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This paper provides new evidence at the intersectionality of gender, family status, and culture by focusing on a previously little researched group of middle-class women in an emerging economy. While the existing literature examines both structural and normative constraints for women entrepreneurship, little is known about the gains from relaxing structural constraints for women when compared to men. In addition to examining this new question, the paper sheds light on the binding nature of normative constraints for women entrepreneurship that persist in a patriarchal developing economy even when structural constraints are significantly eased. Using a mixed-methods approach, the empirical results suggest that higher resource availability differentially impacts the entrepreneurial intentions of women when compared to men indicating the strong presence of normative barriers that inhibit their entrepreneurship. These normative barriers emerge through the roles people play within women life spheres inhibiting their entrepreneurial intentions.

Haemophilus are fastidious Gram negative bacilli, which require factor X (hemin), factor V (NAD), or both for their growth. Haemophilus influenzae is the type species, and is considered to be the most pathogenic. They are associated with many invasive infections including meningitis, epiglottitis, pneumonia, and otitis media. Serotype b is most commonly associated with infections. Haemophilus species isolated from patients in a tertiary care centre in South India were studied. Identification, serotyping and biotyping were done and antibiotic susceptibility test was performed. The incidence of H. influenzae infections in our study was 65.3 cases/100,000 persons. Serotype b was the most common (66.67%), followed by non typeable H.influenzae (NTHi) (25%). Most isolates from adults were type b, while all isolates from pediatric population were non typeable. The most common biotype was type II, followed by type I and type III. Three of 24 isolates were β lactamase producers (12.5%). One isolate was β lactamase negative Ampicillin resistant (BLNAR). Resistance to ampicillin was 16.67%. Resistance to cephalosporins and fluoroquinolones was low (4-10%). Co-trimoxazole resistance was found to be very high (75%). All isolates were susceptible to azithromycin, tetracycline, chloramphenicol and meropenem. No isolates of H.influenzae type b were obtained from the paediatric population which may be due to the introduction of Hib vaccine. The increase in resistance to commonly used antibiotics is worrisome, especially penicillins and co-trimoxazole. Use of co-trimoxazole in empirical therapy of upper and lower respiratory tract infections has a high chance of failure in the current scenario.

This study addressed the question of how the counterfactual thinking of a student in an entrepreneurial university affects his/her future entrepreneurial career intention. In addition to testing this relationship, we also test how counterfactual thinking moderates the influence of attitude and opportunity identification in entrepreneurial career intention in an entrepreneurial university. We found that in an entrepreneurial university, counterfactual thinking is modifying the influence of attitude and opportunity identification in entrepreneurial career intention, but counterfactual thinking has no significant direct influence on entrepreneurial career intention of the students.

It is sometimes argued that ethnic minorities have a cultural predisposition towards self-employment. However, this is generally not the preferred option for minority groups. We argue that ethnic minorities face a double risk in deciding between employment and self-employment. While their chances in employment leave them exposed to greater risk than the majority group, self-employment, which is inherently risky for all workers, adds to their general risk environment. We demonstrate a negative underpinning to their self-employed activity, showing that minority groups in the UK earn less in self-employment relative to the white British majority, work longer hours, and have lower job satisfaction. They also leave self-employment sooner to take up a job as an employee and use resources such as higher education to stand a better chance in employment.

Engagement with work has been one of the most influential management ideas of recent decades. A prevalent assumption is that engagement is inherently beneficial and disengagement is a problem to be addressed. Yet theory and research on disengagement show it may not have the assumed negative impact on organizations, and at times may be beneficial for employees. This research seeks to unpack the underlying assumptions of work disengagement through collating and reviewing studies of the phenomenon. The paper makes three contributions. First, it provides a clear argument for why disengagement is a concept worth studying in its own right, as a functional coping response. Second, it offers a typology of the antecedents that applies to current theoretical frameworks. Third, it suggests differentiating between engaged, not engaged, and disengaged to address various levels of dedication to work domains and provide a basis for more evidence-based HR interventions.

