Melioidosis, caused by Burkholderia pseudomallei,

Melioidosis is known to occur in Bangladesh, but there are few reports about the condition in the published international literature. We set out to review all known cases of melioidosis in the country to date, using both retrospective and prospective data. A web-based literature search was conducted to identify all published case reports, original articles and conference abstracts. Cases were also included from a prospective study conducted in 2017. Fifty-one cases were identified between 1961 and 2017. Cases have been reported from sixteen out of the 64 districts of Bangladesh. The median age of the patients at presentation was 45 years (IQR 37–52), with a significant male (77%) predominance. Many patients (14/39; 36%) were farmers and 83% had diabetes mellitus. A skin/soft tissue abscess was the most common primary clinical presentation (13/49; 27%), followed by septic arthritis (10/49; 20%), pneumonia, and a deep-seated abscess/organ abscess (7/49; 14%). The major challenges to the diagnosis and treatment of melioidosis in Bangladesh are the lack of resources and the lack of awareness of melioidosis. Capacity development programs are urgently required to define the burden of disease and to tackle the mortality rates.

Urinary tract infection (UTI) is common both in the diabetic and non-diabetic patients. The widespread use of antimicrobial agents leads to emergence of resistant microorganisms. Since the pattern of bacterial resistance is constantly changing, the monitoring of the antimicrobial susceptibilities of the predominantly isolated organisms becomes more important. Aim of this study was to determine the etiologic agents and their antibiotic sensitivity pattern in both diabetic and non-diabetic patients with urinary tract infection (UTI). A total of 288 diabetics (196 female and 92 males) and 63 non diabetic patients (43 female and 20 males) with symptomatic UTI were included in this study. Among the study cases, 43.8% diabetic patients and 42.9% non-diabetic patients had positive growth from urine. Rate of isolation of Escherichia coli in diabetic was less (61.8%) compared to non diabetic (77.8%). Rate of other organisms isolated in diabetic and non diabetic patients were respectively: Klebsiella sp 6.9% vs 3.7%, Enterococcus 12.2% vs3.7%, Pseudomonas species 3.8% vs 0%, Candida species 4.6% versus 3.7%, Staphylococcus aureus 4.6% versus 7.4% etc. E coli isolated from diabetic patient was significantly (p<0.05) less sensitive to ceftriaxone, ceftazidime, cefuroxime, netilmicin, gentamicin, ciprofloxacin and nitrofurantoin than that of non diabetic patients. In addition, isolation rate of the Extended Spectrum Beta Lactamase producing gram negative bacilli was found higher among diabetic population (47.8%) compared to the non-diabetics (9.1%). Key words: Urinary tract infection (UTI), Diabetic and non diabetic patient, Extended Spectrum Beta Lactamase. DOI: http://dx.doi.org/10.3329/bjmm.v4i1.8461 BJMM 2011; 4(1): 6-8

Critically ill patients admitted in intensive care units (ICU) are always at a higher risk of developing infections with various antibiotic resistant organisms. The objective of this study was to know the antibiotic resistance pattern of the common isolates from blood, urine, respiratory secretions and pus/wound swab of patients admitted in ICU at BIRDEM ( 7%). Staphylococcus aureus, Enterobacter sp, Citrobacter sp, Enterococcus sp, Providencia spand Serratia sp accounted for 10.6% of the isolates. All the isolates were highly resistant (>80%) to cephalosporins and fluoroquinolones. The frequency of third generation cephalosporin resistant E. coli, Klebsiella and imipenem resistant Pseudomonas and Acinetobacter were >50%. Acinetobacter was remarkably resistant to most antibiotics including imipenem (>70% resistant), but most of the members of the Enterobacteriacae group showed maximum sensitivity to imipenem (50%-94%). The findings of this study might help clinicians to formulate their first line empirical antibiotic treatment regimens for the patients admitted in ICUs.Ibrahim Med. Coll. J. 2010; 4(2): 66-69

Melioidosis is a rarely reported infectious disease in Bangladesh. Patients may present with fever, soft tissue infection, deep seated abscess, arthritis and septicaemia, specially if immunocompromised. It often mimics tuberculosis. Here we describe a case of melioidosis in a middle aged Bangladeshi diabetic farmer who presented with fever, soft tissue infection and septic arthritis involving right hip joint. Culture of pus from soft tissue infection and synovial fluid revealed growth of Burkholderia pseudomallei. He was treated with prolonged courses of antibiotics including ceftazidime in initial phase followed by co-trimoxazole and was cured completely.

