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)

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)

Salmonellosis at the University Hospital of the West Indies

During 1982-83, there were 367 cases of salmonellosis at the University Hospital of the West Indies, caused by 50 different serotypes. Multiresistant strains of Salmonella ohio accounted for 19.3 percent of isolates, compared with 12 percent, 9.8 percent and 9.5 percent for Salmonella derby, Salmonella typhimurium and Salmonella typhi, respectively, Salmonella wre recovered from stool (303), blood (48), skin and soft tissue (7), urine (6), post-mortem material (2), sequestra (1), and sputum (1). Most infections occurred in younger age groups with 63 percent in children < 1 year if age. Twenty patients developed locallising infections. The 48 blood culture isolates included 25 S. tryphi and 23 other salmonella species. Fifteen patients with non-typhoid bloodstream infections developed septicaemia, and 13 of these had underlying disease, whereas only 1 of 8 bacteraemic patients had underlying disease. All S. ohio isolates were resistant to chloramphenicol, ampicillin, cotrimoxazole, neomycin and carbenicillin, and resistance determinants were transferred to E. coli K12J53-2. It was concluded that non-typhoid salmonellas were responsible for a significant degree of morbidity during the period of this study (AU)

Some laboratory, epidemiological and clinical features of strongyloides stercoralis infection in a focus of low endemicity

Data are presented on the prevalence of strongyloidiasis in patients seen at the University Hospital of the West Indies during the period January, 1980 - December, 1981. Only 1 percent of all stool samples was positive for strongyloides; 46 percent of all cases occurred in the 46-55 year-old group, and 64 percent of the cases were in males. There was a mean higher larval density (300-500 larvae/ml stool) in the 26-65-year-old groups. Also, there was a direct relationship between morbidity and larval density in stools. Asymptomatic cases had a very low infestation rate (<100-larvae/ml stool), and were generally in the younger age group (mean age, 18 years). Mildly symptomatic (100-350 larvae/ml), severely symptomatic (350-500 larvae/ml) and suspected hyperinfected patients (>1000 larvae/ml), did not fall into statistically significantly different age groups (mean age, 50 years). An example is given of the difficulty of managing one of the suspected hyperinfected cases. The patient was repeatedly treated with effective doses of thiabendazole (750 mg twice daily for 10 days) but there was recurrence of infestation. Most of the mean monthly cases were detected in November, 2 months after the peak of the wet season. There was no statistically significant correlation between case detection and precipitation (AU)

Cryptococcosis in the West Indies

Crptococcosis with meningitis is reported in seven patients, six from Jamaica and one from Belize. All seven had headache, six had fever and five had confusion/coma. Despite biochemical findings of meningitis in the cerebrospinal fluid of five patients, Cryptococcosis was diagnosed antemortem in only three. Two patients treated with oral flucytosine survived. Awareness that Cryptococcosis occurs in the West Indies may assist in early diagnosis which is crucial to successful treatment (AU)

Haemophilus influenzae as an agent of urinary tract infection

Two cases of urinary tract infection due to H. Influenzae, an unusual urinary pathogen, are described. One was an adult female who presented with endometritis; the other was a male infant who had posterior urethral valves. Increased awareness of the potential existence of this at this site is a prequisite to diagnosis since it does not grow on the conventional media used for urine cultures (AU)

Two cases of pasteurella multocida infections in Jamaica

Two cases of pasteurella multocida infections seen at the University Hospital are described. One was a restaurant chef with fulminating septicaemia and arthritis. The other was a female infant with meningitis. These systemic forms of P. multocida infections usually have a high mortality but both of these cases recovered fully. A high degree of vigilance and awareness on the part of both clinician and bacteriologist are necessary for the diagnosis of these infections (AU)

A comparison of the in vitro sensitivity of Furadantin and Nalidixic acid (Wintomylon) on urinary pathogens

