Indian Journal of Microbiology Research

342-351

Authors: Abhishek Mehta, Vidya S. Date

Aims & Objectives: 1. To isolate and characterize the Candida species from various clinical samples. 2. To determine the spectrum of Candidiasis. 3. To determine the predisposing factors for Candidiasis. Method: This Prospective Analytical study was conducted in the Department of Microbiology of a Teaching Tertiary care Rural hospital of Western India over a period of 1½ years after obtaining Ethical clearance. A total of 1438 samples submitted to department of microbiology for routine diagnostic work up were assessed. A detailed review of history & clinical findings was undertaken. Fifty isolates which fulfilled the diagnostic criteria for Candidiasis were selected, included in the study and subjected to a battery of microbiological investigations aimed at detecting, isolating, identifying and characterizing Candida sp.so as to determine the spectrum of Candidiasis. Results: The incidence rate of Candidiasis in clinical specimens came out to be 35 per thousand samples per year. The species wise distribution of Candida isolates was C.albicans(42%), C.tropicalis(50%), C.glabrata(4%), C.parapsilosis(2%) & C.krusei(2%). Conclusion: Results indicate a significant shift in the species causing invasive Candidiasis away from C.albicans to more resistant Non-albicans species which has important clinical implications.

359-362

Authors: Arundathi HA, Mallikarjun Koppad, Halesh LH, Siddesh KC

Urinary tract infections are the second most common infections in community practice and Escherichia coli is the most commonly isolated organism in community acquired UTI. Fluoroquinolones are the preferred antimicrobial agents for empirical therapy of UTI. However, it is seen that Fluoroquinolone resistance among urinary isolates and its association with multi drug resistance, especially beta lactam antibiotics is on the rise. Hence, this study was undertaken to evaluate the prevalence of quinolone resistance and its co-existence with Extended Spectrum β-Lactamase (ESBL) production among urinary isolates of E.coli. Objectives: 1. To determine the prevalence of quinolone resistance among urinary isolates of E.coli. 2. To evaluate co-existence of quinolone resistance with ESBL production among them. Materials and Methods: All urine samples received at Microbiology laboratory, McGann hospital, attached to Shimoga Institute of Medical Sciences, Shimoga, was included for study. E.coli was isolated by following standard conventional microbiological methods. These isolates were subjected to antimicrobial susceptibility testing by Kirby-Bauer disk diffusion method and ESBL production was tested according to CLSI guidelines 2014. Results: In a total of 932 urine samples, 82 E.coli were isolated. Out of these 82 E.coli isolates, 62 (75.6%) isolates showed quinolone resistance. And out of these 62 quinolone resistant isolates, 54(88.5%) isolates showed ESBL production. Conclusion: Our study shows significant co-existence of quinolone resistance and ESBL production among the urinary isolates of E.coli. The result of this study justifies the need for continuous surveillance, monitoring and revision of the antibiotic use policies to control the dissemination of resistance determinants among the pathogen.

368-372

Authors: Qursheed Sultana, Ayesha Anjum, Nusrath Fathima, Mohammad Siraj, Mohammad Ishaq

Autoantibodies to thyroid antigens in general, and thyroid peroxidase in particular, are considered as the hallmark of autoimmune thyroid dysfunctions. While a pro-inflammatory response is considered as predominant in hypothyroidism, in Grave’s disease it is a predominant antibody response. Objectives: The objective of the present study was to evaluate seropositivity to TPO and TG antigens in these two conditions with apparently diversified patterns of immune responses. Methods: An Enzyme linked immunosorbent assay was employed for detection of Anti-Thyroid Peroxidase (TPO) and Anti-Thyrooglobulin (TG) auto-antibodies in sera of patients with Hypo and Hyperthyroidism. Results: Total seropositivity to both TPO Ab/ TG Ab was found to be 69.09% in hypo and 66.66% in hyperthyroidism; it was 54.54% and 53.33% for hypo and hyperthyroidism respectively for TPO Ab alone. A substantially less seropositivity of 41.81% and 40% was observed for Hypo and Hyperthyroid respectively for TG Ab. Analysis of seropositivity in relation to age at onset revealed higher sero-posiivity (53.33%) in early onset (≤35 years) group in hypo for TPO Ab. Functional significance of TPO Ab in the two thyroid conditions has been discussed particularly in the light of their diagnostic utility and epidemiological significance. Conclusion: It is concluded that higher sera positivity was observed for TPO compare to TG. These variations may be due to differences in antigenic characteristics of these two thyroid antigens.

