Evaluation of phenotypic tests for detection of Klebsiella pneumoniae carbapenemase and metallo-beta-lactamase in clinical isolates of Escherichia coli and Klebsiella species.

CONTEXT: Carbapenemase production is an important mechanism responsible for carbapenem resistance. AIMS: Phenotypic detection and differentiation of types of carbapenemase in carbapenem resistant Enterobacteriaceae is important for proper infection control and appropriate patient management. SETTINGS AND DESIGN: We planned a study to determine the occurrence of Class A Klebsiella pneumoniae carbapenemase (KPC type) and Class B Metallo-ß-lactamase (MBL type) carbapenemase in hospital and community. MATERIALS AND METHODS: Clinical isolates of Escherichia coli and Klebsiella species and simultaneously evaluate different phenotypic methods for detection of carbapenemases. RESULTS: It was observed that 20.72% clinical isolates of E. coli and Klebsiella spp. were resistant to carbapenem on screening of which, 14.64% were E. coli and 29.69% were Klebsiella spp. Using phenotypic confirmatory tests the occurrence of carbapenemase production was found to be 87.01% in E. coli and 91.51% in Klebsiella spp. using both modified Hodge test (MHT) and combined disk test (CDT) using imipenem-ethylenediaminetetraacetic acid. CONCLUSIONS: Both MBL and KPC type carbapenemases were seen among clinical isolates of E. coli and Klebsiella spp. CDT is simple, rapid and technically less demanding procedure, which can be used in all clinical laboratories. Supplementing MHT with CDT is reliable phenotypic tests to identify the class A and class B carbapenemase producers.

C-Reactive Protein (CRP) and its Association with Periodontal Disease: A Brief Review.

Periodontal disease is a chronic infection of the gums characterised by a loss of attachment between the tooth and bone, and bone loss. C-reactive protein (CRP) elevation is a part of the acute phase response to acute and chronic inflammation. Many epidemiological studies have shown that serum CRP levels were elevated in patients with chronic periodontitis. CRP levels increase to hundreds of µg/ml within hours following infection. It out-performs erythrocyte sedimentation rate (ESR) in terms of responsiveness and specificity for inflammation. While CRP elevation is suggestive of inflammation or infection in the appropriate clinical context, it can also occur with obesity and renal dysfunction. Conversely, a lack of CRP elevation in inflammation may be seen with hepatic failure, as well as during flares of conditions such as systemic lupus erythematosus.

Genotype MTBDR plus assay for molecular detection of rifampicin and isoniazid resistance in Mycobacterium tuberculosis.

AIM: This study was performed for the rapid identification of Mycobacterium tuberculosis complex and its resistance to rifampicin and isoniazid, directly from the sputum samples of pulmonary tuberculosis patients. MATERIALS AND METHODS: A commercially available genotype MTBDR plus assay was used for the identification and detection of mutations in Mycobacterial isolates. A total of 100 sputum samples of pulmonary tuberculosis patients were analyzed by using the genotype MTBDR plus assay. The MTBDR plus assay is designed to detect the mutations in the hotspot region of rpoB gene, katG and regulatory region of inhA gene. RESULTS: The genotype MTBDR plus assay detected 22% multidrug resistant (MDR), 2% rifampicin (RMP) monoresistant and 1% isoniazid (INH) monoresistant isolates. In 22 MDR isolates, the codons most frequently involved in RMP-associated mutations were codon 531 (54.55%), 516 (31.82%) and 526 (13.63%), and 90.90% of MDR isolates showed KatG S315T mutations and 9.1% showed inhA C-15T mutations associated with INH resistance. CONCLUSION: The new genotype MTBDR plus assay represents a rapid, reliable tool for the detection of MDR-TB, wherein results are obtained in 5 h allowing early and appropriate treatment, which is essential to cut the transmission path and reduce the spread of MDR-TB. The genotype MTBDR plus assay can readily be included in a routine laboratory work for the early diagnosis and control of MDR-TB.

Extended spectrum beta lactamase producing Proteus penneri: a rare missed pathogen?

Indole negative Proteus species are invariably incorrectly identified as Proteus mirabilis, often missing out isolates of Proteus penneri. We report a case of extended spectrum beta lactamase producing and multidrug-resistant P. penneri isolated from pus from pressure sore of a patient of road traffic accident. Correct and rapid isolation and identification of such resistant pathogen are important as they are significant nosocomial threat.

Maxillary osteomyelitis by mucormycosis: report of four cases.

Mucormycosis is a fungal infection commonly affecting structures in the head and neck, such as the air sinuses, orbits, and the brain. Common predisposing factors include diabetes mellitus and immunosuppression. We describe our clinical experience with four cases of mucormycosis of the maxillary antrum associated with uncontrolled diabetes mellitus managed at our centre. Early diagnosis and prompt treatment can significantly reduce the mortality and morbidity of this lethal fungal infection.

Physician accessories: doctor, what you carry is every patient's worry?

BACKGROUND: Nosocomial infections are on the rise worldwide and many a times they are carried by the health care personnel. Accessories used by physicians and healthcare personnel can be a potential source of nosocomial infection. MATERIALS AND METHODS: We designed a survey with the aim to investigate the prevalence of microbial flora of accessories such as pens, stethoscopes, cell phones and white coat used by the physicians working in a tertiary care hospital. OBSERVATIONS: It was observed that 66% of the pens, 55% of the stethoscopes, 47.61% of the cell phones and 28.46% of the white coats used by the doctors were colonized with various microorganisms. Staphylococcus spp. was the predominant isolate followed by Escherichia coli. Methicillin resistance in Staphylococcus aureus was also found, which was a matter of concern. CONCLUSIONS: Awareness of appropriate hand hygiene is important in order to prevent potential transmission to patients.

External ophthalmomyiasis caused by Oestrus ovis: a rare case report from India.

Myiasis of different organs has been reported off and on from various regions in the world. We report a human case of external ophthalmomyiasis caused by the larvae of a sheep nasal botfly, Oestrus ovis, for the first time from Meerut city in Western Uttar Pradesh, India. A 25-year-old farmer presented with severe symptoms of conjunctivitis. The larvae, 3 in number, were observed in the bulbar conjunctiva, and following removal the symptoms of eye inflammation improved within a few hours.

Beta-lactamase producing Pseudomonas aeruginosa in hospitalised patients.

Beta lactamase continues to be the leading cause of resistance to beta lactam antibiotics in gram-negative bacteria. A total of 50 clinical isolates of Pseudomonas aeruginosa were studied to determine the prevalence of ESBL production in hospital strains and also to study their susceptibility to various other antimicrobial agents. ESBL production was observed in a total of 18/50 (36%) of cases. Most of the ESBL positive isolates showed resistance to 3rd generation cephalosporins including multidrug resistance (MDR) to antibiotics like piperacillin, nalidixic acid, ciprofloxacin, levofloxacin, gentamicin and tobramycin. The ESBL producers however showed good susceptibility to drugs like meropenem, gatifloxacin and amikacin.