Frequency of isolation and susceptibility pattern of E. coli from in and outpatients over a period of five years at The Indus Hospital Network, Karachi Pakistan.

OBJECTIVE: To determine the frequency of isolation and susceptibility pattern of Escherichia coli at a urban health centre. METHODS: The retrospective study was conducted at the Indus Hospital Network, Karachi, and comprised Enterobacteriaceae isolates obtained from urine, blood and routine culture from patients presenting between 2013 and 2017. The samples were evaluated for resistance patterns against a range of antibiotics and frequency of isolation was determined. Data was analysed using SPSS version 21.0. RESULTS: Of the 10,667 isolates analysed, 6380(60%) were Escherichia coli. Outpatient and inpatient isolates constituted 4184(65.6%) and 2196(34.4%) of the total E. coli isolates respectively. Of the 1446(22.66%) isolates obtained from urine, 1007(59.64%) had E. coli which was the highest isolation rate among all types of samples. There was a significant difference in resistance rates between inpatient and outpatient isolates for first-line and second-line injectable and oral antibiotics (p<0.05). CONCLUSIONS: Escherichia coli isolates showed high resistance towards co-amoxiclav, ampicillin, ceftriaxone and ciprofloxacin, leaving little empirical options for treating outpatients.

Persistence of Candida auris on latex and nitrile gloves with transmission to sterile urinary catheters‡.

Candida auris' ability to persist on contaminated gloves and transmit to urinary catheters was evaluated. 105 and 103 cfu/ml suspensions of eight Candida species including C. auris were inoculated on latex and nitrile gloves fingertips and touched on agar surface at different time intervals. Urinary catheter piece, touched by latex glove carrying Candida spp. suspensions at various time intervals, was cultured by roll-plate method. C.auris persisted on latex gloves at both 105 and 103 cfu/ml up to 3 minutes and could be transmitted from both wet and dry contaminated gloves to catheters. Proper glove use with strict hand hygiene should be advocated in settings with ongoing C.auris transmission.

Microbial profile and antibiotic susceptibility trend in postoperative endophthalmitis: a 12-year review.

OBJECTIVE: To identify the microbial profile and susceptibility pattern of pathogens responsible for culture-proven postoperative endophthalmitis, and to investigate possible trends in both pathogens and antibiotic sensitivities. METHODS: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of ophthalmology patients from January 1, 2005, to December 31, 2016. Culture and sensitivity reports of vitreous and aqueous humor samples from all the patients were retrieved from the medical record section of the hospital. SPSS 19 was used for data analysis. RESULTS: Of the samples of 202 patients with a mean age of 58.2±15.8 years, 106(52.5%) were culturepositive. Of them, 55(51.8%) had gram-negative bacteria, 41(38.6%) had gram-positive bacteria, and 10(9.4%) had fungi. Among gram-positive bacteria, coagulase-negative staphylococcus was the principal isolate 18(17%) and among gram-negative bacteria, it was pseudomonas species 20(18.8%). Spectrum of gram-positive sensitivities included vancomycin 100%, gentamicin 91.5%, amikacin 100%, ciprofloxacin 68%, chloramphenicol 100%, and tetracycline 84.6%. Among gram-negative organisms, the sensitivities were ciprofloxacin 52.9%, ofloxacin 66.6%, ceftazidime 91.8%, amikacin 100%, tobramycin 100% imipenem 91.6%, gentamicin 81.2% and tetracycline 75%. CONCLUSIONS: Vancomycin and ceftazidime were the best empirical antibiotic selection to treat postoperative endophthalmitis.

Clinical manifestation and outcomes of multi-drug resistant (MDR) Raoultella terrigena infection - A case series at Indus Health Network, Karachi, Pakistan.

