Distribution of MecA and Erm Genes among Methicillin-resistant Staphylococcus Aureus with Inducible Resistance to Clindamycin.

BACKGROUND: The emergence of Methicillin-resistant Staphylococcus aureus and its ability to confer cross-resistance to macrolide-lincosamide-streptogramin B has complicated the treatment against it. Gene-based studies among phenotypic methicillin-resistant isolates with inducible resistance to clindamycin are less available in Nepal. This work was undertaken to detect the mecA and erm genes among such phenotypes isolated from clinical samples. METHODS: S. aureus isolated from different clinical samples was identified by standard microbiological procedures (Gram-staining, colony morphology, and different biochemical tests). Methicillin-resistant and inducible resistant to clindamycin phenotypes were detected by using cefoxitin disc (30 µg) and a double disk diffusion test according to the Clinical and Laboratory Standards Institute guidelines and mecA and erm genes were detected by polymerase chain reaction. RESULTS: Among 120 S. aureus isolates, 51.67% (n=62) were MRSA, and the prevalence of inducibly-resistant, constitutively-resistant and Macrolide-Streptogramin phenotypes were 15.83% (n=19), 28.33% (n=34) and 15.83% (n=19) respectively. While 35.84% (n=43) of isolates showed sensitivity to both antibiotics, erythromycin and clindamycin. Out of 14 inducibly-resistant phenotypes, 57.14% (n=8) were found carrying ermC and 28.57% (n=4) phenotypes contained both ermA and ermC. All phenotypes were positive for the mecA gene. CONCLUSIONS: Macrolides-Lincosamide-Streptogramin B resistance was predominant among methicillin-resistant S. aureus. While all isolates with inducible clindamycin resistance harbored mecA gene, most of them also harbored ermC gene. The higher prevalence of inducible-resistant to clindamycin indicated the need for rational use of antimicrobial agents.

Renal Hydatid Cyst in a Child Managed with Albendazole.

Primary Renal hydatid cyst is a rare entity. We report a case of isolated right renal hydatid cyst in a 13-year-old female who presented with pain in the right lumbar region for 4-5 months and a palpable mass in the right upper quadrant. The radiological features were suggestive of a hydatid cyst in the right kidney with no cyst in the liver, lungs, or left kidney. She was managed medically with oral Albendazole tablets (400 mg twice daily). A total of 6 cycles of Albendazole were given with each cycle lasting for 4 weeks and a drug-free period of 2 weeks in between two consecutive cycles and kept on follow-up for a year. Her condition improved with no recurrence on follow-up after one year. Keywords: Albendazole; echinococcus granulosus; renal hydatid cyst.

Antibiotic Resistance, Biofilm Formation and Sub-Inhibitory Hydrogen Peroxide Stimulation in Uropathogenic Escherichia coli.

Uropathogenic Escherichia coli (UPEC) is the most prevalent cause of urinary tract infections (UTIs). Biofilm formation and antibiotic resistance could be high among the causative agent. The purpose of this study was to determine antibiotic resistance, biofilm production, and biofilm-associated genes, bcsA and csgD, and sub-inhibitory hydrogen peroxide (H2O2) stimulation in UPEC for biofilm formation. A total of 71 UPEC were collected from a tertiary care hospital in Kathmandu and subjected to identify antibiotic susceptibility using Kirby-Bauer disk diffusion. The biofilm formation was assessed using microtiter culture plate method while pellicle formation was tested by a tube method. In representative 15 isolates based on biofilm-forming ability, bcsA and csgD were screened by conventional polymerase chain reaction, and treated with sub-lethal H2O2. The UPEC were found the most susceptible to meropenem (90.2%), and the least to ampicillin (11.3%) in vitro and 90.1% of them were multi-drug resistant (MDR). Most UPEC harbored biofilm-producing ability (97.2%), and could form pellicle at 37°C. Among representative 15 isolates, csgD was detected only among 10 isolates (66.67%) while bcsA gene was present in 13 isolates (86.67%). This study revealed that level of biofilm production elevated after sub-lethal H2O2 treatment (P = .041). These findings suggested that the pathogens are emerging as MDR. The biofilm production is high and the majority of selected strains contained bcsA and csgD genes. Pellicle formation test was suggestive to be an alternative qualitative method to screen biofilm production in UPEC. The sub-inhibitory concentration of H2O2 may contribute in increasing biofilm formation in UPEC.

Clinical Features, Intensive Care Needs, and Outcome of Carbamazepine Poisoning in Children.

Carbamazepine is commonly used antiseizure medication with a narrow therapeutic range. The data on carbamazepine poisoning in children from India is limited. In this retrospective study, the authors reported 10 children with carbamazepine poisoning admitted to pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India over a period of 8 y (2013 to 2020). The median age was 5.5 (4.3-6) y and 60% cases were males. All had accidental ingestion and the dose ingested was 96 (80-103) mg/kg. The common clinical features were drowsiness (100%), tachycardia (80%), vomiting (60%), seizures (60%), respiratory failure (60%), and dystonia (50%). At admission, 60% children had coma. The treatment included gastric lavage (70%), single-dose-activated charcoal (60%), multidose-activated charcoal (30%), mechanical ventilation (60%), and dialysis (20%). The duration of PICU and hospital stay was 36 (22-45) h and 48 (48-60) h, respectively. There was no mortality.