Objectives Healthy vaginal microbiota is mainly dominated by Lactobacillus species namely L. cris... more Objectives Healthy vaginal microbiota is mainly dominated by Lactobacillus species namely L. crispatus, L. gasseri, L. jensenii, and L. iners. Lactobacilli are thought to play an important role in the prevention of urogenital infections, and Lactobacillus probiotics to restore and/or maintain vaginal health has been advocated. These can interfere with the adherence, growth, and colonization by uropathogenic bacteria, thus reducing the risk of urinary tract infection (UTI). This study aims to isolate and evaluate the susceptibility of healthy vaginal and probiotic Lactobacillus spp. to urinary antibiotics. Materials and methods A total of 50 premenopausal, nonmenstruating women with no symptoms of vaginal infection or UTI or antimicrobial use in the past 2 weeks were enrolled. Two high vaginal swabs were collected for Nugent’s scoring and anaerobic culture. Colonies yielding gram-positive rods were confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrome...
Multidrug-resistant Salmonellae have emerged worldwide as also in India. The aim of this study wa... more Multidrug-resistant Salmonellae have emerged worldwide as also in India. The aim of this study was to study the antimicrobial susceptibility pattern of Salmonella enterica serovars isolated at a tertiary care hospital in northern India. A total of 106 S. enterica serovars isolated from various clinical samples from January 2011 to June 2012 were tested for antimicrobial susceptibility by Kirby-Bauer disk diffusion method. The minimum inhibitory concentration (MIC) of ciprofloxacin, chloramphenicol and ceftriaxone was determined both by agar dilution method and E-test for all the isolates. Salmonella Typhi (73.6%) was the predominant isolate followed by S. Paratyphi A (15.1%), S. Typhimurium (9.4%) and S. Enteritidis (1.9%). Of these, 34 (32.1%) were resistant to ciprofloxacin (MIC ≥1 μg/ml by agar dilution) with MIC90 of ciprofloxacin for S. Typhi, S. Paratyphi A and S. Typhimurium being 32, 4 and 1 μg/ml, respectively. All the isolates were sensitive to chloramphenicol (MIC ≤8 μg/m...
Sensitivity profile of Candida isolates in the tertiary care centre in Delhi 23% by C. albicans a... more Sensitivity profile of Candida isolates in the tertiary care centre in Delhi 23% by C. albicans and 32% by other Candida spp. The susceptibility profile of all candidal isolates showed that 92% were sensitive to amphotericin B, 36% to fluconazole, 24% to itraconazole, 56% to voriconazole and 96% to flucytosine. Notably, while all strains of C. albicans were susceptible to amphotericin B, 42% were resistant to fluconazole. C. tropicalis, the most commonly isolated species, was susceptible to amphotericin B in 87.5% of the isolates and to fluconazole in only 17% of the cases. Mortality associated with candidal bloodstream infections was 60% [Figure].
Annals of Tropical Medicine and Public Health, 2012
Context: Enterococcus is considered an important nosocomial pathogen because of its intrinsic as ... more Context: Enterococcus is considered an important nosocomial pathogen because of its intrinsic as well as acquired antibiotic resistance. It also has the potential of transferring vancomycin resistance to other organisms such as Listeria monocytogens and Staphylococcus aureus. Aims: The objective of the present study was to determine antibiotic-resistance pattern of Enterococcus with special reference to vancomycin. Settings and Design: A total of 54 clinical isolates of enterococci were collected during the study period of 1 year at a tertiary care center in Mumbai. Material and Methods: Speciation and antibiotic sensitivity testing were done by standard procedures. Minimum inhibitory concentration (MIC) to vancomycin was carried out by agar dilution method. Results: Speciation and antibiotic sensitivity testing were done by standard procedures. The MIC to vancomycin was done by agar dilution method. Conclusions: Vancomycin, Linezolid, and Teicoplanin can be safely used for the treatment of serious enterococcal infections.
