Prevalence of Extended-Spectrum ß-Lactamases in Multi-drug Resistant Pseudomonas aeruginosa from Diabetic Foot Patients.

INTRODUCTION: Pseudomonas aeruginosa is one of the major pathogens associated with the acute tissue damage in patients having Diabetic Foot Ulcer (DFU). The treatment of such infections can be an uphill battle due to the serious resistance to all the mainstay antibiotics, owing to overzealous production of Extended-Spectrum Beta-Lactamases (ESBLs). Pakistan also has a high prevalence of diabetes and complications related to it, however genetic disposition of the pathogens remains underinvestigated. AIM: The main objective of the study was to determine the frequency of ESBLs in Multi-drug resistant P. aeruginosa from diabetic foot patients. METHODS: The duration of the present study was one year and 100 patients having DFU were enrolled. All the pus samples were subjected to the bacterial culture, gram staining, catalase test, oxidase test and antimicrobial susceptibility pattern to various antibiotics for the confirmation of P. aeruginosa. Of 23 positive isolates of P. aeruginosa, 10 were ESBLs positive as detected by double disk diffusion test. The positive ESBL strain shows an increase of ≥5mm in the zone of inhibition of the combination discs in comparison to the alone ceftazidime disc. RESULTS: The ESBLs positive strains were also tested for TEM-1, SHV-1, PER-1, and VEB-1, where: (07/10) strains carried SHV-1, (05/10) strains were positive for TEM-1, while none of the isolates were PCR-positive for PER-1 and VEB-1. CONCLUSION: The findings of the current study show a difference in the pattern of ESBL genes compared to that of other such endeavors. The present study also warrants the PCR-based detection of the type of ESBL as a potential factor to consider in deciding the therapeutic strategy at any point during the treatment.

Modified acid fast staining: a better diagnostic tool in chronic diarrhoea due to cryptosporidiosis.

BACKGROUND: Cryptosporidium parvum is an emerging pathogen responsible for chronic diarrhoea in children and immuno-compromised individuals, especially AIDS patients. Currently, there is no effective therapeutic strategy for treating cryptosporidiosis, therefore control and supportive treatment of cryptosporidiosis depends upon rapid and accurate diagnosis of this infection. METHODOLOGY: A descriptive study was conducted in the Pathology Department of Khyber Medical College and Pathology Laboratory of Khyber Teaching Hospital over a period of one year March 2007-April 2008. A total of 200 stool samples were tested for the presence of C. parvm oocysts from children < 5 years age suffering from diarrhoea for > 5 days. Total and differential leukocyte count was determined to assess immune status of the patients. Modified Ziehl-Neelsen (Z-N) staining, a rapid, sensitive and easy test, was used successfully for the detection of C. parvum oocysts in stool specimen. RESULTS: Cryptosporidium oocysts were found in 18 (9.0%) samples. Out of 18 positive cases, 13 (72.2%) children had lymphopenia hence their immune status was impaired. Infection was common in children between 1-24 months of age. Mean duration of diarrhoea was 11 months. Most of C. parvum infected children were consumers of well water (77.8%). CONCLUSION: Cryptosporidiosis, although a self-limiting disease, rarely investigated routinely, can become chronic and life threatening in immuno-compromised individuals. Majority of affected patients are immune-compromised. Modified Z-N is a sensitive and rapid method which can explore the gravity of this infection even further if used routinely and may control morbidity and mortality associated with this infection.

Incidence of methicillin resistant Staphylococcus aureus in Peshawar.

BACKGROUND: There is considerable variation in the percentage of isolates of methicillin resistant Staphylococcus aureus (MRSA). There are several mechanisms for methicillin resistance. The most important is low affinity of penicillin binding proteins for beta-lactam antibiotics. The objectives of this study were to establish the pattern of MRSA incidence in Peshawar in recent years, and to identify high risk groups for acquiring infection amongst the city population. METHOD: All positive MRSA cases reported at city laboratory were employed in the study. These were recorded over the time period elapsing from 2009 to 2011. For each patient, records were looked at for age, sex, specimen tested positive, hospital/community acquired and if hospital acquired then which particular hospital within the city was infection contracted at. Also patient records were addressed for any immune system abnormalities, any operation conducted, presence or absence of diabetes and any history of intravenous drug use. RESULTS: There were a total of 929 MRSA cases in our study, of which 538 were males and 391 were females. MRSA frequency for the year 2009 was 207, for 2010 it was 284 and for 2011 it was 438. The frequency of MRSA increased by 54% from the year 2009 to 2011. CONCLUSION: A potentially alarming increase in MRSA incidence within the city has been observed in recent years threatening to rise further judging the current trend. Those at a high risk of contracting infection include males aged between 20-29 years, hospitalised, diabetics, immune system compromised, and individuals with a history of IV drug use.