The main objectives of the study were to determine the present status of fish biodiversity and socio-economic condition of fishermen in Belai beel during February 2016 to September 2016 by survey method using questionnaires, field visit and interviewing with the fishermen. The results indicated that about 27 species of fish fauna were found in the Belai beel, among them 23 species were indigenous and 4 species were exotic. Major dominant species were Rui ( Labeo rohita ) , Catla ( Catla catla ), Bata ( Labeo bata ), Shingi ( Heteropeneustes fossilis ) , Magur ( Clarius batrachus ), Tengra ( Mystus tengra ), Chanda ( Chanda nama ) , Kakila ( Xenentodon cancila ) , Common carp ( Cyprinus carpio ) , Mola ( Amblypharyngodon mola ) in the study area. During the study period two critically endangered ( Puntius sarana, Pangasius pangasius ), two endangered ( Labeo bata, Channa marulius ), and three vulnerable ( Chanda nama, Channa orientalis, Notopterus notopterus ) fish species were found in the Belai beel. Analysis of socio-economic condition of fishermen showed that maximum (70%) had nuclear family and others (30%) had joint family, as well as fishermen, belonged to the age groups of 31 to 40 years (50%) and the others were 15 to 30 (20%), 41 to 50 (18%), 51 to 60 (10%), 61 to70 (2%). Overall, the present study suggested that fishermen communities should be educated by creating awareness for the proper conservation, management, and enhancement of biodiversity in the Belaibeel. Asian J. Med. Biol. Res. March 2018, 4(1): 69-76

Lack of quality carp seeds is one of the major problems for fish production in Bangladesh. This experiment was conducted during July to December 2013 to study the production and economics of carp polyculture using wild and hatchery produced seeds in ponds in Faridpur district, Bangladesh. Seeds of native major carps (NMCs) ( Catla catla , Labeo rohita and Cirrhinus mrigala ) and non-native carps (NNCs) ( Hypophthalmichthys molitrix , Ctenophryngodon idella , Aristichthys nobilis and Cyprinus carpio ) from four different sources were tested in feed and fertilizer based polyculture ponds under controlled mesocosm trials with four treatments (T 1 –T 4 ), each with four replications. Combination, weight and density of the stocked species were same for all the treatments. Water quality parameters were monitored monthly and mean values were found within suitable range for fish farming. Mean final weight, weight gain, specific growth rate and yield of L. rohita , C. catla and C. mrigala were found significantly ( P < 0.05) higher with treatment T 1 , T 3 and T 2 respectively. Treatments T 1 , T 2 and T 3 varied more significantly ( P < 0.05) than treatment T 4 for total fish yield and cost benefit ratio. Polyculture of wild sourced NMCs and hatchery produced NNCs were found more profitable than aquaculture of hatchery produced NMCs and NNCs.

Soil Transmitted Helmenthiasis (STH) is a major public health problem in the developing countries. Trichuriasis is one of the common prevalent parasitic infestations in the tropical and sub-tropical countries across the globe incuding India. However, there has been a steady decline of STH in the last five years where there has been success of albendazole with Mass Drug Administration (MDA) in National Filariasis Control Program and Kerala state has been one of them. We report a case of whipworm infection that was incidentally diagnosed by colonoscopy where repeated stool microscopy was uncontributory. The worm can be overlooked, particularly if colon preparation is not good.

Background Candida auris is unique due to its multidrug resistance and misidentification as Candida haemulonii by commercial systems. Its correct identification is important to avoid inappropriate treatments. Aims To develop a cheap method for differentiating C. auris from isolates identified as C. haemulonii by VITEK2. Methods Fifteen C. auris isolates, six isolates each of C. haemulonii and Candida duobushaemulonii , and one isolate of Candida haemulonii var. vulnera were tested using CHROMagar Candida medium supplemented with Pal's agar for better differentiation. Results On CHROMagar Candida medium supplemented with Pal's agar all C. auris strains showed confluent growth of white to cream colored smooth colonies at 37 °C and 42 °C after 24 and 48 h incubation and did not produce pseudohyphae. The isolates of the C. haemulonii complex, on the contrary, showed poor growth of smooth, light-pink colonies at 24 h while at 48 h the growth was semiconfluent with the production of pseudohyphae. C. haemulonii complex failed to grow at 42 °C. Conclusions We report a rapid and cheap method using CHROMagar Candida medium supplemented with Pal's agar for differentiating C. auris from isolates identified as C. haemulonii by VITEK2.