Objectives: Over time medical para-clinical subject teachers have felt that undergraduate student... more Objectives: Over time medical para-clinical subject teachers have felt that undergraduate students have difficulty in understanding immunological concepts of infections. The objectives of the study were to compare the effectiveness of traditional method of teaching with the flipped classroom teaching (FCT) model in Immunology and to assess the perception of students towards the flipped classroom teaching (FCT) model using semi-structured feedback. Methodology: In the study, the flipped classroom model was employed. This is a single centre study involving 100 students of second year MBBS where the students were required to learn and understand the supplied material before coming to the class. During the class, clinically applied aspects of Immunology topic including higher levels were discussed. Ten sessions were done on FCT. Pre class and post class student's knowledge of concept was assessed using MCQs on the given session. Also a theory test was conducted on the same topic at the end of completion of the Immunology topic and comparison was done with a topic in which teaching was done based on didactic lectures only. Feedback was taken from the students in the peer validated questionnaire provided having open ended question also. Similar feedback was taken from participating teachers. Results: The MCQ marks were categorized in three groups; students scoring <5, 6-8 and >8 out of 10. In the post class assessment significantly higher proportion of students secured score between 9-10 (P<0.001). Overall scores of students was also significantly higher in post class assessment. However, summative assessment done by Theory test (having long answer questions and short answer questions) showed no statistical difference (P>0.10). Regarding feedback from the students; a positive attitude was seen for incorporating the flipped class teaching as assessment method showing a significant value (p=0.005). In terms of duration for the flipped class study, students disagreed that FCT takes longer time than routine lecture. Feedback from the teachers showed that this is a good method of teaching regards to some difficult topics but some preparation is required beforehand. Conclusions: There was a positive feedback by the students towards flipped classroom teaching method as understanding of the topics covered was much more. According to the assessment, Flipped teaching approach offered no additional benefits as compared to non-flipped traditional method.
The resistance to antimicrobial agents among Staphylococci is an increasing problem. The resistan... more The resistance to antimicrobial agents among Staphylococci is an increasing problem. The resistance to macrolide can be mediated by msr A gene coding for efflux mechanism or via erm gene encoding for enzymes that confer inducible or constitutive resistance to macrolide, lincosamide and Type B streptogramin. The present study was aimed to find out the percentage of Staphylococcus aureus having inducible clindamycin resistance (iMLS(B)) in our geographic area using D-test. Also, we tried to ascertain the relationship between Methicillin-resistant Staphylococcus aureus (MRSA) and inducible clindamycin resistance, association of these iMLS(B) isolates with community or nosocomial setting and treatment options for these iMLS(B) isolates. A total of 200 non-duplicate Staphylococcus aureus isolates from various clinical samples from both outdoor and indoor patients were studied. Susceptibility to routine antimicrobial agents was carried out using Kirby Bauer method. Methicillin resistance was detected by oxacillin disc on Mueller Hinton agar (MHA) supplemented with 2% NaCl. D-test was performed on all erythromycin-resistant and clindamycin-sensitive Staphylococcus aureus strains to detect inducible clindamycin resistance. Among 200 Staphylococcus aureus strains, 50 (25%) were found to be MRSA and 36 were D-test positive. Also, MRSA isolates showed both higher inducible resistance and constitutive resistance to clindamycin as compared to Methicillin-sensitive Staphylococcus aureus (MSSA). Out of 36 isolates of Staphylococcus aureus showing inducible clindamycin resistance, 24 were from the outpatient department and 12 were recovered from indoor patients. All isolates of Staphylococcus aureus showed 100% sensitivity to vancomycin and linezolid. Clindamycin is kept as a reserve drug and is usually advocated in severe MRSA infections depending upon the antimicrobial susceptibility results. We have reported a higher incidence of iMLS(B) from both community (66.67%) as well as hospital (33.33%) setup. Therefore clinical microbiology laboratory should report inducible clindamycin resistance routinely.
Antibiotic associated diarrhea (AAD) is defined as diarrhea that occurs in association with the a... more Antibiotic associated diarrhea (AAD) is defined as diarrhea that occurs in association with the administration of antibiotics. 1 The direct toxic effects of antibiotics on the intestine can alter digestive functions secondary to reduced concentrations of the normal gut bacteria or cause pathogenic bacterial overgrowth. 2 Clostridium difficile is widely known to be responsible for approximately 10-20% of cases of AAD and almost all cases of pseudomembrane colitis. 3 However Klebsiella oxytoca, 4 enterotoxin producing Clostridium perfringens, 5 Staphylococcus aureus, 6 Candida species, 7 Salmonella species and Pseudomonas aeruginosa 8 might also contribute to the development of AAD. 9 C.difficile is the major cause of AAD and colitis. C.difficile is estimated to colonize 3% of healthy adults and 15-20% of hospitalized patients. 10,11 Risk factors associated with hospital acquired C.difficile associated disease include antimicrobial use, laxative use, anti-neoplastic chemotherapeutic use, renal insufficiency, advanced age (>65 yrs), gastro-intestinal surgery/ procedures, severity of underlying disease, nasogastric intubation, gastric acid suppressants, duration of hospital stay, duration of antibiotic course and prolonged hospital stay. 12,13 Antibiotics are the most important risk factors for C.difficile associated diarrhea (CDAD). Clindamycin was the first antibiotic implicated in the precipitation of the disease. Cephalosporins are also the common agents implicated in nosocomially acquired CDAD. In outpatient settings, antibiotics such as ampicillin, amoxicillin or amoxicillin clavulanate combination are important and common causes. Less commonly implicated antibiotics are macrolides, tetracyclines, sulphonamides,
Antibiotic resistance has been an emerging concern for common bacterial infections worldwide. Hel... more Antibiotic resistance has been an emerging concern for common bacterial infections worldwide. Helicobacter pylori, commonly associated with chronic bacterial infections, is also included in bacteria with drug resistant problems. Its infection, once considered curable, is now becoming a matter of grave concern with rising antibiotic resistant patterns reported worldwide. Resistance is mainly reported to the key antibiotics in the treatment of infection i.e. metronidazole and clarithromycin, and to a lesser extent to amoxicillin and tetracyclin, thereby decreasing the cure rates of the combination therapies used. Recently resistance to quinolones has also been reported.
