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Report: prevalence and resistance pattern of pseudomonas aeruginosa against various antibiotics.
Pak J Pharm Sci. 2008 Jul; 21(3): 311-5
Khan JA, Iqbal Z, Rahman SU, Farzana K, Khan A
A prospective study on various clinical isolates from patients admitted from various parts of NWFP and Afghanistan at Post Graduate Medical Institute (PGMI) Hayatabad Medical Complex, Peshawar was conducted from January 2000 to December 2004 to ascertain the prevalence and antimicrobial susceptibility of Pseudomonas aeruginosa infections. Among 4709 positive isolates, 314 (6.67%) were Pseudomonas aeruginosa. The highest rate of infection due to Pseudomonas aeruginosa was observed in orthopedic ward (24.61%) and OPD (20%), in other wards the infection was between 13% to 1.5%. Gender-wise prevalence showed 61.78% male and 38.22% females were infected by Pseudomonas aeruginosa. The highest percentage of Pseudomonas aeruginosa isolates were observed in pus (57.64%) and urine (24.2%) samples. Maximum Pseudomonas aeruginosa isolates were found between March to August and the highest percentage 13.846% was observed in June. Using the disc diffusion method, the resistance patterns of 314 isolates against 14 antimicrobial agents were determined. The highest resistance was observed against ampicillin (> 98.4%), ampicillin/sulbactam (85.3%), co-amoxiclave (83.8%) and ofloxacin (68.4%) and least resistance was observed against amikacin (24%). Similarly the MIC for ampicillin (4 to >2048 mug/ml), ampicillin/sulbactam (1 to 2048 mug/ml) and co-amoxiclave (1 to >2048 mug/ml) against clinical isolates of Pseudomonas aeruginosa was also high. High resistance of Pseudomonas aeruginosa against various commonly used antibiotics showed the alarming situation. The control of drug resistant Pseudomonas aeruginosa required rational prescribing and proper use of antibiotics.
J Chromatogr B Analyt Technol Biomed Life Sci. 2008 Jun 27;
Zhang S, Song N, Li Q, Fan H, Liu C
A reliable liquid chromatography/tandem mass spectrometry has been developed for simultaneous evaluation of the activities of five cytochrome P450s (CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A) in rat plasma and urine. The five-specific probe substrates/metabolites include phenacetin/paracetamol (CYP1A2), tolbutamide/4-hydroxytolbutamide and carboxytolbutamide (CYP2C9), mephenytoin/4'-hydroxymephenytoin (CYP2C19), dextromethorphan/dextrorphan (CYP2D6), and midazolam/1'-hydroxymidazolam (CYP3A). Internal standards were brodimoprim (for phenacetin, paracetamol, midazolam and 1'-hydroxymidazolam), ofloxacin (for 4'-hydroxymephenytoin, dextromethorphan and dextrorphan) and meloxicam (for tolbutamide, 4-hydroxytolbutamide and carboxytolbutamide). Sample preparation was conducted with solid-phase extraction using Oasis((R)) HLB cartridges. The chromatography was performed using a C(18) column with mobile phase consisting of methanol/0.1% formic acid in 20mM ammonium formate (75:25). The triple-quadrupole mass spectrometric detection was operated in both positive mode (for phenacetin, paracetamol, midazolam, 1'-hydroxymidazolam, brodimoprim, 4'-hydroxymephenytoin, dextromethorphan, dextrorphan and ofloxacin) and negative mode (for tolbutamide, 4-hydroxytolbutamide, carboxytolbutamide and meloxicam). Multiple reaction monitoring mode was used for data acquisition. Calibration ranges in plasma were 2.5-2500ng/mL for phenacetin, 2.5-2500ng/mL for paracetamol, 5-500ng/mL for midazolam, and 0.5-500ng/mL for 1'-hydroxymidazolam. In urine calibration ranges were 5-1000ng/mL for dextromethorphan, 0.05-10mug/mL for dextrorphan and 4'-hydroxymephenytoin, 5-2000ng/mL for tolbutamide, 0.05-20mug/mL for 4-hydroxytolbutamide and 0.025-10mug/mL for carboxytolbutamide. The intra- and inter-day precision were 4.3-12.4% and 1.5-14.8%, respectively for all of the above analytes. The intra- and inter-day accuracy ranged from -9.1 to 8.3% and -10 to 9.2%, respectively for all of the above analytes. The lower limits of quantification were 2.5ng/mL for phenacetin and paracetamol, 5ng/mL for midazolam, 0.5ng/mL for 1'-hydroxymidazolam, 5ng/mL for dextromethorphan, 50ng/mL for dextrorphan and 4'-hydroxymephenytoin, 5ng/mL for tolbutamide, 50ng/mL for 4-hydroxytolbutamide and 25ng/mL for carboxytolbutamide. All the analytes were evaluated for short-term (24h, room temperature), long-term (3 months, -20 degrees C), three freeze-thaw cycles and autosampler (24h, 4 degrees C) stability. The stability of urine samples was also prepared with and without beta-glucuronidase incubation (37 degrees C) and measured comparatively. No significant loss of the analytes was observed at any of the investigated conditions. The current method provides a robust and reliable analytical tool for the above five-probe drug cocktail, and has been successfully verified with known CYP inducers.
