Indian Journal of Microbiology Research

1-5

Authors: Vasudha C.L*,B Anuradha,B Nithya Krishna

Introduction: Keratitis may be due to infectious or non-infectious etiology. Breach in the corneal epithelial barrier due to trauma or surgery predisposes to infectious keratitis which can result in scarring and blindness. The most common bacteria implicated is S.aureus. Among the fungi, Fusarium, Aspergillus and Candida spp., are common agents. The fungi are usually inoculated into the cornea by trauma involving plant or vegetable matter. This study was conducted to know the prevalence of fungal keratitis and the different fungal species implicated in patients attending our tertiary care hospital. Materials and Methods: Corneal scrapings collected under slit-lamp examination with aseptic precautions were subjected to KOH mount, Gram stain, inoculated on Sabouraud dextrose agar and sent to Microbiology lab for further processing using standard techniques. Result: Out of the 18 clinically suspected fungal keratitis cases studied, 7 (38.89%) were farmers and most common risk factor associated was trauma 66.66% (12/18) of which vegetative trauma accounted for 27.78% (5/18) cases. 10 (55.56%) cases were both KOH and culture positive. The prevalence of fungal keratitis in our study was 1.54%. Out of the 10 positive cultures, most common isolate was Candida albicans (40%). Conclusion: Fungal keratitis is an important cause of monocular blindness that occurs after trivial trauma to the eyes. Most of the patients do not come to the ophthalmologist immediately after such trauma due to lack of knowledge. Early diagnosis and prompt treatment if initiated in the early phase of the infection can prevent the occurrence of any complications.

11-14

Authors: Ashwini S Waghmare,Praveen Kumar Sadanand*

Introduction: Microbial keratitis is a common, potentially vision-threatening ocular infection that may be caused by bacteria, fungi, or parasites. Successful treatment of corneal ulcer requires proper diagnosis and early institution of intensive therapy with appropriate antimicrobial agents. Aim: To determine specific pathogenic organism and clinical risk factors for infective Keratitis. Materials and Methods: Patient with clinical features of infective keratitis attending Ophthalmology OPD were included whose corneal scrapings were subjected to Gram staining, KOH Mount and culture sensitivity. Statistical analysis done by using appropriate statistical methods. Results: 40 cases were evaluated. 23 were males and 17 females. Age ranged from 21 to 70 years. History of trauma was present in 47.5% of patients, ocular surface disease was present in 10% while diabetes was present in 10% of patients. Based on culture reports, bacterial and fungal keratitis found in (65%) 26 patients. There was no organism isolated from rest of the 14 samples (sterile keratitis). Bacteria were isolated in 14 samples and in 12 samples fungal growth was isolated. The commonest bacterial isolate were Staphylococcus aureus followed by Pseudomonas, Coagulase negative staphylococcus and Klebsiella. Aspergillus species was isolated in 7 patients and fusarium species in 4 patients. Gram positive isolates were maximally sensitive to Ofloxacin, gram negative to Gentamicin. Conclusion: Staphylococcus aureus was the most common bacterium while Aspergillus was the most common fungus isolated. Trauma was the commonest risk factor for corneal ulcer.

18-21

Authors: Syed Tanwir Alam*,Gitika Rajbongshi,Debajit Rabha,Ajanta Sharma

The virus that has posed a serious public health challenge world-wide was pandemic 2009 H1N1 influenza A. This prospective study was undertaken to analyze the clinical profile of 2009 pandemic H1N1 influenza A virus [A (H1N1) pdm 09] infection in patients presenting with influenza like illness from January 2015 to December 2015. A total of 116 respiratory samples were collected from the patients attending the hospitals, which included 71 males and 45 females, ranging in age from one to 79 years. Respiratory specimens were tested for A (H1N1) pdm 09 virus by one step real time reverse transcription polymerase chain reaction. In real-time PCR, the A (H1N1) pdm 09 virus was detected in 14 patients (12.07%) and highest percent of positivity (50.0%) was detected in the age group 25-40 years with the mean age being 40.07 ±4.43 years (SD). Most common presenting symptoms were fever (92.86%) and cough (92.86%) followed by shortness of breath (57.14%), nasal catarrh (50.00%) and sore throat (35.71%). From the study it has been seen that there is prevalence of A (H1N1) pdm 09 virus infection in Assam and thus it needs urgent attention to prevent further spread of the virus in the community

30-34

Authors: Vedavati B. I*,Halesh L. H

Introduction: Healthcare associated infections are an important cause of morbidity and mortality among hospitalized patients. Bacterial flora on hands of nursing staff act as a potential source for health care associated infections. Study of bacterial flora on hands of HCWs and knowing the importance of hand hygiene will play important role in preventing health care associated infections. Present study was undertaken to isolate aerobic bacterial flora on the hands of nursing staff, to study the antibiogram of isolates and to create awareness among the health care provider regarding hand hygiene. Materials and Methods: Present study was done over a period of three months. After obtaining informed consent, swabs collected from the hands of nurses working in critical areas of hospital and subjected to bacterial culture. Organisms were identified by standard conventional methods. The antibiotic sensitivity testing of the isolates was done by Kirby Bauer’s Disk Diffusion method according to CLSI guidelines. Result: Of 100 samples studied, 73(73%) samples showed the growth. Among them 36(49.31%) samples grown pathogenic bacteria, 27(36.98%) samples grown pathogenic bacteria along with probable contaminant non-pathogenic bacteria, 10(13.68%) samples showed only contaminant non-pathogenic bacteria. Among 63 pathogenic bacteria Gram positive bacteria predominate over Gram negative bacteria. Gram positive isolates were Staphylococcus aureus 20(31.7%), CONS 27(42.8%) and Gram negative isolates Klebsiella spp. 6(9.5%) followed by Pseudomonas spp. 4(6.3%) were predominated. Among Staphylococcus aureus 10(50%) isolates were found to be Methicillin resistant. Conclusion: Awareness should be created among HCWs about significance of hand hygiene to prevent HCAIs.

38-43

Authors: V Nagamadhavi,P Subbulu*,Tejaswini

Introduction: Smart phones have become omnipresent in Clinical and Non clinical environment. They have been implicated as a source of bacterial contamination. Drug resistant pathogens such as methicillin resistant staphylococcus aureus (MRSA), Gram negative bacteria. Aims and Objectives: To evaluate the role of mobile phones in relation to transmission of bacteria from mobile phone to health care workers and their pathogenicity. Inclusion Criteria: Medical faculty present on the days of data collection. Exclusion Criteria: Who ever don’t give consent. Materials and Methods: In total, 200 mobile phones were sampled. Two senior medical students were trained by a senior microbiologist to obtain the swabs in a standardized manner. The sides, screen and back of mobile phones were swabbed using a sterile cotton swab. The swabs were taken to the laboratory without delay and are incubated in brain heart infusion broth and incubated at 37 degrees for 24-48 hrs. Positive samples were further sub cultured on different growth media; mannitolsaltagar to isolate Staphylococci, MacConkey-agar to isolate Gram negative bacteria and Entero coccosel-agar to isolate fecal Enterococci. Results: Out of 200 cell phones sampled, 66 were found contaminated with varied number of bacteria. The most commonly isolated organism was aerobic spore bacilli 33(16.5%) followed by Pseudomonas 13(6.5%), Proteus 11(5.5%), Escherichia coli 7(3.5%), Klebsiella 1(0.5%), Staphylococcus aureus 1(0.5%).

50-56

Authors: V Rastogi*,Jyoti Tomar,Tarun Patni,Chhavi Vijay,Pratiksha Sharma

Introduction: Tuberculosis (TB) is a national health priority and with failing current treatment regimens, uses of ethnobotanical therapies are being more vigorously explored. Treatment of TB using oral and inhalational administration (hawan) of a mixture of herbs (hawan samagri, HS) has been practiced in India since ages. In vitro antitubercular effect of extract of HS against H37Ra strain of Mycobacterium tuberculosis (MTB) was recently reported in an ICMR funded research project.1 Hence this study aims to document scientific data on antitubercular effect of this HS extract against clinical MTB strains. Materials and Methods: Minimum inhibitory concentration (MIC) against clinical MTB strains of two different ethnobotanical mixtures (HS1 and HS2) used traditionally in India for the indigenous treatment of TB was compared. Extraction of essential oil (EO) from the mixture was done by hydro distillation and chemical characterization was done by Gas Chromatography and mass Spectroscopy (GCMS). Resazurin Microtiter Assay (REMA) was done to study antitubercular MIC. Result and Discussion: Crude essential oil (EO) extract of HS showed significant antitubercular effect in MIC range 50 - 400 µg/ml. HS1 showed lower MIC values compared to HS2. GCMS analysis of EO showed an array of bioactive compounds known to have antitubercular and other beneficial effects. Conclusion: Scientific validation of ethnobotanical use of HS extract for antitubercular activity was obtained in this work. HS crude EO seems to be a promising natural product with potential for new drug development in the treatment of TB.

61-65

Authors: Vedavati B. I,Halesh L.H,Mallikarjun Koppad

Introduction: Infections due to Gram-negative bacilli are increasing worldwide. The extended spectrum β-lactamases (ESBLs), AmpC β- lactamases and metallo βlactamases (MBLs), have emerged as a cause of antibacterial resistance in Gram negative bacteria (GNB). β-lactamase producing GNB presents significant diagnostic and therapeutic challenge in the management of infection. So the present study was conducted to know the antibiogram of Gram negative bacterial isolates, to detect the different β-lactamases and their co-existence, to guide clinician to start appropriate antibiotic therapy for the management of infection. Materials and Methods: A total of 150 Gram negative clinical isolates were identified and antibiotic susceptibility testing was done according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Detection of ESBL was done by the combined disk diffusion method as per CLSI guidelines. Detection of AmpC β lactamase was done by phenyl boronic acid test. MBL was detected using EDTA disc potentiation test. Result: Among 150 Gram negative bacteria studied, 26(17.34%) were pure ESBL producer, 50(33.34%) were pure AmpC producer. ESBL and AmpC co-existed in 16(10.67%) isolates and AmpC and MBL co-occured in 16(10.67%) isolates. Conclusion: Along with routine antibiotic sensitivity testing, special tests should be done to detect “hidden” resistance mechanisms for the effective management of infection.

71-77

Authors: Pooja Patel,Hiral K Patel*,Alka B Nerurkar

Introduction: A surgical site infections (SSI) are a 3rd most common nosocomial infection and is responsible for morbidity, mortality and increased healthcare costs. Aims and Objectives: The main aim of this study is to identify the isolates causing surgical site infections and its anti-microbial susceptibility pattern. Materials and Methods: A total 50 cases of surgical site infections were taken for the study. The suspected samples were processed by using standard microbiological methods. The modified Kirby-Bauer’s disc diffusion method was used for antibiotic susceptibility pattern. The isolates of Enterobacteriaceae family were initially screened for ESBL production and were further confirmed by Double Disk Synergy Test as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Reference strains of E. coli (ATCC 25922), P. aeruginosa (ATCC-27853), S. aureus (ATCC 25923) and Klebsiella 700603 were used as controls. Result: Out of 50 samples, 19(38%) were culture positive and total 23 organisms were isolated. Pseudomonas aeruginosa 9 (39.13%) was the most common organism isolated, followed by Klebsiella spp. 5 (21.73%), Staphylococcus aureus 3 (13.04%). Most of the Gram-negative isolates were sensitive to imipenem and meropenem followed by piperacillin-tazobactam. Gram-positive organisms were found to be more sensitive to levofloxacin, linezolid and vancomycin. ESBL production was seen among 44.44% isolates of Enterobacteriaceae family. Conclusion: The rate of infection reflects on patient's care and standard of treatment in any hospital. Thus, better stewardship of SSI is required with accurate antibiotic policies. Periodic monitoring of etiology and antimicrobial susceptibility in the community and hospital settings is recommended.