Opportunistic infections (OIs) in Human Immunodeficiency Virus (HIV) infection continue to cause ... more Opportunistic infections (OIs) in Human Immunodeficiency Virus (HIV) infection continue to cause morbidity and mortality in HIV infected patients. Virtually all OIs occur when the CD4+T cell count 3 is less than 200/mm. The gastrointestinal (GI) tract is a common site for clinical expression of HIV. Diarrhea is the most common GI symptom in HIV/AIDS. Prevalence ranges from 0.9% to 14%. Diarrhea may be the presenting symptom of lymphoma and Kaposi's sarcoma. It may affect up to 40-50% of those taking anti-retroviral therapy (ART) and can be induced by other medications. It may also be the result of HIV-associated enteropathy. The agents can be classified as bacterial, parasitic, viral and fungal agents. Almost all bacterial diarrheic agents can cause diarrhea in HIV infected patients, including Clostridium difficile. Intracellular parasites like Isospora belli, Cryptosporidium parvum and Cyclospora are the main causative agents of diarrhea in HIV positive patients. Cytomegalovirus is an AIDS defining opportunistic infection. Candida is the main fungal agent of diarrhea in AIDS. Despite the availability of ART, OIs are common in India as HIV-infected persons in India present with an OI as the initial indicator of their disease. Some of them are aware of their HIV infection but do not take ART and some patients are enrolled in HIV care and prescribed ART but do not attain an adequate virologic and immunologic cure. Thus awareness about optimal strategies for diagnosis, prevention and treatment of OIs in GI tract is essential to provide comprehensive, high quality care for these patients.
Reactive arthritis (ReA) also known as post infectious arthritis, affects 1-4% of people days to ... more Reactive arthritis (ReA) also known as post infectious arthritis, affects 1-4% of people days to weeks after being infected by an enteric, urogenital or upper respiratory infection. The most common enteric bacterial pathogens that have been associated with ReA include Salmonella, Shigella, Campylobacter, enterotoxigenic Escherichia coli and Yersinia. It is quite necessary to determine the burden of ReA due to enteric infections using standard criteria. The clinician should investigate for the evidence of previous bacterial infections. In addition, it is very important to carry follow-up studies of patients with enteric infection so as to clarify the association of ReA with enteric pathogens. No curative treatment for reactive arthritis (ReA) exists. Instead, treatment aims at relieving symptoms and is based on symptom severity. Prevention of enteric and genitourinary bacterial infections is the best option.
Emergence of carbapenem resistance among in different geographical regions is of great concern as... more Emergence of carbapenem resistance among in different geographical regions is of great concern as these bacteria are easily transmissible among patients. Carbapenem-resistance in is due to production of carbapenemases of various classes and hyper production of the ESBLs (Extended spectrum beta lactamases) and Amp C beta lactamases with reduced cell wall permeability mechanisms. Phenotypic detection and differentiation is important for proper infection control and appropriate patient management. This study was done to know the prescence of various beta lactamases and carbapenemases with other mechanisms of resistance in isolates. 50 non-duplicate carbapenem resistant isolates of from blood culture specimens were included and various mechanisms of resistance were studied based on phenotypic and genotypic methods. Out of 50 isolates, 39 (78%) of isolates were Extended Spectrum Beta Lactamase (ESBL) producers based on CLSI guidelines. All 50 showed positive Modified Hodge Test (MHT) and...