Int J Antimicrob Agents. 1997 Sep; 9(2): 127-30
Hamilton-Miller JM, Shah S
A total of 119 strains of coagulase-negative staphylococci isolated from clinical specimens were speciated and tested for sensitivity to methicillin and four fluoroquinolones (ciprofloxacin, sparfloxacin, levofloxacin and ofloxacin). Resistance to fluoroquinolones was significantly more common in Staphylococcus haemolyticus (43%) than in Staphylococcus epidermidis (11%). Methicillin-resistant strains of S. haemolyticus were more often resistant to ciprofloxacin than were methicillin-resistant strains of S. epidermidis (P < 0.05). Sparfloxacin was the most active against fluoroquinolone-sensitive strains, and levofloxacin was twice as active as ofloxacin. There was cross-resistance between the four fluoroquinolones. Levofloxacin was the most active against resistant strains, but MICs obtained for all the compounds seemed to be outside the clinically useful range for the treatment of systemic infections.
Anal Chim Acta. 2008 Aug 8; 623(1): 96-100
Sun Y, Zhang Z, Xi Z
Ofloxacin (OFLX) exhibited strong electrogenerated chemiluminescence (ECL) in NaNO(3) solution with a dual-electrode system when constant current was exerted. Based on this observation, a sensitive direct ECL method coupled with high-performance liquid chromatography (HPLC) separation was developed for determination of OFLX in human serum. Factors affected the ECL emission were investigated. Under the optimal conditions, the ECL intensity has a linear relationship with the concentration of OFLX in the range of 1.0x10(-8) to 4.0x10(-6) g mL(-1) and the detection limit was 4x10(-9) g mL(-1) (S/N=3). The proposed method was sensitive, simple and convenient to operate.
Changing spectrum of antibiotic sensitivity in enteric fever.
Kathmandu Univ Med J (KUMJ). 2008 Jan-Mar; 6(1): 12-5
Neopane A, Singh SB, Bhatta R, Dhital B, Karki DB
Aims and objectives: The study was designed to analyze clinical profile and Antibiotic sensitivity pattern in case of culture positive typhoid fever and compare response of quinolones in vitro and in vivo. Methodology: Forty eight cases of culture positive enteric fever presented in outpatient and emergency department of Kathmandu Medical College, Sinamangal, and Kathmandu were included in the study. Sensitivity pattern of isolates from blood culture was done by antibiotic disc diffusion method and this was compared with clinical response. Results: Response was based on Fever Clearance Time (FCT) and it was found that mean FCT was 3.58 days with standard deviation of 1.84 .Comparison was made separately for FCT >/=5 days and it was found that vomiting as the symptom and stool occult blood positive as the investigation to predict prolong FCT. Nalidixic acid as compared with other quinolones showed that other quinolones (ciprofloxacin, ofloxacin) are effective even in Nalidixic acid resistant cases when FCT was taken as the criteria of response, and it doesn't include the relapse rate. Conclusion: Enteric fever is one of the leading causes of fever in Nepal. The diagnosis in most of the cases is done empirically by clinical features, but culture and sensitivity of blood or bone marrow is the gold standard way of diagnosis and providing treatment. The antibiotic sensitivity pattern is changing and resistance cases are emerging with indiscriminate use of drugs. Key words: Enteric fever, Salmonella typhi, fever clearance time (FCT), antibiotic sensitivity test (AST).
Enteric Fever: A retrospective 6-year analysis of 82 paediatric cases in a teaching hospital.