BACKGROUND: Coliforms and other bacterial indicators are known to be present in Community water samples causing faecal pollution of water. There is also a growing body of evidence demonstrating that the aquatic environmental microbes are drug resistant. OBJECTIVE: The objective of this study was to evaluate the microbial quality of the water from tap, well and pond in urban households of Kochi, Kerala state. MATERIALS AND METHODS: A total of 100 water samples (46 from well water, 45 from tap water and 9 from lakes and ponds) were analysed by the multiple fermentation tube method to determine the presumptive coliform count or the most probable number (MPN) of coliforms, and the isolates were identified using standard procedures, followed by susceptibility testing. RESULTS: Eighty samples were positive for growth (76 grew coliforms, four samples grew non-pathogens). A total of 105 coliform isolates were grown in culture. The MPN numbers were noted to be >100 for over 50% of all the samples (n = 56), thus making the water unsatisfactory for drinking purposes. The highest number of organism isolated was Klebsiella pneumonia (n = 55), followed by Enterobacter spp (n = 34) and Escherichia coli (n = 16). Well water had the highest proportion of all three of these organisms. Up to 26%–40% resistance was seen to amoxicillin–clavulanic acid and 5.4%–5.8% of resistance was noted to third-generation cephalosporins, while two isolates were extended-spectrum beta-lactamase-producing Enterobacteriaceae (CTX-M and TEM types). CONCLUSION: The city municipal water authorities need to adopt more aggressive treatment/disinfection practices to combat high coliform contamination. The bacteriological quality of well water at the source needs to be monitored. Meanwhile, continued adequate home purification is suggested for drinking water. The city water does not pose a threat of antibiotic resistance for now. Environmental sampling should be given equal priority as clinical sampling in the coming days.

Objective: To determine the in vitro activity of daptomycin and vancomycin against 50 strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated from blood and pus specimens. Material and methods: Fifty consecutive MRSA were isolated from pus (n=25) and blood (n=25) were included in the study. Oxacillin susceptibility was determined by cefoxitin disc diffusion, green colored colonies on chromogenic media. Susceptibility testing for 18 antimicrobial agents was determined by a disc diffusion method. The minimum inhibitory concentration (MIC) of daptomycin and vancomycin was determined by the Etest as recommended by the Clinical and Laboratory Standards Institute (CLSI). Results: Antibiotic susceptibility pattern of the MRSA isolates showed that 38% were multi-drug resistant overall and 52% in blood and 24% in pus isolates when expressed separately. The MIC50 and MIC90 of daptomycin were 0.08 and 0.09 mg/L and of vancomycin were 1.2 mg/L and 1.3 mg/L, respectively. Ten percent of the isolates had vancomycin MIC of 2 mg/L which is the upper limit of CLSI breakpoint for sensitive isolates. None of the isolates showed intermediate susceptibility or resistance to vancomycin or daptomycin. Conclusion: Creeping MIC of vancomycin is a matter of concern and MIC of 1.5–2 mg/L of vancomycin in MRSA increases the risk of development of complicated bacteraemia. MIC’s of vancomycin should be reported for all S. aureus isolates and should be used to guide treatment. Otherwise, daptomycin can be considered as an alternative antibiotic for therapy of MRSA infections in India. Key words: Vancomycin , Daptomycin, Methicillin-resistant Staphylococcus aureus (MRSA) , Minimum Inhibitory Concentration (MIC)

BACKGROUND: Ventriculoperitoneal shunt insertions are one of the important neurosurgical procedures done to enhance the neurological functions and improve the survival of patients with hydrocephalus. However, shunt infections are associated with an increased risk of morbidity and the mortality of 30%–40%. The study objective was to evaluate the clinical features, aetiology, resistance pattern and outcome of patients with cerebrospinal fluid (CSF) shunt infections over a 10-year period (2001–2010) amongst the microbiologically-proven cases. METHODOLOGY: Retrospective chart review was carried out to evaluate the age, sex and aetiology of hydrocephalus, biochemical parameters, clinical features and outcome of the culture-positive cases. RESULTS: Out of the 184 post-procedure and initial ( CONCLUSION: CONS continues to be a challenge to neurosurgeons in the treatment of shunt infections. Adequate prophylactic antibiotics based on the local susceptibility pattern should be administered besides strengthening the infection control protocols of the hospital. Surveillance of healthcare-associated infections may well extend to shunt infections at the locations where insertions are carried out.

