Indian Journal of Microbiology Research

352-358

Authors: Archana Bora, PK Khatri, Aruna Solanki, RS Parihar, AK Chandora

With increase in Beta – Lactamases producing microbial infections there is need for rapid method for identification of different types of Beta Lactamases enzyme production & their coexistence in clinical isolates. Vitek – 2 compact play very crucial role in detection of different types of Beta- Lactamases & their coexistence. Materials & Methods: 240 clinical specimen like Urine, Tracheal Secretion, Sputum, pus & Stool were isolated from clinical samples of OPD & IPD Patients of Tertiary Care Hospitals attached to Dr. S.N. Medical College, Jodhpur. Identification of Clinical isolates & detection of Betalactamase enzymes with their antibiotic susceptibility pattern was done by automated Vitek – 2 compact System. Results: 146 (60.83%) E. coli, 67 (27.91%) Klebsiella, 22 (9.17%) Enterobacter, 2 (0.83%) Citrobacter & 3 (1.25%) Serratia spp. were included in present study. Out of 240 isolates 195 (81.25%) were enzymes producers & 45(8.75%) were non-enzyme producer. Of the 195 isolates 147(61.25) were single enzyme producer & 48(20%) isolates were multiple enzyme producers. 105(44%) isolates shows only ESBL enzyme production, 26 (11%) isolates shows AMPc enzyme & 16(7%) isolates shows carbapenemase enzymes production. Of the 48 isolates producing mixed enzymes 45.83% shows ESBL+AMPc and ESBL+CARBAPENEMASE each and 16.66% shows all enzymes (ESBL+AMPc+CARBAPENEMASE) production. Isolates producing ESBL are maximally resistant to Cefepime followed by Cefuroxime, & Ceftriaxone. Organism producing AMP care maximally Resistant to Cefuroxime followed by Trimethoprim - Sulfmethoxazole, Piperacillin-Tazobactum, Ampicillin. Organism producing CARBAPENEMASE are maximally Resistant to Ampicillin, Cefipime followed by Cefuroxime+Sulbactum, and Amoxicillin+Clavulinic acid. Organism producing mixed enzymes are maximally resistant to Cefuroxime, followed by Amoxicillin+Clavulinic acid and Ciprofloxacin. Conclusion: The study show that Betalactamase producing microbial organism are very common in Hospital environment and responsible for majority of infections. Vitek-2 compact is found to be rapid and reliable method to identify Betalactamase and their co-existence. It is better than conventional method.

363-367

Authors: Ashish Khanna, Poonam Sharma, Sarabjit Sharma, Menka Khanna

According to WHO one third of world population has tuberculosis. Early diagnosis and appropriate treatment play an important role in combating the mortality and morbidity caused by tuberculosis. This study was undertaken to compare the efficacy of LED fluorescent microscopy and conventional Ziehl- Neelsen staining for the diagnosis of pulmonary tuberculosis. Materials and methods: The study was conducted in the microbiology department of a tertiary care hospital in northern India by examining 234 consecutive sputum smear samples using LED as well conventional microscope. Observations: Out of 234 sputum samples 62(26.5%) sputum samples were positive for AFB with Ziehl-Nelson and 84(35.9%) sputum samples were positive for with fluorescent microscopy. Conclusion: It was found that LED based fluorescent microscopy is a better technique to identify M. tuberculosis with less time compared to the conventional microscope.

373-382

Authors: Garima, Deepti Chaurasia, VK Poorey

Chronic Suppurative Otitis Media (CSOM) takes a lot of time in the hospital outdoors and operation theatres. It is a chronic disease which is associated with irreversible sequelae and serious intracranial and extracranial complications. Henceforth early & effective treatment needs to be instituted to avoid such complications. Materials & Methods: This study was planned at a tertiary care medical college to assess the bacterial etiology and antibiotic susceptibility profile of CSOM cases and to draw comparison with similar studies throughout India over the last four years. Isolation and identification of pathogen was done using aerobic culture followed by standard biochemical tests and antimicrobial susceptibility testing for commonly used antimicrobials. Results: The commonest pathogens isolated were Pseudomonas aeruginosa, Staphylococus aureus, Klebsiella spp., Escherichia coli, Coagulase Negative Staphylococci (CONS) and other gram negative rods mostly showing susceptibility to high end antibiotics like beta lactam-beta lactamase inhibitor, Carbapenems, Fourth generation cephalosporins & Glycopeptides. Conclusion: There is wide variation in antibiotic sensitivity profile over varied geographical areas and populations throughout the country. For better management of this disease, clinical classification as well as antibiotic susceptibility testing of the organisms is essential for making the right choice of antibiotics. The high rate of multiple drug resistance as well as high level of resistance to individual antibiotics is a cause of concern.

387-391

Authors: Gomathi Maniyan, Dillirani Vedachalam, Nithya Chinnusamy

Non fermenting Gram Negative Bacilli (NFGNB) once considered as contaminants have now emerged as a major cause of life threatening nosocomial infections and as multidrug resistant pathogens. Aim: To isolate and identify the NFGNB and their antimicrobial susceptibility pattern and to detect the Extended Spectrum Betalactamases (ESBL) among the isolated non-fermenters. Materials and Methods: This Cross sectional study conducted in Medical College and Hospital for one year and samples collected like pus, urine, endotracheal aspirates, blood, sputum and body fluids were identified using standard protocol, which includes Grams staining, test for motility, catalase test, oxidase test, OF test and various biochemical reactions. Results: Out of 110 clinically significant isolates of non-fermenters, 54(49%) were Pseudomonas aeruginosa, 36(32.7%) Acinetobacter baumannii, 8(7.3%) Acinetobacter lwoffi, 6(5.4%) S.maltophilia and Pseudomonas stutzeri and Burkholderia cepecia 3(2.8%). The antimicrobial susceptibility pattern revealed maximum resistance to Gentamycin (61.8%), Cotrimoxazole (60%), followed by Ciprofloxacin(50.9%) and Cefotaxime(47.3%). Sensitivity to Polymyxin B (100%) followed by Imipenem and Meropenem (75.5%). ESBL production was 18.18%. Conclusion: Pseudomonas aeruginosa and Acinetobacter baumannii were the most common NFGNB isolated in this study. Difference in antimicrobial susceptibility by nonfermenters pose a great problem in treating these infections. ESBL production by these organisms lead to high morbidity and mortality.

398-400

Authors: Jasvir Kaur, Poonam Sharma, Sarbjeet Sharma

Candida species are the most common cause of opportunistic fungal infections, resulting in a variety of manifestations ranging from mucocutaneous lesions to life-threatening invasive diseases, particularly in immunocompromised patients. Although C.albicans is most common cause of candidiasis, a shift towards non-albicans Candida species is evident in recent years. The transition of Candida spp. from commensal to a potent pathogen is facilitated by a number of virulence factors viz. adherence to host tissues and medical devices, biofilm formation, and secretion of extracellular hydrolytic enzymes. Objective: To study the prevalence of C.albicans & Non-albicans isolates in critical care settings. Material & Methods: The present study was carried out in the Mycology section of Microbiology Department, SGRUHS, Amritsar during the period of July 2014 to June 2016. Candida strains isolated from various clinical samples (i.e. urine, blood, foley’s catheter tip etc.) received from different ICUs of the hospital were included in the study. The isolates were identified upto species level by both conventional and automated methods (vitek 2 compact system) as per CLSI guidelines. Relevant history of all the patients was taken. Results: Out of the 115 isolates obtained from various ICUs, most common isolate was C.tropicalis 60/115(52.17%) followed by C.albicans 45/115(39.13%) and C.utilis 7/115 (6.25%). Isolates of C.lusitaniae, C.parasillosis & C.glabrata were 1/115 (0.86%) each. Conclusions: Our study showed a shift among Candida species from albicans (39.13%) to non-albicans (60.86), thus stressing their emergence as major fungal pathogens in critical care settings.

405-407

Authors: Manmeet Kaur Gill, Amandeep Kaur, Sahiba Kukreja, Namrata Chhabra

Dengue is a global health issue. The clinical illness ranges from an asymptomatic febrile illness to dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Objectives: The present study was undertaken to evaluate sensitivity and specificity of SD (BIOLINE) Dengue Duo (NS1 Ag & Ab combo) rapid test in comparison to capture ELISA for early diagnosis of dengue infection. Material and Methods: It was a tertiary hospital based retrospective cross sectional study. The data was collected by reviewing the records of 250 patients who attended the OPD or were admitted to the hospital with the suspicion of dengue infection, from May 2015 to March 2016. The blood samples were routinely processed in central clinical laboratory and were tested by both, SD (Bioline) Dengue Duo rapid test and ELISA. Results: Out of 250 samples 69 were found to be reactive for Dengue infection by ELISA. Out of these 69 seropositive samples rapid test was reactive in 55 samples. There were 18 samples in which only NS1 Ag was positive by both rapid test and ELISA. Overall sensitivity of rapid test in comparison with ELISA was found to be 79.71% and specificity was 100%. Conclusion: Early diagnosis and treatment of the patient suffering from the infection is important. SD (Bioline) Dengue Duo rapid test can be a useful tool in initial diagnosis of the infection as it detects NS1 Ag in addition to the antibodies. Its results are comparable to ELISA.

412-418

Authors: Angappan Perumal, Ashok Kumar C, Sheila Doris T

Aims: To identify the etiological agents of orthopedic implant infections in patients admitted in postoperative and septic ward. To identify the risk factors for orthopedic implant infection. To study the Antimicrobial susceptibility pattern of the isolates with a view to formulate an empiric antibiotic regimen. To detect emerging pattern of resistance in these organisms by standard methods (CLSI). To know the prevalence of multidrug resistant pathogens among the isolates. Materials and Methods: The study period was one year. One hundred and sixty patients were investigated for early or late postoperative infections of orthopedic bone implants using conventional microbiological procedures. Antimicrobial susceptibility testing was then performed for the isolated bacteria according to the standard guideline. Results: Out of 160 Orthopedic implant infections, the most common procedure that is complicated by infection is Open interlocking nail (Tibia/Femur) (47.5%) followed by closed interlocking nail Tibia/Femur (13.75%). Tibia is the most commonly infected bone (53.75%) after implant surgery followed by Femur (26.87%). Diabetes mellitus and longer duration of surgery were the important risk factors noted in our study. A total of 169 isolates were recovered (166 aerobes and 3 anaerobes). Staphylococcus aureus is the most common organism isolated followed by Staphylococcus epidermidis and Proteus mirabilis. 51.21% of Staphylococcus aureus and 73.52% of Staphylococcus epidermidis were found to be methicillin resistant. The majority of isolated gram positive cocci were sensitive to Rifampin and Vancomycin. 75% of Klebsiella pneumonia and Proteus vulgaris, 70% of Proteus mirabilis and 58.82% of Escherichia coli were found to be ESBL producers. Conclusion: There is needed to develop a good treatment protocol for orthopedic implant infections and also to create a good protocol for prevention of orthopedic implant infections.

