Vancomycin and Linezolid-Resistant Enterococcus Isolates from a Tertiary Care Center in India.

INTRODUCTION: There is increasing development of antibiotic resistance among the Enterococcus species. OBJECTIVES: This study was performed to determine prevalence and characterize the vancomycin-resistant and linezolid-resistant enterococcus isolates from a tertiary care center. Moreover, the antimicrobial susceptibility pattern of these isolates was also determined. MATERIALS AND METHODS: A prospective study was performed in Medical College, Kolkata, India, over a period of two years (from January 2018 to December 2019). After obtaining clearance from the Institutional Ethics Committee, Enterococcus isolates from various samples were included in the present investigation. In addition to the various conventional biochemical tests, the VITEK 2 Compact system was used to identify the Enterococcus species. The isolates were tested for antimicrobial susceptibility to different antibiotics using the Kirby-Bauer disk diffusion method and VITEK 2 Compact to determine the minimum inhibitory concentration (MIC). The Clinical and Laboratory Standards Institute (CLSI) 2017 guidelines were used to interpret susceptibility. Multiplex PCR was performed for genetic characterization of the vancomycin-resistant Enterococcus isolates and sequencing was performed for characterization of the linezolid-resistant Enterococcus isolates. RESULTS: During the period of two years, 371 isolates of Enterococcus spp. were obtained from 4934 clinical isolates showing a prevalence of 7.52%. Among these isolates, 239 (64.42%) were Enterococcus faecalis, 114 (30.72%) Enterococcus faecium, and others were Enterococcus durans, Enterococcus casseliflavus, Enterococcus gallinarum, and Enterococcus avium. Among these, 24 (6.47%) were VRE (Vancomycin-Resistant Enterococcus) of which 18 isolates were Van A type and six isolates of Enterococcus casseliflavus and Enterococcus gallinarum were resistant VanC type. There were two linezolid-resistant Enterococcus, and they were found to have the G2576T mutation. Among the 371 isolates, 252 (67.92%) were multi-drug resistant. CONCLUSION: This study found an increasing prevalence of vancomycin-resistant Enterococcus isolates. There is also an alarming prevalence of multidrug resistance among these isolates.

Biofilm Producing Enterococcus Isolates from Vaginal Microbiota.

BACKGROUND: Enterococcus is an important cause of infection in the hospital as well as in the community. METHODS: A prospective study was done in Medical College, Kolkata for a period of 2 years (from January 2018 to December 2019). After obtaining clearance from the Institutional Ethics Committee, Enterococcus isolates from cases of vaginitis were included in the study. Identification of Enterococcus species was done by Gram stain and conventional biochemical tests along with automated identification by VITEK 2 Compact. These isolates were tested for antimicrobial susceptibility to different antibiotics by Kirby Bauer disc diffusion method and minimum inhibitory concentration (MIC) by VITEK 2 Compact. Interpretation of susceptibility was done according to the Clinical and Laboratory Standards Institute (CLSI) 2017 guidelines. Biofilm detection for Enterococcus species was done. RESULTS: During the period of 2 years, 39 isolates of Enterococcus spp. were obtained from vaginitis cases. Among these, 27 were Enterococcus faecalis and 12 Enterococcus faecium. All isolates were highly susceptible to vancomycin, teicoplanin, and linezolid. Biofilm was detected in eight isolates of which five were strong biofilm producer and three moderate biofilm producers. CONCLUSION: Biofilm production is an important virulence factor in Enterococcus isolates from vaginitis.

A Study of Onychomycosis at a Tertiary Care Hospital in Eastern Bihar.