Vertebral osteomyelitis also known as discitis/pyogenic spondylitis refers to inflammation of the vertebral disc space. It is commonly seen in men and adults more than 50 years of age. Fungal osteomyelitis is a rare scenario compared to its bacterial counterpart. Spinal epidural abscess is a dangerous complication associated with vertebral osteomyelitis. Here, we report two cases of vertebral osteomyelitis caused by Candida tropicalis in patients with renal disorders (stage 5 chronic kidney disease and nephropathy). One of the case discussed here presented with spinal epidural abscess. Both the patients were started on antifungal therapy. One patient responded to treatment while the other was lost to follow up.

The prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in hospitalised and community patients is of significant public health concern. The aim of this study was to estimate the faecal carriage rate of ESBL-PE in hospitalised patients and healthy asymptomatic individuals coming for health check-up. Non-repetitive, consecutive stool samples from 480 adults (260 healthy individuals and 220 hospitalised patients) aged ≥18 years from November 2011 to July 2013 were screened using MacConkey agar supplemented with ceftazidime. All screen-positive isolates were identified to species level and were tested for ESBL production. Representative ESBL-PE isolates were subjected to susceptibility testing and multiplex ESBL PCR. The faecal carriage rate of ESBL-PE was found to be 62.7% among hospitalised patients and 33.8% among healthy asymptomatic individuals. The most common ESBL-PE was Escherichia coli (70.3% and 78.4% in hospitalised patients and healthy individuals, respectively), followed by Klebsiella pneumoniae (26.8% and 17.0%). ESBL-PE showed the highest sensitivity to carbapenems (85% and 100%, respectively), followed by amikacin (67.2% and 98%), cefoperazone/sulbactam (27.8% and 88.2%) and piperacillin/tazobactam (18% and 74.5%). Ciprofloxacin exhibited a high level of resistance among both groups. Molecular analysis for ESBL genes showed a predominance of the CTX-M gene. In conclusion, the faecal carriage rate of ESBL-PE among hospitalised patients was almost double that of healthy individuals. Carriage of carbapenem-resistant isolates is emerging among hospitalised patients. The spread of these organisms in the community merits radical measures to improve sanitation and implement antibiotic stewardship.

Aims & objectives: Protective effect of social support networks on depressive symptoms has been reported. The aim of this study was to examine the association between depressive symptoms and social support from family and community using data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006. Methodology: This is a cross-sectional population-based study of 10,348 people participating in the NHANES 2005-2006. Participants were interviewed on their level of social support and depressive symptoms. Logistic regression and analysis of variance was used to assess the effects of demographic variables and social support with depression. Results: Bing married and having a high education level is inversely related to depressive symptoms. Also social supports from family had protective effect on depression symptoms and impacts of each family member were different. It also became clear that family support in associated with social support had a protective effect on the emergence of depressive symptoms. In this effect, the interaction between spouse and professional support on depressive symptoms were more prominent. In addition to, interaction between children’s emotional support and religious practices was important. Conclusion: The result of this study adherent with the protective theory of social support on depression.

Objectives: To determine the minimum inhibitory concentration of ciprofloxacin among 50 blood stream isolates of Salmonella enterica. Material and Methods: A total of 50 consecutive isolates of Salmonella enterica were tested for susceptibility to antimicrobials using the Kirby Bauer disk diffusion method. Minimum inhibitory concentrations were determined using Hi-Comb strips. All results were interpreted according to the CLSI guidelines. Results: Of the 50 isolates 70%were Salmonella Typhi, 4% Salmonella paratyphi A, 2% Salmonella paratyphi B and the remaining 10% were identified only as Salmonella species. Using the CLSI 2011 breakpoints for disc diffusion, 86% (43/50) were resistant to nalidixic acid(NA), 22% (11/50) to ciprofloxacin, 12% to azithromycin, 6% to cotrimoxazole, 4% to ampicillin and 1% to chloramphenicol. The MIC50 and MIC90 of ciprofloxacin for S.Typhi were 0.181 μg/mL and 5.06 μg/mL respectively. While the same for S. paratyphi A was 0.212μg/mL and 0.228μg/mL respectively. None of the isolates were multi drug resistant and all were susceptible to ceftriaxone. Using the CLSI 2012 revised ciprofloxacin breakpoints for disc diffusion (>31mm) & MIC (

The present study highlights six cases of pneumococcusuria during the time period of May 2008 to May 2010. All the patients had a co-existing predisposing factor with the isolation of Streptococcus pneumoniae in urine. Five of the six patients having signs and symptoms of urinary tract infections (UTI) were treated and cured of the same. It becomes essential to consider pneumococcal UTI in the presence of clinical signs and symptoms associated with urinary tract abnormalities like hydronephrosis and renal stones. S. pneumoniae may be regarded as an emerging pathogen in UTI. Precise microbiological diagnosis must correlate with the clinical signs and symptoms for the administration of appropriate antibiotic therapy.

