Drug resistance profile in postbiliary and gastrointestinal surgical-site infection cases from a tertiary care hospital.

In the developing world, surgical-site infection (SSI)-associated pathogens are becoming more drug resistant implicating higher morbidity and management cost. Here, we tried to analyze the drug resistance pattern in our SSI-related isolates. Over 2 years, 191 clinically diagnosed SSIs (postbiliary tract and postgastrointestinal surgery) were included, and wound swabs were processed by conventional aerobic and anaerobic culture. Antibiotic minimum inhibitory concentration (MIC) was determined by the Epsilometer testing. Multidrug-resistant phenotypes were detected as per guidelines. The rate of SSI was 5.3% with Klebsiella, Staphylococcus, and Pseudomonas, growing predominantly, and no anaerobe detectable. About 19.4% of Staphylococcus aureus were methicillin-resistant S. aureus, and one-third of them had raised macrolide MIC. About 58.2% of Enterobacteriaceae isolates were extended-spectrum beta-lactamase producers. Isolates with raised meropenem MIC were observed. Antibiotic-resistant level in SSI cases is alarmingly high, and in susceptible strains, MIC is approaching the resistant level. Urgent corrective action is an emergency necessity.

Seasonal predominance of atypical agents in adult community-acquired pneumonia in India's northeastern region: Is it the time to look again at empirical therapy guidelines?

Atypical agents such as Mycoplasma, Legionella, Chlamydia species, and Coxiella burnetii (Q-fever agent) are responsible for some adult community-acquired pneumonia (CAP). Insufficient studies on this topic can be blamed for the failure to include atypical pathogens in empirical management. We followed adult CAP cases for two years, and samples (respiratory and serum) were tested by culture, ELISA (IgM, IgG, and IgA), and PCR. A risk factor analysis was performed. Overall in 21.3% adult CAP patients, atypical agents found were Mycoplasma pneumoniae (51.5%), Legionella pneumophila (28.8%), and Chlamydophila pneumoniae (19.7%). However, amongst patients <60 years of age and in the summer season, the proportion of atypical agents increased significantly. There is thus a need to re-examine empirical antibiotic regimes.

High proportion of drug-resistant isolates in adult community-acquired pneumonia from Northeast India: A hospital-based study.

BACKGROUND: Empirical antibiotic therapy is the mainstay of management of adult community-acquired pneumonia (CAP) globally. Knowledge of prevalent pathogen (bacterial) profile and drug susceptibility pattern is very essential for appropriate management of CAP cases, which again calls for regular update of pathogen profile in a given locality. This study was to identify the bacterial etiology of CAP cases and their antibiotic susceptibility pattern. METHODS: This cross-sectional study was done on adult CAP patients from medicine, respiratory medicine, and intensive care unit area in our tertiary care hospital between May 1, 2015, and October 30, 2016. Subjects were enrolled continuously, and expectorated sputum, bronchoalveolar lavage fluid, and blood culture were performed. Urine antigen test was done for Streptococcus pneumoniae and Legionella pneumophila. Three types of ELISA (IgM, IgG, and IgA) were performed for atypical agents (Mycoplasma, Chlamydia, and Legionella) of CAP. Isolates obtained from culture of Sputum/BAL/Blood were further processed for antibiotic susceptibility testing - by disc diffusion as well as E-test method (latter for MIC i.e. minimum inhibitory concentration, determination). RESULTS: About 574 subjects were included, and in 266 (46.3%) cases, bacterial pathogen could be detected. Klebsiella pneumoniae (33.6%) and S. pneumoniae (32.9%) were the predominant agents identified. Atypical agents (Mycoplasma, Legionella, and Chlamydia) were at 15.1%. A high proportion of pneumococci isolates were multidrug resistant (52.6%). Resistance to beta-lactams, macrolide, and other agents was on the higher side, but fluoroquinolones were found to be less resistant (15.8%-21.1%). Extended-spectrum beta-lactamase (among Klebsiella isolates) and methicillin-resistant Staphylococcus aureus were also detected. CONCLUSION: A moderate-to-high degree of drug-resistant in adult CAP was evident, which is detrimental in effective empirical management of such cases. Urgent implementation of antibiotic stewardship scheme is the need of the hour.