram positive species especially CONS continue to be the predominant causative organism in both EOS and LOS and followed by Acinetobacter and E. coli in gram negative species. Bangladesh J Child Health 2020; VOL 44 (3) :133-138

Snails are harvested for food in many parts of the world but are susceptible to environmental contaminations and pollutants due to the continuous ingesting of bacteria from the soil and the environment which they are found. Thus, the study has been designed to investigate the distribution and prevalence of micro-organisms in snails in humid tropics of Nigeria. Fifteen samples of Archachatina marginata were collected from Melege village, Ose local government area, Ondo State, Nigeria. The foot and head were analyzed microbiologically for bacterial loads before and after processing with five cleansing reagents: lime, alum, vinegar, salt and ash. Lime proved most effective reagent for decontaminating snail meats as it had the highest reduction of microbial load after processing (57.1%), followed by salt (44%) and the least was alum (20%). The mean microbial load on the head ranged between 9-22cfu/cm2 before and 4-12cfu/cm2 after processing, while foot ranged between 13-19cfu/cm2 before and 8-14cfu/cm2 after processing. Eight isolates belonging to nine genera including Micrococcus luteus [10(21.31%)] most predominant, followed by Escherichia coli [8(13.11%)], Proteus vulgaris [8(13.11%)], Klebsiella spp [6(16.39%)], Bacillus spp [6(9.84%)], Aeromonas spp [5(11.48%)], Streptococcus pyogenes [6(8.2%)], and least was Enterobacter spp [4(6.56%)] respectively. Results showed different pathogenic bacteria in snails. The presence of higher number of pathogenic Klebsiella spp and Escherichia coli among others, encountered in Archachatina marginata is an indication of public health hazard and also a warning signal for possible occurrence of food borne. The result showed lime as the most effective reagent in processing snail meat. The antibiotic susceptibility patterns of the bacterial isolates showed that all the bacteria isolated were susceptible to Gentamicin (GEN), only Proteus vulgaris and Bacillus spp were susceptible to Ceftazidime (CAZ) and Cloxacillin (CXC) respectively and all the were resistant to Ampicillin (AMP). The presence of these microorganisms showed that snail's samples harbor some potential pathogenic bacteria of medical importance and washing with some cleansing additives, especially lime is recommended for proper decontamination. The resistance of the organisms to some of the drugs portrayed the global increased concern over the continuous use of antibiotics in human and veterinary medicine and the resultant effects.

Pediatric urinary tract infections (UTI) are associated with significant morbidity and potential long term complication like extensive renal scarring leading to end stage renal disease. Prompt diagnosis and early initiation of treatment is necessary to prevent long term complications. Knowledge about bacteriological profile of pediatric urinary tract infections and their antimicrobial sensitivity pattern is helpful for initiation of empirical antibiotic treatment. The aim of this study was to identify the causative bacteria and antimicrobial sensitivity pattern of community acquired UTI in children attending outpatient department of a tertiary level hospital of Bangladesh. This was a cross-sectional study conducted in pediatric outpatient department of Rajshahi Medical College Hospital, Bangladesh over 6 month period from 1st January 2017 to 30th June 2017. Children aged < 12 year who presented with clinical features suggestive of urinary tract infection were subjected for urinary routine and microscopic examination and culture. Colony counts of the culture positive cases were done and antibiotic sensitivity and resistance patterns were studied. Samples with colony count of ≥ 105 CFU/ml were considered significant. Among the 134 clinically suspected cases significant bacteriuria was found in 81 (60.45%) children. Escherichia coli was the most common isolate (74.1%) followed by Proteus (9.8%), Klebsiella spp. (8.6%), Pseudomonas (6.2%) and Staphylococcus saprophyticus (1.2%). E. coli was found to be highly sensitive to imipenem, amikacin, nitrofurantoin and ciprofloxacin. Klebsiella showed good sensitivity against ciprofloxacin and imipenem whereas proteus, Pseudomonas and Staphylococcus saprophyticus showed sensitivity against imipenem, amikacin and ciprofloxacin. Increased resistance was noted against the commonly used empirical antibiotics such as cephradin, cefuroxime, cefixime, ceftriaxone and co-trimoxazole. Therefore, selection of empirical therapy should be based on local bacteriological profile and their antimicrobial sensitivity pattern. TAJ 2020; 33(2): 27-31