Studies in cognitive psychology identified that content specific ‘upward counterfactual thinking’ influences intention and behaviour. Content specific upward counterfactual thinking is regretful th...

We describe a case of bacteraemia caused by Weissella confusa in a 48-year-old male who was operated on for adenocarcinoma of the gastro-oesophageal junction and maintained on total parenteral nutrition. Blood cultures were positive for a vancomycin-resistant streptococcus-like organism which was identified as W. confusa by 16S rRNA gene sequencing.

A 35-year-old man presented with a gradually worsening left-sided loin pain and high-grade fever 10 days in duration. He gave a history of left flank injury due to a road traffic accident 4 months previously, accompanied by pain and transient mild hematuria that was managed conservatively without further evaluation. Computed tomo- graphic scan revealed undisplaced fracture of the left 10th rib with a large perinephric hematoma/abscess causing significant compression and displacement of the left kidney. The collection was evacuated by open drainage, and its culture yielded a hydrogen sulfide (H2S)Yproducing variant of Salmonella paratyphi A resistant to nalidixic acid. Blood and urine cultures were sterile. Drainage with culture-specific antibiotics (ceftriaxone followed by cefixime) was curative. Primary perinephric abscess due to S. paratyphi A without any evidence of systemic involve- ment is rare and classically S. paratyphi A is H2S-negative. We hereby report a case of H2S-positive S. paratyphi A causing primary perinephric abscess of posttraumatic hematoma.

Central nervous system trichosporonosis is a rare clinical entity and so far only six cases including three each of brain abscess and meningitis has been on record. We report a rare case of chronic meningo-ventriculitis and intraventricular fungal ball due to Trichosporon asahii in an 18-year-old immunocompetent male from Burundi, east Africa. Neuroendoscopy showed multiple nodules and a fungal ball within the ventricle, which on culture grew T. asahii. He was initially empirically treated with liposomal amphotericin B. However, the antifungal susceptibility testing of T. asahii isolate revealed high minimum inhibitory concentration for amphotericin B (2 μg ml⁻¹), flucytosine (16 μg ml⁻¹) and caspofungin (2 μg ml⁻¹) but exhibited potent activity for voriconazole, posaconazole, itraconazole and fluconazole. The patient rapidly succumbed to cardiac arrest before antifungal therapy could be changed. Although disseminated trichosporonosis has been increasingly reported the diagnosis represents a challenge especially in rare clinical settings such as intraventricular fungal ball in the present case, which has not been described previously.

Infections caused by Nocardia farcinica are potentially lethal because of the organism's tendency to disseminate and resist antibiotics. Central nervous system involvement has been documented in 30% of infections caused N. farcinica.Case report and review of the literature.A case of primary brain abscess caused by N. farcinica, identified by 16SrRNA sequencing, is presented, and 39 cases reported previously in the literature are reviewed. Our patient underwent a neuronavigation-guided right frontal craniotomy and was treated with trimethoprim/sulfamethoxazole and amoxicillin-clavulanic acid for 12 mo. He showed marginal improvement in his prior left hemiparesis at the last review 14 months later.Cases of N. farcinica infections are being reported increasingly because of recent changes in taxonomy and diagnostic methodology. This change in epidemiology has implications for therapy because of the organism's pathogenicity and natural resistance to multiple antimicrobial agents, including third-generation cephalosporins. Any delay in starting appropriate antibiotic therapy can have adverse consequences.

Chromoblastomycosis is a chronic subcutaneous mycosis commonly caused by Fonsecaea, Phialophora, and Cladophialophora spp. Out of these, Fonsecaea pedrosoi is the most common etiological agent, implicated in 70%–90% of the cases reported worldwide. The histopathological diagnosis of chromoblastomycosis is based on visualization of medlar or sclerotic bodies in the tissue. These sclerotic bodies divide by planar division. Rarely, budding is seen in these sclerotic bodies. As this entity can be confused with phaeohyphomycosis, it is important to be aware of such a presentation also. We report two cases of chromoblastomycosis that showed budding sclerotic bodies.

