Background:For the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections and decolonization of MRSA carriers, the use of mupirocin a topical antibiotic is increasing day by day.Aim:The present study was carried out to determine the prevalence rate of high-level and low-level mupirocin resistant MRSA isolates among patients admitted to a tertiary care hospital.Materials and Methods:This is a prospective study carried out on MRSA isolated from the various clinical specimens from outpatient and inpatient departments during period of one year. A total of 82 MRSA isolates were recovered from 6468 different clinical specimens. Mupirocin resistant MRSA was detected by two different methods: Epsilometer test (E-test) and agar dilution method. D-shaped zone test (D-zone test) was also performed for determination of inducible clindamycin resistance in MRSA isolates.Results:Out of 82 non-duplicate MRSA isolates mupirocin resistance were found in 15 (18.3%) isolates by both E-test and agar dilution method. Of these 15 mupirocin resistant, 8 (53.3%) isolates were high-level resistant (MuH) and 7 (46.7%) isolates were low-level resistant (MuL). Four isolates were D-zone test positive showing simultaneous inducible clindamycin resistance among mupirocin resistant MRSA isolates.Conclusion:Higher prevalence of both high-level and low-level of mupirocin resistant MRSA was observed in patient from the population. It is advisable to perform routine test to detect MRSA colonization among health care workers and nasal decolonization to prevent spread of MRSA infections among hospitalized patients.
Bloodstream infection remains one of the most important causes of morbidity and mortality globally, specifically among intensive care unit patients. This prospective observational study included 887 blood culture samples collected cases admitted to intensive care unit suspected of having sepsis. Samples were cultured and evaluated for antimicrobial susceptibility patterns: 202 (22.78%) blood cultures were positive and yielded microbial growth with 132 (14.88%) having mono-microbial growth. Gram-negative bacteria accounted for 45.2% cases, with Escherichia coli being the most common; Gram positives accounted for 43.9% with Staphylococci haemolyticus being most common and 10.9% were fungal isolates. Gram-negative isolates were sensitive to colistin and tigecycline and 77.3% of isolates were extended spectrum beta-lactamase (ESBL) producers. Gram-positive isolates were sensitive to tigecycline, linezolid, vancomycin and teicoplanin with 97.5% being methicillin-resistant Staphylococci (MRSA). Most of the blood culture isolates from critically ill patients in intensive care unit were multidrug-resistant, ESBL producers and MRSA which raises a serious concern about the development of serious antibiotic resistance.
Background: Salmonella enterica, serotype typhi, remains the predominant Salmonella species causing enteric fever in India. The mode of Salmonella typhi transmission is considered to be predominantly vehicle-borne through contaminated water or food. In India, the incidence of Salmonella typhi occurs between the months of April and June (dry season) followed by July and September (monsoon season). Typhoid fever may be difficult to distinguish clinically from other febrile illnesses and if left untreated, intestinal, neuropsychiatric, and other complications develop in some patients. Objective: The aim of this study was to determine the prevalence of S. typhi in bloodstream infections and its antimicrobial susceptibility pattern among patients with febrile illness. Methodology: Febrile patients admitted in the hospital who were prescribed blood culture tests and whose samples were sent to microbiology laboratory were included in the study. All blood samples (average 5 mL for adults and 2–3 mL for pediatric age group) were immediately inoculated into Bac-T ALERT aerobic blood culture bottles containing sodium polyethanol sulfonate as an anticoagulant (0.025%). If growth was isolated, isolated colony characteristics of growth and Gram stain were assessed. On Gram staining, typical nonlactose fermenting Gram negative bacilli were further subjected to species identification and detection of antimicrobial susceptibility pattern on the VITEK2. Results: In this study period, a total of 511 blood culture (paired) samples were processed, out of which 47 isolates of Salmonella were obtained. Among these isolates, 33 (70.23%) were from males, and 14 (29.77%) were from females. Amongst these, 35 (74.4%) patients were from rural, 8 (17%) were from subrural, and 4 (8.5%) were from urban areas. Out of the total 47 isolates of Salmonella, 42 (89.36%) were Salmonella typhi, 2 (4.25%) were Salmonella paratyphi A and B each, and 1 (2.12%) was Salmonella enterica. Antimicrobial susceptibility pattern of Salmonella isolates revealed that all the isolates of Salmonella species were highly susceptible (95%–100%) to third generation cephalosporins (ceftazidime, ceftriaxone, cefepime, cefoperazone-sulbactam) and other higher antibiotics such as betalactamase inhibitors – piperacillin tazobactam (95%–100%) and Ticarcillin–clavulanic acid (100%). They were also highly susceptible (100%) to carbapenams (imipenem, merpenem, doripenem, and ertapenem) but showed a fairly decreased susceptibility was towards nalidixic acid with 15% for Salmonella typhi and 50% for other Salmonella isolates. Conclusion: Surging drug-resistant Salmonella enterica cases, the level of resistance was not as high as predicted in our study population. Multidrug-resistant (MDR) trends may vary; therefore, drug susceptibility testing side-by-side to empirical therapy is mandatory, especially in developing countries where there is a practice of self-medication.
Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Objectives To evaluate the aeromycoflora of diagnostic microbiology laboratory at a tertiary care center. Methods This is an ecological prospective analytical study. This pilot study was conducted at a diagnostic microbiology laboratory in which the Bacteriology section and Mycology section were the study areas. One indoor and one outdoor community area were taken as community controls and histopathology lab was taken as Laboratory control. The sampling was done every fortnight for a period of 1 year from March 2021 to February 2022. Environmental air samples were collected using the passive settle plate method based on sedimentation on 90 mm Sabouraud Dextrose Agar plates. The plates were exposed for 30 mins at a height of 1 m and a distance of 1m from the wall as per standard references. After sample collection, plates were incubated at 22°C for a maximum of 3 weeks or till the time the colonies were countable. The colonies were counted and the total CFU/m3 was calculated using the Omeliansky Formula. The identification of the isolates was done using standard mycological protocols. Statistical analysis using paired student t-test was also performed. Results A total of 13 types of fungi were isolated in the study belonging to the following genera- Aspergillus, Alternaria, Curvularia, Bipolaris, Cladosporium, Fonseacea, Fusarium, Penicillium, and Rhizopus. In the Bacteriology section, the highest frequency was of A. niger (63%) followed by A. flavus (50%) while in the mycology section the highest frequency of A. fumigatus (50%) followed by A. flavus (46%) was observed. Certain fungal species known to cause serious infections like A. flavus, Rhizopus arrhizus, Fusarium spp., Penicillium spp., Curvularia spp., were isolated only in the laboratory environment and were absent in the Community Controls. The total CFU/m3 ranged from 26.11 to 576.64 in mycology section and 26.11 to 419.37 in Bacteriology section while in the indoor community control the range was between 26.11 to 235.89 CFU/m3 which was found to be statistically significantly lesser using T-test when compared to the laboratory environment. A seasonal variation with higher counts during the autumn months (September-October) was observed in both the labs. Seasonal variation in the distribution of fungi was observed especially in the case of Rhizopus. Conclusion Healthcare workers spending a significant time in this environment need to be made aware of the quality of air in laboratories and initiation of appropriate intervention to make the laboratory environment safer to work as in this study it was found that more pathogenic fungi were grown in a laboratory environment which is clearly due to the processing of clinical samples in labs as compared to the community environment. The use of standard aseptic precautions, biosafety cabinets, fumigation of laboratories, and regular housekeeping activities would help to decrease the aerosols generated in the labs. The results from this study will be useful to spread awareness and help in formulating guidelines for the air quality of laboratories. However, aeromycology data from more such studies over a larger number of labs from different demographic areas are needed to enable a better understanding of the role of the formulation of standards for a safer laboratory environment.
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