Background:The aim of study was to find out the potential pathogenic role of virulence factors elaborated by strains of vancomycin resistant enterococci (VRE) isolated from clinical samples and VRE colonizing the gastrointestinal tract of hospitalized patients.Materials and Methods:Enterococci were isolated from various clinical samples and also from fecal specimens of colonized patients at the time of admission, after 48 h and after 5 days of admission. Various virulence determinants were detected by phenotypic tests. Vancomycin susceptibility in enterococci was detected by disc diffusion and agar screen method. Minimum inhibitory concentration was determined by agar dilution method.Results:Out of all the clinical and fecal samples processed, 12.0% isolates were either vancomycin resistant or vancomycin intermediate. Hemagglutinating activity against rabbit red blood cells was seen with 27.8% and 25.0% of clinical and fecal strains, respectively. Slime layer formation was seen with fecal VRE strains (37.5%) when compared to clinical VRE (27.8%). Among the clinical VRE strains the most prolific biofilm producers were Enterococcus. fecalis (92.9%) when compared to Enterococcus. faecium (52.9%). Biofilm formation/(presence of adhesions) was also seen in (29.2%) of the fecal VREs. In wound infection production of gelatinase, deoxyribonuclease (DNase), and caseinase (70.0% each) were the major virulence factors. The predominant virulence factors seen in the blood stream infection were adhesin, and hemolysin (44.4% each) and in catheter induced infection were DNase and adhesins (75.0% each). Adhesin (29.2%), slime layer (37.6%), DNAse (33.3%), gelatinase (25.0%), lipase (20.8%) and caseinase (16.6%) and hemolysin (8.3%) were produced the fecal isolates.Conclusion:An association between adhesin (as detected by biofilm formation) and urinary tract infection, adhesion and hemolysin with BSI, as also between DNase gelatinase & caseinase with wound infection was noted.

VRE in our study were found to be resistant to a number of commonly used antibiotics. The frequency of isolation of vancomycin resistant E. faecalis (VRE.fs), which is highly virulent, and the number of strains harboring van A gene in our hospital setup is high and needs to be addressed.

In rural areas of South and Southeast Asia malaria is declining but febrile illnesses still account for substantial morbidity and mortality. Village health workers (VHWs) are often the first point of contact with the formal health system, and for patients with febrile illnesses they can provide early diagnosis and treatment of malaria. However, for the majority of febrile patients, VHWs lack the training, support and resources to provide further care. Consequently, treatable bacterial illnesses are missed, antibiotics are overused and poorly targeted, and patient attendance wanes along with declining malaria. This Open Letter announces the start of a new initiative, the Rural Febrile Illness (RFI) project, the first in a series of projects to be implemented as part of the South and Southeast Asian Community-based Trials Network (SEACTN) research programme. This multi-country, multi-site project will run in Bangladesh, Cambodia, Lao PDR, Thailand, and Myanmar. It will define the epidemiological baseline of febrile illness in nine remote and underserved areas of Asia where malaria endemicity is declining and access to health services is limited. The RFI project aims to determine the incidence, causes and outcomes of febrile illness; understand the opportunities, barriers and appetite for adjustment of the role of VHWs to include management of non-malarial febrile illnesses; and establish a network of community healthcare providers and facilities capable of implementing interventions designed to triage, diagnose and treat patients presenting with febrile illnesses within these communities in the future.

Background:The aim of this study was to find out the correlation between presence of virulence (gelatinase [gel E], enterococcal surface protein [esp], cytolysin A [cyl A], hyaluronidase [hyl], and aggregation substance [asa1]) and vancomycin-resistant genes (van A and van B) in enterococci, with their phenotypic expression.Materials and Methods:A total of 500 isolates (250 each clinical and fecal) were processed. Enterococci were isolated from various clinical samples and from fecal specimens of colonized patients. Various virulence determinants namely asa1, esp, hyl, gel E, and cyl were detected by phenotypic methods. Minimum inhibitory concentration (MIC) of vancomycin was determined by agar dilution method. Multiplex polymerase chain reaction (PCR) was used to detect the presence of virulence and van genes.Results:Out of all the samples processed, 12.0% (60/500) isolates carried van A or van B genes as confirmed by MIC test and PCR methods. Genes responsible for virulence were detected by multiplex PCR and at least one of the five was detected in all the clinical vancomycin-resistant enterococci (VRE) and vancomycin-sensitive enterococci (VSE). gel E, esp, and hyl genes were found to be significantly higher in clinical VRE. Of the fecal isolates, presence of gel E, esp, and asa1 was significantly higher in VRE as compared to VSE. The presence of hyl gene in the clinical VRE was found to be statistically significant (P = 0.043) as against the fecal VRE. Correlation between the presence of virulence genes and their expression as detected by phenotypic tests showed that while biofilm production was seen in 61.1% (22/36) of clinical VRE, the corresponding genes, i.e., asa1 and esp were detected in 30.5% (11/36) and 27.8% (10/36) of strains only.Conclusion:Enterococcus faecium isolates were found to carry esp gene, a phenomenon that has been described previously only for Enterococcus faecalis, but we were unable to correlate the presence of esp with their capacity to form biofilms.

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BACKGROUNDUrinary tract infections (UTI) are the common bacterial infections during pregnancy. It may involve the lower urinary tract or bladder. The majority of UTI occur due to ascending infection. Untreated UTI can be associated with serious obstetric complications.The aim of this study was to examine the prevalence of UTI, proper screening and treatment of pregnant woman is necessary to prevent complications. MATERIALS AND METHODSThis study included 350 cases of pregnant women over a period of 1 year. UTI was diagnosed using mid-stream (MSU) culture using > 10 5 colony forming unit per millilitre as a significant level of bacteriuria. RESULTSA total of 350 samples were processed during the study period, of which 98 cases showed significant growth making prevalence of 28%. There was a high incidence in 21 -25 years' age group (48.97%). There was also high incidence of infection in the third trimester of pregnancy (73.46%) compared to first (7.14%) and second trimester (19.38%). Multiparity is associated with increased urinary tract infection in pregnancy. CONCLUSIONThe present study shows the prevalence rate of 28% of UTI among pregnant women. These findings underscore the importance of screening of all pregnant women for significant bacteriuria, so that positive cases should be treated subsequently with antibiotics in order to reduce the adverse effects on both maternal and foetal health.

BACKGROUNDDespite advances in medical and surgical therapies, the management of osteomyelitis is an increasing challenge to clinicians due to growing resistances to antibiotics. The present study was conducted to determine the bacteriological profile of cases of osteomyelitis and also to ascertain the antibiotic susceptibility pattern of these isolates to prevent unnecessary morbidity and mortality.

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