Antibacterial effects of Carica papaya on common wound organisms [abstract]

OBJECTIVE: The objective was to investigate the antibacterial activity of the crude Carica papaya preparations as used by nurses, on gram negative and gram positive organisms; to determine which part and stage of maturity of the fruit yielded the best antibacterial activity, and determine the effects of storage conditions on the observed activity. METHODS: The pathogens commonly found in human wounds were obtained from the Microbiology Department, University of the West Indies, Biochemistry Section, The University of the West Indies and the Jamaican Bureau of Standards. Cultures were routinely maintained in nutrient agar slants at 4§c. Extracts were obtained by separately grinding fractions of the epicarp, endocarp and seeds of the immature, mature and ripe Carica papaya fruit and filtering them through guaze. Sensitivity tests were conducted by adding 0.06 ml. of agar wells (6 mm diameter) prepared from 20 ml agar seeded with 10 cells/ml suspension of one of the eight organisms per plate. The inoculated plates were allowed to equilibrate at 4§c for one hour then incubated at 37§c for 24 hours, after which zones of inhibition were measured in millimeters. Antibacterial activity was expressed in terms of the radius of the zone of inhibition calculated as the difference in radius of the observed zones and the edge of the agar wells. Daily sensitivity tests were carried out on extracts stored at 5§c, 25§c and 35§c for 7 days. RESULTS: The seed extracts from all three stages of the fruit showed an average order of inhibition in the following order: B cereus> E coli> S faecalis> S aureus> P vulgaris> and X flexneri. There was no significant difference in bacterial sensitivity between the immature, mature and ripe fruits tested. The epicarp and endocarp did not produce any inhibition zone in any of the three stages of the fruit tested. There was a gradual reduction in antibiotic activity with increasing storage item. Also, a fall-off of activity was found to be more drastic at higher temperatures. CONCLUSION: The findings show that crude extracts of Carica papaya seed have antibacterial activity that inhibits the growth of both gram positive (B cereus, S aureus and S faecalis) and gram negative (E coli, P vulgaris and S flexneri) organisms. Observed activity was dependent on stage of maturity but tended to decrease with duration and conditions of storage. No antibacterial activity was observed from the epicarp and the endocarp of the fruit. (AU)

Antimicrobial resistance in the Caribbean - Poster abstract

OBJECTIVE: To determine the resistance patterns of organisms causing hospital and community acquired infections in the English-and Dutch-speaking Caribbean. METHOD: The data on antimicrobial resistance of gram negative bacteria isolated in six laboratories during the first 6 month period in 1998 and pathogens isolated from community infections in selectedcountries during 1994-1997 were reviewed. RESULTS: The overall resistance of gram negative aerobic bacilli (excluding salmonella spp and shigella spp)to ampicillin (range 51-85 percent), gentamicin (range 3-11 percent and trimethoprim-sulphamethoxazole (range 27 to 47 percent) did not significantly differ between the laboratories and countries. The resistance to third generation cephalosporins was 9 percent and 16 percent in two laboratories in Trinidad. Multiple antibiotic resistant S typhimurium PT 104b, S heidelberg, Sh flexnerii type 2/2a and low levels of ampicillin and gentamycin resistant S enteritidis strains causing community acquired enteric infections were observed in the Caribbean. The rates of penicillin resistant pneumococci (1 percent) and chloramphenicol resistant H. influenzae ( 3 percent) were low in the Caribbean. CONCLUSIONS: The potential for introduction and spread pf resistance genes in the Caribbean is very high. Hence, continuing surveillance of antimicrobial resistant pathogens in nosocomial and community is essential in the Caribbean. (AU)

The emergence of stenotrophomonas maltophilia as a pathogen in the UHWI

Stenotrophomonas maltophilia is a Gram-negative bacillus, which is known to occur in hospitals and especially in Intensive Care Units. We reported the emergence of the organism at the UHWI for the first time in 1996. During routine infection control surveillance, conducted by the Microbiology Department, Steno maltophilia was first identified in the ICU, UHWI in October 1996 and was the only case reported in that year. Isolates were obtained from blood, urine, sputum, trap sputum, wound, skin, catheter tips and environmental samplimg. Patient's clinical records were reviewed and an attempt made to determine possible risk factors. In 1997 there was a total of 7 patients with Steno. Matophilia with 4 (57 percent) of these coming from the ICU. Up to July 1999, 26 cases were isolated, of these 15 (58 percent cases) came from ICU. The organism was mainly resistant to Menonem, Imipenem, Gentamicin and sensitive largely to Ciprofloxacin and Ceftazidime. Since it was first reported in 1996, Steno. Malto has emerged as a significant pathogen at UHWI. Patients most at risk are those in the ICU. Its multi-drug-resistance characteristics distinguish it as a potentially dangerous nosocomial pathogen and impose the necessity for urgent action to prevent and control its spread.(AU)