Urinary tract infection means the presence and active multiplication of microorganisms within the urinary tract that affects any part of urinary tract. A cross sectional descriptive study was conducted on 601 urine sample to determine the antibiotic sensitivity pattern of bacteria causing urinary tract infection in 250 diabetic and 351non-diabetic patients from February 2016 to March 2016. All samples were investigated by standard laboratory procedures. Out of diabetic patient 111 (44.4%) were female and 139 (55.6%) were male and among non-diabetic, 234 (66.7%) were female and 117(33.3%) were male. The UTI prevalence rate was found to be 13% was statistically significant (p= 0.02), among the significant growth 6.8% diabetic and 6.2% non-diabetic. Escherichia coli (54) was the most predominant organism (42.5% in diabetic and 57.5% non-diabetic) followed by Staphylococcus aureus (8). Amikacin, Cotrimoxazole and Nitrofurantoin were most sensitive to E. coli isolated in diabetic and non-diabetic patients among the tested antimicrobials. High rate of resistance was observed with Norfloxacin and Nalidixic acid. Gentamicin, Cefotaxime, Cotrimoxazole and Ciprofloxacin were highly sensitive to S. aureus in diabetic patients while Oxacillin and Azithromycin were resistance and in non-diabetic patient highly sensitive antimicrobials were Azithromycin, Gentamicin, Cefotaxime, Cotrimoxazole, Vancomycin and Ofloxacin while Oxacillin was resistance. The antimicrobial sensitivity testing of uropathogenic bacterial isolates should be performed before the initiation of treatment for UTI. Prevalance of uropathogenic bacteria and resistance rate should be monitored regularly.

Urinary tract infection is one of the most common bacterial infections seen in clinical practice both in developed and developing countries. The causative agents of Urinary tract infection vary from place to place and they also vary in their susceptibility and resistance patterns. This descriptive study aimed to evaluate the antibiotic susceptibility patterns of pathogens isolated from routine laboratory specimens at Dhaka Medical College Hospital. A descriptive cross- sectional study was done from January 2018 to June 2018. A total of 100 mid-stream urine samples from the suspected UTI patients were tested microbiologically and antimicrobial susceptibility test were performed for the isolated pathogens using Kirby-Bauer disk diffusion method with positivity rate of UTI was 90% (90/100). Escherichia coli (39%) was the most UTI causing bacteria followed by Klebsiella 18(18%), Acinetobacter 12(12%), Staphylococci, 9 (9%), Pseudomonas 6 (6%), Enterococcus species 3 (3%) and Proteus 3 (3%). Female 83 (83%) were more affected in comparison with male. Adult female especially age range 18-30 years were found in high risk. Nitrofurantoin, Amikacin and Meropenem were recorded as most sensitive antibiogram for most of the bacteria’s whereas cephalosporin showed increased resistance. However, for uncomplicated community acquired UTI, Nitrofurantoin (oral) and Amikacin (Injectable) can be chosen as first line medication. J MEDICINE JUL 2020; 21 (2) : 93-97

Background: Urinary tract infection is the most common infection occurs in both male and female. Objective: This study was aimed to identify the uropathogens and their antimicrobial sensitivity pattern. Methodology: This study was carried out in the Department of Microbiology at Dhaka National Medical College & Hospital, Dhaka from January 2018 to December 2018. Result: A total of 1686 samples of urine were collected from suspected cases of urinary tract infections from Dhaka National Medical College & Hospital. Among them, 292 (17.32%) specimens showed significant bacterial growth. The most common uropathogens isolated were Escherichia coli. Conclusion: In conclusion Gram negative bacteria is the commonest uropathogens isolated. Journal of Science Foundation July 2019;17(2):42-45

