BackgroundMultidrug resistant Staphylococcus aureus is common in both tertiary and primary health care settings. Emergence of methicillin resistance in S. aureus (MRSA) along with macrolide, lincosamide, streptogramin B (MLSB) has made treatment of Staphylococcal infection more challenging. The main objective of this study was to detect MRSA, MLSB (inducible; MLSBi and constitutive; MLSBc) resistant S. aureus using phenotypic methods and to determine their antibiogram.MethodsVarious samples were collected from 1981 patients who attended Lumbini Medical College and Teaching Hospital (LMCTH) during the period of 6 months from September 2015 to February 2016. Out of a total of 1981 samples, 133 S. aureus were isolated. Cefoxitin was used to detect MRSA by the disk diffusion test. Inducible clindamycin resistance (MLSBi) was detected by the D-zone test. The antibiotic profile of all isolates was tested by a modified Kirby Bauer disk diffusion method.ResultsAmong 133 S. aureus, there were 58 (43.6%) MRSA, 34 (25.6%) MLSBi and 30 (22.6%) MLSBc. Of a total of 64 MLSB, a significant proportion (62.5%) was MRSA (p < 0.001). Among 11 different antibiotics that were tested for S. aureus, MRSA showed significant resistance to 9 (p < 0.05) with the exception of vancomycin and linezolid. All the isolates were 100% sensitive to linezolid. MLSBi organisms were 100% sensitive to vancomycin and linezolid. Both MLSBi and MLSBc showed a higher degree of resistance to multiple antibiotics (p < 0.05).ConclusionsIsolation of MRSA, MLSBi and MLSBc were remarkably high. Routine use of simple and cost effective methods such as the disk diffusion test by cefoxitin for MRSA and the D-zone test for MLSBi organisms can easily identify these isolates. Antibiotic resistance profiles from this study can optimize the treatment of multi-drug resistant S. aureus.

Introduction: Gallstone disease is one of the most common disease affecting the gastrointestinal tract. Biliary tract infection results from bile stasis due to chronic obstruction, mainly (80%) gallstones. Biliary obstruction increases ductal pressure, resulting in bacterial proliferation and dissemination. Proper guidelines for appropriate use of antibiotics in managing uncomplicated and complicated gallstone disease are lacking; on the other hand, the antibiotic usage for its management cover a broad spectrum of organism which may not be required most of the times. This study aims to determine the microbiology of the bile culture and antimicrobial susceptibility in patients with symptomatic gallstone disease in our setup.   Methods: This prospective study included patients admitted in surgery department with a diagnosis of symptomatic gallstone disease and subjected for laparoscopic or open cholecystectomy from 1st of Oct 2015 to 30th Sep 2016. The intraoperative bile of patients subjected for cholecystectomy were cultured aerobically in Blood agar and MacConkey agar. The isolates were identified and tested for their sensitivity pattern. The data were collected, entered and then analyzed using SPSS version 23. The descriptive statistics were calculated.   Results: Of the total 259 patients, bile culture was negative in 183 patients (70.7%) and was positive in only 76 patients (29.3%). Pseudomonas was the most common cultured organism in 52 (68.4%) patients. Other isolated organisms included E. coli, Staphylococcus, Klebsiella, Enterococci, and Acinetobacter. Imipenem and amikacin were the most effective prophylactic antibiotics.   Conclusion: Bile culture was negative in majority of patients with symptomatic gallstone disease. Few patients are positive in culture with predominantly Pseudomonal growth, mostly sensitive to amikacin or imipenem.

Introduction: Otomycosis is a fungal infection of external auditory canal frequently encountered by otorhinolaryngologists. It causes discomfort to patients with varied symptoms of pruritus, otorrhea, aural fullness and earache. People with a habit of using unnecessary ear drops, cleaning ear with unsterilized objects and those who use mustard oil are all prone to otomycosis. This study aims to find out the association between otomycosis and its predisposing factors. Methods: This study was undertaken in the Department of Otorhinolaryngology of a tertiary hospital from March 2018 to February 2019 and a total of 300 clinically diagnosed cases of otomycosis were enrolled for the study. Results: The mean age ±SD of the patients was 37.7 ± 18.8 years. Females (n=172, 57.3%) were more prone to otomycosis than males (n=128, 42.7%). The most common presenting symptom was pruritus only (n=95, 31.7%) with unilateral involvement being more common. The most common predisposing factor was mustard oil instillation (n=124, 41.3%). Aspergillus niger  was the most common fungus causing otomycosis in this study (n=104, 34.7%). Positive fungal cultures were observed in 285 specimens (95%). The fungal growth (n=285) was high in patients with the history of instilling mustard oil (42.8%) into the ear, 34.0% in topical steroid containing ear drops and 23.2% in self-cleaning group. Conclusion: Otomycosis is common in people using unnecessary steroid containing ear drops, cleaning ear with unsterilized objects and instillation of mustard oil.

Abstract: Introduction: Infective vaginitis accounts for about 90% of all the cases of vaginal discharge in the women of reproductive age group. This includes triad of bacterial vaginosis, candidiasis and trichomoniasis. Method: The study was carried out in Lumbini Medical College and Teaching Hospital, Palpa, Nepal for a time period of 4 months. Total 125 high vaginal swabs from posterior fornix of vagina were collected from November 2014 to February 2015 in the department of Obstetrics and Gynecology, in the patients complaining of vaginal discharge. PH of the vaginal discharge was also determined by using litmus paper. Gram’s and Giemsa stain of vaginal swab smear were done to diagnose Bacterial vaginosis, Candidiasis and Trichomoniasis. Age, parity and pregnancy status of the patients were noted. Result: Out of 125 patient, bacterial vaginosis was found in 16% and candidiasis in 37%.Candidiasis and bacterial vaginosis were observed in child bearing sexually active women. Surprisingly bacterial vaginosis was not observed in pregnant women. Trichomoniasis infection was present in one case (0.8%) while severe invasive Candidiasis was observed in one woman. Conclusion: A definitive diagnosis can easily be made by Gram’s and Giemsa stain and microscopic examination of high vaginal swab. This may help in specific treatment and  prevent associated morbidity and  recurrence. Key words: Bacterial vaginosis, candidiasis, high vaginal swab, Gram’s stain, Giemsa stain.