Pattern of Pediatric Bacterial Infection and Antibiotic Resistance in New Delhi.

The retrospective study analyzed 1025 bacterial isolates from blood cultures collected from pediatric patients admitted in a tertiary-care hospital in New Delhi to find out drug sensitivity patterns. Staphylococcus was isolated from approximate 70% of the cultures, with 63.7% of them being methicillin-resistant. Meropenem resistance among acinetobacter was 38.6%.

In vitro antimicrobial susceptibility patterns of Propionibacterium acnes isolated from patients with acne vulgaris.

INTRODUCTION: Propionibacterium acnes has been implicated in the development of acne vulgaris. Rampant use of topical and systemic antibiotics for acne vulgaris has led to resistance due to selective pressure. This study aimed to determine antibiotic resistance of P. acnes. METHODOLOGY: A total of 102 samples were collected from acne lesions and cultured onto sheep's blood agar and brain-heart infusion agar supplemented with 5 g/L glucose and 2 mg/L furazolidone) (BHIg) under aerobic and anaerobic conditions. Species identification was done by conventional methods and the VITEK2 Compact system. The isolates were tested for penicillin, erythromycin, clindamycin, ciprofloxacin, nadifloxacin, and tetracycline by E-test, and minimum inhibitory concentration (MIC) of minocycline was determined by agar dilution on BHIg. MIC results were interpreted as per EUCAST (European Committee on Antimicrobial Susceptibility Testing) and CLSI (Clinical Laboratory Standards Institute) guidelines. RESULTS: P. acnes was the most common anaerobe (66%) isolated. Resistance rates using EUCAST and CLSI breakpoints were 10.6% and 6.1%, 7.6% and 0%, 7.8% and 0% for erythromycin, clindamycin, and minocycline, respectively. Tetracycline resistance was observed in 9.2% isolates irrespective of the interpretative criteria used. MIC50 and MIC90 values for nadifloxacin (0.25 and 1 µg/mL) were found to be twofold lower than those for ciprofloxacin (0.5 and 1 µg/mL). Similarly, MIC50 and MIC90 values for minocycline (0.125 and 0.5 µg/mL) were also two- to threefold lower than those for tetracycline (0.38 and 1 µg/mL). CONCLUSIONS: To the best of our knowledge, this is the first study focusing on P. acnes resistance from India.

Cedecea lapagei in a patient with malignancy: Report of a rare case.

Cedecea lapagei is a member of the family Enterobacteriaceae and is an uncommon pathogen. There are very few reports of isolation of this organism from biological samples; mostly it is found to be a pathogen in elderly or otherwise medically compromised. We present a rare case of a patient with underlying malignancy of buccal mucosa, who developed an oral ulcer superinfected with C. lapagei. According to the available literature, this is the first case of C. lapagei from India detected in a cancer patient.

Antimicrobial resistance of bacterial isolates from respiratory secretions of ventilated patients in a multi-specialty hospital.

CONTEXT: Ventilator-associated pneumonia (VAP) is a common nosocomial infection occurring in intensive care unit (ICU) settings. VAP occurs due to interplay of three factors - impaired host defense, access of large numbers of pathogenic bacteria to the lower respiratory tract and the virulence of the organism. Knowledge of colonizing microbial flora and their antibiogram in ventilated patients is of great importance in timely institution of empirical therapy, so that mortality and morbidity due to VAP can be reduced. SUBJECTS AND METHODS: A prospective study was performed over a period of 6 months in a multi-specialty hospital to determine the various pathogens in respiratory secretions and to determine the prevalence of multidrug resistance (MDR). RESULTS: Pseudomonas aeruginosa (26%), Acinetobacter (26%), Klebsiella pneumoniae (26%), followed by Escherichia coli (15%), Staphylococcus aureus (6%) and Citrobacter spp. (1.5%) were the common pathogens isolated in our study. In all, 72.73% (48/66) bacterial isolates were isolated from medical ICU, while 25.76% (17/66) were isolated from surgical ICU. Only one strain (Acinetobacter) was isolated from pediatric ICU. Fifty-seven (86.36%) of the 66 pathogens in our study were MDR. CONCLUSION: There is increasing colonization of pathogenic bacteria in ventilated patients admitted in ICUs, which are predominantly MDR. These colonizers may cause infection resulting in VAP. Judicious use of antibiotics, guided by local antibiotic resistance profile coupled with strict infection control practices alongside application of VAP bundle are important measures to prevent these pathogens from causing VAP in ICU patients.

Incidence of multidrug resistant pseudomonas aeruginosa isolated from burn patients and environment of teaching institution.