423-428

Authors: Pavneet Kaur, Arvinder Singh Sood, Sarbjeet Sharma, Aruna Aggarwal

Ear discharge is a common clinical problem presented by patients in the ENT set up. It can be seen in a variety of infectious conditions like otitis externa, otomycosis, and otitis media. It is notorious for its persistence and recurrence despite treatment. It's importance lies in its refractoriness to treatment and chronicity. Thus the need to study the detailed bacteriological profile and resistance patterns of commonly used antibiotics to prevent their injudicious use, thus lowering antibiotic resistance and recurrence. The study aimed to isolate, identify and speciate the bacteria isolated from the patients presenting with ear discharge and to study the antimicrobial resistance of bacterial isolates. Material and Methods: The study included 180 consecutive patients with ear discharge attending the ENT OPD. A proforma was maintained containing demographic and clinical details. Criteria for inclusion was any patient presenting with ear discharge whereas patients on antibiotics for more than seven days were excluded. Ear swabs were obtained and processed and bacteriological profile and antibiotic resistance patterns were studied in detail. Results: Ear discharge has a diverse bacteriological pattern being prevalent in younger population and more commonly associated with poverty with male predominance. Pseudomonas aeruginosa, Staphylococcus aureus and Proteus mirabilis were among the commoner bacteriological agents isolated. Maximum resistance was found to Penicillin-G and Ampicillin. Conclusion: It is emphasized that early diagnosis and proper antimicrobial treatment in addition to the patient education is mandatory to avoid complications and in decreasing morbidity and mortality.

432-435

Authors: Vasanthi Rompicherla, Priyadarshini Shanmugam, Shameem Banu Abdul Sattar

Medical device associated infections are a major cause of substantial morbidity, due to wide usage of intravenous catheters in various medical disciplines like renal dialysis units and in cardiology department. Several species of Staphylococcus which usually occur as normal microbial flora on mucosa and skin are a frequent cause of device associated infections due to biofilm production. This polysaccharide slime synthesis is mediated by ica operon. Aims and Objectives: To determine the prevalence of biofilm producing strains of Staphylococci isolated from Central Venous cannulas by phenotypic and genotypic methods. Materials and Methods: 220 Central Venous devices were received and processed, of which 30 yielded growth. Staphylococci were identified and biofilm production was determined by the tissue culture plate method and by PCR. Genotyping of biofilm producing Staphylococcal species was done for detection of ica genes (intercellular adhesion) by conventional PCR. Results: A total of 220 central venous catheter tips were collected, out of which 30 bacterial organisms were isolated. Among these isolates, 20 (67%) were Staphylococcus species which were considered for phenotyping by tissue culture method and genotyping by conventional PCR. Out of these, 10 (50 %) Staphylococcal species were phenotypically positive for biofilm production and 11 (55%) showed the presence of ica gene by PCR

441-445

Authors: S. Pramodhini, S. Umadevi, KS Seetha

The study was done to detect various virulence factors of urinary isolates of Pseudomonas aeruginosa with special reference to MBL producing strains and to find out its significant association with the virulence factors. Materials & Methods: This study was done in a tertiary care teaching hospital in Pondicherry, which included 50 urinary isolates of Pseudomonas aeruginosa. All isolates subjected to routine antibiotic susceptibility testing by Kirby Bauer Disc Diffusion method and screened for Metallo β-lactamase (MBL) by Imipenem-EDTA disc method. Phenotypic detection of virulence factors like phospholipase, hemolysin, gelatinase and DNAse were done for the same. Results: Out of 50 isolates of Pseudomonas aeruginosa, 26% were MBL producers and 74% were non MBL producers by Imipenem-EDTA disc method. Virulence factors like hemolysin, gelatinase, phospholipase and DNAse were shown in 88%, 78%, 76% and 50% respectively. The association with the production of Virulence factors and MBL production were found to be statistically significant only in case of DNAse production. Conclusion: This study concluded that P. aeruginosa is a pathogen able to accumulate various virulence factors which are often accompanied by multidrug resistance and pan-resistance, making the treatment of infections difficult for the clinicians.

450-453

Authors: Sowmya A. Venkateswaran, Jayalakshmi Gopal, Agatha David

Pneumonia is one of the major infectious public health problem in developing countries .The etiologic agents causing Community Acquired Pneumonia (CAP) has been changed in the recent years. This study is conducted to determine the fungal etiologic agents causing CAP and the associated risk factors. Materials & Methods: About 150 patients were presented with signs and symptoms of pneumonia during the one year study period. Various respiratory samples were processed and the fungal etiologic agents were identified according to standard operating procedures. Results: Out of 150 patients, 75 were immunocompetant (IP) and rest 75 patients were immunocompromised (IC). Most commonly associated risk factor was Diabetes mellitus (48%) and haematological malignancies (18.66%). Monofungal pathogen was isolated in 6.25% of cases of IP group and in 26.78% of cases in IC group. Fungal pathogen as a part of polymicrobial infection was seen only in IC group (2 cases). Aspergillus fumigatus is the most common isolate in the IC patients (52.94%) followed by Aspergillus flavus (23.52%). P.jerovicii is isolated in 5.88% of cases in immunocompromised patients. Hematologic malignancies are more commonly associated with fungal infection (28.57%) followed by Diabetes mellitus (16.66%). Conclusion: Invasive fungal lung infections are increasingly encountered in critical care and pulmonolgy practice. With increasing number of immunosupressed host and emergence of drug resistant fungal pathogens, a high degree of clinical suspicion and better laboratory diagnostic methods are mandatory for prompt and effective treatment of invasive fungal infections in these high risk populations.

458-463

Authors: Varsha Somabhai Khant, Hansa Goswami

Malaria diagnosis presents a challenge to all laboratories. Especially post monsoon season, there is a need for rapid, sensitive and cost effective method to effectively screen all samples, especially when workload is very high. Automated cell counters offer rapid, sensitive and cost effective screening of all samples. Aims and objective: To evaluate the usefulness of automated cell counters analysing their histograms, scatter-grams and the flaggings generated in malaria positive cases. To compare other parameters which could help to identify malaria parasite in microscopic examination of peripheral smear. Methods: The study was conducted in the laboratory of B. J. Medical College, civil hospital, Ahmedabad12 months of duration from November 2014 to November 2015. 775 samples from the patients who presented to emergency department and for whom the attending clinicians had requested full blood count and malaria smears were included in the study. Samples were processed as part of normal routine cell dyn ruby analyser for FBC (Full Blood Count). We had used histograms and scatterplots which were generated by cell dyn ruby and interpreted the histograms in malarial cases. Result: Total 775 cases were studied, out of which 409 cases were positive for malaria which are confirmed by peripheral smear examination.409 positive cases were evaluated, abnormal scattergram were observed in 98% cases of malaria while abnormal WBC histogram peaks were noted in 92% cases of malaria. Haematological parameters such as anaemia, leucopenia, Monocytosis, atypical lymphocytosis, atypical eosinophilia, pink flag were also important for diagnosis. Conclusion: This method of histogram study in malaria is a useful addition to conventional microscopy. Beneficial part of this study is that where workload is high and clinician send only CBC (complete blood count), in such circumstances histogram study in automated analysers as we have used cell dyn ruby in our institute, we can diagnose malaria. If we have trained staff for histogram and scattergram of automated analysers so we cannot miss sample in initial screening.

468-471

Authors: Arularasu P, Alice Peace R, Priyadarshini Shanmugam

Staphylococcus aureus infections have become more difficult to treat due to multidrug resistance. Therefore removal of nasal carriage of Staphylococci plays a major role in infection control. Mupirocin is an effective topical agent for nasal decolonization. Existence of high level mupirocin resistance (HLMR) excludes its use and low level resistance (LLMR) need higher dosage recommendations. Hence screening of HLMR and LLMR in a hospital is essential. Materials and Methods: A total of 100 isolates obtained from skin and soft tissue infections and blood were used and the study was carried out at Chettinad hospital and Research Institute, Kelambakkam, Chennai, India. HLMR and LLMR were detected using 200 µg and 5µg mupirocin discs respectively. The MIC for mupirocin resistant isolates was determined by agar dilution method. Results: Among the 100 strains tested 79 were MSSA (Methicillin sensitive) and 21 were MRSA (Methicillin Resistant). Out of 100 strains 7 (7%) were mupirocin resistant. Out of the seven resistant isolates, one isolate (MSSA) was resistant to 5µg mupirocin and six (2 MRSA and 4 MSSA) isolates were resistant to 200 µg mupirocin. MIC for LLMR and HLMR isolates was 8µg/ml and ≥1024µg/ml respectively. Conclusion: Emergence of LLMR and HLMR isolates has become more common because of its repeated use. Hence continual monitoring for its prevalence is very much needed and also can guide the clinician to select appropriate empirical therapy.

479-482

Authors: Amit R Ugargol, Shilpa K, Katti S. M., Mallapur MD

To study the clinical profile of HIV/AIDS in geriatric patients seeking ART. Material and Methods: This study was conducted in District Hospital, Belgaum. Information, which was collected from 372 HIV/AIDS patients seeking ART during the period of January and February 2010 and were followed up for one year using predesigned, pretested questionnaire with their informed written consent. Results: Out of 372 patients followed only 2.1% were more than 65 years. Majority were male and belonged to low socioeconomic status and were illiterates. 37.5% presented with opportunistic infections and all of them were tuberculosis patients who were ambulatory. With Wilcoxon Sign Rank test improvement in baseline to 1st visit CD4 count (p=0.075) and baseline to 2nd visit CD4 count (p=0.043) was statistically significant. One death was reported during the study period. Almost half of them had side effects to ART. One patient stopped ART voluntarily. Conclusion: Treatment was delayed even though patients were diagnosed earlier. Tuberculosis was the most common HIV co- infection seen. Prognosis was good with improvement in CD4 count and with good adherence to ART. Dropouts should be identified early and reasons for dropouts need to be studied.

489-492

Authors: Vikas Chandra Yadav, Mohammad Zoyev Khan, Sujan Narayan Agrawal

Tinea capitis (scalp ringworm) is the most common dermatophyte infection of the scalp affecting mainly children and rarely adults. The epidemiology of Tinea capitis varies within different geographical areas throughout the world. It may occur sporadically or epidemically and an increase in its incidence has been noted over the last few decades. Objective: To study the pattern of various species of dermatophytes causing Tinea capitis, to find out the incidence of various clinical types and to study the epidemiology of Tinea capitis. Methods: Present study was hospital based cross sectional study. It was carried out for a period of four years at Department of Microbiology. Patients presenting with scalp lesion suspected to be Tinea capitis in the out-patient departments of Dermatology department and giving due consent for the study were sent for detailed history and examination. Those not willing to participate in the study were not included in the study. 75 patients were confirmed as Tinea capitis and they were included in the study. Results: The commonest age group affected was 0-7 years (36%). Prevalence of Tinea capitis was almost equal in both the sexes. Male to female ratio was 1.02:1. Out of 75 clinically diagnosed cases, 68% were positive in direct examination and 74.66% were positive by culture method. 94% of cases were positive in direct examination but negative in culture. The most common clinical type was Seborrheic in 58.66%. 52% of cases were found to be of endothrix type of hair invasion. T. violaceum was the species observed most frequently. Black dot pattern was caused mainly by T. violaceum. Conclusion: Trichophyton violaceum was the commonest cause of Tinea capitis and this was supported by observations of different workers from different regions of India and from other parts of the world. The pediatric age groups, low socioeconomic status, living conditions were the important factors influencing the disease.