383-386

Authors: Gitanjali Badave, Neelima Pantagada, P. Nageswara Rao

Hepatitis B virus (HBV) is a DNA virus belonging to Hepadnaviridae family.1,2 HBV infection leads to a wide range of liver diseases from acute hepatitis to chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC).2 World Health Organization (WHO) has classified HBV prevalence into high endemicity (>8%), intermediate (2-7%) and low endemicity (<2%). HBV prevalence in India is in intermediate range. Every year 100,000 Indians die due to HBV infection related illnesses.3 The diagnosis of HBV infection is based on a group of clinical, biochemical, histological, and serological markers. Interpretation of clinical significance of HBV markers and their relevance to the management of HBV infection is helpful to clinicians for appropriate therapy. It is particularly important for physicians to screen for HBV infection in HBV-endemic areas and to monitor liver disease progression in HBV carriers by using both serological and virological markers, so that effective treatment can be initiated early before the development of advanced liver disease. Soon after its discovery as the “Australia antigen”, Hepatitis B surface antigen (HBsAg) has been the prime diagnostic target for HBV.4 Hepatitis B surface antigen is an important component of HBV infection, being the first serological marker to be elevated in acute HBV infection and persistence of HBsAg for more than 6 months suggest chronic HBV infection.5 HBsAg is also used as an epidemiological marker to calculate the prevalence of hepatitis B infection. Various studies have been carried out in India over the last two decades on the epidemiology of HBV infection. An effective vaccine is available for over two decades that has brought about remarkable changes in the global epidemiology of HBV infection. Many HBsAg rapid tests are commercially available worldwide. According to the assessment report from the World Health Organization Blood Safety and Clinical Technology Department, majority tests were immunochromatographic assays with 98-100% sensitivity and 95-100% specificity.6,7 These HBsAg rapid test are economical and technically simple diagnostic tools. To recognize and evaluate the extent of transmission of a disease in a community and for its control and prevention, the study of its prevalence is very important. The first step in tackling the HBV disease burden in India is to have a more accurate assessment of the burden of the disease. Therefore, the present study was conducted in our hospital to know the seropositivity of Hepatitis B surface antigen amongst the general population.

392-397

Authors: Hetal G. Vaghela, Hitesh R. Ahir

Urinary tract infection in pregnancy has higher rate of morbidity for both mother and baby. Asymptomatic bacteriuria occurring in 2-12% of pregnancy is mainly responsible for the occurrence of Pyelonephritis which occur with complication, such as premature labour and Low birth weight baby. Aim of study was to decide bacteriological profile and antibiotic sensitivity patterns of urinary isolates from pregnant women. Material and Methods: A total of 501 pregnant women without symptoms of Urinary tract infection, attending antenatal OPD at S.S.G. Hospital and Medical College Baroda from April 2005 to March 2006, were enrolled in our study. Organisms were identifed from Midstream urine specimen and antibiotic susceptibility test was performed using bacteriological standard tests. Data were collected using predesigned performa. Results: Out of 501 pregnant women 60 (11.97%) were culture positive. Multiparous women had highest percentage of culture positivity of 26.92%. Staph. aureus was the predominant organism isolated (in 23 out of 60 cases) and E.coli was 2nd most common organism isolated (in 21 out of 60 cases). There were also Pseudomonas Spp., Streptococcus Spp., Proteus mirabilis, Acinetobactor Spp., Enterococcus Spp., Klebsiella Spp., and Candida Spp. The organisms were sensitive to Cefotaxime, Ciprofloxacin, Nitrofurantoin, Gentamicin, Cephalexin and Nalidixic acid in decreasing order. Gram positive organism and gram negative bacteria showed high sensitivity against Cefotaxime, Ciprofloxacin and Nitrofurantoin with a rate of 66.15%, 64.61% & 63.07% respectively. Conclusion: In present study, the isolated organisms from suspected pregnant women were resistance to the routinely used antibiotics. Therefore, it requires screening of all the pregnant women to urinary tract infection and treat those infected with appropriate antimicrobial regimens in order to reduce its complication.