Burkholderia cepacia complex is widespread in the environment and has been recognized as a cause ... more Burkholderia cepacia complex is widespread in the environment and has been recognized as a cause of opportunistic pulmonary infections, particularly in patients with cystic fibrosis (CF). The natural ecology of the bacteria as part of plant growth-promoting rhizosphere provides stark contrast to its infectious potential. Its preponderance as a nosocomial pathogen may be due to its ability to survive in antiseptic solutions, contaminate equipments, and intrinsic antimicrobial resistance. An elderly, diabetic male was evaluated for hemoptysis, fever and cough. Chest computed tomography showed thick walled cavity in left lung and hilar lymphadenopathy. Sputum examination showed Gram negative bacilli and no acid fast bacilli. Sputum culture yielded growth of non-fermentative Gram negative bacilli on two occasions, but blood culture was sterile. The isolate was identified as B. cepacia by Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). The pat...
The rise in carbapenemases-producing organisms has challenged the scientific community. Infection... more The rise in carbapenemases-producing organisms has challenged the scientific community. Infections caused by these bacteria have limited treatment options. There are various types such ascarbapenemase (Ambler class A), metallo-beta-lactamases of VIM-type, IMP-type, NDM-type (Ambler class B), and OXA-48-types (Ambler class D). An efficient strategy for detection of carbapenemase producers is important to determine the appropriate therapeutic modalities. In this study, four methods - Carba NP test, modified Carba NP (MCNP) test, carbapenem inactivation method (CIM) test, and Rapidec Carba NP kit test were evaluated. We evaluated an in-house MCNP test to detect carbapenemase production using a single protocol which gave reliable results. Furthermore, CIM using routine antibiotic discs gives good results. Both these tests were found to be cost-effective.
Urinary tract infections (UTIs) currently rank amongst the most prevalent bacterial infections, r... more Urinary tract infections (UTIs) currently rank amongst the most prevalent bacterial infections, representing a major health hazard. UTIs in females usually start as vaginal infections and ascend to the urethra and bladder. Recurrent UTIs (rUTIs) can be defined as at least three episodes of UTI in 1 year or two episodes in 6 months. Various antibiotics have been the mainstay of therapy in ameliorating the incidence of UTIs, but recurrent infections continue to afflict many women. It necessitates the exploitation of alternative antimicrobial therapy. Probiotics have been shown to be effective in varied clinical trials for long-term preventions of rUTI. Because Escherichia coli is the primary pathogen involved in UTIs which spreads from the rectum to vagina and then ascends up the sterile urinary tract, improving the gut or vaginal flora will thus impact the urinary tract. Since a healthy vaginal microbiota is mainly dominated by Lactobacillus species, in this context, exogenously admi...
Enteric fever caused by Salmonella Typhi is a global public health problem. With adequate treatme... more Enteric fever caused by Salmonella Typhi is a global public health problem. With adequate treatment, most patients recover from the acute phase; however, 2-4% develop a chronic carrier state acting as reservoir of infection by continued shedding of bacteria in faeces and urine. Recovery of S. Typhi from urine is rare, even in endemic areas. The three main causes of bacteriuria arise following a recent episode of typhoid fever, in chronic carrier states involving the urinary system and occasionally following localised urinary tract infection (UTI) due to S. Typhi. Symptomatic Salmonella UTI is mostly encountered in an immunocompromised patient with some underlying structural abnormality involving the urinary tract. We report a case of symptomatic UTI caused by Salmonella Typhi in a 50-year-old immunocompetent woman in a chronic carrier state without any known urological abnormality.
Advance Publication articles have been accepted by JJID but have not been copyedited or formatted... more Advance Publication articles have been accepted by JJID but have not been copyedited or formatted for publication. Title: Sepsis due to Chryseobacterium gleum in a diabetic patient with COPD-case report and mini review Running Title: Chryseobacterium gleum sepsis in an Indian male
Journal of clinical and diagnostic research : JCDR, 2017
Lactobacilli are normal commensals of the gastrointestinal and female genital tract. Due to its l... more Lactobacilli are normal commensals of the gastrointestinal and female genital tract. Due to its low virulence these bacteria are known to cause opportunistic infections. They cause mostly bacteraemia with or without endocarditis and rarely cause pleuro-pulmonary infection. We report a case of Lactobacillus coryniformis pleuro-pulmonary infection and review 14 previously reported cases of lactobacilli causing pleuro-pulmonary infections. Our patient had small cell carcinoma with metastasis. All the 14 cases had pre-existing risk factors like immunosuppresion, cancer or chronic disease. There was no consensus on choice of antimicrobial agents to be used. Different species of lactobacilli were involved. Available susceptibility data showed that lactobacilli species were more susceptible to ampicillin, erythromycin, gentamycin, and clindamycin and decreased to ceftriaxone, ciprofloxacin and trimethoprim-sulphamethoxazole. Isolation of Lactobacillus species from a case of pleuro-pneumoni...