224-229

Authors: Monika Rajani

Introduction: Age wise seroprevalence of acute viral hepatitis still remains debatable. The burden of the disease could be reduced to a considerable extent, if seroprevalence of different viruses are known for various age groups. Objectives: To determine the age wise seroprevalence of hepatitis viral markers in clinically suspected infectious hepatitis at a tertiary care hospital in urban India Methodology: This prospective study was conducted over a period of 1 year from January -December 2008. The study arm had 600 patients with clinically suspected acute infectious hepatitis while control arm had 200 age and sex matched subjects. Both groups were divided into 0-10,11-20, 21-30, 31-40 and >40 years age groups .Serum samples were tested for IgM anti HAV, IgM anti HEV, IgM anti HCV and HBsAg using commercially available enzyme linked immunosorbent assay kits. Results: Highest seropositivity of anti-HAV IgM was in 0-10 years of age for the study arm. HAV seroprevalence decreased with increasing age. Highest seropositivity of HBsAg was in 20-30 years of age group for the study group (7.6%) followed by 11-20 years (4.5%), 0-10 years (2.8%) and >40 years (2.5%). Highest seropositivity to IgM anti HCV was seen in 11-20 years(9%) in the study arm followed by 21-30 years (6.1%), 0-10 years (5.1%) and >40 years (3.7%) of age. Highest seropositivity of anti-HEV IgM was in the 21-30 years (10.7%) in the study arm followed by 31-40 years (2.9%), 11-20 years (2.7%) and 0-10 years (0.9%). Conclusion: Both HAV and HEV are significant causes of enterically transmitted acute viral hepatitis. HAV is the major cause of acute viral hepatitis in childhood. Hepatitis B virus is the major cause of acute viral hepatitis in adults. HCV is a common cause of acute hepatitis in young adults. HCV infections remain under reported while the actual disease burden is much higher.

236-240

Authors: Akshantha B. Sangannavar, Sumangala B., Khalid Ahmed, Sahana Shetty NS

Otitis media is a destructive & persistent disease with irreversible sequelae. It is associated with bacterial or fungal aetiology. Objectives: 1) To identify bacterial isolates causing ear infection and their antibiogram. 2) To identify fungal isolates 3) To screen all smears for Acid Fast Bacilli (AFB). Materials and Methods: This study was conducted for 1 year. Pus was collected with sterile swab before commencement of antibiotics, from 98 patients of otitis media, attending ENT OPD. Gram’s staining & Gabbet’s staining (Modified ZN staining) was done for all the samples. Bacterial & fungal isolates were identified by standard methods. Antibiotic susceptibility testing of bacterial isolates was carried out by Kirby Bauer’s disc diffusion method. Results: Age of the patients studied, ranged from 2 to 68 years. Of the 98 patients, 48 were females and 50 were males. Bacterial isolates and their incidence were: Staphylococcus aureus(31%), CONS(6%), Pseudomonas species(20%), Klebsiella species(7%), Proteus species(5%). 4 fungi were isolated. 2 samples showed acid fast bacilli on Gabbet’s staining. Conclusions: The most common organisim causing Otitis media in this study was Staphylococcus aureus (MSSA). Antibiotic treatment should be individualized depending on antibiotic sensitivity report, to reduce chronicity, complications & morbidity. It also showed in the study that, doing acid fast staining routinely could be of help as it helped to diagnose two cases of pulmonary tuberculosis

245-249

Authors: Asmabegaum Biradar, Faisal Farooqui, Ravichandra Prakash, Sayeda Yasmeen Khaqri, Ifran Itagi

Background: Pyogenic wound infection is major cause of morbidity. Difficulty in treatment of such infection is because of emergence of multidrug resistant strains. To avoid such situation, it is very important for right and empirical choice of antibiotics. Hence it is mandatory for every pus samples to undergo culture and sensitivity. Objectives: 1. To identify and isolate aerobic bacteria from pus samples. 2. To study antibiotic profile of aerobic bacteria. Methods: A cross sectional study was conducted in Department of Microbiology of a private tertiary care hospital in Vijaypur. Total of 256 pus samples send for aerobic culture and sensitivity from different departments to Department of Microbiology from January 2015 to December 2015 were included in the study. Aerobic bacteria isolated, identified and antibiotic profile was determined from pus samples using standard protocol. Data was analyzed using MS Excel 2010. Results and interpretation: In our study among 256 pus samples send from various departments, 169(66.01%) showed positive aerobic growth. Gram negative bacteria outnumbered the gram positive isolates. Commonest isolate was Staphylococcus aureus followed by Pseudomonas. 30(39.47%) of MRSA were isolated. All Staphylococcus aureus were sensitive to Vancomycin and linezolid. Among 48 Pseudomonas isolated Polymyxin B and Piperacillin-Tazobactam were effective drugs. In enterobacteriaceae group most effective antibiotic was Meropenam. Conclusion: It is important for a clinician to send all the pus sample for microbiological analysis and their antibiogram before putting cases on antibiotics so that emergence of drug resistance can be minimized.

255-261

Authors: Danish Vijay Devaraj, Jayanthi Sivasubramaniyan, Shameem Banu AS

Introduction: Water is essential to life and many people do not have access to clean safe drinking water. Poor sanitation is the major cause for water contamination. Death due to infection like cholera, typhoid fever, bacillary dysentery are transmitted through contaminated water. Aims & Objectives: To study the bacteriological profile of drinking water samples, to perform antimicrobial sensitivity testing of the isolates and genotypic identification of resistant gene. Materials and Methodology: Drinking water sample were collected from in and around Kelambakkam for a period of 1year. Antimicrobial susceptibility testing was carried out for the isolates according to standard guidelines. ESBL producers were detected using double disc synergy test method. MBL producer were detected by combined disk test. Screening for bla TEM, bla VIM gene among the drug resistance isolates were done. Result: Among 161 samples from various sources, most common isolates were Escherichia coli (n=41) 25.4%, followed by Klebsiella spp. Out of 41 isolates of E.coli were 23 and 10 were ESBL and MBL producer respectively. Among 10 isolates 8 were both ESBL and MBL producer, isolates positive for bla TEM gene & bla VIM gene were 5 & 2 respectively.

266-269

Authors: Malathi Murugesan, Vijayalakshmi Arumugam, Sowmya AV, Nithya Gomatheeswari

Introduction: Reproductive tract infections (RTI) and Sexually transmitted infections (STI) are the major contributing illnesses among the women of reproductive age group in a developing country like India. Even though preventive measures has been implemented at all health care levels and treatment seeking behavior has increased to a achievable level, still there is a lack of exact epidemiological data about RTI and STI. Aims and Objectives: To estimate the proportion of HBV, HCV, HIV, HSV and syphilis positive cases by serological methods and to correlate the significance of age with positivity. Materials and Methods: A prospective study conducted among 110 women over a period of one year who presented with symptoms and signs of RTI. Screening for HBV, HCV and HSV done by Enzyme Linked Immuno Sorbent Assay (ELISA). Screening for HIV was done by rapid methods according to NACO guidelines. Screening for syphilis was done by Rapid Plasma Reagin (RPR) test and then positive cases was confirmed by Treponema Pallidum Haemagglutination Assay (TPHA). Results: 25.45% of the samples showed positivity for HSV-2 IgG antibodies. 1.89% of the samples were positive for HbsAg antigen detection. 0.91% showed positivity for Treponema pallidum infection. None of the samples were positive for HIV or HCV infection. Conclusion: As there is an increased chance of acquiring STI in genital tract infections, screening for sexually transmitted infections by serological methods should be made mandatory in women with symptoms and signs of genital tract infections at all health care centres.

275-278

Authors: Sundaram Mohan, Khaja Mohiddin Shaik, Anandi Vishwanathan

Introduction: The present study was undertaken to determine the prevalence of non-fermenting gram negative bacilli and antibiogram of Pseudomonas aeruginosa and Acinetobacter baumannii. Materials and Methods: Conventional bacteriological methods were used for identification non fermenting gram negative bacilli and susceptibility testing was performed with the help of the Kirby-Bauer disc diffusion method. Results: A total 195 non fermenting gram negative bacilli were isolated during the study period. Pseudomonas aeruginosa and Acinetobacter baumannii isolates represent 89.23% of all isolated bacteria. Therefore, antibiotic resistance rates were performed specifically against these two bacteria. P. aerurginosa showed good sensitivity to imipenem(94.29%) followed by amikacin(86.67%) and piperacillin/tazobactum(68.57%). A. baumannii showed good sensitivity to imipenem(82.61%) followed by amikacin(76.81%). Conclusion: P. aeruginosa and A. baumannii were the most common NFGNB isolated in our study. Both showed good susceptibility towards imipenem and amikacin. Alarming resistance rate was found towards commonly used antibiotics. Control measures which include the judicious use of antibiotics, antibiotic cycling, the implementation of appropriate infection control measures and the formulation of an antibiotic policy must be done, to prevent the spread of these strains. Introduction: The present study was undertaken to determine the prevalence of non-fermenting gram negative bacilli and antibiogram of Pseudomonas aeruginosa and Acinetobacter baumannii. Materials and Methods: Conventional bacteriological methods were used for identification non fermenting gram negative bacilli and susceptibility testing was performed with the help of the Kirby-Bauer disc diffusion method. Results: A total 195 non fermenting gram negative bacilli were isolated during the study period. Pseudomonas aeruginosa and Acinetobacter baumannii isolates represent 89.23% of all isolated bacteria. Therefore, antibiotic resistance rates were performed specifically against these two bacteria. P. aerurginosa showed good sensitivity to imipenem(94.29%) followed by amikacin(86.67%) and piperacillin/tazobactum(68.57%). A. baumannii showed good sensitivity to imipenem(82.61%) followed by amikacin(76.81%). Conclusion: P. aeruginosa and A. baumannii were the most common NFGNB isolated in our study. Both showed good susceptibility towards imipenem and amikacin. Alarming resistance rate was found towards commonly used antibiotics. Control measures which include the judicious use of antibiotics, antibiotic cycling, the implementation of appropriate infection control measures and the formulation of an antibiotic policy must be done, to prevent the spread of these strains. Introduction: The present study was undertaken to determine the prevalence of non-fermenting gram negative bacilli and antibiogram of Pseudomonas aeruginosa and Acinetobacter baumannii. Materials and Methods: Conventional bacteriological methods were used for identification non fermenting gram negative bacilli and susceptibility testing was performed with the help of the Kirby-Bauer disc diffusion method. Results: A total 195 non fermenting gram negative bacilli were isolated during the study period. Pseudomonas aeruginosa and Acinetobacter baumannii isolates represent 89.23% of all isolated bacteria. Therefore, antibiotic resistance rates were performed specifically against these two bacteria. P. aerurginosa showed good sensitivity to imipenem(94.29%) followed by amikacin(86.67%) and piperacillin/tazobactum(68.57%). A. baumannii showed good sensitivity to imipenem(82.61%) followed by amikacin(76.81%). Conclusion: P. aeruginosa and A. baumannii were the most common NFGNB isolated in our study. Both showed good susceptibility towards imipenem and amikacin. Alarming resistance rate was found towards commonly used antibiotics. Control measures which include the judicious use of antibiotics, antibiotic cycling, the implementation of appropriate infection control measures and the formulation of an antibiotic policy must be done, to prevent the spread of these strains.