Kathmandu Univ Med J (KUMJ). 2007 Apr-Jun; 5(2): 181-7
Malla T, Malla KK, Thapalial A, Shaw C
Objective: To evaluate the clinical and laboratory properties, to see the response to therapy, incidence of antimicrobial resistance and complications of Enteric Fever in children. Methods: This is a retrospective study of 82 cases of enteric fever admitted in department of pediatrics, Manipal Teaching hospital, Pokhara, Nepal .Study period was six years from (Jan 2000 to Dec 2005). Results: Total of 82 cases of Salmonella infections were admitted .There were 50 (60%) males and 32 (40%) females. Most of the patients were above the age of five. The leading clinical feature were Fever (100%) , GI symptoms (73%), followed by splenomegaly (60%), hepatomegaly (58%) , chills & rigor (41%), headache(33%),coated tongue(17%), lymphadenopathy (13%), Respiratory signs (13%) , toxic look (7%). The laboratory reports revealed leucopenia in 26% and leukocytosis in 16%. Widal test was positive in 83%, Blood culture was positive in 37 %.Bone marrow was done in 8 cases, out of which 5(62.5%) were culture positive. Out of 35 culture positive cases 32 were Salmonella typhi and 3 were Salmonella paratyphi A. Regarding the treatment 55% were treated with ciprofloxacin, 29 % with ceftriaxone , 7% with ampicillin , 6% with cefotaxime and 2.4 % with chloramphenicol . Response to therapy was assessed by day of defervescence after antibiotics. Best response was observed with ciprofloxacin (4.7 days) followed by ceftriaxone (5days), ampicillin (5.5 days), cefotaximee (6.4 days), chloramphenicol (10 days) respectively. In the antibiogram resistance was 43% with chloramphenicol, 37% with ampicillin, 31% with trimethoprim- sulfamethoxazole, 5.7%with ciprofloxacin and 4% with cefotaxime .Resistance was 0% with ceftriaxone, cefuroxime, and ofloxacin. Gentamycin was found to show high sensitivity (91%). The complications observed were anemia in 10%, 5% had neurologic signs like clouding of consciousness and 3.7% had CNS irritability. Conclusion: It is important to include Enteric fever in the differential diagnosis of febrile patients with abdominal symptoms. Though blood culture is the definite test, Widal test plays supportive role in diagnosis of enteric fever, especially when patients come after a course of antibiotics. Sometimes when both blood culture and Widal tests are negative Bone marrow can be the diagnostic tool for the diagnosis. Based on this analysis ciprofloxacin is still a good drug for the treatment of Enteric Fever. Ceftriaxone, Cefuroxime and Ofloxacin can be considered as first line treatment for Enteric fever since resistance was nil with these drugs on culture reports. Key words: Enteric fever, salmonella infections.
Clinical profile and antibiotics response in typhoid fever.
Kathmandu Univ Med J (KUMJ). 2006 Jan-Mar; 4(1): 25-9
Bajracharya BL, Baral MR, Shakya S, Tuladhar P, Paudel M, Acharya B
OBJECTIVE: The objective of this study is to evaluate the clinical profile and drug response in typhoid fever. METHODS: This is a retrospective analysis of paediatric patients suffering from typhoid fever who were admitted at Kathmandu Medical College Teaching Hospital, Sinamangal during the period of two years and nine months. RESULTS: Total numbers of 100 cases of typhoid were studied. Diagnosis of Typhoid fever was based on clinical features, Widal test and blood culture. The sensitivity pattern of drugs in blood culture was recorded. The mode of presentation, treatment history, laboratory investigations reports, antibiotics administered and response to therapy were recorded. CONCLUSION: Quinolone is still the highly sensitive drug and most widely used for Salmonella typhi. Because of the indiscriminate use of these drugs, resistant to ciprofloxacin has been quite high and the duration of the defeverscence period has also been prolonged. But Ofloxacin is still showed highly effective and widely used with good response.
Detection of extended-spectrum beta-lactamase in Pseudomonas aeruginosa.
Indian J Pathol Microbiol. 2008 Apr; 51(2): 222-4
Aggarwal R, Chaudhary U, Bala K
Purpose: The present study was designed to detect the extended-spectrum beta-lactamase (ESBL) production in Pseudomonas aeruginosa and to evaluate the susceptibility pattern. Materials and Methods: One hundred forty-eight isolates of P. aeruginosa were analyzed for the presence of ESBL enzyme by double disc synergy test. Antibiotic sensitivity pattern of ESBL-positive P. aeruginosa was determined. Results: Of the 148 isolates tested, 30 (20.27%) were found to be positive. Maximum ESBL production was found in sputum and tracheostomy swabs (28.57%), followed by pus (24.13%), urine (19.04%), cerebrospinal fluid (CSF) and other sterile body fluids (15.38%) and blood (7.14%). All the ESBL-producing P. aeruginosa isolates were multi-drug-resistant. Isolates were 100% sensitive to imipenem. Ofloxacin was the second most (70%) effective drug. Conclusion: From this study, we conclude the presence of ESBL-positive P. aeruginosa in our hospital. This has important implications as carbapenems remain the only choice of treatment for infections caused by these organisms. The control measures include judicious use of antibiotics and implementation of appropriate infection control measures to control the spread of these strains in the hospital.