BACKGROUND Blood stream infections are the leading cause of morbidity and mortality in children in developing countries. Blood culture remains the golden reference standard for the laboratory diagnosis of bloodstream infections (BSIs) and helps in the prevention of emergence of multidrug resistant bacterial strains which poses a major challenge in the management of bacteraemia. Knowledge about the bacteriological profile and antimicrobial susceptibility patterns in the local unit helps the clinician in rationalizing the empirical treatment protocols and optimizing the duration of therapy. METHODS A hospital based retrospective observational study was carried out by reviewing the records of 318 blood cultures received from children aged 1 month to 12 years admitted with clinically suspected sepsis at Institute of Child Health, Niloufer Hospital for Women and Children, Hyderabad over a 4 month period (April 2019 - August 2019). Blood samples were collected under aseptic conditions, identification of isolates and their antibiotic sensitivity pattern was done by disc diffusion method as per CLSI standards 2019. RESULTS During the study period, among the 318 blood cultures studied, 105 (33 %) samples showed positive cultures. Out of the positive cultures, 57 (54.3 %) samples showed growth of Gram-positive bacteria and 48 (45.7 %) samples showed growth of Gram-negative bacteria. Klebsiella spp [30 (28.5 %)] were the most common bacteria isolated followed by Coagulase negative Staphylococcus 28 (26.7 %), Staphylococcus epidermidis 18 (17.1 %), Pseudomonas aeruginosa 12 (11.4 %), Enterococcus species 6 (5.7 %), Staphylococcus aureus 3 (2.8 %), Acinetobacter species 4 (3.8 %), and each one isolate of E. coli, Citrobacter species and Streptococcus pyogenes. The antibiotic sensitivity patterns have shown a high degree of resistance to the Cephalosporins among the Gram-negative cultures and high sensitivity pattern to Carbapenems and Fluoroquinolones. CONCLUSIONS The present study emphasizes the need for continuous scrutiny and surveillance for the most common pathogens isolated in children with blood stream infections along with antibiotic sensitivity pattern in paediatric units for formulating rationalized antibiotic treatment protocols and infection control strategies for prevention of septicaemia in children.

Objective: Bangladesh is an endemic area for enteric fever. Adequate and timely antimicrobial treatment invariably cures this disease. But resistant strains of Salmonella spp. have made it difficult to treat nowadays. This study will help clinicians in understanding the local resistance pattern of enteric fever and identifying recent changes in the trends of the sensitivity pattern of commonly used antibiotics in Bangladesh. Materials and Methods: This cross-sectional study was conducted during the period from January 2016 to June 2019 in Sheikh Hasina Medical College, Tangail, to determine the antimicrobial sensitivity patterns of Salmonella typhi and paratyphi isolated by blood culture from clinically suspected typhoid fever patients. The blood sample was processed on BACTEC 9050 and isolates obtained from subculture were serotyped. Then antibiotic susceptibility testing was carried out using the disk diffusion method. Results and Discussion: A total of 137 cases were recorded in four years. All cephalosporins were found sensitive in more than 90% of cases. We did not find any resistance to Ceftriaxone in our patients’ group. Moxifloxacin and Levofloxacin showed higher sensitivity than Ciprofloxacin (100% and 96% Vs 90%). Nalidixic acid demonstrated lower sensitivity than previously reported (less than 5%), while Gentamicin showed the highest sensitivity around 100%. Conclusion: Multidrug-resistant (MDR) Salmonella typhi and paratyphi are emerging rapidly. To overcome this global issue, rational use of antibiotics has to be ensured. Physicians should also be aware of the local resistance pattern so that they can treat their patients effectively. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 134-137

Introduction Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population. MethodsThis was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics. ResultsCOM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin. ConclusionCOM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin.

Objective: To assess the relevance of urine test (UT), urine culture (UC) and stone culture (SC) for postoperative infections and to investigate the optimal perioperative antibiotic treatment strategy in association with percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Materials and methods: Between September 2016 and September 2018 1,060 patients treated with PCNL were included in the study. The results of UT, UC and SC were reviewed. The details of perioperatively administered antibiotics and postoperative infections were recorded. Results: A positive UT was associated with an increased incidence of infection; this was also the case in patients with negative UC (p < 0.05). There was no significant difference in incidence of infection between patients who were given a single dose of antibiotics compared with those given multiple doses when UC was negative, whether UT was positive or negative (all p > 0.05). The incidence of infection was decreased when pre-operative antibiotics were administered according to the sensitivity pattern based on UC (p < 0.05). This outcome was particularly evident when the treatment duration exceeded 7 days (p < 0.05). A positive SC was associated with increased incidence of infection, even if the patient had a negative UC and UT (p < 0.05). The incidence of infection was significantly decreased when antibiotic treatment was administered based on the results of SC (p < 0.05). Conclusion: Pre-operative prophylaxis with a single-dose antibiotic was sufficient in patients with negative UC, whether UT was positive or negative. Pre-operative treatment with antibiotics according to the bacterial sensitivity pattern should be administered for ≥7 days in patients with positive UC. The postoperative antibiotic treatment strategy should be tailored according to the SC results.