287-291

Authors: Nithyalakshmi J, Vidhyarani R, Mohanakrishnan K, Sumathi G

Background: Pseudomonas aeruginosa well known as opportunistic pathogen, has been implicated in life threatening nosocomial infections in recent years. This can be attributable to acquired resistance by plasmid mediated different types of extended spectrum beta lactamases(ESBL). The present study was undertaken to detect the ESBL production of Pseudomonas aeruginosastrains and analyze their susceptibility pattern. Methods: Various clinical specimens received in our laboratory were processed and Pseudomonas aeruginosa was identified as per standard microbiological procedure. A total of 132 clinical isolates of Pseudomonas aeruginosa identified during the study period were included in the study. All isolates were subjected for ESBL screening test. Potential ESBL producer was then subjected for ESBL Phenotypic confirmatory test –Disc Diffusion method(PCDDT). Antimicrobial susceptibility test was performed by Kirby – Bauer disc diffusion method on all confirmed isolates by PCDDT method as per Clinical Laboratory Standard Institute (CLSI 2016) guidelines. Results: By phenotypic confirmatory method, the frequency of occurrence of ESBL among the isolates identified was 21.96% (n = 29).The highest number of ESBL producers was obtained from urine samples(27.7%) followed by respiratory infection (23.68%) and wound infection (22.95%). In-vitro susceptibility of ESBL producers revealed high level of resistance to third generation cephalosporin. Low resistance was observed to Imipenem (3.4%) and Piperacillin – Tazobactam (13.79%). Conclusion: Our study highlights the unique challenge imposed by Pseudomonas aeruginosa as the therapeutic choices are limited by ESBL production. To overcome this issue, we recommend routine ESBL detection and surveillance of antibiotic resistance in hospital settings.

299-304

Authors: Raminder Sandhu, Shalley Dahiya, Pallavi Sayal

Background: Acinetobacter contributes to increased morbidity and mortality with its strong propensity to colonize and disseminate among humans and environmental sources coupled with its ability to develop resistance to antimicrobial agents. Materials and Methods: Clinical isolates of Acinetobacter recovered from routine samples of inpatients were analyzed retrospectively along with their antibiogram to evaluate in vitro activity of Doxycycline. Multiple antibiotic resistance index was calculated and interpreted. Results: Out of 93 isolates of Acinetobacter species recovered, predominant were from urine 47(50.54%) and blood 27(29.03%) samples. MDR isolates were 57(61. 29%).Overall antimicrobial susceptibility pattern revealed best spectrum of activity with Imipenem (75.27%), Meropenem (68.82%) and Doxycycline (68.82%) whereas in MDR isolates Doxycycline exhibited highest sensitivity (66.67%) followed by Imipenem (61.40%) and Meropenem (52.63%). MAR indexes for different isolates revealed 71 (76.34%) with MAR index greater than 0.2 and 22 (23.66%) less than 0.2. However, three isolates had shown MAR index of 01 (i.e. resistant to all the antimicrobials tested), out of which two were recovered from intensive care unit and one from general surgery ward. Twenty-six MDR patterns were observed with nine antimicrobials tested. Resistance to COT, CIP, GEN, AK, A/S, CPM, IMP, MRP (R8) was most frequently observed pattern in 8(14.04%) of MDR isolates. Conclusion: Doxycycline has exhibited efficacy against MDR Acinetobacter, which can be considered as an alternative therapy to down regulate selective pressure on carbapenems. To confront the immediate threat of Acinetobacter infections, a working antibiotic strategy should be addressed and stringent infection control practices are needed to prevent the spread of multi drug resistant isolates in the hospital.

308-313

Authors: Satyajeet Krishnarao Pawar, Geeta Satish Karande, Ravindra Vasantrao Shinde, Vaishali Satyajeet Pawa

Background: Colistin is one of the last resort of antibiotics used specifically in the treatment of multidrug resistant gram negative bacilli. Though an older class of antibiotic with no use in last four decades, resurgence of colistin use is also causing emergence of colistin resistant gram negative bacilli. Objective: The aim of study was to find prevalence of colistin resistance and antibiotic susceptibility pattern of these colistin resistant strains isolated from different clinical specimens in a tertiary care hospital. Methods: The study included clinical specimens received from wards and Intensive Care Units (ICUs), during January 2015 to December 2015. The specimens were processed by standard method, bacteria were identified by VITEK 2 compact (Biomerieux, France) automation system and antimicrobial susceptibility testing was done with the same system to detect MIC for penicillins, β-lactam/ β-lactamase inhibitor, cephalosporins, carbapenems, aminoglycosides, quinolones, folate inhibitors, glycicyclins and polymixins. Results: Colistin resistance was observed in 9.98% of the clinical isolates. 51.81% of these colistin resistant strains were Pseudomonas spp. Tigecycline (41.50%) showed maximum sensitivity to colistin resistant strains. Conclusion: Colistin resistance (9.98%) found in the study is quite alarming. A restricted and rational use of the colistin is the need of hour. A combination of colistin and tigecycline may be useful to prevent further rise of pan drug resistant bacteria.

317-321

Authors: Kundoly Velayudhan Suseela, Davis Rennis, Santosh Patil, Aiswariya Alex

Background: The course of Chronic Obstructive Pulmonary Disease (COPD) is characterized by intermittent exacerbations of the disease. The bacterial pathogens contribute a lot in mucus secretions and the acute exacerbations. This study was conducted to determine the bacterial profile and antibiotic susceptibility in COPD patients visiting a tertiary care hospital. Methods: A cross sectional study was conducted in a tertiary care hospital over a period of 15 months. The sputum samples were collected from COPD patients admitted in the Pulmonology department. Purulent sputum samples were subjected to Gram staining followed by culture and antibiotic susceptibility testing according to the standard guidelines. Result: Sputum samples from 477 COPD patients (50-85 years) were collected and significant isolates were obtained from 106 sputum samples (94 males and 14 females). The isolates were Streptococcus pneumoniae-22%, Mucoid Pseudomonas aeruginosa-17%, Moraxella catarrhalis-13%, Haemophilus influenzae- 13%, followed by Klebsiella pneumoniae- 11%, Nonmucoid Pseudomonas aeruginosa -8%, Stenotrophomonas maltophilia- 7%, Acinetobacter baumannii- 3% and Staphylococcus aureus and Group C Streptococci 1% each. Only 2 isolates of S. pneumoniae showed penicillin and erythromycin resistance. The mucoid P.aeruginosa, the 2nd most prevalent, was susceptible to ciprofloxacin, ceftazidime and gentamicin. M. catarrhalis and H. influenzae were susceptible to amoxicillin- clavulanic acid and azithromycin. K. pneumoniae and Non-mucoid P. aeruginosa showed variable susceptibility. Isolates of S. maltophilia were susceptible to co-trimoxazole. Conclusion: Susceptible strains of mucoid P. aeruginosa and S. maltophilia have also been isolated as potential pathogens. They were susceptible to fluoroquinolones and S. tenotrophomonas maltophilia was susceptible to co-trimoxazole also.

329-332

Authors: Veena Maheshwari, NavinChandra M. Kaore, Vijay Kumar Ramnani, Rajesh Shah

Background: Infections due to hospital-acquired microbes is an evolving problem worldwide. Prevalence as high as 19%, of these infections in developing countries poses a challenge to health care providers. A major source of horizontal transmission of the nosocomial infections are thought to be bacterial contamination of palm of hand of health care providers like doctors and nurses. Hand hygiene is the single most cost effective preventive measure against hospital acquired infections and education is an important tool to ensure its implementation. The present study was undertaken, to demonstrate the presence of resident microbial flora on the hands of nursing staff after duty hours working at various critical areas in a tertiary care hospital with their antibiogram. Materials and Methods: This cross sectional analytical study was carried out after ethical clearance from June to August 2013on 100 nursing staff of either sex working in critical areas of tertiary care hospital after due informed consent from the nurses. A sterile swab moistened with sterile normal saline was used to collect the swabs from dominant(working) hands after working hours. The collected swabs were processed for isolation, identification and antibiotic sensitivity of organisms. Results: Out of 100 swabs collected from the dominant hands of nurses working in critical areas, 83 showed the growth. All the samples cultured shows growth of more than 2 organisms. The major Gram Positive pathogenic organisms grown were Coagulase negative Staphylococcus spp. 40 (48.19%) followed by Staphylococcus aureus 30 (36.14%) whereas amongst Gram Negative Klebsiella spp. 5(6.025%) and Pseudomonas aeruginosa 4(4.81%)predominated. Conclusions: In the present study, the level of contamination of nursing staff was found to be high. Resident flora consisting of multi drug resistant pathogenic organisms can be greatly reduced by an increase in hand-hygiene awareness coupled with organizational interventions. We recommend to closely monitor hand hygiene practices for effective intervention strategies.

339-341

Authors: Vijayalakshmi T, Nithyalakshmi J, Sumathi G, Selvaraj Stephen

Despite the implementation of a widely adopted strategy to control tuberculosis (TB), the disease remains a major public health problem particularly in developing country, like India. The objective of the study was to find out the prevalence of HIV co infection among pulmonary tuberculosis patients in and around District of Kancheepuram, Tamil Nadu, India. A total of 305 sputum samples were collected from clinically suspected pulmonary tuberculosis patients aged between 20-55 yrs, in a Tertiary care hospital and Research Institute Kancheepuram District, Tamil Nadu, for a study period of 1 year. Among the 305 pulmonary TB suspects, a total of 58 (19%) were identified as pulmonary tuberculosis based on culture results. All culture positive samples were subjected for HIV testing. Out of 58 TB patients, 6(10.34%) patients were reactive for HIV infection. Of the 06 serum positive samples, 3 (5.2%) males and 3 (5.2%) females had HIV and TB co infection. We recommend TB/HIV co infected patients should receive focused intervention as HIV seropositive status may influence the treatment outcome.

84-88

Authors: Anup Kumar Shetty, Niharika Shetty, Nisha Johnny, Prathyusha Kambal.