401-404

Authors: Jaswinder Singh Gill, Ketoki Kapila

Nosocomial infections are known in patients treated at tertiary care hospitals. However this acquires significance as some of these are resistant to most of the major categories of antibiotics. Treatment of such infections become more challenging while treating patients in burn wards. There is a pressing requirement to evaluate combinations of some of the available antibiotics to treat these nosocomial infections in burns patients. No study evaluating combination of meropenem and colistin on clinical isolates of burns patients in a tertiary care hospital is available. Objective: To evaluate synergistic effect of meropenem and colistin antibiotic combination on common multidrug resistant bacteria isolated from the burn ward patients. Methods: A total of 46 strains of multidrug resistant bacteria which included 23 strains each of P. aeruginosa and Acinetobacter baumannii were tested forin-vitro synergistic effect of meropenem and colistin combination. MIC and FIC index was calculated for all the bacterial isolates. Result: 18 out of 23 strains of P. aeruginosa and 19 out of 23 strains of Acinetobacter baumannii showed synergistic activity. Conclusion: This study suggests that the combination of meropenem and colistin could be a good alternative for the treatment of Acinetobacter and Pseudomonas infections in burns patients, until a newer antibiotic agent is available.

408-411

Authors: Mansi Gupta, Navinchandra Kaore, Anshul Gupta

Infections caused by MRSA are worldwide, resulting in increased mortality and morbidity. Detecting the mecA gene or its product by PCR is recognized as a gold standard for detection of MRSA. In resource limited clinical settings phenotypic method which is simple, rapid, accurate and cost effective is required. Cefoxitin disc diffusion is considered as surrogate marker for mecA gene, and could be considered as gold standard for MR isolates. The aim of this study was to do a comparative evaluation of E-test MIC against Cefoxitin disc diffusion for detection of Methicillin resistant Staphylococcus aureus (MRSA). A total of 174 S. aureus isolates were identified, which were subjected to both Cefoxitin disc diffusion and Oxacillin MIC by E-test. A total of 69 isolates were identified as MRSA by Cefoxitin disc diffusion test. In this study sensitivity and specificity of Cefoxitin is 100% while sensitivity and specificity of Oxacillin MIC by E-test comes out as 94.02% and 94.39%.

419-422

Authors: Parimala TV

Enteric fever is a major public health problem in India. Widal test is a cheap, affordable and easily available and the most commonly used test for the serodiagnosis of enteric fever. The purpose of the present study is to evaluate the baseline titre for O and H antigens of Salmonella enterica subspecies enteric serotype Typhi and H antigens of Salmonella enteric subspecies enterica serotype Paratyphi A and Paratyphi B among normal healthy adult population in Tumkuru, Karnataka, India. Methods: Blood samples were collected from healthy blood donors (n= 493) who attended blood bank of this institution from January 2016-March 2016. All the samples were tested for the presence of Salmonella antibody by Widal tube agglutination test. Results: Of the 493 samples which were tested, 199(40.13%)) serum samples were positive for one or more agglutinin(≥1:20) and 294(59.63%) serum samples were negative for agglutinins(≤1:20). Out of these 340(68.96%) and 306(62.06%) samples showed a titer of >1:20 to the O and H antigen of Salmonella enterica serovar Typhi respectively. An agglutinin titre of >1:20 against H antigen of Salmonella enterica serovar Paratyphi A and Paratyphi B were found in 85(17.24%) & 119(24.13%) respectively. Conclusion: Baseline titre of 1:80 for O and H antigens of Salmonella Typhi and 1:40 for H antigens of Salmonella Paratyphi A and B were observed in the present study.

