Cross-country transport and isolation and identification of Streptococcus pneumoniae by use of alternate sources of blood supplemented media among laboratories in India

Background: The isolation of S. pneumoniae (Sp) depends on specimen integrity / transport, media and expertise. The non-availability of sheep blood agar poses a challenge in identification of colonial morphology and identification in India. Methods: Laboratories processed swabs containing either pure Sp or Sp in mixed cultures with a second (confounding) bacterium shipped across the country in cold conditions. Duplicate set of swabs was shipped back to the central laboratory to assess the impact of shipping on culture viability. The identical swab was cultured on sheep, human blood and one additional agar plate used in the laboratory. Results: 46/60(77%) of cultures containing only Sp were correctly identified. In specimens where Sp was present in mixed culture, the proportion of isolates in which Sp was correctly identified varied, with most variability attributed to the particular confounding organism rather than the media. There was no discernible impact of temperature-controlled (4-6°C) transport on the isolation of Sp from culture swabs. Conclusions: The study clearly elucidates the ability of laboratories for isolation of S. pneumoniae on human blood agar in resource limited settings. The results highlight the difficulties inherent in correctly identifying pathogens in mixed cultures in needs improvement using standardized tests across the study centers. The study also reaffirms the ability to transport biological specimens over long geographical distances without loss.

Species distribution and anti-fungal susceptibility of Candidaemia at a multi super-specialty center in Southern India.

Candidaemia is one of the leading causes of nosocomial bloodstream infections. There is a rise in the incidence of non-albicans candidaemia and emergence of anti-fungal resistance. We performed a retrospective laboratory-based study over a period of 2 years (January 2009 to December 2010) at our quaternary care multi super-specialty hospital in Southern India. There had been 68 Candida isolates detected from the bloodstream of 55 patients during the study period. Overall, 74% of cases were due to non-albicans Candida. C. tropicalis was most commonly isolated (39.7%), followed by C. albicans (26.4%). All Candida isolates remain susceptible to voriconazole, whereas highest degree of resistance was observed for fluconazole.