Systemic endemic mycoses, such as blastomycosis, are rare in Asia and have been reported as health risks among travelers who visit or reside in an endemic area. Adrenal involvement is rarely seen in blastomycosis and has never been reported from Asia. We report the first case of blastomycosis with bilateral involvement of the adrenals in a diabetic patient residing in the state of Arunachal Pradesh, India.

Background: Percutaneous endoscopic gastrostomy (PEG) is used to provide enteral access in patients who are unable to swallow. Infection of the stoma is an important complication and there is little data from India on this problem, which can be used to inform infection prevention and prophylactic strategies. Aim: The objective was to assess the prevalence and the role of contributory factors in PEG site infections. Methods: A total of 173 patients underwent PEG insertion from January 2011 to May 2012. Clinical and microbiological data were collected for culture-positive cases. Insertion was performed using a standard sterile pull-through technique. Infections were defined as two of: peristomal erythema, induration, and purulent discharge. Results: A total of 54 PEG infections occurred in 43 patients (28.85%). Seventy-seven organisms were isolated. Pseudomonas aeruginosa was the most common ( n=29) followed by coliforms ( n=21) and meticillin resistant Staphylococcus aureus (MRSA) ( n=6). Thirty-one (72%) received amoxicillin-clavulanic acid as prophylaxis and 12 (28%) were receiving concomitant antibiotics for their underlying conditions. The occurrence of PEG site infections was statistically independent of the administered prophylactic antibiotics ( p=0.3). Conclusions: This study has demonstrated the importance of PEG sites as a cause of healthcare associated infections. Educating patients on wound care practices would play a significant role in prevention of PEG site infections.

A 49-year-old male with underlying liver disease presented with fever and signs of sepsis. Non-O1/non-O139 Vibrio cholerae was isolated from his blood culture, which was positive for the hlyA and toxR genes. We report this fatal case of non-O1/non-O139 V. cholera sepsis and review the literature on non-O1/non-O139 V. cholerae sepsis in patients with chronic liver disease.

Fungal endophthalmitis is a destructive intraocular infection resulting in poor visual prognosis. Endophthalmitis due to Fusarium spp has the worst visual prognosis. We report a case of a 58-year-old female patient who underwent cataract extraction and intraocular lens implantation in the right eye and presented two months after the surgery with fungal endophthalmitis. The aqueous humor culture grew Fusarium dimerum. The patient was treated with intravitreal and oral voriconazole and topical prednisolone. The patient experienced one episode of recurrence following by remarkable improvement. To our knowledge, this is the first reported case of Fusarium dimerum endophthalmitis.

Intraocular gnathostomiasis is a rare parasitic infection caused by the third-stage larvae of spiruroid nematode Gnanthostoma spp. seen mostly in tropical and subtropical regions. It is a food-borne zoonosis caused by ingestion of raw or undercooked freshwater fish, amphibians, reptiles, birds, and mammals, all of which are known to harbor advanced third-stage larvae of Gnanthostoma spp. To date, 74 cases of intraocular gnathostomiasis have been reported from 12 different countries. Only four countries have reported more than 10 cases each, and India shares the rare distinction of being one of them, with 14 cases. Surprisingly, not a single case of cutaneous gnanthostomiasis has ever been reported from India. We present one such case of intraocular gnathostomiasis in a 41-year-old male who presented with an actively motile worm attached to the iris, and we review the pertinent literature of all such cases reported from India.

Coryneform bacteria belonging to the genus Brevibacterium have emerged as opportunistic pathogens. Of the nine known species of Brevibacterium isolated from human clinical samples, Brevibacterium casei is the most frequently reported species from clinical specimens. We report the first case of B. casei brain abscess in an immunocompetent patient successfully treated by surgery and antimicrobial therapy.

Salmonellosis is a common infection in systemic lupus erythematosus patients. The present study reports on two such cases of Salmonella typhimurium septic arthritis among the 102 patients seen during a four-year period.