82-88

Authors: Monita Kulkarni*,Ravindra Khadse,Gopal Agrawal

Introduction: The study was carried out in a tertiary care hospital in India. 178 patients with Pelvic Inflammatory Disease (PID) were considered in the study. Materials and Methods: IgG ELISA was carried out in all the patients for Chlamydia trachomatis (CT). Cervical swabs were taken and were stained by gram stain and giemsa stain. Also culture of the cervical swabs was carried out. 100 healthy controls were taken. Results and Discussion: Total number of seropositive cases because of Chlamydia Trachomatis in Pelvic Inflammatory Disease cases were found to be 26.14% which was statistically significant when compared to controls which was 11%. Also the study of the etiology of Pelvic Inflammatory Disease was carried out to study the various other causative organisms of Pelvic Inflammatory Disease. Conclusion: Chlamydia Trachomatis is an important causative agent of sexually transmitted infections (STI) apart from staphylococcus aureus, Escherichia Coli and Klebsiella pnuemonia.

92-96

Authors: Aradhya Abrol,Savita Mahajan*,Madhu Chauhan,Narender Kumar

Introduction: Biomedical waste has a higher potential for infections and injuries. With an endeavor to reduce health problems, it is essential to have safe and reliable method of segregation and disposal of hospital waste. With this background the present study was conducted to assess the knowledge, attitude and practice of biomedical waste management among health care personal in Dr. Rajendra Prasad Government Medical College (DRPGMC) Tanda, Himachal Pradesh. Materials and Methods: A cross sectional questionnaire based survey containing 30 questions to assess the knowledge, attitude and practices on biomedical waste management. Results: The mean knowledge, attitude score were higher as compared to practices. Significant differences exist in relation to educational qualification of respondent in knowledge and practice score. Conclusion: The present study revealed that knowledge and attitude regarding biomedical waste management among health personal and students of the institute was higher as compare to practice.

430-435

Authors: D Danis Vijay,S Jayanthi*,N Meenakshi

Pneumonia exhibits mortality rates, between 20% and 50% in severe cases. Biomarkers are useful tools for antibiotic therapy modifications as well as diagnosis, prognosis and follow-up treatment of pneumonia. This review presents the biological and clinical features of various biomarkers in Pneumonia patients, including C-reactive protein, Procalcitonin, Coceptin, D-dimers, MRpro-ADM, (Mid-regional pro adrenomedullin), Corisol, Endothelin-1, Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1), Adrenomedullin, Endotoxin, Mid regional Pro-Atrial Natriuretic Peptide (MR-proANP), TNF-? Polymorphisms, Pentraxin 3.

442-445

Authors: Archana Rao K*,Ravindranath C

Introduction: Infections due to Gram-positive bacteria are on a rise, of which those due to Enterococcus spp. form a major part. The shifting pattern of infections caused by Enterococci from novel urinary tract infections to soft tissue and wound infections are increasingly reported. Objective: The aim of the present study is to isolate, speciate Enterococci, determine the antibiotic resistance pattern and to detect vancomycin resistance by E- test. Materials and Methods: All wound swabs, pus samples sent for bacterial culture, irrespective of the diagnosis of the patients which were received to the department of microbiology for a period of one year were included in the study. The samples were processed for isolation, identification and speciation of Enterococci. Antimicrobial susceptibility testing was done by Kirby-Bauer disk diffusion method. Vancomycin resistance was determined by E-test. Results: A total of 3000 pus samples were received over a period of one year. Out of which 43 isolates were detected as Enterococcus species. Among 43 isolates, 26 were E.faecalis, 17 were E.faecium. In present study, ampicillin resistance was seen in 88% followed by resistance to erythromycin (86%) and clindamycin (72%). High level gentamycin resistance was seen in 28% cases. Vancomycin resistance was not detected in any of the samples. Conclusion: The shifting spectrum of infections due to Enterococcus is gaining inquisitiveness among health care workers especially in the trauma care units. Thus there is a prerequisite to isolate speciate and determine the resistance that helps in holistic health care.

451-459

Authors: Deepika Jain*,Vilas Kamble

Blindness is a major public health problem in most developing countries. Corneal ulcer (Keratitis) is a major cause of blindness throughout the world. About 10% cases of blindness are due to corneal ulcer. “Corneal ulcer means loss of corneal substances as a result of infection and formation of raw, excavated area.” Bacterial keratitis is an acute or chronic, transient or recurrent infection of the cornea with varying predilection for anatomical and topographical parts of the cornea like marginal or central. This study demonstrates the Novel pathogenic bacteria Exiguobacterium aurantiacum with bad pigment production, which are causing corneal ulcer and determine the best possible empirical therapy and specific therapy. Particular attention should be given to this condition as it can progress very rapidly with complete corneal destruction can be occur within 24–48 hours.

466-469

Authors: Vinod R*,Sasidharani Govindan,Manju M

Introduction: Colonization with Streptococcus agalactiae or group B Streptococcus (GBS) among antenatal mothers has become an important element which can affect the prognosis of meningitis and sepsis in neonates. Pregnant women with risk factors like preterm labour <37> Aims and Objectives: To find out the prevalence of group B Streptococcus (GBS) among pregnant women of Indian origin in and around our health care centre and to know the antibiotic susceptibility pattern of GBS in our region. Materials and Methods: Rectal and vaginal swabs were collected from 126 antenatal subjects. They were cultured on to enrichment and enriched media. Group B Streptococcus (GBS) was identified by standard methods and confirmed by Latex agglutination method. Antibiotic Sensitivity Testing (AST) was done on all the isolates to know the pattern of susceptibility. Results: Samples were collected from 126 pregnant women. Over all 11 (8.73%) rectal and vaginal samples were positive for GBS. GBS was found to be higher in multigravida, 9 (9.7%) out of 92 than primigravida, 2 (5.8%) out of 34. All the eleven isolates were sensitive to Penicillin, Ampicillin, Gentamycin, Vancomycin and Clindamycin. 2(18%) and 1(9%) of the GBS isolates showed resistance and moderate sensitivity to Erythromycin respectively. 8(73%) GBS isolates were sensitive to Erythromycin. All the 11 isolates were resistant to Chloramphenicol, Cotrimoxazole, Ciprofloxacin, Tetracycline and Ceftriaxone. Conclusion: The exact prevalence of GBS must be investigated more to know its burden. Screening for GBS must be made mandatory during antenatal checkups. Intrapartum antibiotic prophylaxis (IAP) must be administered at the earliest if the screen is positive. Rapid diagnostic methods must be developed for identification of GBS.

476-483

Authors: Swathi B.K,Prajna Sharma

Introduction: Aim of the study was to determine the seroprevalance of HIV, HBS and Syphilis co-infection if any present and the associated risk factors in a tertiary care center of Mangaluru. Materials and Methods: The study was conducted on 500 women attending antenatal checkups at A.J. Institute of Medical Sciences, Mangaluru. They were screened for HIV, HBV and Syphilis and were requested to provide socio-demographic and obstetric data following appropriate counselling and ethical clearance. Results: The seropevalence of HIV, HBV infection and Syphilis were found to be 2.6%, 3.4% and 0.2% respectively. Low literacy levels, early initiation of sexual activity, low per capita income were the most commonly associated risk factors. Conclusion: Sexually transmitted diseases and its complications are a significant part of health challenges the public face today. Most common among the sexually active group, it is a major issue among the reproductive age group as the infection can be transmitted vertically.

488-491

Authors: Usha M. G,Shwetha D C*

Introduction: Staphylococcus is a major pathogen of community and hospital acquired infections. Vancomycin is used in MRSA caused infections. Emergence of VISA and VRSA has been of great concern in clinical aspects. Materials and Methods: All clinical samples were processed in the laboratory according to standard procedure. Inoculated plates were incubated at 37? C for 24-48 hours. Only S. aureus isolates were included in the present study. Antibiotic susceptibility testing was done by Kirby-Bauer disc diffusion method using a panel of drugs. Cefoxitin disc was used to identify methicillin resistance. The MIC of vancomycin for MRSA isolates was carried out by Agar dilution method and E-test according to standard methods. Heteroresistance to vancomycin was detected by using BHI screen agar. Results: 190 S. aureus were isolated from various clinical samples. Most of the isolates were resistant to amoxyclav (96.2%) followed by ciprofloxacin (84.2%), erythromycin (33.2%), Clindamycin (31.2%), Cotrimoxazole (14.6%), Teicoplanin (4.2%), Mupirocin (2.1%) and none of the isolates were resistant to linezolid. Out of 190 S. aureus isolates, 97 (51.1%) were identified as MRSA. None of the isolates were resistant to vancomycin by agar dilution method and E-test method. Four out of 97 (4.1%) MRSA isolates showed intermediate susceptibility to vancomycin. Among the isolates with MIC of 2µg/ml, 5 (19.2%) showed heteroresistance to vancomycin by BHI screen agar method. Conclusion: Rapid identification of patients harboring VRSA, VISA or hVISA and adherence to infection control protocols are very important in controlling the dissemination of these pathogens.

497-503

Authors: Surender Kaur*,Abhijit Awari

Introduction and Objectives: The ESBLs producing organisms are reported worldwide in increasing numbers for which Clinical Laboratory Standard Institute (CLSI) recommends screening for ESBLs producing Escherichia coli and Klebsiella species by phenotypic methods. The study was undertaken to assess the burden of ESBL and comparison of Double Disc Synergy Test (DDST) and Phenotypic Confirmatory Test (PCT) with gold standard E-Test for ESBL detection in clinical isolates of tertiary care hospital, Bhopal. Materials and Methods: 223 clinical isolates of E.coli and Klebsiellae species were included in the study and those showing zone size of < 22> Result: Out of 223 isolates 124 were potential ESBL producers with preponderance of E.coli 58.3%. E-Test showed confirmed cases of ESBL 72/124(58%) which was much higher than by DDST 44/124 (35.5%) but close to PCT 70/124 (56.4%) among suspected clinical isolates. Overall ESBL burden out of 223 isolates was 32.28% which is quite alarming. ESBL producing strain showed maximum sensitivity to Colistin, polymixin-B & Imipenem nearing 100% whereas sensitivity ranging from 60 to 85% for beta lactamase inhibitor combinations. Non-ESBL producers were more sensitive to Amikacin, Fluoroquinolones, Nitrofurantoin, Cotrimoxazole with sensitivity ranging between 40 to 70%. Conclusion: With rise in ESBL producing strains with multi drug resistance, screening with Ceftazidime should be done to detect probable ESBL producer. PCT can be used with confidence with comparable results with that of MIC tests in resource poor microbiology laboratories which will save human, technical and monitory resources in terms of its confirmation by molecular genotypic methods.