Objectives Healthy vaginal microbiota is mainly dominated by Lactobacillus species namely L. cris... more Objectives Healthy vaginal microbiota is mainly dominated by Lactobacillus species namely L. crispatus, L. gasseri, L. jensenii, and L. iners. Lactobacilli are thought to play an important role in the prevention of urogenital infections, and Lactobacillus probiotics to restore and/or maintain vaginal health has been advocated. These can interfere with the adherence, growth, and colonization by uropathogenic bacteria, thus reducing the risk of urinary tract infection (UTI). This study aims to isolate and evaluate the susceptibility of healthy vaginal and probiotic Lactobacillus spp. to urinary antibiotics. Materials and methods A total of 50 premenopausal, nonmenstruating women with no symptoms of vaginal infection or UTI or antimicrobial use in the past 2 weeks were enrolled. Two high vaginal swabs were collected for Nugent’s scoring and anaerobic culture. Colonies yielding gram-positive rods were confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrome...
Multidrug-resistant Salmonellae have emerged worldwide as also in India. The aim of this study wa... more Multidrug-resistant Salmonellae have emerged worldwide as also in India. The aim of this study was to study the antimicrobial susceptibility pattern of Salmonella enterica serovars isolated at a tertiary care hospital in northern India. A total of 106 S. enterica serovars isolated from various clinical samples from January 2011 to June 2012 were tested for antimicrobial susceptibility by Kirby-Bauer disk diffusion method. The minimum inhibitory concentration (MIC) of ciprofloxacin, chloramphenicol and ceftriaxone was determined both by agar dilution method and E-test for all the isolates. Salmonella Typhi (73.6%) was the predominant isolate followed by S. Paratyphi A (15.1%), S. Typhimurium (9.4%) and S. Enteritidis (1.9%). Of these, 34 (32.1%) were resistant to ciprofloxacin (MIC ≥1 μg/ml by agar dilution) with MIC90 of ciprofloxacin for S. Typhi, S. Paratyphi A and S. Typhimurium being 32, 4 and 1 μg/ml, respectively. All the isolates were sensitive to chloramphenicol (MIC ≤8 μg/m...
Sensitivity profile of Candida isolates in the tertiary care centre in Delhi 23% by C. albicans a... more Sensitivity profile of Candida isolates in the tertiary care centre in Delhi 23% by C. albicans and 32% by other Candida spp. The susceptibility profile of all candidal isolates showed that 92% were sensitive to amphotericin B, 36% to fluconazole, 24% to itraconazole, 56% to voriconazole and 96% to flucytosine. Notably, while all strains of C. albicans were susceptible to amphotericin B, 42% were resistant to fluconazole. C. tropicalis, the most commonly isolated species, was susceptible to amphotericin B in 87.5% of the isolates and to fluconazole in only 17% of the cases. Mortality associated with candidal bloodstream infections was 60% [Figure].
Annals of Tropical Medicine and Public Health, 2012
Context: Enterococcus is considered an important nosocomial pathogen because of its intrinsic as ... more Context: Enterococcus is considered an important nosocomial pathogen because of its intrinsic as well as acquired antibiotic resistance. It also has the potential of transferring vancomycin resistance to other organisms such as Listeria monocytogens and Staphylococcus aureus. Aims: The objective of the present study was to determine antibiotic-resistance pattern of Enterococcus with special reference to vancomycin. Settings and Design: A total of 54 clinical isolates of enterococci were collected during the study period of 1 year at a tertiary care center in Mumbai. Material and Methods: Speciation and antibiotic sensitivity testing were done by standard procedures. Minimum inhibitory concentration (MIC) to vancomycin was carried out by agar dilution method. Results: Speciation and antibiotic sensitivity testing were done by standard procedures. The MIC to vancomycin was done by agar dilution method. Conclusions: Vancomycin, Linezolid, and Teicoplanin can be safely used for the treatment of serious enterococcal infections.