BACKGROUND AND OBJECTIVES: There is paucity of literature available on Raoultella terrigena infection. Microbiological identification of Raoultella terrigena is difficult and isolates are frequently misidentified as Klebsiella species. This series of 3 cases with Raoultella terrigena septicemia provides a description of the pitfalls and challenges in the diagnosis and management of the highly resistant strains isolated and to the best of our knowledge, is the first report from Pakistan. METHODS: The medical records of 3 cases of R. terrigena reported in the hospital over two months were reviewed retrospectively to record all relevant clinical information. Organism was identified by using Analytical profile index (API) 20 E with 90-95% successful identification and the sensitivity testing was performed by disc diffusion method. RESULTS: This organism caused fulminant sepsis in case 2 resulting in mortality and complicated urinary tract infection in the third, while in case 1 it preceded the fatal candidemia. All three patients were females who had multiple co-morbid and had a history of protracted hospital stay and antibiotic usage elsewhere before being shifted to our hospital. The isolates were resistant to all beta lactams and were even colistin resistant in two patients, creating challenges and suboptimal response for effective antibiotic therapy. CONCLUSIONS: The purpose of this case series is to highlight the highly drug resistant profile of this organism and the fulminant infection it can cause, which if spreads in our hospitals due to breaches in infection control practices, can pose risk as a deadly and untreatable nosocomial infection.

Pelvic abscess caused by a slow growing anaerobic bacterium, Eggerthella lenta: First case report from Pakistan.

We report a case of intrauterine contraceptive device (IUCD) related pelvic abscess caused by a challenging to grow anaerobic Gram positive rod named Eggerthella lenta. A middle aged lady presented with complaints of lower abdomen pain, intermittent vaginal bleeding since two weeks. Ultrasound of abdomen and pelvis showed right adnexal mass involving fallopian tubes, right ovary and gut omentum. She underwent removal of adnexal mass and total abdominal hysterectomy and was treated empirically with vancomycin, ciprofloxacin and metronidazole. Histopathological examination disclosed adenomyosis and chronic non-specific endometritis. Microbiological evaluation of pus aspirate grew Eggerthella lenta.

Antimicrobial susceptibility testing of Neisseria gonorrhoeae isolates in Pakistan by Etest compared to Calibrated Dichotomous Sensitivity and Clinical Laboratory Standards Institute disc diffusion techniques.

BACKGROUND: Accurate detection of Neisseria gonorrhoeae antimicrobial resistance is essential for appropriate management and prevention of spread of infection in the community. In this study Calibrated Dichotomous Sensitivity (CDS) and Clinical Laboratory Standards Institute (CLSI) disc diffusion methods were compared with minimum inhibitory concentration (MIC) by Etest in Neisseria gonorrhoeae isolates from Karachi, Pakistan. CDS and CLSI disc diffusion techniques, and Etest for ceftriaxone, penicillin G, spectinomycin and ciprofloxacin against 100 isolates from years 2012-2014 were performed. Due to lack of CLSI breakpoints for azithromycin, it was interpreted using cut-offs from British Society of Antimicrobial Chemotherapy (BSAC). Due to lack of low concentration tetracycline discs, tetracycline was tested with CLSI disc diffusion and Etest only. Comparisons were based on the identified susceptibility, intermediate susceptibility and resistance (SIR) categories using the different methods. Complete percent agreement was percentage agreement achieved when test and reference method had identical SIR-category. Essential percent agreement was percentage agreement when minor discrepancies were disregarded. RESULTS: There was 100 % and 99 % overall essential agreement and 50 % versus 23 % overall complete agreement by CDS and CLSI methods, respectively, with MICs for all tested antibiotics. Using either method, there was 100 % complete agreement for ceftriaxone and spectinomycin. There was 90 % versus 86 % complete agreement for ciprofloxacin, and 60 % and 75 % for penicillin using CDS and CLSI method, respectively. Essential agreement of 99 % and complete agreement of 62 % was found for tetracycline with CLSI method. There was 100 % essential and complete agreement by CDS, BSAC and Etest for azithromycin. CONCLUSION: No major errors with regard to identified SIR-categories were found for penicillin, ciprofloxacin, ceftriaxone and spectinomycin using CLSI and CDS methods. All isolates were susceptible to ceftriaxone and spectinomycin, and 99 % to azithromycin. In low-resource settings, both the CLSI and CDS disc diffusion techniques might be used for susceptibility testing of gonococcal isolates. However, these methods require considerable standardization and quality controls for adequate levels of reproducibility and correct interpretation to reflect appropriately the MIC values of the different antimicrobials. New, emerging, or rare resistance should be confirmed by MIC determination.