Evaluation of augmentin and cotrimoxazole against 276 pathogens in community acquired urinary tract infections [abstract]

OBJECTIVE: Augmentin and cotrimoxazole are the front-line drugs in the therapy of community acquired urinary tract infections. This report examines the in vitro efficacy of these two drugs against 276 urinary pathogens encountered from patients attending outpatient clinics at the University Hospital of the West Indies. METHODS: The urines collected from outpatients in 3 months (March to May, 2001) were cultured semi-quantitatively. The isolates (o 10 cfu/ml) were identified by routine methodology and antimicrobial susceptibilities were determined by the standard disc-diffusion technique. RESULTS: Of the 276 isolates, 190 (68.8 percent) were gram negative and 86 (31.2 percent ) were gram positive pathogens. The common isolates in order of frequency were: Escherichia coli 89 (32.2 percent), Enterococci/Group D Streptocci 33 (12.0 percent, Proyteus mirabilis 28 (10.1 percent), Klebsiella sp 25 (9.1 percent) and coagulase negative Staphulococci 20 (7.2 percent). These five organisms together accounted for over two-thirds (70.7 percent of all isolates. Augmentin was effective against 71.0 percent of all, 68.9 percent of gram negative and 75.6 percent of gram positive pathogens and cotimoxazole was effective against 63.0 percent of all, 58.4 percent gram negative and 73.3 percent of gram-positive isolates. CONCLUSION: Despite decades of their usage, augmentin and cotrimoxazole continue to be effective in community acquired urinary tract infections. (AU)

Frequency of occurence and antimicrobial resistance in isolates of bacterial conjunctivitis in patients at the University Hospital of the West Indies [abstract]

OBJECTIVE: There is paucity of published data on bacterial conjunctivitis in patients at the University Hospital of the West Indies and the wider community in Jamaica. This report analyses 208 bacterial isolates from 198 eye swab cultures of patients with clinical diagnosis of conjunctivitis in this hospital. METHODS: Culture of eye swabs was done by routine methodology, and anti-microbial susceptibility tests were performed by the standard disc-diffusion technique. RESULTS: Two hundred and eight bacterial isolates were encountered in the 198 ocular cultures. Eighty of these (32.9 percent) were likely contaminants (normal commensal from skin of the eyelid). The common isolates in order of frequency in the remaining 128 were: Haemophilus influenzae pneumoniae 12 (9.4 percent) and Pseudomonas aeruginosa 5 (3.9 percent). These four organisms together accounted for over two-thirds (69.5 percent) of the 128 isolates. More than 90 percent of these strains were susceptible to chloraphenicol and gentamicin. CONCLUSIONS: The contamination rate in eye swab cultures is very high and there is need for improvement of the collection procedures. Haemophilus influenzae remains the most common pathogen of bacterial conjunctivitis as in many other parts of the world. The common eye preparations such as chloramphenicol and gentamicin (alternatively, tobramycin) continue to be highly effective against pathogens from conjunctivitis at the University Hospital of the West Indies. (AU)

The medical management of diabetes mellitus with particular reference to the lower extremity: the Jamaica experience

Predisposing factors for the diabetic foot include peripheral neuropathy, peripheral vascular disease (PVD), hyperglycaemia and increased duration of diabetes. From the records of patients admitted to the University Hospital of the West Indies with the diabetic foot, we reviewed the results of the microbiology of wound swabs from diabetic foot ulcers. We noted the high prevalence of PVD (66.6 percent), peripheral neuropathy (50 percent), hyperglycaemia (75.6 percent) and increased duration of diabetes (17.5 years). A history of past foot ulcers was common and 87.2 percent had polymicrobial infection. The commonest organisms were gram positive organisms which were usually sensitive to the 2 antibiotic regimes that were commonly used. Euglycaemia, a favourable lipid profile, control of blood pressure, yearly foot examination and institution of measures to prevent foot trauma are important in the prevention of foot ulceration.(Au)

Evaluation of antibacterial activity of cefotaxime after eight years of its usage at the University Hospital of the West Indies - abstract

Cefotaxime is one of the commonly used third generation cephalosporines in many parts of the world. The antibiotic was introduced at the University Hospital of the West Indies in 1983 and its use is being closely monitored by the Department of Microbiology. After 8 years of judicious usage, we evaluated the efficacy of cefotaxime against 493 multi-resistant strains (strains resistant to 3 or more antibiotics) of gram-negative bacilli, except pseudomonas, encountered during the period January, 1991 to November, 1992 in this hospital. The vast majority of strains tested (66 per cent) were resistant to 5 or 6 antibiotics. Cefotaxime was effective against 94 per cent of resistant E. coli, 90 per cent of Klebsiella and 100 per cent of Proteus mirabilis strains. These 3 organisms together account for over one-half of all Gram-negative infections in this hospital. Overall, the compound was effective against 86 per cent of all multi-resistant strains encountered during the period. Of the 68 cefotaxime-resistant isolates, 20 (30 per cent) were Enterobacter and 28 (41 per cent) were Acinetobacter strains. Bacterial resistance to third generation cephalosporins such as cefotaxime is often due to the production of an extended spectrum chromosomal class-1 betalactamase. The gene encoding this enzyme has translocated and is also found on the plasmid site. Potential for increase in resistance to these antibiotics by increase in usage therefore exists and is being reported in recent years. It is therefore essential that hospitals institute appropriate antibiotic policies for judicious usage of cefotaxime and other valuable broad spectrum agents to prolong the life span of these antibiotics and retain their value as antibiotics of last resort (AU)