Abstract Proper hand hygiene is the single most important, least expensive means of reducing infections. Alcohol based handrub have been proven to be the most effective method of hand hygiene. This study aims at testing efficacy of an in-house handrub solution and compares it with a commercial handrub solution. The sample size was 80 which included healthcare personnel. One half of the group was provided with commercial handrub and the other half with in-house handrub solution. The in-house handrub solution was prepared as per World Health Organization formula. Hand swabs were collected from participants before and after hand hygiene. The colony counts were later compared to look for the percentage of reduction in colony count. The overall reduction in the bacterial growth after using handrub solution compared to bacterial growth before using handrub solution ranged from 30.15% - 100% for commercial handrub & 33.91% - 100% for in-house handrub solution. The efficacy of in-house handrub is comparable to commercial handrub, significantly cheaper, practical and an effective alternative to commercial handrub solution. Key words: Handrub, In-house, Commercial, Comparison, Hand hygiene

89-92

Authors: Asmabegaum Biradar, Yasmeen Kauser, Irfan Itagi, Nadeem Akthar Jamadar.

Background: Dengue fever is emerging arbo-viral acute febrile illness, which is endemic in India. Continuous surveillance of dengue fever is important for the proper and timely institution of vector control measures. With this study we made an attempt to know seasonal variation of incidence of dengue infection and correlation between thrombocytopenia and leucopenia in dengue positive cases. Apart from dengue serological markers platelet count and leucocyte count are also important in proper management of dengue infected cases. Methods: This study was conducted in department of Microbiology Al-ameen medical college Vijaypur from January 2014-december 2015. Serum samples were collected from patients suspected with dengue fever and dengue serology was done using immunocrhomatographic card test, along with this platelet count and total count was done by automation. Results: Of 284 samples received 58 (20.42%) samples were positive for one or more parameters of dengue. 27(46.55%) samples were positive for only NS1, 4(6.89%) were positive for only IgM, 14(24.13%) were positive for only IgG. Remaining 13 were positive for more than one serological markers. 36.26% of dengue positive cases had thrombocytopenia whereas only 4.28% of dengue negative cases had thrombocytopenia. 55.17% of dengue positive cases had leucopenia whereas only 12.38% of dengue negative cases had leucopenia. The increase incidence of cases coincides with the mason and post monsoon season. Conclusion: Incidence of dengue infection was higher in monsoon and post Manson period. Thrombocytopenia and leucopenia provide high suspicion of dengue infection, mainly where dengue serological tests are not available. Keywords: Dengue fever, NS1 antigen, IgM antibody, Seasonal, Platelet count

93-98

Authors: Rudrakshi Singh, Navinchandra M. Kaore.

Introduction: Nasal carriage of Mupirocin resistant Staphylococcus aureus amongst Health Care Providers (HCP) is a matter of concern for Hospital acquired infection due to Methicillin resistant stains of S. aureus. CDC recommends use of Mupirocin for decolonization only in outbreaks or other high prevalence situations. This Cross-sectional Analytical study was carried out to assess the burden of Mupirocin resistance in nasal carriage isolates of Staphylococcus aureus in Health care providers form Tertiary care hospital in central India. Methods: Thirty non repetitive samples each from four groups of health care provider i.e. Consultants, Residents, Nursing staff & Cleaning Staff were collected after informed consent and ethical clearance. Samples from anterior nares were processed for isolation of S. aureus and screened for Methicillin resistance with MIC of Mupirocin. Data maintained in Microsoft office Excel was analyzed with statistical tools like tests of proportion & Chi Square test for significance. Results: Thirty five S. aureus strains were isolated of 120 samples collected of which 15 were MRSA. A total of 11 strains were found to be having High level Mupirocin resistant (MupH) of which 9 were Methicillin resistant while 2 were Methicillin sensitive. MupH strain colonization was more in Residents group but Low level Mupirocin Resistant was not found in any group. Statistically no difference was found between Clinical & Non Clinical Groups for MupH. Conclusion: MupH is on rise in MRSA as well as MSSA strains. Regular screening of HCP for nasal carriage of MRSA & use of Mupirocin only in outbreaks or critical areas in view of developing Mupirocin resistance is of prime importance. Key-words: Mupirocin resistance, Nasal colonization, MRSA, MIC, Health care provider, Hospital Acquired Infections Key Messages: The control and prevention of the infection ascribed to MRSA can only be achieved when there is a regular screening of carriers among healthcare providers thus preventing the spread of MRSA in hospital settings as well as community. Large scale multi-centric trials for nasal carriage of Staphylococcus aureus and also the CONS with assessment of Mupirocin resistance should be done restricting the use of Mupirocin to decolonization of nasal carriage of MRSA stains in outbreaks or other high prevalence situations amongst Health Care Professionals.

99-101

Authors: Prasana Chhagan Nakate, Virendra Ashok Kashetty, Mangala Prakash Ghatole.

Background: Ventilator associated pneumonia (VAP) is common complication in patients receiving mechanical ventilation. The causative organisms of VAP are diverse and many times multidrug resistant. An early, appropriate antibiotic therapy depending on the likely pathogens is a key to VAP management. The present study aims at finding the incidence of VAP and identifying prevalent microbial pathogens associated with VAP in a tertiary care hospital. Methods: Endotracheal aspirates from clinically suspected VAP patients were subjected to microbiological analysis. Isolated pathogens were identified by standard microbiological techniques. Results: A total of 330 patients received mechanical ventilation for more than 48 hours with a total of 1490 ventilator days. 78 (23.63%) patients were clinically suspected to have VAP. The rate of VAP was 52.34 cases per 1000 ventilator days. With microbiological analysis, significant pathogens were isolated from 74 patients, with predominance of Gram negative bacteria. The most prevalent organism isolated was Klebsiella species from 29 patients (39.18%), followed by Pseudomonas aeruginosa, Acinetobacter species, Citrobacter species, Proteus species, E. coli and S. aureus in that order. Conclusion: Knowledge of prevalent organisms causing VAP (e.g. Gram negative organisms in our study) is useful to formulate an effective empirical antibiotic policy, to reduce the morbidity, hospital stay and cost of the treatment of these patients. Keywords: Ventilator associated pneumonia, VAP, Pneumonia, Mechanical ventilation, Endotracheal aspirates

102-106

Authors: Priyadarshini Shanmugan, Nirupa Soundararajan, Vidhya Ravi, Preethi Venkatesan.

Introduction: Dengue is a mosquito borne viral fever, which is prevalent in India. A one year study was conducted from July 2014 to June 2015, to determine the prevalence of Dengue infection in patients with clinically suspected Dengue fever at Chettinad Hospital and Research institute, Kelambakkam, a suburb of Chennai. Materials and Methods: The samples were tested for Dengue NS1antigen, IgM antibodies and IgG antibodies using the ELISA Methodology. 1231samples were tested during this period. Results: Total positive cases were 474(38.5%). 299 samples were collected from adult males and 65 from pediatric males. 86 samples were collected from adult females and 25 from pediatric females. In males, dengue prevalence rate was higher (76.8%) than females (23.2%).Total positive cases for IgM was 215(45.6%) and for IgG was 203(43%). 284(76.8%) were positive for NS1 antigen. About 43(12%) cases were positive for both IgM and IgG antibodies and NS1 antigen. An increase in the prevalence of dengue was recorded during the months of June, July, August, September, and October. This increase in prevalence was due to the onset of the monsoon season in Tamil Nadu when the vector Aedes aegypti occurs in large numbers.50.6%of the positive cases had thrombocytopenia and 11.6% had leucopenia. Total IgM positivity has increased from 5.04% to 45.6% and total IgG positivity has increased from 14.2% to 43%, as when compared to our previous study. Key words: pyrexia, dengue, prevalence, ELISA, Leucopenia, thrombocytopenia

107-112

Authors: Priyanka Soni, Smita Kulsrestha, R.S. Parihar, P.K. Khatri.

Introduction: Reproductive Tract infections among women of reproductive age group {including both sexually Transmitted Infection (STI) & Non STI} are responsible for major ill health and have important concern as these are associated with risk of HIV Transmission & complications like Pelvic inflammatory Disease (PID), Infertility etc. This study was conducted to determine prevalence of microorganism & their antibiogram & their association with socio demographic profile & menstrual hygiene. Methods: This was a cross sectional study included 200 women with discharge of 15-44 year age. Detail history was taken about their socio demographic data, Symptoms & menstrual hygiene; vaginal or endo cervical swab & blood sample (for serological diagnosis of syphilis) were collected. Results: Among STI most common infection is Candidiasis (45.6%) & Bacterial Vaginosis (27.8%) whereas among Non STI Esch. coli (27.3%) & Staph. aureus (26.4%). Among STI most common symptom was lower abdominal Pain & Lower backache whereas in Non-STI Vulvular itching & fever. Both STI & Non STI shows statically significant positive association with Labourer population & who uses cloth during their menstrual period whereas STI also shows statically significant positive association with younger, lower education & lower socio economic status population. Staph. aureus highly sensitive to linezolid, vancomycin whereas Esch.coli was most common gram negative bacteria & highly sensitive to imipenem & piperacillin-tazobactum. Conclusions: To conclude, by proper assessment of Prevalence & risk factor of STI and Non STI & by health education, we can reduce these infection & antibiotic resistance by prudent use of antibiotics. Key Words: Reproductive tract infection, STI, Non-STI

113-117

Authors: Qursheed Sultana, Humera Ansari, M.A. Wahab Ansari.

Background: Blood stream infections (BSI) are an important cause of morbidity and mortality. An assessment of a patient with BSI includes routinely a blood culture. Blood cultures provide us information on the causative organism and their antibiotic susceptibility over the past few decades. Objective: To identify organisms responsible for Blood stream infections, study their bacteriological profile and antimicrobial susceptibility patterns. Methods: This study was undertaken to analyze all blood culture reports from January 2015-July 2015 at a tertiary care hospital in Hyderabad, India. A total of 485 blood culture reports were analyzed all suspected cases of septicemia. Results: Best sensitivity of the gram positive isolates were for vancomycin and Tigecycline, both giving 97.67% sensitivity followed by Linezolid at 91.86%.The isolates showed good sensitivity of 77.91% to Teicoplanin and Beta-Lactamase combination showing a sensitivity of 72.09% to cefoperazone sulbactam, 66.28% to Ampicillin-sulbactam and 73.26% to cefepime-tazobactum. Resistance was high to other Beta-lactam antibiotics and the Macrolides. Conclusion: The study showed a predominance of gram positive organisms as compared to gram negative isolates, most of the isolates were resistant to multiple antibiotics. Key words: Staphylococcus aureus, Blood stream infections, Vancomycin

118-121

Authors: Kotgire Santosh A.