508-511

Authors: Thressia Thomas,Meena Dias*

Introduction: Candida is an important cause of blood stream infections (BSI). It ranks fourth in the United States and seventh in Europe. It is a leading cause of morbidity and mortality in critically ill patients. There is an epidemiological shift from a predominance of Candida albicans to non albicans Candida species in recent decades. Speciation of Candida can help in better approach towards outcome of the patients and to know the intrinsic resistance of various Candida species to antifungal agents. Objectives: To determine the epidemiological profile of Candida infection in septicemic patients and to identify the Candida species isolated. Materials and Methods: A hospital based descriptive study was conducted over a period of 2 years in a tertiary care centre. Candida was isolated in blood culture from 54 patients. Candida isolates were identified to the species level, using both conventional and automated techniques. Results: The most common Candida species isolated were C.parapsilosis complex, C.tropicalis, C.albicans, C.krusei, C.glabrata, C.haemulonii, C.firmetaria and C.guillermondii var membranifaciens. Significant risk factors for candidemia includes HIV/AIDS, diabetes, antibiotic therapy, chemotherapy, presence of intravascular catheters, malignancy, surgery, parenteral nutrition. 51.85% of the patients received antifungal therapy with Fluconazole (71.43%) being the most common treatment option which is followed by Voriconazole (10.71%) and Amphotericin B (7.14%). Conclusion: Candidemia is a significant cause of mortality with C. parapsilosis and C. tropicalis being the predominant pathogens. This study shows a significant epidemiological shift to higher isolation of non albicans Candida species.

516-523

Authors: Vasanth Ayswarya*,Vamsi Lavu,Suresh Ranga Rao

Introduction: Methanogenic archaea are single celled methanogenic anaerobic microorganisms that are potential hydrogen competitors. It serves as a syntrophic partners with other members of the subgingival biofilm community leading to methanogenesis, sulfate reduction and acetogenesis thereby producing hydrogen sulfide, a potent Volatile Sulphur compound to cause halitosis. Aim: To evaluate the presence of methanogenic archaea in supra gingival plaque, subgingival plaque and tongue coating in subjects with and without oral halitosis. Materials and Methods: A case control study of 50 subjects with 25 halitosis and 25 healthy subjects were included in the study. Supragingival plaque, subgingival plaque and tongue coating were collected from all the subjects. DNA extraction was done from the samples by Bacterial genome extraction kit. Conventional PCR was done to detect the presence of Methanogenic archaea. Results: The prevalence of methanogenic archaea in supra gingival plaque, subgingival plaque and tongue coating in halitosis subjects were 16%, 60% and 16% respectively and in controls without halitosis were 4%, 8% and 0% respectively. A highly statistical significant difference (p 0.000) was found between subgingival plaque samples of cases and controls. Conclusion: A significantly higher presence of methanogenic archaea was observed in halitosis subjects than controls, with increased detection in the subgingival plaque thereby fulfilling the association criteria of Socransky’s postulates. However, a larger sample size, identification of VSC production and synergistic activity with other microorganisms needs to be established.

530-534

Authors: Harshika Y K,Shobha Medegar K. R*,Asha B Patil,Smita N R

Introduction: Body fluids like pleural fluid, ascitic fluid, cerebrospinal fluid etc are usually sterile, but they can get infected by different micro organisms, thus leading to life threatening infections.1,2 Aims and Objectives: 1) To isolate the causative organisms of sterile body fluid infections. 2) To determine the antimicrobial resistance pattern of the isolates. Materials and Methods: 1) This is a retrospective observational study, conducted from January 2017 to December 2017 in the department of Microbiology KIMS Hubli. 2) Sterile body fluids were processed according to Standard laboratory Procedures. 3) Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method as per CLSI guidelines. Results: A total of 635 samples were studied out of which 233(36.6%) were pleural fluids, 222(34.9%) were ascitic fluids, 174(27.4%) were cerebrospinal fluids and 06(0.9%) were pericardial fluid. In our study the predominant organisms were E-coli (23.23%) and NFGNB (19.01%) followed by Pseudomonas (14.08%), Klebsiellaspp (13.38%), S.aureus (10.56%) and Citrobacter spp (7.04%). Gram negative isolates were 100% sensitive to Imipenem followed by Amikacin (78%), Gentamicin (74%), Cefepime (69%). The Gram positive isolates were 100% sensitive to Vancomycin and Linezolid followed by Gentamicin (96%), Cefepime (94%), Amikacin (92%). The Pseudomonas isolates were highly sensitive to Imipenem (96%) and Piperacillin Tazobactum (92%). High resistance was observed to Ceftazidime, Cefoperazone and Levofloxacin. Conclusion: Knowledge of bacteriological and antimicrobial profile of sterile body fluids is necessary, so that the life threatening infections can be effectively treated and thus to prevent antimicrobial resistance associated with it.

538-542

Authors: Anup Saha,Jayanta Debnath*,Pradip Kumar Da,Niladri Sekhar Das,Pranjal Tripathi

Introduction: Lower respiratory tract infections with multidrug resistant gram negative bacteria are hard to treat and cause high morbidity and mortality. This study gives an account of isolation of multidrug resistant bacterial pathogens causing Lower respiratory tract infections and their antibiogram, in this geographical area of North East India. Materials and Methods: A total of 500 samples were collected and processed following the standard protocol. Antibiotic susceptibility test were performed by disc diffusion method, from which multidrug resistant strains were detected as per the criteria. Results: Out of 190 Gram Negative Bacilli isolated, 76 (40%) strains were confirmed to be multidrug resistant. Klebsiella pneumoniae (45.61%) was the predominant multidrug resistant Gram Negative Bacilli isolated, followed by Pseudomonas aeruginosa (36.48%), Acinetobacter spp (33.33%) and Citrobacter spp (28.57%). The multidrug resistant strains exhibited considerable susceptibility to Amikacin (65.78%), Gentamicin (68.42%) and Levofloxacin (68.42%). The Carbapenems, Beta-lactams and Beta-lactamase inhibitor combinations exhibited significant resistance in the present study. Conclusion: Klebsiella pneumoniae and Pseudomonas aeruginosa can be stated as the major causative agents of LRTI in this region. The present data represents the effective antibiotic agents against the MDR pathogens causing LRTI to be Amikacin, Gentamicin and Levofloxacin. Since none of the MDR strains attained a significant level of sensitivity against the tested antibiotics, specific treatment in our centre need to be decided based upon the antibiotic sensitivity profile of the isolate

290-294

Authors: Ramamoorthi Arularasi Aberna, Kesani Prabhakar

Objective: To determine the species of Enterococcus prevalent in the gastrointestinal tract (GIT) of patients in hospitals and community and to determine the antimicrobial susceptibility pattern for the isolates. Materials and Methods: Enterococcus species were isolated from stools and rectal swabs using selective media. Antimicrobial susceptibility pattern for 9 antibiotics were evaluated by Kirby-Bauer’s disc diffusion method. Phenotypic characterization of vancomycin resistant enterococcus (VRE) isolate was done by determining the minimum inhibitory concentration (MIC) to vancomycin and teicoplanin by agar dilution method. Results: Enterococcus species were isolated from gastrointestinal tracts among 74.4% of hospitalized patients and 90% of community patients. E. faecium was the frequent species isolated from both patients. Hospitalized patients had lesser number of other unusual Enterococcus species. Resistance to antibiotics was higher among isolates from hospitalized patients and 1.49% of hospitalized patients showed colonization with VanB phenotype VRE. Conclusion: Gastrointestinal carriage of antibiotic resistant enterococci including VRE among hospitalized patients mandates the need for periodic surveillance among high risk patients in order to prevent infections and dissemination.

299-302

Authors: Atul J. Sakhiya, Kruti Tanna, M.M. Vegad, Pranay K. Shah, Piyush Panchal

Introduction: Influenza is viral fever with the main symptom of respiratory tract like cough, fever, breathlessness, nasal discharge, sore throat. The influenza affects a large segment of the world population resulting in significant mortality, morbidity and economic loss. Objective: To monitor the trend of influenza A virus. To know the prevalence of influenza A, H1N1 and seasonal H3 subtypes of influenza virus. To study the seasonal pattern of influenza A virus. Materials and Methods: This prospective study was carried out in the department of Microbiology, B.J. Medical College, Ahmadabad from January 2014 to December 2014. Surveillance samples were taken as per ILI (Influenza like illness) case definition for out Patient department and SARI (sever acute respiratory syndrome) for indoor patients. Total 614 samples are taken and tested with PCR method. Result: Out of 614 samples total 201(32.73%) were positive for influenza. Out of 201 positive samples, 13 (2.11%) were positive for swine H1N1 and 11 (1.79%) for seasonal H3, 177 (28.82%) were positive for influenza A. Conclusion: Prevalence of influenza 201(32.73%). out of this 13 (2.11%) were positive for swine H1N1 and 11 (1.79%) for seasonal H3, 177 (28.82%) were positive for influenza A. swine H1N1 was common in winter and seasonal H3 was common in late monsoon. swine H1N1 and seasonal H3 both are more common in male than female. swine H1N1 is more in >12 age and seasonal H3 is more common in <12>

307-312

Authors: Fareya Haider, Zahida Parveen Dar, Aman Gupta, Shadma Yaqoob, Mastan Singh

Introduction: Multidrug resistance pathogens have been found to be an increasing cause of neonatal sepsis in developing country like India. The present study was conducted to study the multidrug resistant pattern in bacterial isolates of neonatal septicaemia in Neonatal intensive care unit (NICU) of a tertiary referral hospital, Northeastern part of U.P., India. Material and Methods: It was a prospective study in which blood culture sample was taken from 450 neonates who had clinical features of sepsis or had presence of risk factors (one major–prolonged rupture of membranes/evidence of chorioamnionitis, intrapartum fever, foul smelling liquor or two minor–febrile illness of mother 2 weeks prior to delivery, meconium stained liquor amnii, more than 3 vaginal examinations during labour, low birth weight or prematurity, prolonged labour, low Apgar score) over a period one year. Results: A total of 102 (22.7%) suspects were found to be positive for sepsis. In present study, among positive cases of neonatal sepsis, the prevalence of early onset was around three forth as compared to late onset sepsis. Among all gram positive and gram negative isolates Klebseilla pneumoniae was found to be maximum followed by Grp B streptococcus. Out of total isolates only five isolates were MDR, whereas 4 MRSA and 17 ESBL. Conclusion: Presence of Multidrug resistant isolates as well an increasing rate of ESBL producers among neonates noted in this study is alarming. Thus regular monitoring of susceptibility profile of bacterial pathogen is the need of the hour to treat and curtail the increasing trend of neonatal septicemia.

318-325

Authors: Hosam Eldin El-Sayyad, Samir Basha Eskander, Talat A. Bayuomi

Introduction: The bioremediation, as a treatment process for low- and medium radioactive liquid wastes generated from various applications of nuclear technology in our daily life, represents a biotechnological innovation as well as an excellent tool for bioconcentration of radionuclides. Aim: study the capability of Aspergillus niger (A. niger) to removal of Cesium-137 (Cs-137) and/or Cobalt - 60 (Co-60) from simulated spiked solutions. Materials and Methods: This part of experimental work was carried out to evaluate the factors influencing the performance of the fungus and optimizing the bioconcentration of those two radionuclides. The impacts of incubation periods, irradiation of fungus spores prior seeding, age of A. niger and the initial concentrations of the radioactivity added on the bioconcentration factor (CF) for the two radioions were studied on laboratory scale experiments. Results and Discussion: Based on the data reached it was found that A. niger can bioconcentrate, from the spiked solution, more than 80% of Co-60 and about 25% of Cs-137 within 48 hours. Conclusion: Therefore, Aspergillus niger can be easily grown in substantial manner using unsophisticated techniques, inexpensive growth media. Besides, the acceptable bioconcentration factor achieved by the fungi constituted an economical pattern for treating hazardous effluents spiked with radioactive ions, and it might have a synergetic role during applying other treatment methods.

