Indian Journal of Microbiology Research

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.