Background and Objectives: The rate of positive blood culture in ventilator- associated pneumonia (VAP) ranges from 8-20% and some studies report that bacteremia is not always related to pulmonary infection. The present study was undertaken to assess the usefulness of blood culture in microbiological diagnosis of VAP. Material and Methods: The study was carried out in the Department of Microbiology, Dr. Ulhas Patil Medical College for a period (January 2013 to December 2014). 85 patients receiving mechanical ventilation hospitalized for more than 48 hrs, were evaluated for VAP. Endotracheal aspirate (ETA) and blood culture performed after establishing a clinical diagnosis of VAP using mucus extractor and 2 set of blood culture bottles (Himedia Mumbai) was used respectively. A growth of organism more than 105 cfu/ml was considered as microbiological VAP while less than 105 cfu/ml was considered as not significant or commensal growth. Bacteremia was diagnosed when both 2 set of blood culture yields a microorganism or when only one set was positive but same microorganism was present in ETA in concentration more than 105 cfu/ml. Result: 39(45%) patients were ETA positive and remaining 46(55%) does not yield any significant growth of microorganisms while in blood culture only 12(14.11%) shows same isolate that were found in ETA culture while in 10(11.76%) blood culture microorganism were found which were not the same microorganism isolated from ETA culture and were considered as extra pulmonary source. Conclusion: Blood culture have limited value in microbiological diagnosis of VAP. ETA shows 45% positive culture while blood culture yields only 25.88% positive culture. Blood culture may be useful in finding extrapulmonary source of infection associated with VAP. Key Words: Blood Culture, Ventilator Associated Pneumonia, Bacteremia

122-125

Authors: Diksha Budhani, Sonia Mehta, Samar Rudra, Ashwani Kumar.

Aim/Objectives: To determine the predominant candidal species in Vulvovaginal Candidiasis. To find out the antifungal susceptibility pattern of the candidal isolates and to assess the risk factor associated with Vulvo-Vaginal Candidiasis (VVC). Methods: A total of 100 high vaginal swabs (HVS) were collected from women suspected of having Candidal Vulvovaginitis from May 2014 to February 2015. Wet mount preparations in potassium hydroxide (KOH) and Gram-stained smears were performed directly on specimens. Cultures for Candida species were done using Sabouraud’s dextrose agar (SDA) at room temperature (25-28ºC). Antifungal susceptibility of the Candida species to Amphotericin B, Fluconazole and Ketoconazole was assessed using the NCCLS guidelines on Mueller Hilton agar. Results: The incidence of non albicans (60%) was significantly higher than the Candida albicans (40%) which was found to be sensitive to Fluconazole (95%) followed by Amphotericin B (85%). The common presenting symptoms of vulvovaginitis found to be thick white vaginal discharge followed by itching pruritus. Conclusion: The predominant candidal species in vulvovaginitis was non-albicans (candida tropicalis). Candida was most sensitive to fluconazole. Keywords: Vulvovaginal candidiasis; Candida tropicalis; Antifungal sensitivity

126-131

Authors: S Senthil Priya, AS Alliratnam, R Shankar.

Background: Menstruation is a normal physiological process that begins during adolescence and many a times associated with various symptoms that occurs either before or during the menstrual flow. Many of the adolescent girls experience some problems associated with menstruation, which might indirectly have an impact in their academic excellence, sports activities and their self-esteem. Aim: To study the types and the frequency of problems related to menstruation among the adolescent girls. Methodology: A cross sectional study was undertaken among 500 adolescent girl students in the age group of 14 – 19 years who had attained menarche. The student’s data were collected by personal interviews by using a pre tested and a structured questionnaire. The questionnaire comprised of age, socio economic status, educational status, menarcheal age, menstrual pattern, premenstrual symptoms (PMS), dysmenorrhoea, impact of menstrual disorders on school attendance, consultation for menstrual problems and the hygienic practices followed during the time of menstruation Results: The mean age of menarche in our study population was 12.67 years. 62.2% of the adolescent girls had pre-menstrual symptoms. Among the various menstrual symptoms the most common were abdominal pain (94.6%), cramps (82.2%) and backache (77.8%). Among the various menstrual problems experienced by our study subjects dysmenorrhoea(65%) was the most common one followed by oligomenorrhoea(16%) and menorhagia (11%). Only 41.6% of them had the habit of using sanitary pads and majority had said that the average pad/cloth (51.4%) used on those days were only 2 and 90% of the girls did not had the habit of cleaning the genitals with soap and water. Conclusion: The pre-menstrual symptoms and the menstrual problems were quite commonly prevailing in this age group as well as the poor menstrual hygiene. So a proper awareness programme had to be conducted on a routine basis in all schools particularly the rural schools emphasising the importance of genital hygiene and the remedies for the common menstrual problems which occurs in adolescent age group. Keywords: Menstruation, Adolescent girls, Rural area, Menstrual problems

132-136

Authors: Shamshad Begum Shaikh, Sandhya Jampala, S. Shyamala Devi, M. Mallika.

Aims and Objectives: To study the incidence, risk factors, clinical presentations and sites of Ectopic pregnancy among the patients attending to department of Obstetrics and Gynecology, Government General Hospital, Anantapuramu. Material and Methods: The current prospective study was conducted over a period of 2 years from October 2013 to September 2015 in the department of Obstetrics & Gynecology at Government general hospital, Anantapuramu, Andhra Pradesh, India. Various parameters studied were age, parity, risk factors, symptomatology and sites of ectopic pregnancy, laterality of ectopic pregnancy, admission to surgery interval, and requirement of blood transfusions. Results: A total of 25 patients were admitted with ectopic pregnancy during the study period amounting to an incidence of 1.6 per 1000 deliveries. Most of the patients were multiparous belonging to the age group 21 to 30 years. Risk factors were present in 64% of cases, the commonest being previous abortion (32%) followed by tubal surgery (24%). The classic triad symptoms observed were history of amenorrhea, pain abdomen and bleeding per vagina. Ampullary part of the fallopian tube was the most frequent site as observed in 48% of cases. Right fallopian tube was observed to be the most common site of occurrence of ectopic pregnancy. On an average of three units of blood transfusion was administered for each surgery. All patients were managed by surgical intervention within three hours of admission. Conclusion: Ectopic pregnancy is a challenge for every obstetrician due to its bizarre clinical presentation. Early diagnosis and early intervention would reduce the morbidity and mortality in ectopic pregnancy. Hence ectopic pregnancy should be highly anticipated on an emergency basis in a woman in reproductive age group irrespective of tubal ligation as the condition is compared to black cat in dark room. Key words: Clinical picture, Ectopic pregnancy, risk factors, surgical intervention

137-139

Authors: Kalavathi Dharamaraj Biradar.

Introduction: Uncontrolled hypothyroidism is associated with serious maternal, fetal, and neonatal morbidity, and mortality. Overt hypothyroidism is defined as a clinical syndrome of hypothyroidism associated with elevated TSH and decreased serum levels of T4 or T3. Subclinical hypothyroidism is defined as a condition without typical symptoms of hypothyroidism, elevated TSH (>5 µU/mL), and normal circulating thyroid hormone. Material & Methods: The present hospital based cross sectional study was conducted in the Department of Obstetrics and Gynaecology, Dr. B. R. Ambedkar Medical College & Hospital, Bangalore. From the outpatient clinics, a total of 200 pregnant women of 1st trimester were selected in the study. Informed consent was taken from the study participants. Complete thyroid profile was done. Results: Mean age was found to be 23.6±2.5 and mean gestational age 8.2±2.6. Among the total study participants (n=200), the overall prevalence of hypothyroidism was 16.5% (n=33). Elevated TSH levels (>5mIU/ml) was found in 16.5% (33) of the study population. With regards to thyroid hormone levels, decreased levels of T3 & T4 were observed in 24.3% (08) and 75.7% (25) had normal levels of T3 & T4. Majority had subclinical hypothyroidism 75.7% (n=25) and 24.3% (n=8) had overt hypothyroidism. Keywords: Pregnancy, Hypothyroidism, Prevalence, Thyroid profile, Subclinical

141-144

Authors: S. Mathavi, G. Sasikala, A. Kavitha, R. Indra Priyadarsini.

Introduction: Candida species occurs as commensal organisms but in immunocompromised patients and those on long term antibiotics, these unrecognized opportunistic fungi may become fatal. Although C. albicans is the most frequently isolated pathogen, the incidence of infections due to non-albicans Candida are on the increase especially with fluconazole resistant strains. Identification of Candida to species level therefore becomes important for selecting the appropriate antifungal agents. The need for rapid identification and the difficulty in detecting mixed cultures on the traditional Sabouraud’s dextrose agar (SDA) have led to the development of chromogenic media. Aim: This study was done to evaluate the usefulness of CHROMagar Candida for rapid identification of Candida species and to identify mixed Candida infection from sputum samples. Materials and methods: A total of 126 sputum samples were inoculated on CHROMagar Candida. The plates were incubated at 37◦C for 48 hrs and the growth identified based on the colour of the colony. Results: Single yeast infection was observed in 113 samples (89.7%) and 11 samples showed mixed infection (8.7%). In our study, C.albicans (61.5%) was the predominant species and among the non-albicans Candida, C. tropicalis (18.5%) was the commonest species. Conclusion: Certainly CHROMagar Candida will be useful as a primary culture medium for identifying the yeast infections directly from the clinical specimens and also for the detection of mixed yeast infections which cannot be done on conventional SDA. Hence it helps us in selecting the appropriate antifungal agents for therapy and prophylaxis. Keywords: Candida albicans, Non-albicans Candida, CHROMagar, Mixed yeast infections, Antifungal agents

145-148

Authors: Rana M Badri.

This study show the estimate of antibiotics sensitivity profiles of some selected clinical isolates from clinical laboratories. 10 antibiotics were bought from different pharmacy and their sensitivity profiles were tested against some clinical isolates obtained from microbiology section of medical laboratories, these include (E coli, P aeruginosa, P mirabilis, and S aureus).The results were recorded as sensitive/ resistant according to ATCC strains as control strains. S aureus was sensitive to 06(60%) and resistant to 04(40%) of 10 antibiotics used. E coli was sensitive to 07 (77.7%) and resistant to 02 (22.2%) of 9 antibiotics used. P aeruginosa and P mirabilis were both sensitive to 07(70%) and resistant to 03 (30%) of 10 antibiotics. Key words: Antibiotics, Multidrug resistant (MDR), Clinical Isolates, Sensitivity Profiles

151-157

Authors: Krithikaa S, Rajesh Kondian Rangachari, Indra Priyadharsini R..