331-333

Authors: Dilip Gedam, Mousumi Kilikdar, Nitin Ambhore

Introduction: Needle stick injuries are the most common occupational hazard for health care workers as well as they carry the highest risk of transmission of various blood borne infections. The greatest menace are hepatitis B and hepatitis C followed by HIV. The present study was carried out to determine the incidence of needle stick injury (NSI) among the health care workers (HCWs) and also the efficacy of preventive strategy. Materials and Methods: This study was conducted at ICTC-1 (Voluntary counselling and testing centre), Department of Microbiology, GMC Akola which is a 600 bedded, tertiary care hospital in Maharashtra, India. The study was carried out over two and half years from April 2015 to October 2017 on various HCWs. Data was collected from ICTC-1 and follow up of patient was done up to 6 months. Biomedical waste (BMW) management workshops and training were also conducted every 6 months. Results: A total of 318 HCWs who were exposed to NSI visited ICTC-1. The highest rate was found among intern doctors (31.44%) and waste handlers (29.87%) followed by student nurses (20.44%), staff sister/brother (11.32%), laboratory technician (5%) and senior doctors (1.88%). There has been increased reporting and awareness among the HCWs due to the regular workshops and training programmes for BMW management. Conclusion: A lot needs to be done to reduce the burden of NSI. Substitution of needles with safe, newer devices, adequate training of health care workers regarding safe use and disposal of needles, post exposure prophylaxis, vaccination (Hepatitis B) might change the scenario.

339-341

Authors: Shadma Yaqoob, Vaibhav Shukla, Mastan Singh, Priyanka Shukla, Fareya Haider

Introduction: Asymptomatic bacteriuria is the most common problem in elderly diabetics may be due to high glucose concentration in the urine of such patients that favour the growth of uropathogens. Objective: This study was done to determine the prevalence of asymptomatic bacteriuria in diabetic and non diabetic patients, to determine the uropathogens responsible for ASB and also to know the antimicrobial susceptibility pattern of the pathogens. Materials and Methods: Urine samples were collected from elderly diabetics and non diabetics. Cultures Antibiotic susceptibility tests were performed using standard microbiological technique. Results: ASB was found to be 9.8% and 4.6% in diabetics and non diabetics Escherichia coli were the most common isolates followed by Klebsiella pneumonia, Imipenem, Nitrofurantoin were the most sensitive antibiotics against the urinary isolates. Conclusion: The patients may progress to symptomatic UTI so treatment is advisable in elderly cases of asymptomatic bacteriuria with poorly controlled diabetes but after culture and sensitivity.

348-354

Authors: Debapriya Das Choudhury, N P Singh, Sumit Rai, Prerna Batra, Vikas Manchanda

Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) isolates are resistant to carbapenem and other beta-lactam drugs. Infections with these CREs have been reported in different age groups and are difficult to treat because of their resistant pattern and thus, they have become epidemiologically important. Materials and Methods: Rectal swabs from 150 term/ late preterm neonates (> 35 weeks) and 150 preterm neonates (< 35> 3 days. Three rectal swabs were taken; 1st within 24hrs of birth (day 0), 2nd on day 3 and 3rd before discharge (day 4-10). They were screened for CRE in stool/rectal swab according to CDC criteria. These were further confirmed by following CLSI guidelines (MHT) to observe the carbapenemases production and real-time PCR for blaNDM-1, blaIMP, blaVIM, blaKPC. Results: A total of 8.7% (26/300) possible CREs were isolated in term/late preterm (15/26, 57.7%) and preterm neonates (11/26, 42.3%). Klebsiella pneumoniae was the commonest organism. In total, 22/26 (84.6%) possible CREs were MHT positive and rest 4 were MHT negative. The majority of MHT positive CREs were multidrug-resistant whereas MHT negative CREs was sensitive to tested carbapenem drugs. Carbapenemases genes (blaNDM-1=10, blaVIM=8, blaIMP=1, blaKPC=0) were identified in 19/26 of possible CREs, but multiple carbapenemases genes were not found. Conclusions: In this study, neonates were colonized with CRE within their gut as early as 72 hours after birth. This can cause infection in the postnatal period and may lead to spread of CRE in the community.

358-363

Authors: Patel Bhavikakumari C, Patel Disha A, Vegad Mahendra M

Context: Dengue is a major public-health concern throughout tropical and subtropical regions of the world including India. All four serotypes of the dengue can produce wide range of the symptoms from mild clinical diseases to sever diseases. Dengue haemorrhagic fever and dengue shock syndrome may occur in secondary dengue infection with serotype other than primary infection. Early diagnosis is required for proper management of this disease and to reduce mortality. Aim and Objectives: Present study was carried out to know prevalence of dengue in Gujarat, its epidemiological status and to co-relate the serological and haematological data for early diagnosis of dengue infection. Materials and Methods: A retrospective study was carried out over a period of one year from January 2016 to December 2016. A total of 12,413 samples having signs and symptoms of dengue fever were processed for NS 1 Ag detection and IgM Ab detection test by ELISA according to their duration of illness. Laboratory tests of dengue positive parameters and its haematological profile were co-related. Results: A total of 1430 samples (11.52%) were positive for dengue. Males in the age group of 16yrs to 30 yrs were predominantly affected. Monsoon and post-monsoon is a most favourable season for dengue transmission. Thrombocytopenia was more consistently associated whenever IgM was detected compared to NS1 detection. Conclusions: Early recognition and diagnosis are important for favourable outcome. NS 1 Ag detection test by ELISA can give positive results from the 1st day of illness. Haematological profile acts as indicators for provisional and early diagnosis of dengue.

368-373

Authors: Ullas Bhabhor,Hitesh Bhabhor*,Hitesh Shingala,Mala Sinha

Introduction: Blood stream infection is a most common health care associated infection causes significant disease and death worldwide. Patients are admitted to ICUs carry higher risk of nosocomial BSI than those who are admitted in other type of units. Early Identification of causative agents & their antibiotic sensitivity pattern are useful to reduce mortality & improve clinical outcome of the patients. Materials and Methods: A prospective study conducted in tertiary care hospital. During study all the patients monitor for nosocomial blood stream \ infection. Blood sample collected from suspected patient of blood stream infection for detection causative organism & antimicrobial susceptibility pattern. Result: A Total 620 samples were tested out of these 173 (27.90%) were positive growth in culture. Maximum number of blood stream infections were from paediatric ICU (69.62%), followed by Medical ICU (18.35%) and from surgical ICU (12.02%). In present study incidence of length of stay is more after five day of admission in ICU (68.35%). The incidence of blood stream infection due to gram positive organism was (51.28%). Among them Staphylococcus aureus 72 (45.56%) was most common organism. Gram negative organism were quite low (48.73%) among them Klebsiella spp. (16.45%) was most common. The antimicrobial susceptibility pattern of isolated organisms showed high resistance to routinely used antimicrobial agents. Conclusion: The systemic approach by studying the culture of organisms from the foci and blood culture and the antibiotic profile may help the clinician to select appropriate empirical antimicrobial agents.

378-381

Authors: Khyati Jain,Madhurendra S Rajput*,Arjun S Gurjar

Introduction: Neonates are very susceptible to Pseudomonas aeruginosa. Single case of Pseudomonas aeruginosa in preterm neonates is a sign for immediate action. Aim: To describe control of an outbreak of Pseudomonas aeruginosa bloodstream infections (PA-BSI) by being vigilant and by immediate intervention, that occurred in the neonatal intensive care unit (NICU) of a teaching institution and hospital in Dewas, India. Materials and Methods: The outbreak investigations included hunt for additional cases, evaluation of patient’s records, environmental and health care worker screening, immediate reporting to authority, and detection of source by minimal available aid i.e. quantitative antibiogram. Results: Health care worker screening samples were negative on culture for Pseudomonas aeruginosa and an environmental source was detected to be a curtain near washroom. Conclusion: This study described control of an outbreak of PA-BSI occurring over a week among neonates which was controlled following vigorous infection control measures. Quantitative antibiogram data should be routinely used for typing purposes as an essential part of hospital associated infection control procedure in source limited settings.

387-392

Authors: K. Vidyasagar*,T Nagarathnamma

Introduction: Catheter associated urinary tract infection (CAUTI) is most common nosocomial infection accounting for 40% of all institutionally acquired infections and is significantly associated with increased morbidity and health care costs. The study was undertaken to identify the incidence of CAUTI, the causative organisms and their antibiotic sensitivity and biofilm production by Escherichia coli in patients with urinary catheter for more than 24 hours. Materials and Methods: The study included 250 hospitalized patients who catheterized for more than 24 hours. The urine sample aspirated from the port of catheter and subjected to wet mount and Gram staining and inoculated on blood agar, MacConkey agar and CLED media by standard loop method. The isolates with significant counts (?102CFU/ml) were identified and antibiotic susceptibility testing was done by Kirby Bauer disc diffusion methods as per CLSI guidelines. Escherichia coli isolates were tested for biofilm production qualitatively by Tube method and Congo Red Agar method. Results: The present study showed CAUTI in 27.2% of the catheterized patients. Escherichia coli was the most common organism isolated (33.8%).The most effective antibiotics against Gram negative isolates were Imipenem (95.23%) and against Gram positive isolates were Vancomycin and Linezolid (100% each). 91.6% Escherichia coli isolates were biofilm producers. Conclusion: The Study showed that the duration of catheterization (?6 days) is the most important predisposing factor for developing CAUTI. Escherichia coli is the most common organism causing CAUTI. The high incidence of resistance to conventional antibiotic such as Ampicillin, Co-trimoxazole and Ciprofloxacin among the pathogens causing CAUTI.

398-403

Authors: R Vanaja,S Geetha Banu*

Introduction: The role of quantitative microbiology in the management of wound infections is very crucial. In this study semi-quantitative swab technique is used as a simple procedure for assessing the bacterial load of chronic non healing wounds, thereby distinguishing the patients with infected ulcers from colonized one, thereby restricting the use of antibiotics only to the appropriate infected population. Aim: To assess the role of semi-quantitative bacterial culture of chronic non healing wounds in differentiating between colonised and infected wounds based on bacterial load. Setting and Design: This is a cross sectional study carried out in the Department of Microbiology in a tertiary care government medical College. Materials and Methods: Two wound swabs were taken using sterile cotton swabs from 100 patients with chronic non healing ulcer wounds. Semi-quantitative aerobic bacterial culture was done. Results: Among 100 patients for whom semi-quantitative culture was done, 72 patients showed growth, of which 21 patients had poly-microbial growth making a total of 93 isolates. Out of the total 93 isolates, 73 isolates had a significant count of ?3+, hence considered as pathogens. The most commonly isolated pathogens were Staphylococcus aureus (24.6%) and Pseudomonas aeruginosa (24.6%). 55.5% were Methicillin resistant Staphylococcus aureus (MRSA). 65% of Enterobacteriaceae were ESBL producers and 15% were AmpC ?-lactamase producers. Conclusion: This study emphasizes the importance and benefits of semi-quantitative bacterial culture technique in differentiating between pathogens and colonisers and enable refinement of antibiotic regimens and thereby curbing antibiotic resistance.

