Many patients with pulmonary tuberculosis have co-infection with Candida spp. The prevalence of non-albicans Candida species is increasing and may be associated with inadequate response to anti-tubercular drugs. C. glabrata infection has a strong association with old age.

Background: Publication bias and discrimination are increasingly recognised in medicine. A survey was conducted to determine if medical journals were more likely to publish research reports from members of their own than a rival journal's editorial board. Methods: A retrospective review was conducted of all research reports published in 2006 in the four competing medical journals within five medical specialties. Only three journals were willing to divulge the authorship of reports that had been rejected. Results: Overall, 4460 research reports were published in 2006 by the 20 journals from five subspecialties (mean 223 (SD = 164) reports per journal; median 176; interquartile range 108-238). On average, 17.2 (7.7%) reports were from a journal's own editorial board (SD = 10.7; median 15; interquartile range 10-23; n = 20), and 6.3 (2.8%) reports were from a member of the editorial board of one of the three rival journals within the specialty (SD = 7.3; median 3.5; interquartile range 1-8; n = 60).

VAP is a common nosocomial infection associated with ventilated patients. The mortality associated with VAP is high. The organisms associated with VAP and their resistance pattern varies depending on the patient group and hospital setting. The diagnostic methods available for VAP are not universal; however, a proper infection control policy with appropriate antibiotic usage can reduce the mortality rate among ventilated patients.

Background: Diabetic foot infections are one of the most feared complications of diabetes. This study was undertaken to determine the common aetiological agents of diabetic foot infections and their in vitro antibiotic susceptibility. Methods: A prospective study was performed over a period of one year in a tertiary care hospital. The aerobic bacterial agents were isolated and their antibiotic susceptibility pattern was determined. Members of Enterobacteriaceae were tested for extended spectrum β-lactamase (ESBL) production by combination disc method and staphylococcal isolates were tested for susceptibility to oxacillin by screen agar method. Results: Klebsiella pneumoniae (20.5%), Pseudomonas aeruginosa (17%), Staphylococcus aureus (17%) and Escherichia coli (14.6%) were the most common aetiological agents. Polymicrobial infection was observed in 52% patients. The members of Enterobacteriaceae as well as Pseudomonas spp. and Acinetobacter spp. were found to be susceptible mainly to amikacin, piperacillin-tazobactam and imipenem. Staphylococcus aureus and Enterococcus spp. were susceptible mostly to vancomycin, with varying susceptibility to tetracycline. 56% of the isolates belonging to Enterobacteriaceae were producing ESBL and 65.5% of Staphylococcus aureus were methicillin-resistant. Conclusion: High prevalence of multi-drug resistant pathogens was observed. Amikacin, piperacillintazobactam, imipenem were active against gram-negative bacilli, while vancomycin was found to be active against gram-positive bacteria.

Background: Information about antibiotic use and resistance patterns of common microorganisms are lacking in hospitals in Western Nepal. Excessive and inappropriate use of antibiotics contributes to the development of bacterial resistance. The parameter: Defined daily dose/100 bed-days, provides an estimate of consumption of drugs among hospital in-patients. This study was carried out to collect relevant demographic information, antibiotic prescribing patterns and the common organisms isolated including their antibiotic sensitivity patterns.

VAP occurred in a sizeable number of patients on MV. Chronic lung failure, H2 blockers usage, and supine head position were the risk factors associated with VAP. Awareness about these risk factors can be used to inform simple and effective preventive measures.

BackgroundBlood stream infections (BSIs) are important determinants for prolonged hospital stay and if uncontrolled, progress to become life-threatening. The aim of this study is to determine the common bacterial agents associated with BSI and their antimicrobial susceptibility patterns in a tertiary care teaching hospital in the Western region of Nepal. MethodA cross-sectional study was conducted for a 20 month period from January 2006 to August 2007. All adult patients with fever (temperature ≥ 38°C) when assessed in the outpatient department or various inpatient wards were enrolled in the study. ResultsOf the 933 patients with febrile illness, only 96 were diagnosed to have BSIs. Salmonella spp., Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus were the common etiological agents of BSIs. S. Paratyphi A and S. Paratyphi B were responsible for 46.7% of the enteric fever cases. The clinical diagnosis of enteric fever was not sensitive and specific. The members of Enterobacteriaceae were frequently resistant to ampicillin, amoxicillin/ clavulanic acid and gentamicin. About one-third of the K.pneumoniae, E.coli and Enterobacter spp. produced extended-spectrum β-lactamases. The non-fermenters were unusually sensitive to most antibiotics. ConclusionGram-negative bacteria were the predominant causes of BSIs. The occurrence of drug resistant S. Paratyphi A is of great concern for travellers, as they are not protected with an effective vaccine. Imipenem showed good activity against Pseudomonas aeruginosa indicating lack or low level of MBL activity.

We studied the prevalence of ceftazidime resistance in Pseudomonas aeruginosa and the rates of extended-spectrum β-lactamase (ESBL), AmpC β-lactamase (AmpC) and metallo-β-lactamase (MBL) production among the ceftazidime resistant Pseudomonas aeruginosa. A very high rate of MBL production was observed, which suggested it to be an important contributing factor for ceftazidime resistance among Pseudomonas aeruginosa.