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INTRODUCTION: Non-Fermenting Gram Negative Bacilli (NFGNB) are emerging now-a-days because of their tendency to colonize various surfaces and inherent resistance to commonly used disinfectants. They are responsible for multi-drug resistant hospital acquired infections. Detection of carbapenem resistance mechanisms is essential for treatment and infection control purpose as can spread to other organisms causing hospital outbreaks. AIM: To characterize non-fermenters from various clinical samples and to detect different carbapenem resistance mechanisms in meropenem resistant isolates. MATERIALS AND METHODS: The prospective study was conducted at Sri Aurobindo Medical College and Post Graduate Institute, Indore over a period of one and half year from December 2014 to May 2016. A total of 1310 samples were collected from Ventilator Associated Pneumonia (VAP), Surgical Site Infection (SSI), Urinary Tract Infection (UTI), septicaemia, Lower Respiratory Tract Infection (LRTI) and middle ear infected patients. Non-fermenters were identified by standard microbiological tests. Meropenem resistance was determined by Kirby-Bauer disk diffusion method and resistant isolates were further tested by Modified Hodge test, Combined disc test and AmpC disc test. RESULTS: Isolation rate of non-fermenters was 13.82% (181/1310). Colistin, amikacin and imipenem were the antibiotics with maximum sensitivity. Overall meropenem resistance was found to be 44.2% (80/181). Metallo-ß-lactamase and AmpC-ß-lactamase were produced by 56.82% (25/44) and 72.22% (26/36) of meropenem resistant Pseudomonas and Acinetobacter species respectively. CONCLUSION: Detection of carbapenem resistance mechanisms and implementation of antibiotic policy are needed to prevent the emergence of non-fermenter infections.
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BACKGROUND: The natural history of chronic obstructive pulmonary disease is characterized by frequent exacerbations. Majority of exacerbations are infectious and bacteria responsible for 30-50% of these cases. The purpose of this study was to determine the bacteriology of acute exacerbations of chronic obstructive pulmonary disease in hospitalized patients in our institution and their antibiotic susceptibility pattern to formulate cost effective antibiotic strategy and reducing the emergence of drug resistance. MATERIALS AND METHODS: One hundred and seven clinically diagnosed cases of acute exacerbations of chronic obstructive pulmonary disease admitted in medicine, tuberculosis and chest wards were selected for the study. Direct gram stain was done for all sputum samples. The suitable sputum samples were cultured. Identification of organism and antimicrobial susceptibility testing was done by standard microbiological techniques. RESULTS: Our study showed growth of pathogenic organisms in 41.12% cases. Males (67.29%) are more affected than females (32.71%). Gram negative bacilli were more isolated than gram positive cocci. The commonest isolate was Klebsiella pneumoniae 15 (38.46%), followed by Staphylococcus aureus 9 (23.08%), Streptococcus species 6 (15.39%), Pseudomonas aeruginosa 4 (10.26%), E.coli 2 (5.13%), Acinetobacter species 2 (5.13%) and Enterobacter species 1(2.56%). The antibiotic susceptibility reveals that vancomycin, linezolid, azithromycin and clarithromycin were most effective drugs for gram positive cocci, meropenem & piperacillin-tazobactam for gram negative bacilli and amikacin & levofloxacin for both gram positive cocci & gram negative bacilli. CONCLUSION: In developing country like India acute exacerbations of chronic obstructive pulmonary disease is common in adults more than 50 years of age due to smoking habits and high indoor pollution. This leads to a major impact on the quality of life of patients with the condition. They are a major cause of hospital admission and health care utilization.
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BACKGROUND: Neonatal sepsis is one of the most common causes of neonatal mortality and morbidity, particularly in the developing countries. Its causative bacteria and their respective sensitivity patterns are different in each hospital and region. The objective of this study was to determine the causative bacteria and pattern of susceptibility to antibiotics in NICU of a tertiary care centre, which in turn may help in implementation of empirical therapy. MATERIAL AND METHODS: This prospective study was carried out at a medical college during the period from 1st April 2011 to 31st March 2013. A total of 364 cases of suspected sepsis were admitted in our NICU during the mentioned period. Out of which, 137 cases were positive for culture. All the neonates of suspected sepsis were screened by using a panel consisting of CRP, ANC, I/T ratio, micro ESR and culture and sensitivity. RESULTS: A total of 137 cultures were found to be positive out of 364 cases. The most common organism isolated was Staphylococcus aureus (37.22%) followed by Klebsiella pneumoniae (27.01%) and Escherichia coli (19.70%). Other organisms were much less in number, which included pathogenic Streptococci, Coagulase negative Staphylococci (CoNS), Pseudomonas, Acinetobacter and Enterobacter species. The gram positive organisms except Streptococci displayed a high degree of resistance to most penicillins and ciprofloxacin but were sensitive to vancomycin, amikacin and cefepime. There was a high incidence of resistance noted with ampicillin, gentamicin and ciprofloxacin amongst most gram negative organisms' where-in cefepime, amikacin and meropenem were effective in most cases. CONCLUSION: There is an increasing trend of antibiotic resistance to the commonly used first line drugs. Continuous surveillance for antibiotic susceptibility is needed to ensure proper empirical therapy.