408-414

Authors: Stephen K. Mathew

Scope: Vancomycin-resistant enterococci (VRE) are being increasingly reported from hospitals across the world. This study provides a profile of enterococcal infections and compares various methods of detecting vancomycin resistance. Materials and Methods: All clinically significant isolates of enterococci over a 2-year period were included. Antibiotic susceptibility was carried out as per CLSI guidelines. Vancomycin resistance was detected by 3 methods: disk diffusion, agar screen, E-test. The 3 methods were compared. Results: 156 clinical samples yielded Enterococcus spp. over the study period. Maximum resistance was noted to penicillin, erythromycin, and ciprofloxacin. E. faecium strains showed a higher percentage of resistance to the antibiotics tested. 15 (9.6%) enterococcal strains were resistant to vancomycin; 10 (6.4%) strains were intermediate. Compared to E-test, disk diffusion and agar screen had sensitivities of 100%. Disk diffusion had 97.2% specificity and agar screen demonstrated 92.9% specificity. Conclusion: Prevalence of VRE in Indian hospitals is increasing. Though disk diffusion had a higher specificity than the agar screen at identifying resistant isolates, intermediate strains were identified as sensitive. BHI agar containing 6 µg/ml of vancomycin can be used to screen for VRE, and E-test can be used to confirm resistance.

421-424

Authors: Arthi K,Deepa R*,Mangala A

Introduction: Quantitative Microbiology involves measurement of an absolute quantity of bacteria per unit of volume. The threshold to distinguish colonisation from infection is 105 CFU/g. Quantitative cultures are used in predicting the risk of post operative infection. Aim: To determine the role of quantitative bacteriology as a predictor of risk of infection in patients with open fractures. Materials and Methods: One hundred patients who had sustained open fractures of long bones were included in the study. During debridement before antiseptic wash, a piece of tissue (muscle/skin) was collected under aseptic precautions for quantitative culture. A quantitative count of ? 104cfu/gm was interpreted as significant microbial burden. These patients were followed up for 6 weeks for development of clinical signs of infection and two swabs were collected by Levine’s technique for semiquantitative culture. Results: The preoperative culture of the debrided tissue of 41% yielded a microbial load of ?104 cfu/gram among which 85.3% had 105 cfu/gram of microbial load. Polymicrobial growth was reported in 12.2% of patients. Postoperatively 39% developed signs of infection Seventy one percent of patients with 105 cfu/gram of microbial load in the preoperative period developed postoperative infection. All patients with polymicrobial growth in the preoperative debridement cultures with ?104 cfu/gm of microbial load, developed infection in the postoperative period. Conclusion: Quantitative Microbiology plays a precise role in predicting the risk of infection as it is valuable in estimating the bacterial bioburden. Polymicrobal etiology can lead to clinical infection if not managed effectively.

147-150

Authors: R Anupama, Anusha Balasingh

Lactobacilli are a group of bacteria that are ubiquitous and contribute to the normal microbial flora of human beings. They are Generally Regarded as Safe (GRAS) and are not lethal to host. Bacteriocins are ribosomally synthesized antimicrobial peptides produced by Lactic Acid Bacteria (LAB) that exhibit antagonistic activity against food contaminating microorganisms and inhibit similar or closely related bacterial strains. Hence, these bacteriocins are considered bio-preservative and are demonstrated as food preservatives, as therapeutics for veterinary and medicinal uses or as phytosanitary means for plant protection. The present study involved isolation of Lactobacillus species from dairy samples, purification of bacteriocin and the study of antagonistic activity against food borne pathogens. The study showed that purified bacteriocin exhibited inhibitory activity against Escherichia coli and Shigella flexneri.

154-157

Authors: K. Bharathi, Jeevan Malaiyan

Almost 70% of the myocarditis and dilated cardiomyopathy (DCM) cases are found to be caused by Enterovirus genus, the majority of these infections were caused by coxsackie virus B (CVB) group. There is no recent data available on extra-intestinal infection particularly myocarditis and DCM caused by this virus in south India. Presence of IgM antibody specific for CVB in myocarditis and DCM patients were detected using SERION ELISA. The prevalence of Coxsackie B virus among myocarditis and dilated cardiomyopathy patients was found to be 75.75% when tested using an immunoassay specific for IgM antibodies. The mortality rate among study population is found to be 6%

163-167

Authors: Nithya Lakshmi, Mohana Krishnan K., V. Darshine, Sumathi G.

Biofilm formation by respiratory pathogen favour their colonization, persistence and virulence. Cigarette smoke have the ability to cause induction and increase in biofilm formation. This quantitative in vitro study is aimed at understanding the dose-dependent change in the biofilm formation, which can be correlated to the degree of virulence of the respiratory pathogens. Materials and Methods:In the present study, 77 respiratory isolates of non-smokers were included. They were processed and exposed to varying concentrations of Cigarette Smoke Extract (CSE).Quantification of biofilm production was done according to the Microtitre dish biofilm formation assay. Fischer’s exact test was used to compare the biofilm production status. Results:We observed that 42[80.77%] isolates out of 52 biofilm producers and 12[48%] isolates out of 25 non-biofilm producers were found to show an increase in Biofilm index (BFI) with exposure to CSE. Among the total of 77 respiratory isolates, 32 isolates accounting for 41.57% [95% CI; 30.6% to 52.6%] showed a dose-related augmentation of biofilm formation on exposure to CSE. Interpretation and Conclusions:Progressive increase of biofilm with increase in concentration of CSE was the major finding. This emphasizes the need to initiate appropriate empirical therapy for smokers at the earliest.

171-173

Authors: Manali Shah, Ullas Bhabhor, Yogita Mistry, Summaiya Mullan

Introduction: Extra-pulmonary tuberculosis is a major public health issue with a significant cause of morbidity and mortality in developing countries. Diagnosis is difficult due to various clinical presentations and pauci-bacillary nature. The less number of tubercular bacteria at extra-pulmonary sites may cause diagnostic difficulty demanding for rapid, sensitive and specific test. Material and Methods:It was a 1 year retrospective study in tertiary care hospital. Different extra-pulmonary samples received by laboratory were included in the study. Microscopy by ZN stain, culture on Lowenstein-Jensen media and RT-PCR on ABI 7300 was performed after decontamination of the samples using 4% NaOH and 2.9% sodium citrate. Results:Total 300 extra-pulmonary samples were tested. 122 samples were positive by either method. Sensitivity of PCR was 59%. ZN microscopy and culture method showed 46% and 48% sensitivity respectively. Tubercular bacilli were isolated were mainly body fluids, pus and endometrial biopsy. The most common age group affected was 20-29 years. Conclusion:PCR is still a good diagnostic tool for extra-pulmonary tuberculosis even if CBNAAT is available. Even more comparative studies should be done between different molecular methods, so that in future the best option for diagnosis of extra-pulmonary tuberculosis without much more false negative results will be available

179-183

Authors: Sanjeev H, Abhay Kumar, K. Snehaa3, Amit Banik, Amber Prasad

Acinetobacter, gram negative coccobacillus, has become a frequent pathogen in hospitals and other health care settings. Acinetobacter species cause a wide variety of illness in debilitated and hospitalized patients especially in intensive care units (ICU). Carbapenems constitute the backbone of treatment of complicated Acinetobacter infections. However, resistance to Carbapenem is established and observed globally, leading to limited therapeutic options. The study was designed to understand the extent of resistance in Acinetobacter species in our hospital which is located in an island separated from mainland India. Isolates showing resistance to either Imipenem (IMP) and/or Meropenem by disc diffusion method was considered as Carbapenamase producing and further subjected to identification by phenotypic methods. Of the 160 isolates, 111 were resistant to either Imipenem and/or Meropenem. The susceptibility patterns of antibiotics tested suggests high resistance to 3rd/4th generation Cephalosporins (CTR 93.7%, CAZ 88.29%, CPM 85.59%) and least resistance to Colistin and Polymyxin B. MHT alone was positive in 66.98% isolates suggesting production of OXA type class D ?-lactamase and DDST alone was positive in 7.55% isolates suggesting production of Metallo-?-lactamase /Group B ?-lactamase. The present study adds to the literature available in respect to increasing instances of Carbapenem resistance and their presumptively mechanism of resistance

188-193

Authors: Amit Pandey, Ankita Srivastava, Niharika Chandra, Dheerendra Kumar, Sunil Kumar

The search for new bioactive compounds from the natural environment has rapidly been gaining momentum with the increase in multi-drug resistant (MDR) pathogens. In the present study, the antimicrobial potential of new bacterial species has been evaluated by initial screening of fourteen soil samples. Primary and secondary screening was performed against Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa. Four active isolates were selected for further study. Microbial strains were identified on the basis of growth conditions and other biochemical characters. One most active microbial strain was identified using 16S rRNA sequence homology and designated as Bacillus cereus (C13). Furthermore the production of secondary metabolites was done in optimized production media and the analysis involved HPLC method to identify metabolites based on retention time where 2.833 min retention time obtained using C18 column at 265 nm wavelength, which is similar to valinomycin antibiotic which is also secreted by Streptomyces griseus. It shows presence of bioactive secondary metabolites which is responsible for antibacterial activity of bacterial isolates

198-201

Authors: Shweta Sharma, R K Agarwal, Barnali Kakati

Introduction: The non-fermentative Gram negative bacilli (NFGNB) are a group of aerobic, non-spore forming, Gram negative bacilli that either do not utilize carbohydrates as a source of energy or degrade them through metabolic pathways other than the fermentation. Material and Methods:The study was undertaken to identify various non- fermenters isolated from patients in our hospital, a Tertiary Care Center at Uttarakhand. 252 (14.15%) non-fermenters were isolated from 1780 clinical specimens on MacConkey and blood agar plates incubated at 35°C for 24-48 hours. Any growth that was identified as non-fermenters by Vitek-2 was subjected to identification by additional conventional tests. Results and Conclusion: Patients mostly belonged to age group of 51 to 70 years and were commonly male. Sputum & ET secretion were the commonest samples. Psuedomonas aeruginosa was the commonest isolate followed by Acinetobacter calcoacetecus baumanii complex. Out of total 252 isolates, 221(87.69%) could be accurately identified upto species level by conventional tests. The conventional tests could identify 243 (96.42%) isolates upto genus level. Majority of them showed multidrug resistance. The most effective antibiotics were Tigecycline and Polymyxin B/ Colistin

208-212

Authors: Sharanya K, Sindhu Cugati, Chitralekha Saikumar

Introduction: Klebsiella is an important opportunistic pathogen that is found to be the causative of hospital acquired pneumonia, urinary tract infections, skin and soft tissue infections and bacteremia. It has developed resistance to most of the currently used antibiotics and even resistance to higher antibiotics like carbapenems is on the rise. Hospital acquired infections caused by multidrug resistant strains of Klebsiella species are associated with high rates of morbidity and mortality. Aim: To assess the diversity and state of resistance of K. pneumoniae to antibiotics in a tertiary care centre. Materials and Methods: Klebsiella strains were isolated from clinical samples received in microbiology laboratory in a tertiary care centre and were identified by standard biochemical techniques. 368 Klebsiella strains were included in the study. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion method following CLSI guidelines. Quality control was performed by using standard strain E. coli ATCC 25922. Results: 13.16% of strains isolated from clinical samples were found to be Klebsiella species. Out of 368 Klebsiella strains 42% were resistant to Ceftriaxone, 46% to Cotrimoxazole, 52% to Amoxycillin-clavulanicacid. Resistance to Meropenem & Piperacillin-Tazobactum was 10% & 12% respectively. Conclusion: Detection of drug resistance mechanisms, formulation of a good antibiotic policy and a proper antibiotic stewardship program should be incorporated to combat emerging multidrug resistance which is a global threat.

