Hepatitis B and C Viruses, Their Coinfection and Correlations in Chronic Liver Disease Patients: A Tertiary Care Hospital Study.

INTRODUCTION: There has been a rapid increase in the cases of viral hepatitis in Malwa region of Punjab. Quantification of seroprevalence of hepatitis B virus (HBV)/hepatitis C virus (HCV) and their coinfection among liver disease patients in tertiary care settings is needed to know the associated disease burden. AIM: The aim of this study is to analyze the seroprevalence of HBV, HCV, their coinfection, and implications in liver disease patients. MATERIALS AND METHODS: This prospective study was conducted from June 2015 to August 2015 on a total of 100 chronic liver disease (CLD) patients. Venous blood samples were tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies by performing required serological tests using sandwich ELISA technique and solid-phase immunochromatography. RESULTS: Out of 100 cases, 80 (80%) were male and 20 (20%) were female with mean age of 47.44 ± 14.56 years. Out of 100 cases of hepatic disorders, 26 were HBsAg positive and 40 were anti-HCV positive. Majority of the HBsAg-positive cases had alcohol as a risk factor (27%) and were diagnosed with cirrhosis (38.5%). Maximum number of anti-HCV-positive cases had blood transfusion as risk factor (30%) and were diagnosed with cirrhosis (45%). Out of total 62 seropositive cases, 4 had coinfection of HBV and HCV. Coinfected patients did not demonstrate greater risk of developing cirrhosis or progressing to hepatocellular carcinoma than mono-infected patients. CONCLUSION: HBV and HCV are the major causes of CLD at the place of study. Patients with dual HBV and HCV infection do not have greater risk of developing cirrhosis or progressing to HCC than mono-infected patients.

Antibiotic susceptibility profiles of non-fermenting gram-negative Bacilli at a Tertiary Care Hospital in Patiala, India.

BACKGROUND: Non-fermenting Gram-negative bacilli (NFGNB) have emerged as a major cause of healthcare-associated infections and are innately resistant to many antibiotics. AIM: The aim of this study was to determine the prevalence of NFGNB isolated from various clinical specimens and evaluate their antimicrobial susceptibility profiles. MATERIALS AND METHODS: This retrospective study was done at our Department of Microbiology from December 2015 to December 2016. NFGNB were isolated from a variety of clinical specimens, plated on blood agar and MacConkey agar and incubated at 37°C for 18-24 h under aerobic conditions. Appropriate biochemical tests were done to identify the organisms isolated. Antibiotic susceptibility test was performed using the modified Kirby-Bauer disc diffusion method using commercially available discs on Mueller-Hinton agar. Data was analyzed using SPSS IBM version 20. RESULTS: Out of 19065 clinical samples, cultures were positive in 1854 samples. Out of 1854 culture-positive samples, 216 (11.6%) yielded NFGNB. Pseudomonas aeruginosa was the most common NFGNB, isolated in 190/216 (87.96%) samples, followed by Acinetobacter baumannii (17/216, 7.87%). Overall, most of the NFGNB isolates were susceptible to polymyxin B (88.4%), imipenem (82.9%) and cefoperazone + sulbactam (50.9%), and a total of 11 (64.71%) multidrug-resistant A. baumannii (MDRAB) strains were isolated in the study. CONCLUSION: Our study showed a significantly high prevalence of NFGNB. Isolation of multidrug-resistant P. aeruginosa and MDRAB in the present study raises the concern of rapidly emerging antibiotic resistance in this group of bacteria in our region.

A retrospective study of the changing trends of antimicrobial resistance of Klebsiella pneumoniae isolated from urine samples over last 3 years (2012-2014).

BACKGROUND: In our country, the problem of antibiotic resistance is compounding because of overuse and misuse of antibiotics. There is no systematic national surveillance of antibiotic resistance and insufficient data are available to quantify the problem. OBJECTIVES: To study the changing pattern of antimicrobial resistance of Klebsiella pneumoniae isolates from patients of urinary tract infections over last 3 years. MATERIALS AND METHODS: A retrospective, record-based study carried out based on the records culture sensitivity reports of indoor patients, during past 3 years (2012-2014). The type of organisms most common in urine sample was noted, and the drugs still effective for the particular organism were noted. RESULTS: Klebsiella was the second most frequent isolate throughout the 3 years (14%) of the total isolates). Analysis of the results year wise indicated that the lowest percentage of resistance was manifested against imipenem between 11.94% (2012) and 13.75% (2014). Over the successive years, resistance to ceftriaxone tends to increase from 74.95 % (2012) to 81% (2014). Klebsiella showed very high resistance 90.78% (2012) and 95.63% (2012) to co-trimoxazole and tetracycline, respectively with increasing trend to absolute resistance to both groups over the 3 years period. On an average over the 3 years Klebsiella showed a high amount of resistances to fluoroquinolones (72.71%) and aminoglycosides (76.22%). While multi-drug resistant Klebsiella range between 65% (2012) and 67% (2014). CONCLUSION: The antimicrobial resistance patterns are constantly evolving and vary from region to region it has become a necessity to do constant antimicrobial sensitivity surveillance. This will help clinicians to provide safe and effective empirical therapies.