Increasing incidence of penicillin and tetracycline resistance in strains of Neisseria gonorrhoeae isolated from patients at the University Hospital of the West Indies, Jamaica - abstract

The levels of resistance to penicillin and tetracycline in strains of Neisseria gonorrhoeae from patients at the University Hospital of the West Indies, Jamaica between 1989 and 1991 were analysed and the data compared with those obtained ten years ago in 1980 - 1981. Virtually all strains were susceptible to both the antibiotics in 1980 - 1981. Only one out of 143 was found to be resistant during that period. The levels of resistance, however, have increased over the years. In 1989, 16 out of 67 or 24 percent of the strains were resistant to pencillin and this increased to 40 percent in 1991. Tetracycline resistance was low in 1989 (1.5 percent). This, however, has increased dramatically in 1990 and 1991 to attain levels of 25 percent and 44 percent, respectively. By 1991, 21 percent of all strains were resistant simultaneously to both penicillin and tetracycline. The results suggest that penicillin and tetracycline should no longer be the front line antibiotics for the empirical therapy of gonococcal infections. The therapy should be guided by the susceptibility data and hence the need for routine culture of specimens in the diagnosis of gonococcal infections. Ceftriaxone, cefuroxime, quinolones such as ciprofloxacin and norfloxacin, spectinomycin and erythromycin are some of the alternatives and these should be included in the susceptibility testing of gonococcal strains. There is a need for a coordinated national or regional gonococcal susceptibility programme to monitor the minimum inhibitory concentrations, betalactamase production and plasmid profile of local strain (AU)

Disseminated infection caused by penicillin-resistant gonococci in two Jamaicans

Disseminated gonococcal infection due to penicillin-resistant organisms is very unusual. Two such cases occuring at the University Hospital of the West Indies are described. Implications for therapy are discussed (AU)

Serogroup frequency and drug sensitivity of Shigella strain encountered at the University Hospital of the West Indies

Serogroup frequency and sensitivity to four standard drugs of Shigella strains isolated at the University Hospital in the two years between July, 1983 and June, 1985 were studied. Three hundred and thirty-four strains were isolated during this period of which 217 (65percent) were Shigella flexneri and 117 (35 percent) Shigella sonnei. There were no isolates of Shigella dysenteriae or Shigella boydii. Three hundred and thirty of the strains (98.8 percent) were susceptible to ampicillin, 328 (98.2 percent) to tetracycline, 330 (98.8 percent) to cotrimoxazole, 332 (99.4 percent) to chloramphenicol and 325 (97.3 percent) to all four drugs. Of the nine resistant strains, six were resistant to one drug (two to ampicillin, three to tetracycline and one to cotrimoxazole), one was resistant to two new drugs (tetracycline and cotrimoxazole) and two strains were resistant to all four drugs. Although there are reports of a very high incidence of drug resistance among Shiellae in other parts of the world, currently it is not a major problem in Jamaica. Ampicillin and tetracycline still remain the drugs of first choice in treatment of Shigellosis in our environment. The occurrence of a few strains resistant to all four drugs, however, is a case for concern. Patients infected with such strains should be carefully monitored to prevent dissemination of the strains in the community. Nalidixic acid is described as an alternative agent in the treatment of infections due to such strain (AU)

Antimicrobial resistance in clinical isolates of staphylococcus aureus at the University Hospital of the West Indies

Antimicrobial resistance in clinical isolates of staphylococcus aureus encountered at the University Hospital of the West Indies from January to December 1980 was studied. Compared to the data from 1975, there was a marked increase of penicillin resistance in out-patient strains, approximating that found in in-patient isolates (82 percent and 84 percent). Resistance to cotrimoxazole also increased (from 1 percent to 2.1 percent) while there was a decrease in the prevalence of resistance to streptomycin, trtracycline and chloramphenicol. Methicillin resistance was not found. The high prevalence of penicillin resistance in out-patients strains suggests that a penicilinase-resistant penicillin must be selected in the initial therapy of all suspected staphylococcal infections whether in or out of the hospital. The non-occurence of methicillin resistance in this institution should not lead to complacency, as sudden and epidemic outbreaks of methicillin-resistant strains have occured in hospitals in which there was no previous resistance. The epidemiological and therapeutic problems associated with methicillin-resistant strains are further discussed (AU)

Aminoglycoside resistance in clinical isolates of gram-negative bacilli at the University Hospital of the West Indies

The pattern of aminoglycoside resistance in clinical isolates of gram-negative bacilli at the University Hospital of the West Indies, Jamaica, was studied. The levels of resistance were (1) kanamycin 50.4 percent, (2) gentamicin 6.7 percent, (3) tobramycin 5.9 percent and (4) amikacin 0.6 percent. There was considerable cross-resistance between gentamicin and tobramycin among strains of enterobacteriaceae. Tobramycin, however, was superior to gentamicin against isolates of Pseudomonas. Amikacin was the most active aminoglycoside and was effective against 99.4 percent of all isolates tested. Furthermore, it was effective against isolates resistant to one or more of the other amino-glycosides. Measures to prevent further increase in aminoglycoside resistance, especially in the judicious usage of these valuable agents and strict adherence to the principles of cross-infection control while dealing with patients infected or colonized with resistant strains, are discussed and emphasized (AU)