218-223

Authors: Wagh Kailash B., Ghule Shubhangi B., Karande G. S., Mohite S. T.

Introduction: Discharging otitis media with superadded fungal infection is now become major otolarynological problems in India commonly seen in children and also in adults. The incidence has been increased in proportion to the wide spread use of topical antibiotics aural preparations. Materials and Methods: Total 176 patients belonging to all age groups and both sexes(128 – male and 48 – female) were included. All were prediagnosed cases of discharging otitis media enrolled in the study. Results:Out of 176 cases, 106 cases (76-male, 30-female) belong to acute suppurative otitis media (ASOM) and 70 cases (52-male, 18-female) belong to chronic suppurative otitis media (CSOM). In mycological profile of both type of otitis media acute and chronic, 10 fungus isolated, 9 isolates were in chronic suppurative otitis media, of which 6 were of Aspergillus species and remaining 3 were belong to Candida isolates. Only one isolates of Candida albicans was seen in acute suppurative otitis media. Conclusion:We found that majority of the patients of chronic suppurative otitis media with superadded fungal infection as compared to acute suppurative otitis media.

229-235

Authors: Nirbhavane H M, Bagde U S

The aim of this study was to understand the mechanism of resistance towards the heavy metal Lead and Nickel using resistant and sensitive Enterobacter spp. The cellular biochemistry of this microorganism was checked with the help of estimations of dehydrogenases activity, and at the molecular biology level determination of Lead and Nickel resistant plasmid through Agarose gel Electrophoresis. The Minimum inhibitory concentration (MIC) determined was 100 ppm (Lead) and 50 ppm (Nickel) in sensitive Enterobacter spp. that completely inhibited the growth, and activity of dehydrogenases of the TCA (Tricarboxylic Acid) cycle. The tolerance level of Lead and Nickel in the resistant Enterobacter spp., were found to be 300 ppm and 200 ppm respectively. Mechanism of resistance was found to be the presence of the resistance plasmid

240-243

Authors: Elanithi K, Kavitha E, Joshy M Easow

Introduction: The aim is to isolate and to identify Staphylococcus aureus from the nasal swabs of the health care workers and screen for the mupirocin resistance among the isolated Staphylococcus strains. Materials and Methods: Present study is a prospective type of study. A total of 100 nasal swabs were collected from health care workers. All the nasal swabs were cultured on MacConkey and Blood agar. Isolated organisms were subjected for antibiotic susceptibility testing by Kirby-Bauer disk diffusion method. Results: Among the 100 nasal swabs, Staphylococcus spp. was isolated in 100 (100%) samples which comprised of 13 (13%) Staphylococcus aureus isolates and 87(87%) were Coagulase negative Staphylococcus. Of 13 Staphylococcus aureus isolates, 7 (53.84%) and 6 (46.15%) were detected as Methicillin Resistant Staphylococcus aureus and Methicillin Sensitive Staphylococcus aureus respectively. None of S.aureus isolates was resistant to mupirocin. Low level mupirocin resistant (MupL) was seen in 10 (30%) of Methicillin Resistant Coagulase negative Staphylococcus and 5 (14.7%) in Methicillin Sensitive Coagulase negative Staphylococcus isolates, respectively. High level mupirocin resistant (MupH) was seen in 4 (12%) of Methicillin Resistant Coagulase negative Staphylococcus and 4 (12%) of MRCoNS and MSCoNS isolates, respectively. Conclusion: Mupirocin is a potent antibiotic to treat the nasal carriage of S. aureus. As resistance to mupirocin both low and high level is on rise, it is a matter of great concern. Policies and guidelines should be framed to create awareness among the health care workers regarding the screening methods for the detection and treatment of nasal carriage

249-251

Authors: Swarooparani N.B., Mita D. Wadekar

Introduction: Recently, Salmonella Typhi resistance to many of the commonly used antibiotics like chloramphenicol, amoxicillin and cotrimoxazole, has posed a challenge to treat enteric fever. Minimum inhibitory concentration (MIC) of ciprofloxacin is increasing which is responsible for both treatment failure and causing serious complications. Resistance to nalidixic acid can be used as an indirect indicator to detect increased ciprofloxacin MIC. Hence, study was conducted to know the antibiotic sensitivity pattern of Salmonella enterica serovar Typhi with special reference to nalidixic acid resistance. Materials and Methods: A retrospective study of S. Typhi isolates was conducted. 106 blood samples from patients of all age group who were clinically suspected of enteric fever were included. Blood culture was done and S. Typhi isolates were identified and tested for susceptibility to ampicillin, chloramphenicol, cotrimoxazole, ciprofloxacin, ceftriaxone and nalidixic acid by disc diffusion method. Result: 22(20.8%) S. Typhi isolates were isolated from 106 blood samples. Chloramphenicol showed 100% sensitivity. Susceptibility to ampicillin (81.8%), cotrimoxazole (81.8%) and ceftriaxone (90.9%) was high and to ciprofloxacin (72.7%) and nalidixic acid (45.5%) was low. Conclusion:Ampicillin, chloramphenicol, cotrimoxazole and ceftriaxone showed maximum sensitivity and hence can be used for effective treatment. Nalidixic acid resistance was very high and all these resistant isolates showed decreased sensitivity to ciprofloxacin. Hence nalidixic acid sensitivity can be used for the detection of decreased susceptibility to ciprofloxacin

258-265

Authors: Raja Sundaramurthy, Rajendran Tiruvanamalai, Swetha T. Sivaraman, Ramesh Arunagiri, Jhansi Charles

Aims: Urinary tract infections (UTI) is the most common infection seeking medical attention. Most of UTI cases were treated empirically with broad-spectrum antibiotics which invariably resulted in development of resistance even to carbapenem. Fosfomycin has broad spectrum of activity which may be useful against these resistant pathogens. Study aims to address microbiological profile, susceptibility pattern of UTI pathogens and fosfomycin susceptibility against all urinary isolates of Escherichia coli (E.coli) Methodology and Results:All urine samples received in our central laboratory over a period of 2 months (May-June 2017) which showed significant growth were included in the study. After getting the written informed consent, data was collected using a questionnaire regarding demographic and clinical details. In vitro susceptibility of fosfomycin carried out for all E.coli. Among 1280 samples, only 156 (12.2%) yielded significant growth which emphasises the importance of urine culture for definite diagnosis of UTI. Females and >50 years of both gender showed higher prevalence. Majority of cases from medicine ward (41.7%) and ICU (23.1%) with diabetes (55.1%), catheter (34.6%) was common predisposing factor. E.coli (63.2%) was the predominant organism followed by Candida (11.6%) which has become an emerging threat. Higher resistance pattern seen with catheterised group. 40.4% were extended spectrum beta lactamase (ESBL), 12.8% inducible AmpC and 29.8% carbapenamases producers. All E.coli isolates including ESBL, carbapenamase producers showed susceptible to fosfomycin. Conclusions:Study emphasis evidence based practice is the need of hour to combat with raising resistant pattern. Fosfomycin shown promising results to all ESBL and carbapenamase producing E.coli.

271-274

Authors: Siddabathuni Aruna

Faecal carrier rates of extended spectrum beta lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae were analysed in 138 inpatients, 126 outpatients and 216 healthy individuals. Overall faecal carriage of these ESBL producing organisms was found to be 24.2% (116 out of 480 samples). The frequency of carriage was higher among inpatients (42.03%) followed by outpatients (29.37%) and healthy subjects (9.72%). Among ESBL producers E.coli was the predominant isolate. The present investigation suggests circulation of ESBL producing organisms both in the hospital environment and community

280-283

Authors: Rajeswari Pilli, Vamsi Chakradhar Kapaganty

Introduction and Objectives: Escherichia coli and Klebsiella pneumoniae are major uropathogenic isolates producing Extended spectrum beta lactamases (ESBL) which confer high resistance to common antibiotics. This study was done to know the antibiogram pattern of ESBL producing isolates from urine samples. Materials and Methods: Culture and Antibiotic susceptibility tests (AST) were done from midstream urine samples (MSU) collected from patients. AST was done by Kirby-Bauer disc diffusion method and the isolates resistant to ceftriaxone and cefotaxime were subjected to phenotypic double disc diffusion test as per CLSI guidelines using cefotaxime (30?g) disc alone and cefotaxime plus clavulanic acid (30/10?g) combined disc for confirmation of ESBL production. Results: Out of 726 urine samples, 172 showed significant growth. Among 172 isolates, klebsiella species(10.4%).Total ESBL producers among these isolates were 68 (39.5%). Of which 63(92.6%) E.coli and 5 (7%) Klebsiella spp. These ESBL producing E.coli showed maximum resistance to Ampicillin and sensitivity to Nitrofurantoin. Similarly Klebsiella spp. showed maximum resistance to Ampicillin and sensitivity to Amikacin. These ESBL producing E.coli & Klebsiella spp. were also minimally resistant to Meropenem, about 14% and 20% respectively.most predominant isolate was Escherichia coli (81%) and then Conclusion: ESBL producing E.coli was high among uropathogens and most of them were highly resistant. So antibiotic sensitivity testing should be routinely done in order to prevent antibiotic resistance and treatment failure. Treatment should be followed according to the local antibiogram to specific ESBL producing isolates.

288-289

Authors: Awadhesh Kumar, Chinmoy Sahu, Avinash Singh, Kashi Nath Prasad, Tapan K. N. Dhole

Chryseobacterium indologenes is a non-motile, catalase-positive, oxidase-positive, indole-positive, non-glucose-fermenting Gram-negative bacillus that produces yellow coloured colonies on routine culture media. As common environmental saprobe, it is a known colonizer of inanimate objects in the hospital environment. Chryseobacterium indologenes is an emerging .pathogen of nosocomial origin in background of increased use of higher antibiotics. In the present study, positive blood cultures bottled from critically ill patients suspected of nosocomial sepsis were inoculated on routine bacteriological media for a period of six months. The identity and antibiotic sensitivity of Chryseobacterium indologenes were confirmed by Phoenix automated system® followed by automated MALDI-TOF system and Pulsed Field Gel Electrophoresis (PFGE) typing. All the patients had underlying morbidities (7 out of 7 patients). Phoenix automated system and MALDI-TOF system correctly identified the bacterial isolates. We reiterate the fact that levofloxacin should be the first choice of antibiotic in Chyrseobacterium indologens infections followed by cefoperazone + sulbactam. All the isolates were of different clonality as determined by PFGE. To our knowledge, this is the first report on the identification of Chrysobacterium indologenes isolates using automated system, MALDI-TOF and PFGE in India. So, in ICUs of tertiary care centers, where higher antibiotics are used, this bacteria can be an important cause of nosocomial bacteremia.

1-6

Authors: Aaftab G.P, Asha B Patil, Shobha Medegar.

