Clinico-bacteriological profile of primary pyodermas in Kashmir: a hospital-based study.

Pyodermas are a common group of infectious dermatological conditions on which few studies have been conducted. This study aimed to characterise the clinical and bacteriological profile of pyodermas, and to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in primary pyodermas in a dermatology outpatient department in Kashmir. Methods We conducted a hospital based cross-sectional study in the outpatient Department of Dermatology, Sexually Transmitted Diseases and Leprosy of Shri Maharaja Hari Singh Hospital, Srinagar, Jammu and Kashmir, India. Patients presenting with primary pyodermas were included in the study. A detailed history and complete physical and cutaneous examination was carried out along with microbiological testing to find aetiological microorganisms and their respectiveantimicrobial susceptibility patterns. Antimicrobial susceptibility testing, including that for methicillin resistance, was carried out by standard methods as outlined in the current Clinical and Laboratory Standards Institute guidelines. Results In total, 110 patients were included; the age of the study population ranged from 3 to 65 years (mean age 28 years); 62% were male. Poor personal hygiene was noted in 76 (69%). Furunculosis (56; 51%) was the most common clinical presentation. Staphylococcus aureus was isolated in 89 (81%) of cases, and MRSA formed 54/89 (61%) of Staphylococcus aureus isolates. All MRSA strains were sensitive to vancomycin. Conclusion The prevalence of MRSA was high in this sample of communityacquired primary pyodermas. It is therefore important to monitor the changing trends in bacterial infection and their antimicrobial susceptibility patterns and to formulate a definite antibiotic policy which may be helpful in decreasing the incidence of MRSA infection.

Recurrent meningitis due to Salmonella enteritidis: a case report from Kashmir India.

Recurrent bacterial meningitis in children is potentially life-threatening and induces psychological trauma to the patients through repeated hospitalization. Here we report a case of recurrent meningitis in a one month old baby. The CSF and blood culture grew Salmonella enteritidis. Injection ciprofloxacin and ceftriaxone were given for 3 weeks. Baby became symptomatically better and was afebrile at discharge. Twenty eight days after discharge baby got readmitted with complaints of fever and refusal of feeds. Blood and CSF culture again showed growth of Salmonella enteritidis. Physicians should be educated about the possibility of recurrence which may occur days or even weeks after apparent successful antibiotic treatment.

Extended spectrum B-lactamase mediated resistance in Escherichia coli in a tertiary care hospital.

BACKGROUND: ESBL occur mostly in Enterobacteriaceae e.g. Escherichia coli. ESBLs are clinically important because they destroy cephalosporin's, work horse hospital antibiotics, given as first line agents to many severely ill patients. Delayed recognition and inappropriate treatment of severe infections caused by ESBL producers with cephalosporin has been associated with increased mortality. ESBL-mediated resistance is not always obvious in vitro to all cephalosporin. Many ESBL producers are multi -resistant to non-B-Lactam antibiotics such as quinolones and amino glycosides, narrowing treatment options. Some producers achieve outbreak status spreading among patients and locals, perhaps owing to particular pathogenicity traits. METHODS: A total of 221 Escherichia coli isolates from different clinical specimens during the period of August 2005 to July 2007, were screened for potential ESBL activity. These strains were isolated from different clinical specimens like urine, blood, sputum, pus and other body fluids which were received in the bacteriological division of microbiology. RESULTS: Two hundred and twenty one Escherichia coli isolates were isolated from different clinical specimens like urine, blood, sputum, pus and other body fluids submitted for both in and out-patients of the hospital during the period August2005 to July2007. All of them were subjected to screening by using ceftazidime, cefotaxime or ceftriaxone. Two hundred and eleven were positive for potential ESBL producers out of 221. 95.4%of E. coli (211/221) were screen positive which were subjected to confirmatory tests CONCLUSION: Maximum number of ESBLs was from in-patients followed by out-patients. The out-patient presence of ESBL is of main concern as it is now come to the alert of the physician that ESBL is spreading fast in the community and responsible for community-acquired ESBLs and maximum number being from urine specimen.