CONTEXT: Pseudomonas aeruginosa is an important pathogen which causes nosocomial infections in immunocompromised patients, especially in hospitalized burn patients. In recent times, it has emerged as a widespread Multi Drug Resistant (MDR) pathogen which requires antibiotic susceptibility testing on a regular as well as a periodic basis. AIM OF THE STUDY: The present study was undertaken to determine the antibiogram of P. aeruginosa which was isolated from inpatients and environmental sources, and to type the strains, based on their antibiogram patterns. SETTINGS AND DESIGN: A prospective study was undertaken with 525 samples (blood and wound swabs) which were taken from 60 patients who were admitted to Vardhman Mahavir Medical College and Safdarjang hospital with burn injuries and with 101 samples which were obtained from environmental sources viz. surgical instruments, dressings, suction devices, sinks, antiseptic solutions, etc. MATERIALS AND METHODS: The strains were cultured and identified by standard microbiological techniques and Kirby- Bauer disc diffusion antibiotic susceptibility testing was done for each. STATISTICAL ANALYSIS: Chi -squire tests were done and p- values of less than 0.05 were considered to be significant. RESULTS: Fifty six strains and two strains, respectively, of P. aeruginosa were isolated from inpatients and environmental samples (one strain from sink and one strain from door wall, among the two) respectively. In total, 58 (81%) P. aeruginosa strains were found to be resistant to aminoglycosides, 41-70% were resistant to beta-lactams - piperacillin, ceftazidime, and aztreonam, 34.5% were resistant to piperacillin-tazobactam, 12.06% were resistant to ciprofloxacin and 13-19% were resistant to carbapenems. All strains were sensitive to colistin. P. aeruginosa was resistant to three of the four 'in-use' drugs i.e. piperacillin+tazobactam, imipenem, ceftazidime, and gentamicin, which was taken as MDR, which depicted MDR percentage as 36.2 (21/58). CONCLUSION: Strategies of optimal prescribing, including control of antibiotic usage, coupled with periodic studies on MDR P. aeruginosa infections in burn patients, appear to be leading priorities which help in improving therapeutic gains in such patients.

Multidrug-resistant Staphylococcus hominis subsp. novobiosepticus causing septicemia in patients with malignancy.

A new subspecies of Staphylococcus hominis described by Kloos et al. in 1998 and named S. hominis subsp. novobiosepticus (SHN) has been implicated in nosocomial outbreaks. Multidrug resistance, including resistance to novobiocin and oxacillin, is a particularly important feature of SHN. In our institute, we encountered 13 cases of S. hominis subsp. hominis in cancer patients with septicemia, of which seven were methicillin resistant. The isolates were identified by VITEK ® 2 compact automated system, using GP REF 21342 identification card and antimicrobial susceptibility testing card P-628. The biochemical reactions and antibiotic susceptibility pattern of the seven methicillin-resistant isolates were re-analyzed and patient details were re-checked to finally identify them as SHN. The increasing number of cases reporting isolation of SHN from biological specimens point to potential virulence and clinical importance of this bacterium.

Bacterial profile and patterns of antimicrobial drug resistance in intra-abdominal infections: current experience in a teaching hospital.

CONTEXT: Bacterial isolates from intra-abdominal infections, in particular, peritonitis and their unpredictable antimicrobial resistance patterns, continue to be a matter of concern not only globally but regionally too. AIM: An attempt in the present study was made to study the patterns of drug resistance in bacterial isolates, especially gram negative bacilli in intra-abdominal infections (IAI) in our hospital. MATERIALS AND METHODS: From 100 cases of peritonitis, identification of isolates was done as per recommended methods. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) testing were performed following the CLSI guidelines. RESULTS: A total of 133 clinical isolates were obtained, of which 108 were aerobes and 22 anaerobes. Fungal isolates were recovered in only three cases. Escherichia coli (47/108) emerged as the most predominant pathogen followed by Klebsiella spp. (27/108), while Bacteroides fragilis emerged as the predominant anaerobe (12/22). Among coliforms, 61.7% E. coli and 74.1% Klebsiella spp. were ESBL positive. A high level of resistance was observed for beta lactams, ciprofloxacin, amikacin, and ertapenem. Ertapenem resistance (30-41%) seen in coliforms, appears as an important issue. Imipenem, tigecycline, and colistin were the most consistently active agents tested against ESBL producers. CONCLUSION: Drug resistance continues to be a major concern in isolates from intra-abdominal infections. Treatment with appropriate antibiotics preceded by antimicrobial resistance testing aided by early diagnosis, adequate surgical management, and knowledge of antibiotic - resistant organisms appears effective in reducing morbidity and mortality in IAI cases.