Objectives: Over time medical para-clinical subject teachers have felt that undergraduate student... more Objectives: Over time medical para-clinical subject teachers have felt that undergraduate students have difficulty in understanding immunological concepts of infections. The objectives of the study were to compare the effectiveness of traditional method of teaching with the flipped classroom teaching (FCT) model in Immunology and to assess the perception of students towards the flipped classroom teaching (FCT) model using semi-structured feedback. Methodology: In the study, the flipped classroom model was employed. This is a single centre study involving 100 students of second year MBBS where the students were required to learn and understand the supplied material before coming to the class. During the class, clinically applied aspects of Immunology topic including higher levels were discussed. Ten sessions were done on FCT. Pre class and post class student's knowledge of concept was assessed using MCQs on the given session. Also a theory test was conducted on the same topic at the end of completion of the Immunology topic and comparison was done with a topic in which teaching was done based on didactic lectures only. Feedback was taken from the students in the peer validated questionnaire provided having open ended question also. Similar feedback was taken from participating teachers. Results: The MCQ marks were categorized in three groups; students scoring <5, 6-8 and >8 out of 10. In the post class assessment significantly higher proportion of students secured score between 9-10 (P<0.001). Overall scores of students was also significantly higher in post class assessment. However, summative assessment done by Theory test (having long answer questions and short answer questions) showed no statistical difference (P>0.10). Regarding feedback from the students; a positive attitude was seen for incorporating the flipped class teaching as assessment method showing a significant value (p=0.005). In terms of duration for the flipped class study, students disagreed that FCT takes longer time than routine lecture. Feedback from the teachers showed that this is a good method of teaching regards to some difficult topics but some preparation is required beforehand. Conclusions: There was a positive feedback by the students towards flipped classroom teaching method as understanding of the topics covered was much more. According to the assessment, Flipped teaching approach offered no additional benefits as compared to non-flipped traditional method.
The resistance to antimicrobial agents among Staphylococci is an increasing problem. The resistan... more The resistance to antimicrobial agents among Staphylococci is an increasing problem. The resistance to macrolide can be mediated by msr A gene coding for efflux mechanism or via erm gene encoding for enzymes that confer inducible or constitutive resistance to macrolide, lincosamide and Type B streptogramin. The present study was aimed to find out the percentage of Staphylococcus aureus having inducible clindamycin resistance (iMLS(B)) in our geographic area using D-test. Also, we tried to ascertain the relationship between Methicillin-resistant Staphylococcus aureus (MRSA) and inducible clindamycin resistance, association of these iMLS(B) isolates with community or nosocomial setting and treatment options for these iMLS(B) isolates. A total of 200 non-duplicate Staphylococcus aureus isolates from various clinical samples from both outdoor and indoor patients were studied. Susceptibility to routine antimicrobial agents was carried out using Kirby Bauer method. Methicillin resistance was detected by oxacillin disc on Mueller Hinton agar (MHA) supplemented with 2% NaCl. D-test was performed on all erythromycin-resistant and clindamycin-sensitive Staphylococcus aureus strains to detect inducible clindamycin resistance. Among 200 Staphylococcus aureus strains, 50 (25%) were found to be MRSA and 36 were D-test positive. Also, MRSA isolates showed both higher inducible resistance and constitutive resistance to clindamycin as compared to Methicillin-sensitive Staphylococcus aureus (MSSA). Out of 36 isolates of Staphylococcus aureus showing inducible clindamycin resistance, 24 were from the outpatient department and 12 were recovered from indoor patients. All isolates of Staphylococcus aureus showed 100% sensitivity to vancomycin and linezolid. Clindamycin is kept as a reserve drug and is usually advocated in severe MRSA infections depending upon the antimicrobial susceptibility results. We have reported a higher incidence of iMLS(B) from both community (66.67%) as well as hospital (33.33%) setup. Therefore clinical microbiology laboratory should report inducible clindamycin resistance routinely.
Antibiotic associated diarrhea (AAD) is defined as diarrhea that occurs in association with the a... more Antibiotic associated diarrhea (AAD) is defined as diarrhea that occurs in association with the administration of antibiotics. 1 The direct toxic effects of antibiotics on the intestine can alter digestive functions secondary to reduced concentrations of the normal gut bacteria or cause pathogenic bacterial overgrowth. 2 Clostridium difficile is widely known to be responsible for approximately 10-20% of cases of AAD and almost all cases of pseudomembrane colitis. 3 However Klebsiella oxytoca, 4 enterotoxin producing Clostridium perfringens, 5 Staphylococcus aureus, 6 Candida species, 7 Salmonella species and Pseudomonas aeruginosa 8 might also contribute to the development of AAD. 9 C.difficile is the major cause of AAD and colitis. C.difficile is estimated to colonize 3% of healthy adults and 15-20% of hospitalized patients. 10,11 Risk factors associated with hospital acquired C.difficile associated disease include antimicrobial use, laxative use, anti-neoplastic chemotherapeutic use, renal insufficiency, advanced age (>65 yrs), gastro-intestinal surgery/ procedures, severity of underlying disease, nasogastric intubation, gastric acid suppressants, duration of hospital stay, duration of antibiotic course and prolonged hospital stay. 12,13 Antibiotics are the most important risk factors for C.difficile associated diarrhea (CDAD). Clindamycin was the first antibiotic implicated in the precipitation of the disease. Cephalosporins are also the common agents implicated in nosocomially acquired CDAD. In outpatient settings, antibiotics such as ampicillin, amoxicillin or amoxicillin clavulanate combination are important and common causes. Less commonly implicated antibiotics are macrolides, tetracyclines, sulphonamides,
Antibiotic resistance has been an emerging concern for common bacterial infections worldwide. Hel... more Antibiotic resistance has been an emerging concern for common bacterial infections worldwide. Helicobacter pylori, commonly associated with chronic bacterial infections, is also included in bacteria with drug resistant problems. Its infection, once considered curable, is now becoming a matter of grave concern with rising antibiotic resistant patterns reported worldwide. Resistance is mainly reported to the key antibiotics in the treatment of infection i.e. metronidazole and clarithromycin, and to a lesser extent to amoxicillin and tetracyclin, thereby decreasing the cure rates of the combination therapies used. Recently resistance to quinolones has also been reported.
