BACKGROUND: A high prevalence of antimicrobial resistance among urinary isolates in the Garhwal region of Uttaranchal. AIMS: To identify the most appropriate antibiotic for empirical treatment of community-acquired acute cystitis on the basis of local antimicrobial sensitivity profile. SETTINGS AND DESIGN: A prospective clinico microbiological study including all clinically diagnosed patients with community acquired acute cystitis attending a tertiary care teaching hospital over a period of three years. METHODS AND MATERIAL: Clean-catch midstream urine specimens, from 524 non pregnant women with community-acquired acute cystitis, were subjected to semiquantitative culture and antibiotic susceptibility by the Kirby-Bauer disc diffusion method. A survey was also conducted on 30 randomly selected local practitioners, to know the prevalent prescribing habits in this condition. STATISTICAL ANALYSIS: The difference between the susceptibility rates of E. coli isolates to Nitrofurantoin and the other commonly prescribed antibiotics was analysed by applying the z test for proportion. RESULTS: 354 (67.5%) specimens yielded significant growth of E. coli. >35% of the urinary E.coli isolates were resistant to the fluoroquinolones, which were found to be the most commonly used empirical antibiotics in acute cystitis. Resistance was minimum against Nitrofurantoin (9.3%, 33) and Amikacin (11.0%,39). >80% of the fluoroquinolone-resistant strains were found to be sensitive to Nitrofurantoin. CONCLUSION: The best in vitro susceptibility profile in our study has been shown by Nitrofurantoin and a significantly high proportion of the urinary E. coli isolates have already developed resistance to the currently prescribed empirical antibiotics, viz. the fluoroquinolones. In view of these in vitro susceptibility patterns, a transition in empirical therapy appears imminent.

The infection control knowledge among the nurses was fairly good; however, there is still a wide scope of improvement with regular educational programs and in-house training.

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Ascariasis is a common disease in many developing countries and is a common cause of biliary and pancreatic diseases in endemic areas. Numerous studies have been published on biliary tract ascariasis. All these have documented ultrasonography as the primary imaging modality for biliary tract ascariasis. Magnetic Resonance Cholangiopancreatography (MRCP) has been the latest entrant for the study of bilary tract. MRCP findings of biliary tract ascariasis have been scarcely documented. MRCP is a unique non-invasive investigation for demonstrating ascariasis in Gall bladder and bilary tract clearly. We present MR appearances of Gall bladder and biliary tract in a proven case of biliary ascariasis.

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