Ciprofloxacin-resistant Gram-negative isolates from a tertiary care hospital in Eastern India with novel gyrA and parC gene mutations.

BACKGROUND: Expanded-spectrum quinolones (ciprofloxacin) are highly effective against gram-negative bacteria, but significant resistance to quinolones has been increasingly reported. We sought to evaluate the prevalence of gram-negative ciprofloxacin-resistant isolates (CRIs) from our hospital and their mechanism of action. METHODS: Gram-negative CRIs were identified as per standard procedures and confirmed using the Ezy MICTM Strip (HiMedia). DNA from 67 CRIs was amplified for the quinolone resistance-determining region (QRDR) and plasmid-mediated quinolone resistance genes. Thirty isolates positive for QRDR DNA were sequenced by Sanger's method to detect mutation. RESULTS: Of the isolates, 42.5% were found to be CRIs, the majority (74.42%) from inpatient departments, and E scherichia coli (64.19%) was the predominant isolate. Among the CRIs, 24.55% were ESBL producers and 35.29% were multidrug resistant. The polymerase chain reaction results showed the majority were amplified by QRDR target regions of gyrA (35.4%) while 4.61% were amplified for the plasmid-mediated fluoroquinolone resistance region of the qnrB gene. Further sequencing of QRDR-positive genes showed point mutations with amino acid changes at codons Ser83 and Asp87 in the gyrA gene and Ser80, Glu84, and Leu88 positions in the parC gene. CONCLUSION: Ciprofloxacin resistance observed in our study was mostly due to point mutations. Hence, strategies for rational use of ciprofloxacin and adherence to the dose and duration of treatment could be helpful to prevent selection and spread of mutant CRIs/strains.

Soil transmitted helminth infections among school going age children of slums from Bhubaneswar, Odisha.

OBJECTIVE: The objective is to determine prevalence and risk factors for soil-transmitted helminth (STH) infection among school-going age children from slums of Bhubaneswar. DESIGN: Cross-sectional observational study. SETTING: Microbiology laboratory of a tertiary care hospital, Bhubaneswar, during May 1-October 30, 2015 (6 months) including 360 children of 3-15 years from two populated slums of Bhubaneswar, assuming STH prevalence - 50%, confidence interval 95% and 10% relative precision. Purposively sampling by house to house visit was adopted to collect stool samples along with risk factors through questionnaires from each child after written informed consent of parents/guardians. MATERIALS AND METHODS: Direct saline mount and egg counting by Kato-Katz (KK) method for STH-positive samples was done. RESULTS: STH prevalence was 13.3%, more in males (68.8%), and significantly high (62.5%. P < 0.05) in school-going children between 6 and 12 years of age. Predominant STH was Ancylostoma duodenale (56.2%), 15% of parents were illiterate, 80% of houses had toilets, 70% were washing hand with soap and using footwear. STH infection was much less (12.5%) in those practicing handwashing with soap. Fifty percent of children had STH infection even after receiving deworming within the past 6 months. More egg counts - 216 eggs/gram of feces were found in 29 cases by KK method. Entamoeba histolytica (56.5%) was predominant among non-STH infections. CONCLUSION: STH prevalence of Bhubaneswar slums was minimum (13.3%), school-going children of 6-12 years were more affected and handwashing habit with soap was the key factor to prevent STH infection. The proportion of participants having toilet facility and using footwear regularly had no role in STH prevention.

Clinico-epidemiological analysis of scrub typhus in hospitalised patients presenting with acute undifferentiated febrile illness: A hospital-based study from Eastern India.

Acute undifferentiated febrile illness (AUFI) constitutes the predominant cause of healthcare seeking in Odisha. This prospective study was conducted to analyse the clinical, epidemiological and laboratory profile of scrub typhus patients presenting with AUFI from January to December 2017. Four hundred and thirty-two samples were tested for dengue, malaria, scrub typhus and enteric fever. Scrub typhus was overall the most common cause of AUFI (26.3%, 114/432) followed by dengue (19.2%, 83/432). Eschar was seen in 6.1% of cases. Aetiologies of 38.6% of AUFI remained unidentified. In the present study, there was no mortality attributed to scrub typhus.

Liver Abscess due to Streptococcus constellatus in an Immunocompetent Adult: A Less Known Entity.

BACKGROUND: Pyogenic liver abscesses (PLAs) are an uncommon, but potentially life threatening infection. We report a case of PLA due to Streptococcus constellatus, a member of the Streptococcus anginosus group (SAG) bacteria, commonly found as commensals of the oropharyngeal, gastrointestinal and genitourinary flora. CASE: The patient, a 42-year-old man with no premorbidities, non-smoker and non-alcoholic, presented to our hospital with high-grade fever associated with chills and rigors and right upper quadrant pain of one month duration. Culture of the ultrasound-guided liver aspirate yielded a pure growth of S. constellatus subspecies constellatus identified by conventional biochemical tests. In a standard antimicrobial disk-diffusion test, the isolate was susceptible to cefepime, cefotaxime, ceftriaxone, vancomcyin, levofloxacin, clindamycin and linezolid. Treatment with parenteral ceftriaxone alongwith appropriate surgical management led to resolution of the abscess with no recurrence of infection at three months follow-up. CONCLUSIONS: The pathogenic potential of SAG has generally been disregarded because of the commensal nature of these microorganisms; however, streptococci belonging to this group have been increasingly reported as relevant pathogens in abscesses and blood cultures. An underlying condition, such as diabetes, cirrhosis or cancer or some medical manipulation, such as dental extraction, acupuncture, or hemorrhoidectomy is associated with the majority of patients with SAG abscess. However, the present case highlights the need to include S. constellatus and other members of the SAG while investigating for etiology of PLA, even in immunocompetent adults.