Introduction: Extended spectrum β-lactamase (ESBL) and AmpC producing organisms pose unique challenges to clinical microbiologists, clinicians, infection control professionals. The objective of the present study was to analyze the risk factors that will help in identifying those at risk of acquiring infection by ESBL and/or AmpC producing organisms thereby making appropriate changes in the choice of antimicrobial therapy and minimizing treatment failures. Materials and Methods: Risk factors were evaluated using a retrospective Case control design. 100 patients with infections due to ESBL and/ or AmpC producing E.coli or K. pneumoniae were employed as cases. These were matched with 100 patients with non ESBL- non AmpC producing organisms (Controls). Univariate and Multivariate logistic regression analysis was performed to identify variables associated with becoming a case. Results: Out of the total 100 cases, E.coli 61 (61%) was the predominant ESBL and/or AmpC producer, followed by Klebsiella pneumonia 39 (39%). In the multivariate analysis, we found that duration of hospital stay for more than 5 days (OR=0.16, P=0), stay in ICU (OR=2.98, P=0.02) and prior treatment with antibiotics (OR=2.81, P=0.003) were statistically significant risk factors associated with acquisition of ESBL/AmpC producers. We also found invasive procedures like usage of urinary catheter (OR=3.34, P<0.005), central venous catheter (OR=3.35, P=0.018), intravenous catheter (OR=7.38, P<0.005) and other surgical procedures (OR=3.14, P=0.0002) contributed significantly to the spread of ESBL/AmpC producers. Conclusion: ESBL and AmpC producing strains were found to show higher rates of resistance to various class of antibiotics when compared to non ESBL and AmpC producers. Knowledge on risk factors of infection helps physicians in framing appropriate empirical antibiotic policies.

14-19

Authors: Jaya Lalwani, Riddhi Hathiwala, Pavan Pandey.

Introduction: Irrational use including non-compliance with prescribed antibiotics is most crucial determinants for the emergence and spread of antimicrobial resistance. The aim of the present study was to assess the prevalence of ‘unused’ antibiotics among households. Materials and Methods: A cross-sectional study was conducted among 2400 households of District Bhopal, Madhya Pradesh using a structured questionnaire. Descriptive statistics were used to describe the study results. Results: The prevalence of unused antibiotics among surveyed households was 17.9%. Most common age group for which unused antibiotics were initially prescribed was 0-5 year of age. The major source of unused antibiotics was a public hospital (59.9%), followed by self-medication (29.6%). A total of 1,470 tablets/capsules of antibiotics were found lying unused in the surveyed homes. Conclusion: Non-compliance with prescribed medicines and self-medication of antibiotics is a troublesome problem. More sophisticated research is needed to evaluate factors involved in the irrational use of antibiotics.

24-30

Authors: Charu Kaushik, Namratha Kurunji Gangadhar, Subrahmanya Bhat K., Subbannayya Kotigadde.

Introduction: Urinary tract infection (UTI) is one of the important causes of morbidity in the community.Development of antibiotic resistance among uro-pathogensposeproblem in the treatment of UTI.Hence it is essential to examine the prevalence of such uro-pathogens and study theiranti-biogram. Materials and Methods: Bacteria isolated from midstream urine samples collected aseptically from 266 patients over a period of 6 months from November 2016 to April 2017 were identifiedbystandard microbiological procedures. Anti-biogram was done by Kirby–Bauer disc diffusion method and interpreted as per the CLSI guidelines. Result: Out of 266 urine samples, 136 (51.12%) were found to be positive for microbial isolates, of which 96 (71.3%) samples were from females and 40 (29.4%) samples were from males. Escherichia coli was the predominant organism (47.05%) followed by Pseudomonas species (13.2%), Enterococcus species (11.7%), Klebsiella species (7.3%), Citrobacter koseri (4.4%) and Proteus species (2.9%). Enterobacteriaceae shows highest sensitivity towards nitrofurantoin (86%), amikacin (68%) and gentamicin (59%) and resistance towards norfloxacin (74%). Sensitivity of Pseudomonas spp was 72.2% for piperacillin/tazobactam, 44.4% for amikacin and 66% resistance to ceftazidime. Sensitivity pattern of Enterococci spp to nitrofurantoin 96.6%, aminoglycosides 78%, and fluroquinolones 50%. An attempt was made to study ESBL production among Enterobacteriaceae members. The isolates were 54.4% multidrug resistant (MDR) and 38.8% were ESBL producers. Conclusion: In our study E.coli was the most common uropathogen isolated. Patterns of antibiotic resistance in a wide variety of pathogenic organism were noted. To prevent the development of resistance, periodic evaluation of antibiotic susceptibility patterns is necessary.

38-43

Authors: Arunagiri Ramesh, Anand B Janagond, Sundaramurthy Raja, Sorakka Pandurangan Gobinathan, Jhansi Charl.

Introduction: Catheter-associated urinary tract infections (CAUTI) being the commonest hospital-acquired infection (HAI) [40%], its burden, aetiology along with antibiotic susceptibility is essential to implement and monitor an effective infection control program. Aims: To assess the incidence and rate of CAUTI in a tertiary care hospital and to identify the common organisms and their antibiotic sensitivity pattern. Settings and Design: Prospective hospital based observational study was carried out in a tertiary care hospital in South Tamilnadu for a period of 2 months (June 2016 to July 2016) after obtaining the Institutional Ethics committee approval. Materials and Methods: Total of 100 catheterized adult ICU patients were observed for signs of UTI on a daily basis. On clinical suspicion of UTI, urine sample was analysed microbiologically. CAUTI among various gender and age groups; pathogenic isolates, antibiotic sensitivity pattern and associated co-morbid conditions were expressed as percentages Results: Incidence of CAUTI was 16/100 catheterization. Device utilization ratio was 0.72. CAUTI rate was 36.2/1000 catheter days. CAUTI was commonly seen among patients with >80 years, females with altered sensorium. Diabetes mellitus (35.7%) was the most common comorbid condition followed by TB (25%). Risk of CAUTI after 3-5 days of catheterization was 11.7% and proportionately increased with prolonged catheterization (100% if >20 days). Escherichia coli (37.5%) followed by Candida Spp. (25%) were common pathogens among 3-5days of catheterization. Pseudomonas Spp. was the commonest isolate after one week of catheterization. Imipenem, colistin resistance was highest among pseudomonas. Conclusions: CAUTI rate was higher than the benchmark set by NHSN (0-4). Appropriate health education, strict infection control practices, appropriate antibiotic policy, proper guided bundle care of catheter are need of the hour to prevent the CAUTI.

47-51

Authors: T. S. Shailaja, A. Mohan Kumar, Rajan J. Payyappilly.

Introduction: Antimicrobial resistance (AMR) is a global menace of recent times which does not spare the uropathogenic bacteria also. We aim to study the changes in bacteriological profile and antibiotic resistance pattern among the bacterial isolates of Urinary tract infections (UTI) in a multi-centric study from two different tertiary care hospitals located in rural parts of Kerala in two different time periods. Materials and Methods: First study was conducted from Jul 2008 – Jun 2009 and the second from May 2016 - Apr 2017. Results: Total numbers of urine samples processed in the first and second study are 3262 and 3772, of which 1096 and 1265 respectively showed significant bacteriuria. The predominant isolate is E.coli in both, with a percentage of 50.8 and 48.9 respectively followed by Klebsiella sp. and Enterococcus sp. There is a marked increase in the resistance rate of E.coli to cefotaxime, piperacillin tazobactam and imipenem. In case of first line drugs, there is a minimal fall in resistance rate except for ciprofloxacin. Similarly for aminoglycosides there is no significant increase in resistance. Conclusion: The high prevalence of resistance to empirical drugs has long been appreciated in this area which precludes their use. Resistance to higher antibiotics also is on the rise. Very high rate of AMR is exhibited by the bacterial agents of UTI even in rural areas which necessitates routine culture and sensitivity mandatory in all cases. In order to stop this growing menace, judicious use of antibiotics has to be implemented.

57-60

Authors: Monika Sekar, Swapna M., Joshy M Easow.

Introduction: Health care workers (HCWs) are constantly associated with generation, segregation and disposal of biomedical wastes (BMW). Knowledge, attitude and practice (KAP) of BMW management among HCWs are the three determinants used to evaluate the effective functioning of BMW management system of the Institution. Aims: This study aims to detect the degree of knowledge, attitude and practice of BMW management among HCWs in a tertiary care hospital. Materials and Methods: This study included 150 HCWs from five groups (postgraduates, interns, nurses, technicians and sanitary staffs), each group comprising of 30 individuals. They were instructed to tick their response in the questionnaire containing 30 questions (10 questions about each parameter) and were graded as good, average and poor based on individual score. Results: Order of decreasing knowledge and practice seen among the five groups was postgraduates followed by laboratory technicians, interns, nurses and sanitary staffs. Decreasing order of attitude was postgraduates, interns and laboratory technicians with same score, followed by nurses and sanitary staffs. In our study, 81.33%, 86.7% and 69.33% of participants had above average KAP values respectively. Conclusion: Postgraduates and interns had better understanding of BMW management than other groups. Laboratory technicians were better than nurses and sanitary staffs. Sanitary workers were highly ignorant regarding BMW management. So a continuing medical education program on BMW management should be conducted on yearly basis to train and update newly appointed as well as existing HCWs.

66-70

Authors: Anna Cherian, Jyothi R..

Introduction: Acanthamoeba keratitis (AK), a potentially devastating disease is caused by free-living amoebae of the genus Acanthamoeba . The number of reported cases worldwide is increasing year after year, mostly in contact lens wearers as also in non-contact lens wearers. Interestingly, AK has remained significant due to an incomplete understanding of the pathogenesis and pathophysiology of the disease, diagnostic delays and problems associated with chemotherapeutic interventions. Corneal blindness is a major public health problem worldwide and infectious keratitis is one of the predominant causes. Aim: To find out the Parasitic Etiological Agents in Suppurative Keratitis at a tertiary eye care referral centre in South India. Materials and Methods: A hospital based study was done on total of 350 cases of keratitis, during the period from January 2013 to December 2013 .The samples were examined as wet mount as well as cultured onto Non nutrient agar with E.coli overlay. Result: Acanthamoeba species were isolated from 314 cases. Most of the corneal ulcers responded well to treatment which was started early in their course due to early detection of the parasite by direct microscopy and confirmation by culture.

76-79

Authors: Mahesh Kumar Shankar, Sharon V. A..

Introduction: Worldwide, the most common type of acute viral hepatitis is hepatitis A, transmitted via the fecal-oral route occasionally leading to death due to acute fulminant hepatitis. The present study was undertaken to study the seroprevalence of HAV infection in a tertiary care hospital over a five year period. Materials and Methods: A cross-sectional study was conducted from January 2012 to December 2016 on samples of blood obtained from cases of clinically suspected hepatitis infection by IgM 'capture' assay ELISA. Results: A total of 173 cases were included in the study. The number of positive cases were 35(20.2%). The percentage positivity rate of anti HAV IgM was higher among the children tested 32(30.8%) when compared to adults tested 3(4.3%). Seasonal distribution showed maximum number of seropositive cases in the monsoon months. Conclusion: Increase in the number of samples received during 2014 and 2015 and a zero positive rate in 2015 indicates a rise in the awareness about preventive measures against hepatitis A virus infection. Uniform and well structured protocols which monitor HAV cases and assess disease load are necessary to capture and probe into the sudden rise in the seropositivity, as seen in the last four months of 2016 in this study.

