Pseudomonas species is a common cause of health care acquired infection and also stand in second place in WHO critical list for antimicrobial resistance. Acquisition of antibiotic resistance gene in pathogenic bacteria has been a growing problem worldwide. The presence of resistance gene in class 1 integrons is associated with multi- drug resistance among Pseudomonas species. This study aimed to detect the class 1 integron and antibiotic susceptibility patterns of Pseudomonas species isolated from clinical specimens at No. (1) Defence Services General Hospital (1000-bedded) during the period of January to September 2020. The hospital and laboratory based descriptive study was conducted among the clinical samples received at Microbiology laboratory. Isolation, identification and antimicrobial susceptibility testing were performed by Vitek 2 automated systems. All Pseudomonas species were tested for the presence of class 1 integron by PCR. In this study, 77 Pseudomonas species isolated from various clinical specimens. According to the finding, the most common resistance was observed towards cefotaxime (97.4%), while resistance to amikacin was less observed among isolates (22%). Out of 77 Pseudomonas species isolates, 54 (70%) were multidrug resistant (MDR) according to CLSI 2020 guidelines. Among the multidrug resistance, 38 (95%) isolates were class 1 integron positive (p<0.001) and 16 (43.24%) were class 1 integron negative (p<0.001). Therefore, this finding indicates the strong association between the presence of class 1 integron and multidrug resistance. Therefore, integrons play an important role in acquisition and dissemination of antibiotics resistance genes among Pseudomonas species.
Introduction: Acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19) patients affects their health outcomes. Incidence and outcomes varied in the literature, particularly with different population and epidemiological demographics. Data remain scarce in the Southeast Asia region. We report the incidence, outcomes, pattern, types of AKI, and factors that influence AKI patient outcomes in Brunei Darussalam.Methods: All patients (N = 930) with COVID-19 who were admitted to the National Isolation Center (between 7th August 2021 and 30th September 2021) were included in the study. The confirmation of AKI was based on the KDIGO (Kidney Disease Improving Global Outcomes) criteria.Results: The mean age of the patients was 41.9 ± 14.4 years with diabetes mellitus (DM), hypertension (HT), and chronic kidney disease (CKD) accounting for 11.7%, 29.1%, and 4.8% of comorbidities, respectively. Overall, 109 (11.7%) had AKI (KDIGO Stage 1 [67.9%], 2 [13.8%], and 3 [18.3%]), while 75.2% of the cases occurred pre-admission and 26.6% were cases of acute exacerbation of CKD. Univariate analysis identified age (odd ratio [OR] 1.06), male gender (OR 1.63), local nationality (OR 8.03), DM (OR 4.44), HT (OR 5.29), vascular disease (OR 6.08), presence of gastrointestinal symptoms (OR 2.08), antibiotic (OR 3.70) and nephrotoxins exposures (OR 8.57) as significant variables. Multivariate analysis showed age (adjusted OR [AOR] 1.04), male gender (AOR 1.67), gastrointestinal symptoms (AOR 1.61), antibiotic (AOR 2.34), and nephrotoxins exposure (AOR 4.73) as significant.Conclusions: Our study showed that one in nine patients with COVID-19 developed AKI with almost a third having stages 2 and 3 AKI. Older age, male gender, presence of GI symptoms, and antibiotic and nephrotoxin exposures were significant predictors of AKI. Patients with these factors should be prioritized for admission and treatment. Even though manifestations are generally now less severe, findings from this study can guide the management of COVID-19 as the disease enters the endemic stage. Furthermore, lessons learned from the COVID-19 pandemic will provide useful information and knowledge for future viral outbreaks or pandemics.
Klebsiella species is commonly associated with serious nosocomial infections. Multi-drug resistant Klebsiella species isolates are becoming increasingly prevalent in the clinical and nosocomial environments. The high prevalence of Klebsiella infections is related to the ability of Klebsiella species to acquire and disseminate exogenous genes associated with mobile elements, such as plasmids, transposons and integrons. This study was conducted to find out the presence of class 1 integron and antibiotic susceptibility patterns of Klebsiella species from clinical specimens at No (1) Defence Services General Hospital (1000-Bedded). A laboratory based cross-sectional descriptive study was carried out from January to september, 2020. Identification and antimicrobial susceptibility testing of Klebsiella species was performed by VITEK 2 Compact Analyzer. Class 1 integrons were detected by conventional PCR. In this study, 110 Klebsiella species were isolated from various clinical specimens and most of the isolates were from medical ward (52.3%, 63 isolates). The highest rate of resistance was observed for ampicillin (100%) and Cefotaxime (97.3 %) whereas the lowest antibiotic resistance was to Amikacin (15.5%). Out of 110 Klebsiella isolates, 107 (97.3%) were multidrug resistant (MDR). Forty-four (40%) out of 110 Klebsiella isolates carried int1 gene and all these isolates were MDR. However, there was no association between multidrug resistance and integron positivity (p value = 0.273). The presence of class I integron genes among Klebsiella species highlights the continued monitoring is necessary for prevention of wide dissemination of integrons and infections by MDR pathogens.
Background: In COVID-19 pandemic, the diagnosis and treatment must be as early as possible to save the life of each patient. Moreover, screening of asymptomatic carriers, close contacts or healthy subjects must not be delay to prevent transmission to publics. For confirmation of diagnosis of SARS-CoV-2 infection, nasopharyngeal swab must be tested either by real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests or Rapid Antigen Test (RAT). RAT is faster, easier and cheaper; thus, it is suitable for health service in developing country. Objectives: The aim of this study was to assess the diagnostic accuracy of Roche SARS-CoV-2 Rapid Antigen Test (RAT) in diagnosing SARS-CoV-2 infection. Methods: Hospital based exploratory study was done in out-patient department and fever clinic, and molecular laboratory of No. (1) Defence Services General Hospital. Nasopharyngeal swabs were taken, and the Roche SARS- CoV-2 RAT was conducted in parallel with RT-PCR test (reference standard). Results: Among the 932 patients/subjects recruited, RT-PCR was positive in 468 individuals, corresponding to a prevalence of 50.2%. The RAT was positive in 363 patients (60.4%), false positive in 120 patients; it was negative in 569 individuals (39.6%), false negative in 225 patients. The overall sensitivity of the RAT was 51.9% (95% Confidence Interval [CI] 47.29-56.53) and, the specificity was 74.1% (95% CI 69.9-78.07); positive predictive value was 66.9% and negative predictive value was 60.5%. The sensitivity varied with Ct value; 78% in clinical samples with Ct values < 20, 57.5% in those with Ct values between 21 and 25, 41.8% in samples with Ct values between 26 and 30, and, 36.4% in samples with Ct value > 30. Conclusion: The accuracy of the SARS-CoV-2 Roche RAT in diagnosing SARS-CoV-2 infections was inferior to RT-PCR and manufacturer’s data. The sensitivity was with low Cycle threshold values < 20 which were inversely related to the viral load. RAT test should be used in association with clinical impression of physicians. In hospital setting especially in emergency department, the role of RAT should be reconsidered in those patients presenting with anosmia and some cases of dyspnoea, late symptoms in the course of disease, as the RAT results would be false negative. Other errors may arise if the operator for RAT has to handle more than recommended tests per hour especially in the peak of epidemics.
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