429-431

Authors: Prasanna Chhagan Nakate, Mangala Prakash Ghatole, Virendra Ashok Kashetty

Mobile phones of health care workers (HCW) may harbor pathogenic microorganisms and act as a source of infections for patients. This study was conducted to determine the bacterial contamination of mobile phones in health care workers (HCW) and to compare it with mobile phones of non-HCW’s. Methods: Mobile phones of 125 HCW’s were screened for bacterial contamination and it is compared with mobile phones of 125 non-HCW’s. The isolated bacteria were identified using standard microbiological techniques. Results: The study revealed bacterial contamination in case of 120 mobile phones of HCW’s and 121mobile phones from non-HCW’s. Commonest organism isolated was Coagulase negative Staphylococci in both groups. 37bacterial isolates (30.83%) from HCW’s were significant nosocomial pathogens whereas 46 isolates (38.01%) from non-HCW were pathogenic; Staphylococcus aureus being the most frequent isolate for both groups. Conclusion: As mobile phones act as reservoir of micro-organisms among HCW’s, frequent disinfection of these along with good hand hygiene practices is important for preventing transmission of infectious organisms. In addition screening of mobile phones for nosocomial pathogens and restricting their use in sensitive areas of hospital is also advisable.

436-440

Authors: Lavanya Jagdish, Trupthi B. Naik, Ravi Kumar Gupta, Manoj Jais

Septicemia contributes significantly to morbidity and mortality especially in hospitalized patients. The situation further deteriorates with increasing rate of multidrug resistance. Therefore, the early and accurate diagnosis and start of empirical treatment is a success key to cure such infection. However, for successful treatment, geographical epidemiological etiology is must. Blood culture is the gold standard for the diagnosis of septicemia. Methods: In the present study, etiological and antimicrobial susceptibility profile of blood culture collected from in-patients, out-patients, and ICU patients in three months at a tertiary care hospital was done. Blood culture positive isolates were identified using standard microbiological, biochemical tests. The antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion method. Oxacillin disc diffusion test was used to identify MRSA. Results: A total of 217 blood culture were positive out of which 110 (50.6%) were from pediatric group. Gram positive cocci (60.8%) outnumbered Gram negative bacilli (39.2%). Among Gram positive, S. aureus (51.5%) was the most common isolate followed by CoNS (39%). Among Gram negative, Klebsiella spp. (32%) was most common followed by Acinetobacter spp. (21%). Among isolates, 35% were MRSA and 30% were ESBL producer. Conclusion: The results indicate emergence of high rate of antimicrobial resistance among septicemia patients. The results warrant continuous monitoring of etiology and antimicrobial pattern so as to build geographical epidemiological data. This may help clinicians to select appropriate empirical treatment to control such infections especially in hospitalized patients.

446-449

Authors: Sathish JV, Ashwini M, Sujith Pavan

The purpose of this study was to determine the rate of biofilm production by S.aureus and S.epidermidis isolated from different clinical specimens. Methods: Quantitation of biofilm formation by staphylococci was carried out using three in vitro methods namely tissue culture plate (TCP), tube method (TM), and congo red agar (CRA) method. Results: Out of 237 (94.8%) S.aureus isolates tested, 25 strains were found to form biofilm, out of these one (0.42%) was strong biofilm producer and 24 (10.12%) were moderate biofilm producers. In TM and CRA method 20 (8.43%) and 10 (4.2%) strains were moderate biofilm producers, rest were considered as weak or non-biofilm producers. All the 25 biofilm positive strains were S.aureus. Conclusion: The TCP method is more sensitive to detect biofilm formation by S.aureus when compare to tube method (TM), and congo red agar (CRA) method.

454-457

Authors: Sreedevi Hanumantha, Hema Prakash Kumari Pilli

The etiological agents of Catheter associated urinary tract infection (CAUTI) are sundry and often multidrug resistant. An early, appropriate antimicrobial therapy based on culture sensitivity report and implementation of infection control practices together play a key role in management of CAUTI. Objectives: 1. To find the incidence of CAUTI in intensive care unit (ICU) patients. 2. To identify etiological agents responsible for CAUTI. 3. To determine antimicrobial susceptibility pattern for bacterial agents obtained. Methods: Urine samples from clinically suspected cases of CAUTI were obtained from patients with urinary catheters admitted in ICUs. Urine samples were subjected to wet mount, culture and sensitivity testing. Responsible pathogens and their antimicrobial susceptibility pattern were obtained based on CSLI standards. Results: A total of 640 patients were having indwelling urinary catheter with an aggregate of 5199 catheter days over a period of 6 months. 19 were culture positive out of 45 clinically suspected cases of CAUTI. The CAUTI rate was 3.65 cases per 1000 catheter days. Most predominant etiological agents responsible for CAUTI were Citrobacter species (26.3%) followed by P.aeruginosa (21.1%) and E. coli (21.1%). 2(18.2%) ESBL producing Gram negative bacteriawere obtained among Enterobacteriaciae. The most effective antibiotics were ceftazidime/clavulinic acid, colistin and meropenam for Enterobacteriaciae; piperacillin/tazobactam for P.aeruginosa; linezolid and vancomycin for Enterococcus species.