Background: Staphylococcus aureus, a pyogenic bacterium, causes a wide spectrum of diseases, ranging from minor skin infections to fatal necrotizing pneumonia. The emergence and spread of MRSA (Methicillin Resistant Staphylococcus aureus), VISA (Vancomycin Intermediate Staphylococcus aureus) and VRSA (Vancomycin Resistant Staphylococcus aureus) has left us with very few antibiotics to treat Staphylococcal infections. Clindamycin is the most important antibiotic to treat infections with Methicillin Resistant Staphylococcus aureus (MRSA). In vitro routine diagnostic tests for Clindamycin susceptibility fail to detect inducible Clindamycin resistance due to erm genes resulting in treatment failures and Clindamycin sensitive strains possess msr gene. Such resistance is detected by phenotypic methods like D – test and Agar dilution method and genotypic methods like PCR detect the ermA, ermC and msrA gene. Methods: A total of 200 Staphylococus aureus isolates from various clinical samples were subjected to study by D - Test and Agar Dilution as per CLSI guidelines and gene detection was done by PCR. Result: Among the 200 Staphylococcus aureus isolates, 103 (51.5%) were erythromycin resistant. Out of which, 72 (69.9%) were MRSA and 31 (30.1%) were MSSA. Among the 72 MRSA isolates 30 (41.7%) were iMLSB phenotype, 17 (23.6%) were cMLSB phenotype and 25 (34.7%) were MS phenotype. Among the 31 (30.1%) MSSA, 14 (45.3%) were iMLSB phenotype, 15 (48.3%) were MS phenotype and 2 (6.4%) were cMLSB phenotype. Among the 63 (31.5%) Clindamycin resistant isolates 43 (68.2%) showed the presence of ermA gene and 20 (31.2%) had ermC gene. Among the 40 MS phenotype, 36 (90%) showed msrA gene. Conclusion: Keeping the mode of action, adverse reactions and pharmacokinetics of certain antibiotics like Vancomycin in mind, Clindamycin should be preferred as the drug of choice for the treatment of severe and resistant Staphyloccous aureus infections. Key Words: Inducible Clindamycin Resistance, MRSA, D – Test, Agar Dilution, iMLSB phenotype, PCR

162-165

Authors: Sunil Sonu Hatkar, Santosh Arvind Kotgire, Alka Ramchandrasingh Thakur.

Objectives: Present study was carried out to determine average baseline widal titer among the healthy individuals in and around Badnapur, Marathwada Region. Methods: A total of 340 blood samples were collected from the apparently healthy individuals were further subjected to standard quantitative widal tube agglutination test to find out baseline widal titre among healthy individuals. Result: The most frequently recorded titre for O agglutinins were 1:40 and For the H agglutinins were 1:80. The baseline anti-H agglutinin titre of the paratyphoid A(H) were 1:40 and Paratyphoid B(H) were 1:20. Conclusion: Evaluation of baseline widal titre from single serum sample is mandatory for proper interpretation widal test to guide the clinicians. Therefore it was concluded that the cut-off values for TO, TH, A(H), B(H), were 1:40, 1:80, 1:40, and 1:20 respectively for the diagnosis purpose of enteric fever in this region. Keywords: Enteric fever, Salmonella Typhi, Endemic titre

180-184

Authors: Shireen Rana, S.B. Siddesh, R. Vijayaraghavan.

Rapid emergence of ESBL production in bacteria like Klebsiella and Proteus species has put forward a major challenge in their detection as well as treatment options. This study was conducted from Oct 2012 to May 2015 to know the prevalence and antibiogram of ESBL producing Klebsiella pneumonia & Proteus mirabilis. Blood, sputum, pus, wound samples were collected and processed; identification of isolates was done as per standard methods. ESBL detection was done with double disk test and combination disk and confirmed with MIC reduction test. 208/578 (36.0%) &126/ 405 (31.1%) isolates of Klebsiella pneumoniae & Proteus mirabilis were ESBL producers respectively. The present study showed a high percentage of ESBL producers among clinical isolates of Klebsiella pneumoniae and Proteus mirabilis to frequently used antibiotics. Knowledge of antibiogram studies will help physicians in choosing an empirical treatment. To know the changing trends in resistance regular antibiotic susceptibility studies should be conducted. Key words: Extended spectrum beta lactamases (ESBL), Klebsiella pneumoniae, Proteus mirabilis, antibiogram, Resistance

190-193

Authors: Manjunath M., Mallikarjun Koppad, Dadapeer, Sushma.

Background: Dermatophytosis refers to superficial fungal infection of keratinized tissues caused by dermatophytes. Dermatophytes colonize only the cornified layer of epidermis or suprafollicular portions of hair and do not penetrate into deeper anatomical sites. Although Dermatophytosis is not debilitating or life threatening, it can be persistent, troublesome and are often confused with other skin disorders. So, laboratory investigations are essential for correct diagnosis, management and to minimize cost. Objectives of Study: To isolate & speciate the dermatophytes & to analyze clinico-mycological profile of Dermatophytosis. Materials and Methods: Samples like skin scrapings, nail clippings, hair & hair stub were processed for 130 clinically suscespected Dermatophytosis case. All the samples were subjected for KOH mount & culture on to SDA. Results: Majority of the patients were male 76(58.46%) compared to female 54(41.53%). Most commonly affected age group 20-30 years. Tinea corporis was the predominant type comprising 66(50.76%), followed by tinea cruris 25(19.23%), tinea unguinum 18(13.84%) & tinea capitis 10(07.69%). Trichophyton rubrum was the predominant isolate comprising of 27(38.57%) cases followed by Trichophyton mentagrophytes 16(22.85%), Microsporum audoni 15(21.42%), Microsporum gypsium 08(11.43%), Trichophyton violaceum 03(4.28%) and Epidermophyton fluccosum 01(1.43%). Conclusion: Dermatophyte infections are very common in our country where hot and humid climate along with the poor hygienic conditions favor the growth of these fungi. There is varying difference in isolation of different species across the different parts of India. The predominant species was the Trichophyton rubrum followed by Trichophyton mentagrophytes, Microsporum audoni. Key words: Dermatophytosis, Trichophyton rubrum, Tinea corporis, Microsporum spp. Key messages: Dermatophytosis also known as Tinea is common in India which is the tropical country where poor hygiene, overcrowding & high humidity favors the spread of the disease

203-208

Authors: Khaja Moinuddin, Haja Abdul Nazeer, Anandi, Kalai Vani, Bhanu Prakash, Murlidhar.

Background: This study was aimed at determining the prevalence of external ocular infections and susceptibility profile of associated bacteria along with special reference to methicillin-resistant Staphylococcus aureus (MRSA). Materials and Methods: During the study period, 227 ocular samples were collected from patients clinically diagnosed with external ocular infections such as conjunctivitis, keratitis, and blepharitis. All samples were processed for direct microscopy, culture and identification by standard methods. Susceptibility testing was done by Kirby-Bauer method as per Clinical and Laboratory Standard Institute (CLSI) guidelines. Methicillin resistance was determined by cefoxitin disc diffusion method. All the analysis was performed using simple percentage method. Results: Out of 227 ocular specimens, 158 specimens yielded significant bacterial growth. The isolation rate was 70.54% in conjunctivitis (91 of 129), 77.05% in keratitis (47 of 61) and 54.05% in blepharitis (20 of 37). Newborn to under two years of age group recorded highest cases 73(46.20%). The predominant bacterial species isolated was staphylococcus aureus 39 (27.4%) followed by Pseudomonas aeruginosa 35 (22.15%). Overall prevalence of methicillin-resistant Staphylococcus aureus was 5 (12.82%). All Gram positive cocci were susceptible to vancomycin including methicillin-resistant Staphylococcus aureus. All Gram positive cocci and Gram negative bacilli showed good response towards amikacin and moxifloxacin in a range of 60-100%.Apart from vancomycin, all methicillin-resistant Staphylococcus aureus isolates remained susceptible to chloramphenicol. Conclusion: Gram-positive cocci were the most frequent bacteria isolated from ocular infections and were sensitive to moxifloxacin and vancomycin, while gram negative isolates were more sensitive to amikacin. Keywords: Bacteriology, External Ocular Infections, Antibiogram

213-218

Authors: Bilal Ahmad Mir, Siddesh Basawaraj Sirwar, R. Vijayaraghavan.

Introduction: Gonorrhea is one of the most common sexually transmitted infections (STIs) in developing countries, and the emergence of resistance to antimicrobial agents in Neisseria gonorrhoeae is a major hindrance in the control of gonorrhea. Over the past decade, Neisseria gonorrhoeae has developed resistance against commonly used antibiotics. Method: This was a prospective study done for a period of 3 years, both in men and women with the age group of (15 – 50 years) with any signs and symptoms for STIs were included. Discharge specimens like urethral, vaginal and endocervical were collected under strict aseptic conditions and smears were prepared for Gram staining and culture was done on selective and non-selective agar media. Antibiotic susceptibility was done according to Clinical and Laboratory Standards Institute guidelines. Results: Antibiotic resistance was higher in gonorrheal patients co-infected with HIV. The overall prevalence of gonorrhoea and its co-infection with HIV was 9% and 23.6% respectively. Highest resistance was seen with Penicillin, Tetracycline, Nalidixic acid, Ciprofloxine, Cefotaxime and Cefoxitin in both positive and negative cases of HIV. Conclusion: Periodic monitoring of antimicrobial sensitivity profile will help in detecting change in susceptibility pattern and the emergence of drug-resistant strains. Key words: Neisseria gonorrhoeae, Sexually Transmitted Infections (STI), Human Immune Deficiency Virus (HIV), Antibiotics, Resistance

5-10

Authors: Nikhil Shah, Rohit Nikam, Shikha Gaikwad, Vaijayanti Sapre, Jaspal Kaur

There are many insoluble substrates that remain unavailable for macro and micro organisms. A microorganism synthesizes surface active agents to utilize these substrates that are collectively called as biosurfactants. Biosurfactants enhances the surface area of hydrophobic water-insoluble substrates that organism utilizes it for its growth and work efficiently in process of biodegradation, bioremediation and biocontrol. Oil spilling is a distressing problem for the environment that is affecting chemical, physical and biological equilibrium of all systems. A microorganism does many miraculous jobs. In such oil spilling conditions, they are personalized to grow in environmental conditions that are rich in oil. Their ability of utilizing oil we cannot ignore that highlights its importance to utilize the hydrocarbons as sole sources of energy. The hydrocarbon-utilizing microorganisms generates surface active agent that accelerates the process that are best defined as biosurfactants. Many methods are there to check the biosurfactants potentiality of the bacterial isolates such as Hemolytic activity, Drop collapsing test, Oil spreading test, Emulsification index test, Blue agar plate or CTAB agar plate method and Hydrocarbon overlay agar method. In this paper its classification, properties, methods and significance are presented. The paper also highlights its importance in reducing the oil spills.

14-16

Authors: Irfan, Farooq, Subhannaya K

Introduction: Infections are the most important cause of infant mortality, of which, umbilical cord infections are an important precursor. In developing countries, umbilical cord infections constitute a major source of neonatal morbidity and pose significant risk for mortality. Methods: Prospective analytical study was conducted at KVG Medical College and Hospital, Sullia with an objective to study the aerobic bacteriological profile of umbilical cord in new born and their characterization and to compare two umbilical cord care regimens, that is, dry cord care, and 5% povidone iodine for their impact on colonization and infection. 50 cases, each in category of dry cord care and 5% povidone iodine application on umbilical cord were studied. Results: The study showed that 5% povidone iodine application to the umbilical cord though appeared to reduce colonization with S. aureus, fail to inhibit it completely. Conclusion: Antimicrobial application may enhance colonization with more dangerous multidrug resistant staphylococci (MRSA and MR-CONS). 5% povidone-iodine appeared to be inferior to dry cord care in preventing clinical manifestation in infants.

