Testing MIC of Vancomycin for all staphylococcal isolates is mandatory according to the current CLSI guidelines and this will considerably increase the cost of culture and sensitivity testing. This study is an attempt to re-consider the utility of the conventional disc diffusion method for cost-effective testing in resource poor settings. MATERIALS AND METHODS: Thirty coagulase positive and twenty eight coagulase negative staphylococci from various clinical samples have been randomly tested for minimum inhibitory concentration along with the Kirby Bauer disc diffusion method for Vancomycin over a period of five months. RESULTS: Susceptibility results of all the 58 isolates tested have been identical by both disc diffusion and HiComb MIC methods. Out of 58 isolates, 57 (98.26%) staphylococci have been sensitive to vancomycin by Kirby Bauer disc diffusion method as well as by the MIC testing method. The MICs of the susceptible strains have been <2 µg/mL. One isolate, a coagulase negative staphylococcus, has been tested to be resistant to vancomycin by both the methods with an MIC of 32 µg/mL SUMMARY: In our study of staphylococcal isolates from various clinical samples, there is overt significant concordance between disc diffusion and MIC testing methods in the routine susceptibility testing of vancomycin. CONCLUSION: Kirby Bauer disc diffusion method may still be of utility for routine testing of vancomycin susceptibility except for few cases especially in resource poor settings.
INTRODUCTION: S.pneumoniae is the major cause of morbidity and mortality in India and abroad and carriage is the key to invasive disease. Carriage (20-60%) and invasive disease are more prevalent in children and in the elderly. Increased case fatality is due to the emergence of Penicillin and Multidrug Resistant S.pneumoniae worldwide. Penicillin has been the drug of choice for treatment of pneumococcal infections but the increasing number of reports of penicillin resistant pneumococci (PRP) throughout the world makes it essential to regionally determine the prevalence of PRP. MATERIALS AND METHODS: Nasopharyngeal swabs were collected from children between ≥ 3 months and ≤ 5 years of age attending paediatric immunization OPD in a medical college tertiary care hospital and research centre, Bengaluru, between December 2008 and August 2009 (8 months). S. pneumoniae were isolated based on colony morphology, Gram's staining, optochin sensitivity, and bile solubility. Antimicrobial susceptibility testing was carried out by Kriby-Bauer disc diffusion method for recommended commonly prescribed antibiotics. Oxacillin resistant strains denoting penicillin resistance were tested for Minimum inhibitory concentration for Penicillin G by Epsilometer test. RESULTS: 53 (27.89 %) S. pneumoniae were isolated from 190 nasopharyngeal swabs. 9 (16.98%) isolates have been intermediately penicillin resistant by E test. Only 5 (9.43%) and 34 (64.15%) isolates were sensitive to co-trimoxazole and tetracycline respectively. 51 isolates were susceptible to cefotaxime, 48 (90.56%) each were susceptible to erythromycin and ciprofloxacin. 25(47.19%) out of 53 isolates could be recovered at the end of one year stored in STGG medium at-20˚ C. Serogroup types 19, 10, 3, 14, 7, were common among the isolates. CONCLUSION: Carriage of S. pneumoniae is prevalent among young children in Bengaluru, which may predispose them to subsequent invasive pneumococcal diseases. There is decreased susceptibility to penicillin and other recommended antibiotics that may warrant appropriate culture and sensitivity testing during the management of invasive pneumococcal diseases and prescription of antibiotics in general. KEY WORDS: Streptococcus pneumoniae, pneumococcal carriage, epsilometer test, penicillin resistant pneumococci INTRODUCTION: S. pneumoniae is a major cause of morbidity and mortality in India and abroad and carriage is the key to invasive disease [1, 2, 3]. S. pneumoniae causes infections of the middle ear, sinuses, trachea, bronchi, and lungs by direct spread from the nasopharyngeal site of colonization. Infections of the CNS, heart valves, bones, joints, and peritoneal cavity usually arise
ABSTRACT:The increasing occurrence of Enterococcus species, worldwide, since late 1980s, is of particular concern due to the emergence of Vancomycin Resistant Enterococci (VRE). The appearance of VRE has limited the therapeutic options available for clinicians. VRE infection is the most common type of infection acquired by patients while hospitalized. Patients at risk for VRE are those who are already ill, and hospitalized, including individuals with diabetes, elderly, ICU patients, kidney failure patients, or patients requiring catheters.Present study was undertaken to detect vancomycin resistance in enterococcal isolates from hospitalized patients and the comparison of Kirby-Bauer disc diffusion method and vancomycin agar screen method to screen for vancomycin resistance.A total of 45 enterococcal isolates from various samples of hospitalized patients were speciated by standard biochemical reactions and screened to detect vancomycin resistance by Kirby-Bauer disc diffusion method and vancomycin agar screen method. Out of 45 enterococcal isolates, 26 (57.77%) were Enterococcus faecalis, 18 (40%) were Enrerococcus faecium and 1(3.33%) was Enterococcus avium. Resistance to vancomycin was 29% (13 isolates) where as 71% (32 isolates) were sensitive. By Kirby-Bauer disc diffusion method, 1 isolate (2%) showed resistance to vancomycin whereas by vancomycin screen agar, 13 (29%) showed resistance.The study highlights that vancomycin screen agar method is more sensitive than KirbyBauer disc diffusion method for detecting vancomycin resistance in enterococcal isolates. This study also signals the emergence of VRE in the hospital and highlights the importance of screening for VRE in enterococcal isolates from various samples.
BACKGROUND: Infections contribute to major morbidity and mortality in the developing countries. Antimicrobial resistance is another major problem with the increasing infections and non availability of ideal antimicrobial agent. Despite the advances in antimicrobial therapy, infections remain a serious burden. This study was designed to assess the increasing infection rates and antimicrobial susceptibility patterns in neurosurgical and neuropsychiatric patients. Over a period of three years and six months from January 2009 to June 2012, various samples were processed, isolated the infectious agent and identified. The different samples included samples like CSF, urine, pus, tracheal aspirates, shunt & catheter tips, tissue and blood. These were assessed for antimicrobial susceptibility patterns by conventional and automated culture and sensitivity systems. The results were then statistically analyzed. This study found that in general, there is a trend towards increased rates of infections, the majority of which were caused by Multi Drug Resistant Gram Negative Bacilli (MDRGNB), followed by Candida species and Cryptococcus species, Methicillin Resistant Staphylococcus aureus (MRSA), and Mycobacterium tuberculosis. The infection rates, from January 2009 to June 2012, were 3.7% to 5.1% for MDRGNB, 2.89% to 4.24% for Candida, 2.93% to 3.13% for Cryptococcus, 2.8% to 2.1%(till June 2012) for MRSA and 1.3% to 5.7% for Mycobacterium tuberculosis. Also, a trend towards increasing resistance among the isolates to the carbapenem antibiotics was observed. The increasing trend of infections is a cause for concern throughout the country. Indiscriminate use of antibiotics, hospital personnel not adhering to safety precautions etc are the main reasons for the increased infection rates. Newer therapeutic agents and strict antibiotic policies are required to effectively control the issue of emerging infections.
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