Opportunistic infections (OIs) in Human Immunodeficiency Virus (HIV) infection continue to cause ... more Opportunistic infections (OIs) in Human Immunodeficiency Virus (HIV) infection continue to cause morbidity and mortality in HIV infected patients. Virtually all OIs occur when the CD4+T cell count 3 is less than 200/mm. The gastrointestinal (GI) tract is a common site for clinical expression of HIV. Diarrhea is the most common GI symptom in HIV/AIDS. Prevalence ranges from 0.9% to 14%. Diarrhea may be the presenting symptom of lymphoma and Kaposi's sarcoma. It may affect up to 40-50% of those taking anti-retroviral therapy (ART) and can be induced by other medications. It may also be the result of HIV-associated enteropathy. The agents can be classified as bacterial, parasitic, viral and fungal agents. Almost all bacterial diarrheic agents can cause diarrhea in HIV infected patients, including Clostridium difficile. Intracellular parasites like Isospora belli, Cryptosporidium parvum and Cyclospora are the main causative agents of diarrhea in HIV positive patients. Cytomegalovirus is an AIDS defining opportunistic infection. Candida is the main fungal agent of diarrhea in AIDS. Despite the availability of ART, OIs are common in India as HIV-infected persons in India present with an OI as the initial indicator of their disease. Some of them are aware of their HIV infection but do not take ART and some patients are enrolled in HIV care and prescribed ART but do not attain an adequate virologic and immunologic cure. Thus awareness about optimal strategies for diagnosis, prevention and treatment of OIs in GI tract is essential to provide comprehensive, high quality care for these patients.
Reactive arthritis (ReA) also known as post infectious arthritis, affects 1-4% of people days to ... more Reactive arthritis (ReA) also known as post infectious arthritis, affects 1-4% of people days to weeks after being infected by an enteric, urogenital or upper respiratory infection. The most common enteric bacterial pathogens that have been associated with ReA include Salmonella, Shigella, Campylobacter, enterotoxigenic Escherichia coli and Yersinia. It is quite necessary to determine the burden of ReA due to enteric infections using standard criteria. The clinician should investigate for the evidence of previous bacterial infections. In addition, it is very important to carry follow-up studies of patients with enteric infection so as to clarify the association of ReA with enteric pathogens. No curative treatment for reactive arthritis (ReA) exists. Instead, treatment aims at relieving symptoms and is based on symptom severity. Prevention of enteric and genitourinary bacterial infections is the best option.
Emergence of carbapenem resistance among in different geographical regions is of great concern as... more Emergence of carbapenem resistance among in different geographical regions is of great concern as these bacteria are easily transmissible among patients. Carbapenem-resistance in is due to production of carbapenemases of various classes and hyper production of the ESBLs (Extended spectrum beta lactamases) and Amp C beta lactamases with reduced cell wall permeability mechanisms. Phenotypic detection and differentiation is important for proper infection control and appropriate patient management. This study was done to know the prescence of various beta lactamases and carbapenemases with other mechanisms of resistance in isolates. 50 non-duplicate carbapenem resistant isolates of from blood culture specimens were included and various mechanisms of resistance were studied based on phenotypic and genotypic methods. Out of 50 isolates, 39 (78%) of isolates were Extended Spectrum Beta Lactamase (ESBL) producers based on CLSI guidelines. All 50 showed positive Modified Hodge Test (MHT) and...