22-23

Authors: V.Nagamadhavi, P.Samatha

Introduction: Staphylococcus aureus is a frequent cause of infections in both the community and hospital. Methicillin-resistant Staphylococcus aureus continues to be an important nosocomial pathogen and infections are often difficult to manage due to its resistance to multiple antibiotics. Aims and objectives: Aim of the study is to determine the nasal carriage rate of S. aureus and also to detect the antimicrobial susceptibility patterns of the isolates, which include methicillin resistance among medical students. Inclusion criteria: Medical students who have just passed 1st yr and started attending clinical postings. Exclusion criteria: History of antibiotic usage, students using nasal drops for any treatment, recent hospitalisation. Materials and methods: Nasal swabs were collected, and isolation of Staphylococcus aureus was and they were identified using conventional culture methods. Routine antibiotic susceptibility test was performed by modified Kirby-Bauer disc diffusion method by using 0.5 Mc Farland standards. Methicillin resistance is be detected by using cefoxitin disc as per CLSI guidelines. Results: Of 91 samples the nasal carriage of S.aureus is seen in 18 students (19.7%), among them MRSA is identified in 3 students (11.1%). Overall prevalence of MRSA is 3 out of 91(2.1%).

27-30

Authors: Nithya Chinnnusamy, Dillirani Vedachalam, Vijayalaksmi Arumugam

Background & Objectives: The morbidity and mortality still remain significantly high in patients with severe lower respiratory tract infections. But data related to the offending organisms and their antibiotic sensitivity pattern is limited. Therefore, this study was designed to identify the bacterial pathogens and their antibiotic sensitivity of sputum samples in patients with severe lower respiratory tract infections which were received by Microbiology Department, between January 2015 to December 2015. Methods: The present study was conducted during a one year period (January to December 2015). A total of 130 sputum samples were processed. All the samples were processed through Gram’s stain and culture. The culture was identified by standard protocols and antibiotic susceptibility was performed by Kirby Bauer disc diffusion method. Results and conclusion: Out of the 130 sputum culture samples, significant pathogens were isolated in 82 [63%] sputum samples. Among the isolated organisms, Klebsiella pneumoniae [31.7%] was the commonest isolated organism, followed by pseudomonas spp [14.63%]. Majority of isolates were only sensitive amikacin, Pipracillin- tazobactum and imipenem. Staphylococcus aureus was isolated in 11 samples and 6 were Methicillin resistant Staphylococcus aureus [MRSA] which were sensitive to Vancomycin. There were a significantly high proportion of patients who were affected by drug resistant strains. Before starting empirical antibiotics on patients with moderate to severe lower respiratory tract infections, it is always advisable to obtain sputum for culture and antibiotic sensitivity test.

37-39

Authors: Mythri B.A, Asha B. Patil, Arati K., Sharon V.A

Background: Infections of musculoskeletal injuries due to road traffic accidents, especially open fractures, continue to pose a challenge. There is limited information on the early bacterial contaminants of these wounds and their antibiotic sensitivity patterns in our environment. This study was done to determine the aerobic bacteriological profile of wound site infections in road traffic accident patients at initial presentation and their antibiotic susceptibility profile. The study was carried out over a one year period. Method: Discharge and swabs from the wounds of 247 patients presenting to the Casualty, KIMS Hospital were collected with aseptic precautions prior to the initiation of empiric antibiotic therapy. Gram stain, culture were performed and the isolates were subjected to antibiotic susceptibility testing by Kirby-Bauer disc diffusion method, as per CLSI guidelines. Results: Of the 247 samples studied, growth was observed in 232 samples of which 221 were monomicrobial and 11 were polymicrobial. A total of 273 bacterial isolates were recovered. Gram positive cocci constituted 40.3% and gram negative bacilli constituted 59.7% of the isolates. The most common pathogen isolated was Staphylococcus aureus followed by Pseudomonas spp. and Coagulase Negative Staphylococci. 36.5% of the Staphylococcus aureus isolates were found to be methicillin resistant. Conclusion: This study shows that Staphylococcus aureus and pseudomonas were the commonest organisms associated with the RTA wound site. A high rate of MRSA, MBL and ESBL producers was observed which imply treatment failure with empirical antibiotics. Hence the antibiotic susceptibility pattern of the isolated organisms should be obtained at the earliest to avoid unwarranted prolonged empirical therapy and to administer appropriate and

44-46

Authors: Rupali S Shinde, Kalpita K Gumaste, Basappa G. Mantur

Introduction: Rise of MRSA infection in hospitals is a matter of concern. MRSA infection in hospitals is acquired either by MRSA colonizers i.e. health care worker or fomites which are heavily contaminated with MRSA. It is necessary to detect MRSA carriers among health care workers in order to cut down the increasing rate of MRSA infection in hospitalized patients, especially in intensive care units. Aims & objectives: To find the MRSA carriage rate among health care workers in intensive care units. To find out the antibiotic susceptibility pattern in these MRSA isolates. Materials & methods: Hand & nasal swabs were collected from the health care workers of critical care units. The isolation of MRSA & their antimicrobial susceptibility were carried out by standard bacteriological procedures. Result: MRSA carriage rate was 6.35% by nasal swab method whereas it was 4.76% by hand swab method. MRSA isolates were resistant to most of the antibiotics. Conclusion: Strict adherence to infection control practices is the single most important factor in preventing MRSA infection. Simple preventive measures like hand washing before & after patient examination, the use of sterile aprons & masks can reduce the disease transmission rate considerably.

53-57

Authors: Sumita Rajeevan, Marina Thomas, Boppe Appalaraju

Background: Over the last 20 years, the rates of fungal infection have increased and Candida has emerged as a major cause of human disease. Furthermore there is an increase in nonalbicans candida species in many countries. The emerging pathogens are resistant to conventional antifungal therapy. Objective: To find out which species of Candida is predominant in clinical infection and determinate their antifungal susceptibility patter. Materials and method: All Candida isolates recovered from various clinical samples during the period from February 2011 to August 2012 were studied. The isolates were speciated using, both conventional and automated techniques. Antifungal susceptibility testing was done by disk diffusion methods according to Clinical and Laboratory Standards Institute guidelines. Various risk factors associated with the candida infection were also looked into. Results: A total of 269 Candida isolates were isolated. (Prevalence of 5.3%). 42% of isolates were from patients above 60 years of age Candida tropicalis (46%) was the most common isolate. All the 269 Candida isolates (100%) were sensitive to amphotericin B. Resistance of more than 70% to the three azoles tested was noted amongst the C albicans and the C parapsilosis spp. The risk factors commonly associated with candida infection were Catheterization (87.5%), ventilator assistance (75%) and Diabetes mellitus (31%). Conclusion: In our study Candida tropicalis was the predominant isolate. All candidal isolates were sensitive to Amphotericin B however marked resistance to azole derivative was found with Candida albicans than C.tropicalis. CHROMagar candida medium and tetrazolium reduction medium are found to be useful in identification of Candida species. All candidal isolates were sensitive to Amphotericin B.

65-68

Authors: Vijayalakshmi. Arumugam, Dillirani. Vedachalam, Malathi. Murugesan, Ananthakrishnan. Parthasarathy

Background: Staphylococcus aureus is the most common cause of hospital and community acquired infections. The increasing prevalence of Methicillin Resistant Staphylococcus aureus (MRSA) has led to the widespread usage of Vancomycin which in turn leads to the emergence of resistance to glycopeptides antibiotics. Hence this study is aimed at analyzing the prevalence of Methicillin Resistant Staphylococcus aureus isolates from various clinical specimens. Methodology: A retrospective study was conducted over a period of one year in a tertiary care hospital from various clinical samples received during the study period. Staphylococcus aureus isolates were identified by phenotypic methods and MRSA isolates were identified by Cefoxitin disk diffusion method as per CLSI guidelines. Results: Out of 10842 different types of samples processed, 212 isolates of Staphylococcus aureus were identified. Among them 59 (27.83%) were found to be Methicillin Resistant Staphylococcus aureus (MRSA) and 153 (72.17%) were found to be Methicillin Sensitive Staphylococcus aureus (MSSA). Conclusion: The above study concludes that it is a must to implement appropriate diagnostic methodology for isolating MRSA strains and also to ensure strict antibiotic policy in all the health care institutions with precautionary measures before starting the patient on Vancomycin.

74-76

Authors: Balamurugan R, Gopal R, Saleem M, Kaviraj M, Sunil S. Shivekar, Mangaiyarkarasi T

Background: HBV infection in humans is a global health problem which accounts for morbidity and mortality rates associated with its serious complications like cirrhosis of liver and carcinoma of liver. The incidence of HBV in India has an intermediate range of 2 % to 7%. A five year retrospective study was conducted on the seroprevalence of HBs Ag among the patients attending Sri Manakula Vinayagar Medical College and Hospital, Pudhucherry from January 2011 to December 2015. Materials and methods: A total of 67903 patients of both sexes and ages ranging from 1 year to 88 years were included in this study. HBsAg screening was primarily done by rapid card test and reconfirmed by ELISA. Results: 1.73 % of the study population was positive for the presence of HBsAg with a male predominance of 2.73% over female (1.09%). A gradual increase in the prevalence rate was seen during each successive years of this study. Conclusion: An increasing prevalence was observed in each succeeding year of the study. Preventive measures and awareness programmes are to be taken into serious consideration to control the rising trend of HBV infection.

194-196

Authors: Prakash Hindurao Waghmare, Prachala Govind Rathod, Kishor Vishwasrao Ingole, Nasira Khalid Shaikh, S.

Background: Cholera, one of the Notifiable Diseases is known to cause serious epidemics and pandemics in developing countries like India. An outbreak had occurred in 2013 in Solapur and the isolates revealed certain change in the trends of the epidemiological markers. Methods: A total of 30 cases presented with gastroenteritis during the months of July and August of 2013. 30 stool specimens were cultured on Blood agar, Mac Conkey agar and TCBS medium and enriched on alkaline peptone water broth. Identification of the isolates was done by standard Biochemical and Serological Agglutination tests. Antibiotic susceptibility testing was done using Kirby Bauer disc diffusion method, according to CLSI guidelines. Phage typing was done at the National Institute of Cholera and Enteric Diseases, Kolkata. Results: Out of the 30 stool specimen cultured, 14 strains of V.cholerae biotype El Tor serotype Ogawa was isolated. Phage Typing could be done on 6 isolates. All the strains identified belonged to T-2 phage type, according to Basu and Mukherjee scheme. According to the new scheme, two isolates belonged to T-27 phage type, two belonged to T-3 phage type, while one each belonged to T-6 and T-12 phage types. Most of the strains isolated in 2013 epidemic were sensitive to tetracycline, cotrimoxazole, and ciprofloxacin and resistant to ampicillin and gentamicin. Interpretation and Conclusion: Due to the changing epidemiological markers of V.cholerae such as Phage type and Antibiogram, all the epidemics must be thoroughly investigated and the isolates must be subjected to complete identification and Antibiotic Susceptibility Testing. Keywords: Antibiogram, Basu and Mukherjee scheme, epidemiological markers, phage typing, Vibrio cholerae