A comparison of the in vitro sensitivity (disc method) of Furadantin and Nalidixic Acid on proven urinary pathogens has been presented. The latter was introduced at the University Hospital of the West Indies in 1967, on a trial basis. It was found to be more effective, than the former, except aganist E. coli which was equally sensitive to both drugs. The former, in use at the above Hospital since 1962, was found to be just as effective in 1967 except against Proteus sp. This organism became markedly more resistant over the 5-year period (AU)

Staphylococcal infection in the University Hospital of the West Indies

An analysis of 1,425 infections with coagulase positive staphylococci at the University Hospital of the West Indies for a forty-two month period (July 1958-December 1961) was made. This was analysed for the incidence by month, year, ward and among out-patients and in-patients. Sensitivity patterns were also reviewed and phage typing done where possible. There was a tendency for lower percentages of staphylococcal infections during the cooler period from November to February and an increased incidence during the warmer months from July to September. Among inpatients the highest percentages of staphylococcal infection were found in the paediatric and obstetric wards. Antibiotic sensitivity studies revealed the greatest incidence of resistance to be against penicillin and the least against chloramphenicol. Group I (particularly phage type 80/81) and Group III phages were the predominant strains discovered. Methods to reduce staphylococcal infection were recommended (AU)

The epidemiology of leptospirosis in Jamaica

L. icterohaemorrhagiae and L. kremastos are known to exist in Jamaica. The kremastos type, a member of the hebdomadis serogroup, was first isolated in January in 1956. An analysis of cases of leptospiral infection from 1953-1963 was made with regard to sex, occupation, soil and rainfall distribution as well as the incidence in different parts of the island. The study incorporated both clinical and survey sera. The results show the greatest incidence in the parishes of Kingston and St. Andrew, St. Catherine, Clarendon, Manchester and St. Elizabeth. A serological investigation of domestic and wild animals also revealed evidence of leptospiral antibodies. Cows, equines and pigs have been the highest reactors. The leptospires known to affect animals are potentially pathogenic for man. These facts emphasize the need for further research in this field (AU)

Further studies on the antihelminthic drug CI-416

A follow-up study of the antihelminthic drug CI-416, produced by Parke Davis and Company, was carried out against hookworm, ascaris and trichuris cases using single dose treatment. Fifty cases of hookworm were also treated with alcopar for comparison. Stools were analysed by egg counts. While statistical significance could not be declared between the CI-416 and alcopar groups, CI-416 did not appear to be very effective in reducing ova counts among these nematodal infections (AU)

A survey of parasitic infection in two communities in Jamaica and a drug trial on positive cases

An analysis of 1,953 stools - 194 from Lawrence Tavern and 1,659 from Bellevue Hospital - was done. In the rural area (Lawrence Tavern) the predominant parasites were Ascaris lumbricoides, Necator americanus, Entamoeba coli and Trichuris trichiura. In the urban area (Bellevue Hospital) there was a reversal of this order - Trichuris trichiura being the main finding followed by Entamoeba coli, Necator americanus and Ascaris lumbricoides. Stools from a small percentage of Hookworms and Ascaris cases were studied by egg counts and a comparison of direct examination and concentration methods was made. Positive cases of Hookworm, Ascaris and E. histolytica were treated with CI-416 and Humatin and with current drugs for comparison. The results show that CI-416 is not as effective as Alcopar and Antepar respectively, against Hookworm and Ascaris. Humatin on the other hand seems to be very effective against E. histoytica. Side effects with the trial drugs were minimal and were limited to minor gastrointestinal symptoms in a few cases (AU)

The epidemiology of leptospirosis in Jamaica

An analysis of cases of leptospirosis from 1953-1961 was presented. Studies were made with regard to occupation, age, sex, soil, rainfall and location in Jamaica. The highest incidence was found in the parishes of St. Catherine, Clarendon, Manchester and St. Elizabeth. The role of farm irrigation was discussed. There was serological evidence of this disease in domestic as well as wild animals and it was stressed that the leptospirae known to affect animals are potentially pathogenic for humans (AU)