BACKGROUND: Onychomycosis (OM) is a major public health problem which is increasing worldwide. It is associated with high morbidity and causes physical, psychological, and occupational problems in patients. AIMS: This study aims to study the pattern of etiological agents, clinical features, and severity assessment of OM in this part of India. MATERIALS AND METHODS: Sixty eight clinically suspected patients with positive potassium hydroxide and fungal culture were studied. RESULTS: Males were infected more often than females (1.61:1). The most common age group affected was 21-40 years. Finger nails were affected more frequently than toe nails. Distal and lateral subungual OM was the most common (48 cases, 70.59%) clinical pattern. For most of the patients (66.18%), nail involvement was severe. Discoloration was the most common (67 cases, 98.53%) change, followed by subungual hyperkeratosis (51 cases, 75%). Principal causative agents were dermatophytes (55 cases, 80.88%) with Trichophyton rubrum being the most common one (35 cases, 51.47%). In 9 (13.23%) cases, Candida albicans, in 6 (8.82%) Aspergillus niger and in 1 (1.47%) case Acremonium sp. (AC) have been isolated as the sole causative agent. In 2 (2.94%) cases, mixed infection with dermatophyte and Aspergillus and in 1 (1.47%) case dermatophyte and Candida were noted. CONCLUSION: Although dermatophytes were the most common causative agent of OM, nondermatophytic molds, and yeasts were also encountered. The genus and species identification helps in the proper diagnosis and management. Morphological changes in nail may help in presumptive diagnosis of OM.

Stenotrophomonas maltophilia: Complicating treatment of ESBL UTI.

Stenotrophomonas maltophilia (S. maltophilia) is a gram-negative bacillus emerging as an opportunistic, nosocomial pathogen associated with a high mortality rate. The organism has been shown to survive several biocides used in the hospital setting. Hospital water sources can serve as a reservoir for S. maltophilia. The transmission of S. maltophilia to susceptible individuals may occur through direct contact with the source or through the hands of health care personnel. S. maltophilia is usually resistant to third-generation cephalosporins, aminoglycosides and antipseudomonal penicillins. These microorganisms are intrinsically resistant to carbapenems, and exposure to these agents has been linked to selection of S. maltophilia. There have also been reports of the organism developing resistance to trimethoprim-sulfamethoxazole (TMP-SMX), which was initially considered as the drug of choice for S. maltophillia infections. We describe a case of nosocomial urinary tract infection (UTI) due to S. maltophilia in a diabetic patient, which the patient developed during treatment with meropenem for UTI due to Klebsiella pneumonia that was resistant to TMP-SMX.

The first linezolid-resistant Enterococcus faecium in India: High level resistance in a patient with no previous antibiotic exposure.

Linezolid provides high rates of the clinical cure and microbiological success in complicated infections due to Enterococcus spp., including vancomycin-resistant Enterococcus faecium. However, the emergence of resistance during linezolid treatment has been reported for clinical strains of Enterococcus, which is alarming given the fact that, this leaves the clinician with very few treatment options. We report the first case of linezolid resistant Enterococcus faecium from India, which was isolated from the blood culture of a hypoglycemic encephalopathy patient. There have been previous reports of linezolid resistant enterococci from different parts of the world, with minimum inhibitory concentration (MIC) ranging from 16 to 64 µg/mL and most of them were associated with vancomycin resistance but the isolate reported over here had an MIC of 1024 µg/mL and interestingly was sensitive to vancomycin.

Tigecycline activity against metallo-ß-lactamase-producing bacteria.

BACKGROUND: [corrected] Treatment of serious life-threatening multi-drug-resistant organisms poses a serious problem due to the limited therapeutic options. Tigecycline has been recently marketed as a broad-spectrum antibiotic with activity against both gram-positive and gram-negative bacteria. Even though many studies have demonstrated the activity of tigecycline against ESBL-producing Enterobacteriaceae, its activity is not well-defined against micro-organisms producing metallo-ß-lactamases (MBLs), as there are only a few reports and the number of isolates tested is limited. AIMS: The aim of the present study was to evaluate the activity of tigecycline against MBL-producing bacterial isolates. MATERIALS AND METHODS: The isolates were tested for MBL production by (i) combined-disk test, (ii) double disc synergy test (DDST), (iii) susceptibility to aztreonam (30 µg) disk. Minimum inhibitory concentration to tigecycline was determined according to agar dilution method as per Clinical Laboratory Standards Institute (CLSI) guidelines. Disc diffusion susceptibility testing was also performed for all these isolates using tigecycline (15 µg) discs. RESULTS: Among the total 308 isolates included in the study, 99 were found to be MBL producers. MBL production was observed mostly in isolates from pus samples (40.47%) followed by urine (27.4%) and blood (13.09%). MBL production was observed in E. coli (41.48%), K. pneumoniae (26.67%), Proteus mirabilis (27.78%), Citrobacter spp. (41.67%), Enterobacter spp. (25.08%), and Acinetobacter spp. (27.27%). The result showed that tigecycline activity was unaffected by MBL production and it was showed almost 100% activity against all MBL-producing isolates, with most of the isolates exhibiting an MIC ranging from 0.25-8 µg/ml, except 2 MBL-producing E. coli isolates who had an MIC of 8 µg/ml. CONCLUSION: To conclude, tigecycline was found to be highly effective against MBL-producing Enterobacteriaceae and acinetobacter isolates, but the presence of resistance among organisms, even before the mass usage of the drug, warrants the need of its usage as a reserve drug. The study also found that the interpretative criteria for the disc diffusion method, recommended by the FDA, correlates well with the MIC detection methods. So, the microbiology laboratories might use the relatively easier method of disc diffusion, as compared to the comparatively tedious method of MIC determination.