Analysis of pathogens isolated from urinary tract infections in Barbados

The isolation of pathogens from urine specimens was surveyed during a six-month period when 1611 urine specimens were examined in the Public Health Laboratory, and 8769 were examined in the Microbiology Laboratory of the Queen Elizabeth Hospital. Significant growth (defined as >10 organisms/ml urine) was detected in 393 (24,4 percent) of the urine cultured in the Public Health Laboratory and in 1218 (13.9 percent) of urines cultured in the Queen Elizabeth Hospital. The overall isolation rate 15.5 percent; Gram-negative bacilli were more commonly isolated from hospital patients, whereas Gram-positive cocci were relatively more common in community patients. The most common pathogens detected were coliforms (1233 isolates), streptococci (197) and coagulase-negative straphylococci (182); 50 percent of all isolates were sensitive to amoxycillin, 68 percent to cephradine, 61 percent to co-trimoxazole, 62 percent: to nalidixic acid and 79 percent to nitrofurantoin. Anti-bacterial activity was detected in 130 (8 percent) of the urine specimens received in the Public Health Laboratory. (AU)

Resistance to third-generation cephalosporins in Barbados

Resistance to third-generation, or extended-spectrum, cephalosporins caused by induction of class I B-lactamases has been reported rarely from developing countries. Seven isolates of cephalosporin-resistant Gram-negative rods were recovered recently from urine, burns and ulcers in the Queen Elizabeth Hospital, Barbados. The isolates were identified as Acinetobacter calcoacetius (2), Citrobacter freundii (1), Enterobacter cloacae (1), Morganella ;morganii (1), Providencia stuartii (1) and Proteus sp. (1). Induction of B-lactamase by cefoxitin was demonstrated, and minimal inhibitory concentratrions (MIC) were determined by agar dilution. B-lactamases were demonstrated by isoelectric focusing; the presence of chromosal B-lactamases were confirmed in at least three of the resistant isolates. The only antibiotics which were uniformly active against these resistant strains were imipenem and ciprofloxacin. These data confirm the existence of resistance to the third-generation cephalosporins in Barbados, and emphasise the necessity for continuous surveillance of resistance patterns in the Caribbean region. (AU)

Peritonitis in acute peritoneal dialysis at the University Hospital of the West Indies: a five-year review

The records of patients receiving acute peritoneal dialysis during the 1983 - 1987 were retrospectively evaluated. Of a total of 59 patients receiving dialysis, 10 developed peritonitis. Staphylococcus aureus was the single most frequently isolated organism. However, gram-negative bacilli as a group were more common. We recommend the use of cloxacillin orally and gentamicin intra-peritoneally as empiric antibiotic coverage until results of culture reports are available (AU)

Outbreak of Bacillus Calmette-Guerlin-associated lymphadenitis and abscesses in Jamaican children

An outbreak of axillary lymphadenitis and abscesses after Bacillus Calmette-Guerlin (BCG) vaccination (Pasteur Paris, Batch N5122) occurred in 139 Jamaican children between January and July, 1988. The overall rate of this complication was 0.95 percent. The attack rate was 1.92 percent among the 0- to 6 week age group and 0.6 percent in the 7- to 52-week age group. Of 139 patients there were 77 males and 62 females and the mean age at presentation was 4 months. The mean size of the BCG scar, duration of healing and Mantoux reaction size differed significantly in patients compared with those of control infants (P less than 0.01). Mycobacterium bovis was isolated from 11 patients. Immunologically index patients and controls differed significantly only with respect to T lymphocyte subpopulation percentages and concanavalin A stimulation indices. Evaluation of the BCG vaccine did not reveal either increased potency or microbial contamination. We conclude that increased susceptibility to the Pasteur strain of BCG might have contributed to the increased incidence of complications in these Jamaican children and hence caution should be exercised in switching one vaccine for another as is often done in the developing countries. (AU)

Microorganisms encountered in blood cultures at the Queen Elizabeth Hospital and their antibiotic sensitivity pattern

The importance of blood cultures in the early detection of organisms is examined with the following conclusions. The isolation of of gram-positive and gram negative organisms are isolated from blood cultures with equal frequency. K. pneumoniae and E. coli are the most frequently isolated gram gram-negataive organisms. Staph, epidermis is isolated more frequently than Stap. aureus. Gentamcin was found to be the most effective antibiotic against Gram-negative blood culture isolates. Clindamycin and cloxacillin were found to be the most effective antibiotics against the gram-positive isolates. Chloramphenicol was found to be the most effective agent against the anaerobes as a group

Transferable antibiotic resistance at the University Hospital of the West Indies

One hundred and twenty gram-negative bacteria recovered from clinical specimens and resistant to at least one antimicrobial were tested for transferable antibiotic resistance. Organisms from 9 different genera with an average of 3.9 resistance markers were mated with a recipient strain of E. coli. Ninety-one isolates (76 percent) were able to transfer an average of 3.0 resistance markers to the recipient. Transfer occurred most often in Serratia (100 percent), and at least often in Acinetobacter (20 percent). Resistance markers with the highest transmission rates were tetracycline (67.6 percent), trimethoprim (65.1 percent), and cephaloridine (62.5 percent) whereas lower rates were seen with ampicillin (52.4 percent), gentamicin (55.5 percent), tobramycin (46.6 percent) and amikacin (30 percent). (AU)