We studied the aerobic bacterial isolates from bile and their susceptibilty pattern in patients with biliary tract disease. Samples of bile collected during endoscopic retrograde cholangio pancreatography (ERCP) and surgery, were inoculated on standard media. Bacterial identification and susceptibility were done by standard techniques. A total of 209 samples were cultured, out of which 128 samples showed growth. Total number of isolates obtained was 221. Poly-microbial infection was detected in 67 patients. Predominant aerobic bacterial isolates obtained were Escherichia coli 30% (67), Klebsiella species 23.98% (53), Enterococcus species 12.21% (27). Multi-drug resistance was noted in 57%. Higher resistance rate was noted among Gram negative bacilli for ampicillin (92.4%), cephalexin (82.46%), ciprofloxacin (68.42%), piperacillin (64.33%). Sensitivity to meropenem was 90.64% and amikacin was 76.61%. Gram positive bacteria showed high resistance to gentamicin (39.53%). Sensitivity to ampicillin was 86.05% and penicillin was 81.4%. Vancomycin and teicoplanin showed 100% sensitivity. From our study we conclude that E. coli, Klebsiella species and Enterococcus species are common pathogens infecting biliary tract. Poly-microbial infection and multi-drug resistance warrants culture and sensitivity to guide antimicrobial therapy. We recommend combination of amikacin and ampicillin for empirical therapy at our institution.

A51-year-old male, who had undergone laparoscopic deroofing of a simple renal cyst on the left side two years ago, presented with left flank pain of one month’s duration near the port site, along with low-grade fever. There was no abdominal distension or mass, nor alteration in bladder or bowel habits. He was not a diabetic nor had he any other important medical history. Physical examination revealed a temperature of 100.4 F, soft abdomen with severe tenderness over the left iliac fossa, and unremarkable left flank and costovertebral angle. The white blood cell count was 19,000/mcL, and the serum creatinine concentration was 1.52 mg/dL. A magnetic resonance imaging scan of the abdomen revealed a collection with enhancing septations in the left posterior pararenal space, extending into the psoas and quadratus lumborum muscles and adhering to the posterolateral abdominal wall. There was left perirenal stranding (Fig. 1) and a small left renal upper polar cortical cyst (Fig. 2). Blood and urine culture studies yielded no growth. Empiric antibiotic therapy was of no benefit and the patient returned with a pointing abscess about to rupture. The collection was incised and drained after ruling out any urine leak from the left upper urinary tract by retrograde urography, and a closed suction drain was left in the abscess cavity. The pus sample sent for culture yielded growth of nonfermenting gram-negative bacilli, identified by VITEK 2 compact system (bioMerieux, Inc., St Louis, MO) as Achromobacter xylosoxidans with a 99% probability and an ‘‘excellent identification’’ confidence level. The isolate was susceptible to piperacillin, levofloxacin, co-trimoxazole, ceftazidime, cefoperazone-sulbactam, and meropenem, but resistant to aminoglycosides and tetracycline using Clinical and Laboratory Standards Institute (CLSI) break points for nonEnterobacteriaceae. The drain was removed on the fifth post-operative day and the patient was discharged on oral levofloxacin and cotrimoxazole. Three days after discharge, the patient returned in sepsis with similar complaints and pus draining from the incision. On retaking the history, it was determined that the patient had stopped taking the antibiotics after discharge. On examination, his temperature was 101.6 F and he had tenderness of the left flank. Abdominal ultrasonogram showed minimal residual collection at the abscess site. A second incision and drainage was performed immediately under cover of intravenous cefoperazone-sulbactam. A small amount of purulent material was drained and the abscess wall was debrided. The benign-looking small cortical cyst towards the upper pole was left undisturbed on both occasions. After 1 wk of intravenous antibiotic and supportive therapy, the patient was discharged in good health on oral co-trimoxazole and levofloxacin for 2 wks. On clinic follow-ups at 1 mo and 3 mos, there was no evidence of any continuing infection or any local symptom or abnormal findings on imaging studies other than the unchanged cortical cyst. Achromobacter xylosoxidans is a non-fermenting gramnegative, motile oxidase-positive bacillus belonging to the Alcaligenaceae family [1]. It is characterized by the ability to utilize xylose and glucose oxidatively. Identification using traditional phenotypic test often is unreliable and A. xylosoxidans can be mistaken for non-aeruginosa strains of Pseudomonas or for strains of Burkholderia cepacia complex. Achromobacter xylosoxidans is an opportunistic pathogen capable of causing nosocomial and community-acquired infections, with the source being either endogenous or from a contaminated aquatic hospital environment [2]. It frequently has been iso

Reports of oxacillin-susceptible mecA -positive Staphylococcus aureus strains are on the rise. Because of their susceptibility to oxacillin and cefoxitin, it is very difficult to detect them by using routine phenotypic methods. We describe two such isolates that were detected by chromogenic medium and confirmed by characterization of the mecA gene element.