Red discoloration of urine caused by Serratia rubidae: A rare case.

There have been only a few reported human cases of infections caused by Serratia rubidae in literature. Among these sparse cases there is only one reported case of urinary tract infection (UTI) due to S. rubidae in literature. The organism is known to produce a red pigment known as prodigiosin. We report a case of UTI caused by S. rubidae in a diabetic patient who presented with burning micturition and reddish discoloration of urine, which on laboratory diagnosis, was proved to be due to the reddish pigment produced by the organism. This case report highlights that this rare organism might be associated with UTI leading to reddish discoloration of urine.

Corneal ulcer with Scopulariopsis brevicaulis and Staphylococcus aureus--a rare case report.

Scopulariopsis brevicaulis is a saprophytic fungus, found in soil. It causes human nail infection. Corneal ulcer with this organism is unusual. Here a case of a 36-year-old farmer is reported who developed a paracentral corneal ulcer in the right eye. The ulcer was caused by mixed infection with Staphylococcus aureus and Scopulariopsis brevicaulis. It was treated with topical natamycin 5% and moxifloxacin 0.5% drops. This is a unique case of corneal ulcer with mixed infection of Staphylococcus aureus and Scopulariopsis brevicaulis without any history of trauma, which was treated successfully, resulting in a minimal corneal opacity.

Bactibilia due to enterococcus species in a case of periampullary carcinoma.

Biliary obstruction due to pancreaticobiliary malignancy is often accompanied by bactibilia and cholangitis; which are associated with postoperative septic complications and may adversely affect the clinical course. The enterococcus species is most responsible for postoperative complications in patients with malignant biliary obstruction. Here a case of bactibilia in a 60-year-old male patient, admitted with peri-ampullary carcinoma is reported. The bile sent for Gram-stain showed the presence of pus cells and Gram-positive cocci in pairs and the bacteriological culture revealed the growth of Enterococcus faecium. The patient developed fever with chills on the second postoperative day. The blood cultures of the patient showed growth of Enterococcus faecium for which he was given vancomycin. The patient went on to develop a surgical site infection, the wound swab of which revealed the growth of klebsiella species. The patient was treated for the wound infection and was later on discharged after three weeks of hospital stay. The patient was doing well during follow-up with the subsidence of the jaundice and Iiver enzymes.

A study on blood culture positivity and C-reactive protein variability in neonatal septicaemia at neonatal intensive care unit of a tertiary care hospital.

Neonatal septicaemia is an important cause of neonatal morbidity and mortality. Blood culture is the gold standard for diagnosis of neonatal septicaemia. Several laboratory investigations are available to detect neonatal sepsis, one important is 'sepsis screen' which includes C-reactive protein (CRP), micro -ESR, total WBC count including immature to mature (VT) ratio and absolute neutrophil count. Blood culture was done among 210 samples from neonatal intensive care unit (NICU), RG Kar Medical College with suspected septicaemia along with CRP estimation. Among all the parameters, clinical correlation of CRP is significant; 65.2% of patients has blood culture positive. CRP positivity varied in different organisms. CRP is a non-specific acute phase reactant and rises significantly after 12 hours onwards. It can be used as an important parameter in infant at risk of septicaemia (significant > 6 mg/dl) and early institution of antimicrobials therapy. It has got prognostic value.