464-467

Authors: Yedla Kavita, Mohan Sundaram, Anandi V

Escherichia coli and Klebsiella species are the most important uropathogens. The present study was undertaken to isolate uropathogens causing community acquired urinary tract infections (CAUTIs) and their antibiogram. Materials and Methods: A total of 755 clean voided mid-stream urine samples were collected and processed. All the specimens were collected from patients attending various OPDs of our hospital. The specimens were cultured and the isolates were identified using standard microbiological techniques. The antibiotic susceptibility was determined by disc diffusion technique. Simple percentage method was used in analyzing data. Results: From 755 urine specimens, 197 urine specimens yielded significant bacterial growth accounting for 26.09%. Females (75.13%) are more commonly affected than males (24.87%). E.coli119 (60.40%) was the most frequent organism isolated followed by Klebsiella species(24.87%). Klebsiella species showed high degree of resistance towards the antibiotics tested. Conclusion: High isolation rate was observed among young females in reproductive age groups. E. coli was the predominant bacteria causing UTI followed by Klebsiella species. Very high resistance rates were observed towards commonly used antibiotics in community.

472-478

Authors: Sadhna Sodani, Ranjana Hawaldar

The multidrug resistant nature of P. aeruginosa is a major cause of morbidity in immunocompromised patients. The mechanisms which play a role in causing multidrug resistance of P.aeruginosa includes lower outer membrane permeability, increased expression of efflux pumps, presence of Amp C Beta lactamase enzyme. The present retrospective study aims to analyse the antibiotic sensitivity pattern of P.aeruginosa in our clinical setting in various clinical specimens and to study the various mechanisms playing a role in resistance to antibiotics. Materials and methods: The retrospective study included all the Psedomonas aeruginosa isolates from clinical specimens received in our microbiology department between June 2015 to June 2016. The specimens included pus, aural swab, conjunctival swab, blood, urine and endotracheal tube. A total of 40 cases were included in the study. Results: highest sensitivity was observed for amikacin(65%), Piperacillin/ tazobactum(52.5%),Gentamycin(47.5%) Highest resistance (77.5%) was to Trimethoprim/ sulphamethaxazole, 62.5% to nalidixic acid, 57.5% cases had resistance to quinolones. Impermeability to carbapenems accounted for 42.5% cases, followed by carbapenamase(metallo-oxa) resistance mechanism in 37.5%. Conclusion: Growing resistance to commonly used antibiotics is a major concern to clinicians as several complex mechanisms are involved in the multi-drug resistance nature of P.aeruginosa. Careful use of antibiotics, culture and sensitivity testing and prudent selection of drugs and effective infection control measures would help the clinicians in planning and executing effective treatment thus limiting the emergence of multidrug resistant strains of Pseudomonas aeruginosa.

483-488

Authors: Anukriti Verma, Yamini Patidar, Aditi Vaishampayan

Potassium is one of the important component of plant nutrients to meet the requirement of plant’s growth, crop yield and quality of product. Isolates of KSB was carried out using mica (insoluble potassium) from the soil sample of different regions of India basically U.P and M.P on Aleksandrow’s agar media. Out off 14 isolated bacterial isolates 7 bacterial isolates MPS1C2, MPS2C5, MPS2C4, MPS5C1, UPS1C1, UPS2C1, UPS3C1 showed highest D/d ratio 3.13, 3.50, 2.0, 3.22, 5.00, 4.13, 3.75. Optimum pH and temperature was pH-7 and 28±2°C. Maximum K solubilization was achieved in KCl and K2SO4. The isolated bacterial strain was identified as Micrococcus varians and Corynebacterium kutscheri. KSB treated Groundnut plant showed maximum pods of 16 and seeds 72 per plant as compared to control having pods 7 and seeds 21.