Material and methods: This retrospective study was conducted in the Department of Microbiology at Desh Bhagat Dental College January 2017 to June 2017 for a period of 6 month. The pus samples were collected from the patients who were visited in General hospital of Desh Bhagat University Mandi Gobindgarh Punjab, India, with skin and soft tissue infection. Bacteria were detected by culture and biochemical test and antibiotic susceptibility test done by disc diffusion method.

Introduction: Gram negative bacteria are commonly involved in wound infections and are significantly associated with morbidity and mortality because of increasing resistance to commonly used antibacterial agents. This study aims to evaluate the pattern of antibacterial sensitivity of the gram negative bacteria from wound swabs of accidental trauma cases. Methods: This retrospective study was done by collecting all the culture positive reports for wound swabs of accidental wounds from the microbiology laboratory and analyzing the reports showing growth of gram negative bacteria for frequency of sensitivity to commonly used antibacterial agents. Results: Culture positivity rate was 21.95% with growth of gram negative bacteria in 79.7% of cases. The most commonly isolated organism was Escherichia coli being 41.3% among gram negative isolates. Highly resistant bacteria were E. coli, Klebsiella pneumoniae and Acinetobacter spp. Conclusions: As there is low culture positivity rate for wound swabs obtained before washing the wounds inflicted by accidental trauma, prolonged routine use of prophylactic antibiotic is not justified. Thoroughly washing the wound is very likely to decrease the rate of wound infection further and reduces the need of antibacterial agents. Culture and sensitivity test should guide the treatment when wound is infected because highly resistant gram negative organism may be involved in such cases.

Introduction: Pseudomonas aeruginosa (P. aeruginosa) is one of the major cause of nosocomial infection. Multi-drug-resistant P. aeruginosa (MDR PA) are increasingly encountered in clinical samples .Therefore, this study was undertaken to know the sensitivity pattern of P. aeruginosa and to detect MDR PA from clinical samples. Methods: This was a laboratory based retrospective-cross sectional study conducted at Department of Microbiology at a tertiary care referral centre in Kathmandu, Nepal from December 2018 to December 2019. Total of 200 isolates of P. aeruginosa were isolated from clinical samples. Non repetitive sample per patient was included in the study. Samples were processed according to standard methodology and antimicrobial sensitivity testing (AMST) was carried out by Modified Kirby Bauer disk diffusion test as per Clinical Laboratory Standard Institute guideline. MDR was defined as strains resistant to one or more agent of ≥ 3 groups of antimicrobial categories. Results: Highest number of P. aeruginosa were isolated from sputum (93), followed by wound swab (35), and pus (29). AMST revealed the most sensitive drug to be Amikacin (91.51%) followed by Meropenem (78.5%) and Piperacillin/Tazobactam (77.50%). Out of 200 isolates, 69 (34.5%) were MDRPA. Conclusions: The information regarding sensitivity pattern of P. aeruginosa will help clinicians to choose most effective antimicrobials for the treatment of patients thus saving the time duration and total cost of patient management and also it will play a key role in setting antimicrobial stewardship policy.

Background: Empirical antibiotics are used in the intensive care unit based on developing countries’ guidelines due to a lack of a bacteriological profile of individual ICU and institution policy. Therefore, this study was conducted to know the antibiogram of the intensive care unit and to make institution policy for antibiotic use in ICU. Materials and methods: It was a prospective descriptive cross-sectional study conducted in the mixed surgical and medical intensive care unit of a tertiary care hospital for one year in 625 patients. Various clinical samples were collected aseptically and organisms were identified by the cultural characteristics, morphology, gram stain, and different biochemical test. Antimicrobial susceptibility was done with a disc diffusion test. Data collection was done in a preformed sheet that included all tested antibiotic and demographic variables. Statistical analysis was done by using statistical package for the social sciences. The result was presented as frequency and percentage. Results: Out of 625 samples, 135(22%) showed growth in culture. Among them, 96(71%) and 39(29%) were gram-negative bacilli and gram-positive cocci respectively. The tracheal aspirate was the most common type of specimen which comprised 49(36.29%) isolates. The most common organism was Staphylococcus aureus which accounts for 27(20%) isolates, followed by Acinetobacter baumanni 25(18.51%), Klebsiella pneumoniae 22(16.29%) and Pseudomonas aeurignosa 21(15.55%). The incidence of multidrug-resistant and extended drug resistance was 44(32.5%) and 45(33%) respectively. Meanwhile, the incidence of methicillin-resistant staphylococcus aureus was 70%. However, in the case of Acinetobacter baumannii and Enterobacteriaceae, all were sensitive to polymyxin B and meropenem. Conclusion:Antibiotics should be prescribed based on the antibiogram of individual intensive care units that can decrease antibiotic resistance. Polymyxin B and meropenem can be prescribed for gram-negative bacilli and vancomycin for Staphylococcus aureus.