Eye. 2008 Jul 4;
Ramakrishnan R, Bharathi MJ, Shivkumar C, Mittal S, Meenakshi R, Khadeer MA, Avasthi A
PurposeTo identify the microbial aetiology of infectious endophthalmitis and to determine the in vitro antibacterial susceptibilities of bacterial isolates.MethodsA retrospective analysis was carried out of all patients presenting between January 1997 and December 2006 with clinically diagnosed infectious endophthalmitis who underwent microbiological evaluation. Intraocular specimens (aqueous and vitreous fluids) were collected from all cases of clinically suspected infectious endophthalmitis. In addition to intraocular aspirates, blood specimens from endogenous endophthalmitis, and corneal and scleral scrapes from relevant cases were also collected. The collected intraocular specimens, blood specimens, and corneal and scleral scrapes were subjected to microbiological evaluation.ResultsSamples from 955 patients with endophthalmitis underwent microbiological analysis, of which 424 (44.4%) were found to be culture positive. Of 424, 364 (85.8%) had bacterial growth and the remaining 60 (14.2%) had fungal growth. Among post-surgical endophthalmitis, Gram-negative bacilli (75%) were found to be the predominant cause for developing fulminant onset, Staphylococcus spp. (68.6%) for acute, and Streptococcus spp. (75%) for chronic onset of infections, whereas in post-traumatic endophthalmitis, Gram-negative bacilli (65.2%) were found to be the predominant cause for fulminant onset, Gram-positive bacillus (28.4%) for acute onset, and fungi (52.3%) for chronic onset of infections. Endophthalmitis associated with microbial keratitis was mainly caused by filamentous fungi (37.2%) and Gram-negative bacilli (37.2%). Overall, gatifloxacin (97.7%) showed highest activity against bacterial isolates followed by ciprofloxacin (95.9%) and ofloxacin (95.1%).ConclusionGram-negative bacilli cause predominantly fulminant onset, Staphylococci and Gram-positive bacilli acute, and Streptococci, Nocardia, and fungi chronic endophthalmitis. Gatifloxacin demonstrated greatest efficacy against these bacterial isolates.Eye advance online publication, 4 July 2008; doi:10.1038/eye.2008.197.
[BCG infection of the glans penis after intravesical BCG therapy.]
Ann Dermatol Venereol. 2008 Jun-Jul; 135(6-7): 479-83
Michelet N, Spenatto N, Viraben R, Cuny JF, Mazet J, Trechot P, Barbaud A, Schmutz JL
BACKGROUND: BCG therapy is an effective adjuvant treatment for superficial bladder tumors. Therapy involves intravesical instillation of live attenuated Calmette-Guérin bacilli. BCG infection of the glans is a rare local complication associated with this treatment, two cases of which are reported below. PATIENTS AND METHODS: Case 1: A 77-year-old man presented relapsing urothelial bladder carcinoma treated by endoscopic resection and BCG therapy. One week after the seventh instillation, severe balanitis developed. Three months later, examination revealed massive painful perimeatal ulceration with yellowish papules in the peripheral regions. Histology revealed epithelioid giant-cell granulomas. Ziehl-Neelsen staining was positive. Slow cure of the lesions was achieved within 12months using double antitubercular antibiotic therapy. Case 2: In a 61-year-old man receiving BCG therapy for relapsing bladder carcinoma in situ, the sixth instillation was considered traumatic since it was highly painful. One week later, papular nodules appeared on the glans with a sclerosing lesion of the balanopreputial sac, dark purple perimeatal papules and a mass beneath the mucosa of the glans. Antibiotic treatment comprising ofloxacin followed by rifampicin for two months proved ineffective. Histology revealed granulomatous dermal lesions with eosinophilic necrosis. Triple antitubercular antibiotic therapy was initiated. DISCUSSION: The first reported case of BCG infection of the glans in patients undergoing intravesical BCG therapy was published in 1992. Since then, there have been nine other reports. There is no stereotypical clinical presentation. In most cases, an infiltrated erythematosus plaque is seen together with yellowish papules in certain patients. Diagnosis is based upon history and histological examination.