Burkholderia cepacia complex is widespread in the environment and has been recognized as a cause ... more Burkholderia cepacia complex is widespread in the environment and has been recognized as a cause of opportunistic pulmonary infections, particularly in patients with cystic fibrosis (CF). The natural ecology of the bacteria as part of plant growth-promoting rhizosphere provides stark contrast to its infectious potential. Its preponderance as a nosocomial pathogen may be due to its ability to survive in antiseptic solutions, contaminate equipments, and intrinsic antimicrobial resistance. An elderly, diabetic male was evaluated for hemoptysis, fever and cough. Chest computed tomography showed thick walled cavity in left lung and hilar lymphadenopathy. Sputum examination showed Gram negative bacilli and no acid fast bacilli. Sputum culture yielded growth of non-fermentative Gram negative bacilli on two occasions, but blood culture was sterile. The isolate was identified as B. cepacia by Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). The pat...
The rise in carbapenemases-producing organisms has challenged the scientific community. Infection... more The rise in carbapenemases-producing organisms has challenged the scientific community. Infections caused by these bacteria have limited treatment options. There are various types such ascarbapenemase (Ambler class A), metallo-beta-lactamases of VIM-type, IMP-type, NDM-type (Ambler class B), and OXA-48-types (Ambler class D). An efficient strategy for detection of carbapenemase producers is important to determine the appropriate therapeutic modalities. In this study, four methods - Carba NP test, modified Carba NP (MCNP) test, carbapenem inactivation method (CIM) test, and Rapidec Carba NP kit test were evaluated. We evaluated an in-house MCNP test to detect carbapenemase production using a single protocol which gave reliable results. Furthermore, CIM using routine antibiotic discs gives good results. Both these tests were found to be cost-effective.
Urinary tract infections (UTIs) currently rank amongst the most prevalent bacterial infections, r... more Urinary tract infections (UTIs) currently rank amongst the most prevalent bacterial infections, representing a major health hazard. UTIs in females usually start as vaginal infections and ascend to the urethra and bladder. Recurrent UTIs (rUTIs) can be defined as at least three episodes of UTI in 1 year or two episodes in 6 months. Various antibiotics have been the mainstay of therapy in ameliorating the incidence of UTIs, but recurrent infections continue to afflict many women. It necessitates the exploitation of alternative antimicrobial therapy. Probiotics have been shown to be effective in varied clinical trials for long-term preventions of rUTI. Because Escherichia coli is the primary pathogen involved in UTIs which spreads from the rectum to vagina and then ascends up the sterile urinary tract, improving the gut or vaginal flora will thus impact the urinary tract. Since a healthy vaginal microbiota is mainly dominated by Lactobacillus species, in this context, exogenously admi...
Enteric fever caused by Salmonella Typhi is a global public health problem. With adequate treatme... more Enteric fever caused by Salmonella Typhi is a global public health problem. With adequate treatment, most patients recover from the acute phase; however, 2-4% develop a chronic carrier state acting as reservoir of infection by continued shedding of bacteria in faeces and urine. Recovery of S. Typhi from urine is rare, even in endemic areas. The three main causes of bacteriuria arise following a recent episode of typhoid fever, in chronic carrier states involving the urinary system and occasionally following localised urinary tract infection (UTI) due to S. Typhi. Symptomatic Salmonella UTI is mostly encountered in an immunocompromised patient with some underlying structural abnormality involving the urinary tract. We report a case of symptomatic UTI caused by Salmonella Typhi in a 50-year-old immunocompetent woman in a chronic carrier state without any known urological abnormality.
Advance Publication articles have been accepted by JJID but have not been copyedited or formatted... more Advance Publication articles have been accepted by JJID but have not been copyedited or formatted for publication. Title: Sepsis due to Chryseobacterium gleum in a diabetic patient with COPD-case report and mini review Running Title: Chryseobacterium gleum sepsis in an Indian male
Journal of clinical and diagnostic research : JCDR, 2017
Lactobacilli are normal commensals of the gastrointestinal and female genital tract. Due to its l... more Lactobacilli are normal commensals of the gastrointestinal and female genital tract. Due to its low virulence these bacteria are known to cause opportunistic infections. They cause mostly bacteraemia with or without endocarditis and rarely cause pleuro-pulmonary infection. We report a case of Lactobacillus coryniformis pleuro-pulmonary infection and review 14 previously reported cases of lactobacilli causing pleuro-pulmonary infections. Our patient had small cell carcinoma with metastasis. All the 14 cases had pre-existing risk factors like immunosuppresion, cancer or chronic disease. There was no consensus on choice of antimicrobial agents to be used. Different species of lactobacilli were involved. Available susceptibility data showed that lactobacilli species were more susceptible to ampicillin, erythromycin, gentamycin, and clindamycin and decreased to ceftriaxone, ciprofloxacin and trimethoprim-sulphamethoxazole. Isolation of Lactobacillus species from a case of pleuro-pneumoni...
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Papers by Varsha Gupta