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Identification of organisms and effective antibiotic therapy is an important component of treatment of diabetic foot infections. This study was undertaken to determine the organisms associated with diabetic foot infection (DFI) and their antibiotic sensitivity pattern. A total of 75 patients having type 2 diabetes mellitus with Wagner's grade 1-5 foot ulcers attending BIRDEM hospital were included in the study. Specimens were processed for aerobic culture. The bacteriological isolation and antimicrobial sensitivity tests of the isolates were done by standard microbiological methods. Gram negative bacilli were tested for extended spectrum β lactamase (ESBL) production by double disc diffusion method. Culture was positive in 92% of the cases which yielded 135 pathogens. Of the positive culture, 75.3% had multiple organisms. Polymicrobial infection was more in higher grade of foot ulcers. Gram negative organisms were most frequently isolated (80%) bacteria. Pseudomonas (48%) and Proteus sp.(33%) was the most common Gram negative organisms isolated. Staphylococcus aureus was the most commonly isolated gram positive organism (21.3%). ESBL production was noted in 31.5% Gram negative bacilli and methicillin resistance was noted in 43.8% of Staphylococcus aureus. Most of the Gram negative bacilli were resistant to various classes of antibiotics. Imepenem was the most effective agent against Gram negative organisms, while vancomycin was for staphylococcus. The present study has shown that infection with multidrug resistant Gram negative bacilli is the most common cause of DFI in BIRDEM hospital.Ibrahim Med. Coll. J. 2009; 3(2) A good outcome of DFI depends upon being familiar with the microbiological profile of the infection that can help in selecting the most appropriate antimicrobial therapy.13 This study was conducted with an aim to attempt determining the microbiological and microbial susceptibility profile of organisms isolated from diabetic foot ulcers of patients attending BIRDEM hospital. Methods Study population and grading of foot ulcersSeventy five diabetic patients with clinically infected foot ulcers attending both Surgery and Orthopedics outpatient and inpatient departments at BIRDEM hospital during the period of June 2008 to October 2008 were studied.A detailed clinical history was obtained from each patient which included age, sex, type and duration of diabetes, treatment history, and other associated diseases (e.g. hypertension, neuropathy, peripheral vascular disease). Clinical assessment for signs of infection namely swelling, exudates, surrounding cellulitis, odor, tissue necrosis, local crepitation, redness, indurations, pain, warmth and fever were noted. Ulcer size was determined by multiplying the longest and widest diameters and expressed in centimeters squared. Ulcers were graded into following six categories according to the Wagner's Classification system (Fig-1 Grade 1-Superficial ulcer. Disruption of skin without penetration of the subcutaneous fat layer. Superficial infection with or ...

Background : Ventilator-associated pneumonia (VAP) is the most common type of nosocomial infection in critical care practice with high morbidity and mortality. Microorganisms responsible for VAP vary from place to place. So, identification of causative organism and knowledge of their resistance pattern is very important for empirical choice of antibiotic in managing VAP. The aim of this survey was to evaluate the quantitative cultures of endotracheal aspirates to determine the microorganisms responsible for VAP and to study their antibiotic resistance pattern.Materials and Methods: This cross sectional study was performed over a period of six month starting from November, 2015 to April, 2016 in the Intensive Care Unit (ICU) of BIRDEM General Hospital. Patients with a clinical and radiological diagnosis of VAP were included in this study.Result: A total of 51 patients with a clinical diagnosis of VAP were included in this study. Growth was obtained in100% of the samples yielding 88 organisms. Gram-negative organisms were the mostly isolated organism (76.13%), followed by fungi (17.04%) and gram-positive cocci (6.81%). The most common pathogen was Acinetobacter sp. followed by Klebsiella sp., Candida sp. and Pseudomonas sp. respectively. Among the gram negative organisms, Acinetobacter sp., Klebsiella sp. and Pseudomonas sp. were highly resistant (>80%) to third generation cephalosporins and fluoroquinolones. Resistance to aminoglycosides (>68%) and imipenem (>60%) was also high. Resistance of Pseudomonas sp. to piperacillin-tazobactum was lower (18.2%) in comparison to Acinetobacter sp. and Klebsiella sp. All the Gram-negative organisms were 100% sensitive to colistin except proteus. Regarding gram-positive cocci,Staphylococcus aureus is 100% sensitive to netilmycin and vancomycin with variable resistance pattern to other antibiotics.Conclusion: Emergence of drug resistance against the microorganism causing VAP is a serious concern in most of the ICUs. A knowledge of antibiotic susceptibility pattern will avoid its irrational use in order to control the spread of infection and for proper management of VAP.Bangladesh Crit Care J September 2016; 4 (2): 69-73