84-86

Authors: Sudheendra Kulkarni, B. V. Peerapur.

Introduction: Urinary tract infection (UTI) due to Escherichia coli (E. coli) is a common health problem among women. Pregnant women are at increased risk from both symptomatic and asymptomatic UTI because of the physiologic changes associated with pregnancy which may cause complications such as pyelonephritis, chronic renal failure, premature delivery and foetal mortality. Our study aimed to check the prevalence of asymptomatic UTI due to E. coli and its antibiotic profile among pregnant women of Bidar district of North Karnataka, India. Materials and Methods: An independent study was done from January to February 2015 to investigate asymptomatic UTI among pregnant women attending Antenatal care clinic (ANC) of Bidar Institute of Medical sciences (BRIMS) Teaching hospital Bidar. 150 mid-stream urine samples were processed for culture and antimicrobial drug susceptibility testing at Department of Microbiology, BRIMS, Bidar as per the routine microbiological techniques. Diagnosis of UTI was made when there were at least 105 colony forming unit (CFU)/ml of urine. Isolates other than E. coli are not considered for this study. Results: Among 150 samples tested, 65 samples grown E. coli with colony count of 105 CFU/ml of urine. (43.33%).The Majority of pregnant women were in their 2nd and 3rd trimester and the mean age of study population was 23.46. The rate of UTI was highest among age group of 20-25 years. E. coli isolates showed highest resistance to antibiotics Ampicillin (96.92%), Cefuroxime (55.38%) and ceftriaxone (53.85%). It was uniformly sensitive to routinely used drugs for treatment of UTI. Discussion: Many Gram negative and Gram positive organisms including Yeast cause UTI in pregnant women. Our study revealed the high prevalence of asymptomatic UTI among pregnant women due to E. coli in Bidar (43.33%) as compared to studies conducted in other parts Karnataka. This study also showed the antibiotic profile of E. coli to different drugs tested and showed highest resistance to Ampicillin. Conclusion: Asymptomatic Bacteriuria in pregnant women due to E. coli is relatively higher in Bidar district and it showed resistance against commonly used antimicrobial agents. Hence it is strongly recommended to undertake routine urine culture in pregnancy and provide appropriate treatment to reduce its complications.

92-95

Authors: Meerah Srinivasagam, Vijayalakshmi Arumugam, Rajeswari Jayakumar.

Introduction: Scrub typhus is a disease caused by Orientia (Rickettsia) tsutsugamushi which belongs to Rickettsiaeceae family. Early diagnosis of Scrub typhus is important because timely anti-microbial therapy may help an excellent response and prevent complications. Serology is widely used for diagnosis of scrub typhus. The Aim of this study isto detect the IgM antibodies by Capture Enzyme linked immuno sorbent assay (ELISA) and Weil –Felix agglutination test against Scrub typhus and to compare the results of IgM ELISA with Weil – Felix test. Materials and Methods:Total of 723 blood samples were collected from clinically suspected Scrub typhus patients. IgM ELISA (commercial) and Weil –Felix agglutination test for Scrub typhus were performed on all serum samples. Results: Among 723 patients, 31(4.2%) showed positive by Weil-Felix test against OX K antigen and 43 (6%) showed positive by IgM ELISA. Among 43samples which were positive by IgM ELISA, 13(1.8 %) showed negative by Weil-Felix test. Out of 31samples positive by Weil-Felix test, one sample showed negative by IgM ELISA. The sensitivity of IgM ELISA and Weil –Felix agglutination test is 96.77% and 69.76 % respectively. Conclusion:Early diagnosis and treatment will prevent complications of Scrub typhus. This study has found out the IgM ELISA is highly sensitive and dependable for diagnosis of scrub typhus than Weil –Felix agglutination test.

100-105

Authors: Sodani Sadhna, Hawaldar Ranjana.

Introduction: Respiratory tract infections (RTI) are one of the most common cause of infections and are responsible for loss of working hours in affected individuals. Many newer antibiotics have been introduced to treat these infections whose sensitivity pattern is still not clearly understood due to paucity of published data in this regard.Several studies have been published in different parts of the world but still there are limited data from Indian subcontinent. The present retrospective study was carried out in microbiology department of our diagnostic centre with the aim of analyzing the various causative bacteria of CAP and to study their antibiotic sensitivity pattern. Materials and Methods: The present retrospective study of sputum cultures was carried out between July to September 2017 in the microbiology department of our diagnostic centre. A total of 100 sputum samples collected from patients of all ages and both sexes were included in the study. Sputum samples were collected in wide mouth, sterile containers by standard protocols. Gram’s staining and Zheil Neelsen staining for acid fast bacilli was done after inoculating the specimen on Blood and MacConkey Agar plates. Results: There were 68 males and 32 females with a male to female ratio of 2.1:1. Maximum 23% patients were in 61-70 years age group followed by 15% each in 41-50 and 51-60 years age group. 3% patients were above 80 years of age. Normal bacterial flora was grown in 71% cases. Growth of pathogenic bacteria was observed in 29% cases. Klebsiella pneumoniae was the most commonly isolated micro-organism accounting for 13% cases. Staphylococcus aureus was isolated in 6% cases followed by Pseudomonas aeruginosa in 3% and 2% each of Enterococcus, E.coli and Candida species. Conclusion: The role of sputum culture has for long been debatable and is limited by the fact that it is difficult to obtain a deep cough specimen in paediatric and geriatric patients .However, epidemiological value of sputum cultures as a tool in providing information about microbiological profile and antibiotic sensitivity pattern in different geographical areas of the world cannot be underestimated.

110-114

Authors: Prakash H. Waghmare, Shalaka S. Rudrakshi, Kishor V. Ingole, Rashmi S. Bawane, Sadiya V. Shaikh.

Asymptomatic bacteriuria leading to urinary tract infection is the most frequently encountered condition in pregnancy, which has been associated with an increased risk of pre-term delivery and low birth weight. Clinically the diagnosis of UTI can be difficult as symptoms are non-specific. Gold standard method for diagnosis of UTI is urine culture. Up to 18 hours are required for bacterial growth on culture media by standard laboratory techniques, which leads to delay in the treatment. In the present study 100 midstream urine samples from asymptomatic pregnant women were collected. Gram staining, Griess Nitrite Test, Triphenyl tetrazolium chloride test (TTC), Catalase test, these four screening tests were performed on the samples and their results were compared with the results of urine culture. Among these 100 samples, the study revealed that 14 pregnant women had significant bacteriuria (1,00,000 or more bacteria/ ml of urine) giving a prevalence of 14%. This study showed that Gram staining has highest sensitivity i.e. 92.85% and TTC has highest specificity i.e. 98.83% for the detection of significant bacteriuria. To conclude if we perform these two tests in combination then we get a sensitivity of 98.97% and specificity of 94.22% which is not 100% but very close to it. Use of these screening tests will help in early diagnosis and initiation of treatment of UTI in pregnant women.

119-125

Authors: Sumaira Qayoom, Mariraj Jeer, Muzaffar Amin, Talat Masoodi, Syed Khurshid.

Objective: To find out the bacteriological profile of post burn infections in wound. Place and duration of study: Vijayanagar institute of medical sciences, ballari, over a period of one year from 1st January 2014-31st December 2014. Study design: Prospective Materials and Methods: Swabs were collected from the burn wounds using standard methods and cultured for the growth of the bacteria.The organisms isolated were identified by standard microbiological methods following which antimicrobial susceptibility test was done by Kirby-baeur disk diffusion test. Results: The predominant organism isolated from swab culture was Pseudomonas aeruginosa(23%), followed by Staphylococcus aureus(22%), E.coli(14%), K.pneumoniae(9%), K.oxytoca(8%), CONS(7%), Proteus mirabilis(5%), C.freundii(4%) and C.koseri(3%),others(3%) and sterile culture(3%).The antibiogram of Pseudomonas aeruginosa showed high susceptibility to Imipenem( 81%) Piperacillin/Tazobactam (78%), Amikacin(76%), Ceftazidime(60%) and low susceptibility to Gentamicin(57%), Tobramycin(57%), Cefotaxime(47%), and Ceftriaxone(39%).Total resistance pattern was noted in Ampicillin, Cotrimoxazole, Ciprofloxacin.

132-137

Authors: Vinoba S., Rashmi K. S..

Introduction: Metallobetalactamase producing Acinetobacter species has been reported to be an important cause of nosocomial infection and is a critical therapeutic problem worldwide, especially in the intensive care unit. Objectives: To determine the frequency of metallo‐β‐lactamases among imipenem‐resistant Acinetobacter species and to compare different phenotypic methods. Materials and Methods: 59 imipenem‐resistant Acinetobacter species isolated from various clinical samples were tested for metallo‐β‐lactamase production using different phenotypic methods. Minimal Inhibitory Concentratrion (MIC) to meropenem was determined by E test. Results: Of all the imipenem resistant isolates, 50.8% of Acinetobacter species were MBL producers. MIC of all those MBL producing isolates were ≥ 16μg/ml. Among the Acinetobacter species MBL production were detected in 30 isolates (50.8%) by E test, 29 isolates (49.2%) by CDT and in 15 isolates (25.4%) by DDST and DPT. The sensitivity and specificity of CDT, DDST and DPT compared to E test was 98%, 48.1%, 48.1% and 100%, respectively. Conclusion: Prevalence of MBL producing Acinetobacter species is being increasingly reported in ICU patients. The MIC of all the MBL producing isolates for meropenem were >16μg/ml (Resistant). E test and CDT were more reliable for MBL detection. CDT was cost effective, easy to perform and interpretation also straightforward. MBL producing isolates were multidrug resistant making therapeutic choices limited. Continuous antibiotic surveillance, infection control practices and an effective antibiotic policy are required to address the problem of MBL – associated infections.

143-146

Authors: Sunayana M. Jangla, Susan Cherian, Raji Naidu.

Introduction: Tuberculosis (TB) causes severe morbidity and mortality in millions of people every year, worldwide and India in particular. Hence this study was undertaken to find out the role of the widely used GeneXpertMTB/Rif test in tuberculosis detection. Materials and Methods: A total of 155 samples (pulmonary and extrapulmonary) from patients clinically suspected to have tuberculosis were received for testing by ZN (Ziehl-Neelsen) stain and GeneXpert/MTB Rif. These samples were also processed for histopathology or cytology and mycobacterial culture on request of clinician. The results were studied and compared. Result: Out of the total samples received, lymph node aspirates were 23%,pleural fluid 20%,sputum 19%,pus 10%,tissue 8%,ascitic fluid 8%,cerebrospinal fluid 7%,endometrial tissue 3%,synovial fluid 1% and urine 1%.Nine sputum samples (31%) were positive by GeneXpertMTB/Rif of which two were negative on smear, two positive on culture and there was no culture request for the remaining seven samples.29 (23%) extrapulmonary samples were positive by GeneXpertMTB/Rif out of which there was no culture request for 16 samples. One sample which was negative by GeneXpert MTB/Rif grew Atypical Mycobacteria on culture. Four isolates were detected as rifampicin resistant by GeneXpertMTB/Rif but none of them were sent for Drug Susceptibility Test (DST). Conclusion: GeneXpertMTB/Rif should be used in combination with other tests for diagnosing tuberculosis.