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), accounting for 25% of all ICU infections. Antimicrobial resistance is increasing and becoming a significant health problem worldwide, increasing hospital length of stay, mortality and costs. Identifying antibiotic resistance patterns in VAP is important as this can cause outbreaks in ICUs. To date, there have been limited studies assessing this in Bangladesh. Consequently, the primary objective of this research was to study the species of bacterial growth and to determine the antibiotic resistance patterns of Metallo-β-Lactamase (MBL) producing gram-negative bacilli among ICU patients with VAP in a public medical school hospital, Bangladesh. In addition, identify the factors associated with a positive culture to provide future guidance. METHOD: Cross-sectional study performed in the Chattogram Medical College Hospital, Bangladesh. Mueller Hinton agar plates were used for antibiotic sensitivity testing by the Kirby-Buer disc diffusion test. RESULTS: Among 105 clinically suspected VAP cases, qualitative cultures were positive in 95 (90%) of them. The most common bacteria identified were Acinetobacter spp. (43.2%), Klebsiella spp. (20%) and Pseudomonas spp. (18.9%). A positive culture was not associated with patients' age or gender. Among 41 isolated Acinetobacter spp., 38 (92.7%) were resistant to gentamicin followed by 36 (87.8%) to ceftriaxone. Among 24 isolated Klebsiella spp., 22 (83.3%) were resistant to ceftriaxone. Among 18 isolated Pseudomonas spp., 16 (88.8%) were resistant to ciprofloxacin, and 13 (72.2%) were resistant to ceftriaxone. Among nine isolated E.coli, all were resistant to ceftriaxone and ciprofloxacin. All four Proteus spp. (100%) isolated were resistant to ciprofloxacin. Additionally, phenotype MBL producing was 65.22% and genotype was 45.65% among imipenem resistant pathogens. Imipenem resistant pathogens were sensitive to amoxyclav, amikacin¸ azithromycin, ceftazidime, ceftriaxone, colistin and gentamycin. CONCLUSION: A positive culture was detected in 90% of VAP patients, but it was not associated with the patients' age and gender. The most common bacteria identified were Acinetobacter spp., Klebsiella spp. and Pseudomonas spp., where the majority of these were resistant to ceftriaxone. The results are being used to provide future guidance on the empiric management of VAP in this hospital.

Background: Surgical site infection (SSI), is a major complication of surgery and third most commonly reported nosocomial infection. SSI increase length of stays in hospital, costs of health care and morbidity and mortality of patients. This study aims to determine the incidence, associated risk factors and type of pathogenic organisms causing laparotomy wound infection. Methods: This study was done on 200 patients who underwent elective and emergency laparotomy. Diagnosis of wound infection was clinical. Discharge from all wounds was subjected to microbiological analysis.Results: The incidence of SSI following laparotomies is 25%. Risk factors being emergency laparotomy, dirty wound, male sex, increased age, smoking, diabetes mellitus, obesity, haemoglobin 2hrs. Most common organism isolated was E. coli.Conclusion: In handling laparotomy cases all aseptic precautions should be maintained, risk factors should be identified early and infections should be treated as per culture sensitivity pattern.

Scrofuloderm is a rare manifestation of cutaneous tuberculosis. The article describes a clinical case of secondary scrofuloderm in a 35-year-old man. The case demonstrates significant and irreversible cosmetic defects of scrofuloderm as well as importance of timely use of effective methods for diagnosis of tuberculosis (molecular genetic and histological tests, multi-slice computed tomography of the chest) and modern approaches to tuberculosis therapy based on the drug sensitivity pattern.