Antibiograms of gram-negative bacteria recovered from clinical specimens at the University Hospital of the West Indies (August, 1982 - January, 1983)

The sensitivity patterns of gram-negative organism were recorded over a six-month period from August 1982 to January 1983, and percentage sensitivities were calculated for urine and non-urine isolates. Sensitivity patterns did not differ substancially from those previously reported. However, urine isolates were shown to be significantly more resistant to antimicobials when compared with non-urine isolates. Multiresistant strains of Serratia marcesens demonstrated considerable resistance to all anibiotics except amikacin. Analysis of data on a monthly basis revealed significant changes in the antibiograms of E. coli and Acinetobacter sp. Antimicrobials on restricted usage maintained a high level of activity with the exception of tobramycin. (AU)

Resistance plasmids in gram negative bacteria isolated at the University Hospital of the West Indies, Jamaica

One hundred and sixty-five multiply resistant gram negative bacteria isolated at UHWI were tested for their ability to transfer their antibiotic resistance to a recipient Escherichia coli K12 strain J53-2. The isolates were representatives of 9 diferent genera. The majority of the isolates (68) were from urine, 48 isolates were Salmonella ohio strains from stools, and the remaining 53 isolates were from blood, pus, burn swabs and other sources. 82.8 percent of the 169 isolates tested transferred part of all of their resistance determinants to strain J53-2 at 37§C. The incidence of transferable resistance was found to differ according to the genera considered with quite high frequencies in some genera, e.g. S. ohio (100 percent), E. coli (80.9 percent) and Klebsiella pneumoniae (72.3 percent), and lowest incidence in Acinetobacter (20 percent). A higher frequency (80.9 percent) of transferable resistance was demonstrated in urine than non-urine (69.8 percent) isolates. In addition, particular genera (E. coli, K. pneumoniae, Proteus and Enterobacter) had a higher incidence of transferable resistance when organisms were isolated from urine than when isolated from non-urine specimens. The incidence of resistance to trimethoprim (Sxt), tetracycline (Te), cephaloridine (Cf) and ampicillin (Am) was higher than that of resistance to gentamicin (Gm), amikacin (AN) and tobramycin (NN). Similarly, transfer of resistance to Sxt, Te Cf and Am occurred with higher frequency than transfer of resistance to Gm, AN and NN. Simultaneously resistance to 3, 4 and 5 antibiotics was more prevalent (accounting for 72.8 percent of the positive isolates) than was simultaneous resistance to 1, 2, 6 and 7 antibiotics (27.2 percent of the positive isolates). Transfer of resistance to 1, 2, 3 and 4 antibiotics occurred more frequently than transfer of resistance to 5, 6 and 7 antibiotics. Experiments were done to validate the method used to detect transferable resistance. The biochemical characteristics, nutritional requirements and antibiotic resistance of E. coli K12 strain J53-2 exconjugants obtained from transfer experiments indicated that the method used was a valid one for detection of transferable resistance. Filtrates of multiply resistance donor isolates did not transfer resistance to E. coli K12 strain J53-2. Transfer of resistance by whole cell cultures of the donors to J53-2, was unaffected by the presence of deoxyribonuclease I in the medium used for mating. Of the 29 isolates that did not transfer resistance to E. coli K12 strain J53-2 at 37§C, 13 (44.8 percent) were able to do so at 30§C, 4 (13.8 percent) were able to transfer resistance because they produced a colicin that was active against J53-2 and 5 (17.2 percent) possessed nonconjugative R plasmids which could not be transferred to J53-2 unless another "intermediate" host, E. coli K12 strain NH4104 was present. Three of the twenty-nine isolates were lost during storage. Two of the seven isolates, an E. coli and a Serratia marcescens isolate, tested for curing of antibiotic resistance by use of acridine orange and/or ethidium bromide demonstrated curing of part or all of their antibiotic resistance. Results of the curing experiments were inconclusive. Taking into account transferable resistance at 37§C and 30§C, the presence of nonconjugative R plasmids and loss of donors in storage this study provided evidence for the occurrence of R plasmids in 91.8 percent of 169 gram negative bacteria isolated from UHWI during the period May 1983 to March 1984. For two of the isolates with transferble resistance demonstration of curing of antibiotic resistance provided further evidence for plasmid encoded resistance (AU)

Laboratory studies of a multiple-antibiotic spray

A spray delivering neomycin, bacitracin and polypmyxin in powder form was tested for its effect upon potentially pathogenic bacteria under laboratory conditions. Cultures of all of the 168 bacterial strains tested were inhibited by the spray. Agar-diffusion methods were employed to demonstrate various interactions between the component antibiotics. The various bacterial groups studied revealed different antibiotic-interaction patterns. Tube tests confirmed that the majority of these were not diffusion artefacts. No evidence was found of antagonism sufficiently pronounced to contraindicate the use of this antibiotic triad. It is possible, though by no means certain, that neomycin alone would be as useful as the triad.(AU)