What are we drinking? Assessment of water quality in an urban city of Punjab, India.

INTRODUCTION: Ground water is the ultimate and most suitable fresh water resource for human consumption in the urban areas of India. Studies regarding ground water quality have shown that the higher rate of exploration as compared to the rate of recharging, inappropriate dumping of solid, as well as liquid waste, lack of strict enforcement of law has led to the deterioration of ground water quality. The present study was thus, carried out to evaluate physicochemical, as well as a microbiological profile of tap water, and filtered water in urban areas of Patiala, Punjab. MATERIALS AND METHODS: The three zones under Municipal Corporation and two areas under Public Health Department were chosen according to the simple random sampling from Patiala city. From each area, 10 houses were chosen according to the systematic random sampling technique (n = 50). Water was taken from two sources, tap water, and from the water filter. Two samples were taken from each source one for the physicochemical analysis and another for bacteriological analysis. The samples which were sent for bacteriological assessment were collected in a sterile container. RESULTS: The number of water samples found to be within desirable limits with respect to physicochemical parameters were significantly more with the filter water sample than the tap water samples. Suspicious/unsatisfactory microbiological quality of water was observed in 28% and 4% of tap and filter water samples, respectively. CONCLUSION: The results indicate that certain chemical parameters such as hardness, chloride, and fluoride levels were beyond the permissible limits. Therefore, we recommend that home filters should be installed, serviced appropriately, and their water quality should be checked routinely. Also, any leak from sewage pipes should be promptly repaired to prevent contamination of drinking water.

Evaluation of efficacy and tolerability of cefotaxime and sulbactam versus cefepime and tazobactam in patients of urinary tract infection-a prospective comparative study.

OBJECTIVE: Urinary tract infection (UTI) is the third most common infection experienced by humans after respiratory and gastro-intestinal infections. Cephalosporins are now widely been used in UTI, but emerging resistance is a problem to that. Our study aims at evaluating efficacy and safety of third generation cephalosporin combined with beta lactamase inhibitors compared with fourth generation cephalosporin. MATERIALS AND METHODS: The present, open, randomised, parallel group comparative study includes 60 patients of urinary tract infection. Group A patient were put on treatment regimen of cefotaxime and sulbactam (0.5-2 gms IV/IM BD) and Group B patients were prescribed cefepime and tazobactam (0.5-1 gm IV/IM BD) depending upon urine culture and sensitivity pattern of causative agent and condition of the patient. Bacteriological cure rate, clinical cure rate will be assessed for efficacy and adverse drug reaction (ADR) recorded for evaluating safety. RESULTS: The study showed a male predominance with 37 males (61.6%) and 23 (38.4%) females out of the total 60 patients with a maximum number within the age group of 50-70., and the most common organism isolated was E coli (73.3%), in rest of the patients Klebsiella (13.33%), Proteus (6.66%), and Staphylococcus (6.66%) were isolated. The overall bacteriological cure rate, in the present study, with cefotaxime/sulbactam and cefepime/tazobactam was 86.5%±6.5 and 93.3%±6.7 respectively. The clinical cure rate post five days of therapay, in goup A1 was 79.03%±2.82 and the same in group B1 was 87% ± 2.11. The clinical cure rate post ten days of therapy in group A2 98.57±0.03 and the same in group B2was 100%. Overall success rate as evaluated by our data in the present study in group A i.e those treated with cefotaxime/sulbactam was 89.28±9.1% and in group B i.e. those treated with cefepime/ tazobactam and 94.49±5.06%. CONCLUSION: From the present study, those drugs in both generations of cephalosporins combined with beta lactamase inhibitors cefotaxime/sulbactam and cefepime/tazobactam were equally effective and well tolerated in the treatment of UTI. However the cost effectiveness and safety parameters are the important deciding factors for prescribing the same.