Biofilm formation in central venous catheters (CVC) is a prerequisite for catheter-related bloodstream infection (CRBSI). The catheter lock technique has been used to treat biofilm infection, but the ideal agent, concentration and the minimum exposure time necessary to eradicate the biofilms are not clearly known. In this study, biofilm-producing strains of staphylococci were used to find out the minimum biofilm eradication concentration of ethanol compared with three other conventional antibacterial agents. Eight representative methicillin-resistant staphylococci, from colonized CVCs, were studied. The biofilms were exposed to 1, 5 and 10 mg mL(-1) of gentamicin, ciprofloxacin and vancomycin. The ethanol concentrations used were 20%, 40% and 80%. Biofilms were examined for the presence of live organisms after exposure to these agents from 30 min to 24 h. The three antibiotics were unable to eradicate the biofilms even after 24 h, while ethanol at 40% concentration could do so for all the isolates in 1 h. Our study highlights the efficacy and rationale of using 40% ethanol for a short period as catheter lock solution to eradicate biofilms and thus to prevent CRBSI, instead of using high concentrations of antibiotics for extended periods.

This study was an attempt to establish the clinical significance of coryneform organisms. The high level of resistance shown by this group to some of the common antibacterial agents highlights the importance of processing these isolates in select conditions to guide the clinicians towards an appropriate therapy.

The differentiation of sepsis and systemic bacterial infections from other causes of systemic inflammatory response is crucial from the therapeutic point of view. The clinical signs and symptoms are non-specific and traditional biomarkers like white cell count, erythrocyte sedimentation rate and C-reactive protein are not sufficiently sensitive or specific to guide therapeutic decisions. Procalcitonin (PCT) is considered a reliable marker for the diagnosis and prognosis of moderate to severe bacterial infections, and it has also been evaluated to guide the clinicians in the rational usage of antibiotics. This review describes the diagnostic and prognostic role of PCT as a biomarker in various clinical settings along with the laboratory aspects and its usefulness in risk stratification and antibiotic stewardship.

Background: Fungal infections are gaining prominence in recent years and are becoming a cause of significant morbidity as well as mortality. Reliable data from India about the spectrum of pathogens causing fungal infection in various body systems, and particularly about the antifungal susceptibility pattern of Candida spp., which is the most common isolate worldwide is not available. Methods:We prospectively studied 48,155 clinical samples submitted for fungal work-up to the microbiology laboratory at our tertiary care teaching hospital. Standard procedures were followed for fungal identification. Candida isolates were differentiated into Candida albicans and non-albicans candida (NAC) by germ tube test. Antifungal susceptibility of Candida isolates was determined by disc diffusion technique using amphotericin B (10 µg), fluconazole (25 µg), and voriconazole (1 µg) discs.Results: A total of 555 fungal isolates were obtained of which 541 were Candida spp, while the others were filamentous fungi. Male gender and age over 50 years were found to be independent risk factors. Proportion of NAC isolates (n = 384, 69.2%) were greater compared to C. albicans (n = 157, 28.3%). Aspergillus spp. was the second most frequent isolate. Azole resistance was significantly more in NAC group as compared to C. albicans. For fluconazole, 57.5% of the NAC showed resistance compared to 24.8% seen in strains of C. albicans while the corresponding figure for voriconazole was 56.8% Vs 22.9%. Overall resistance for amphotericin B was low (8.9%). Conclusions:Our observations bring to light the spectrum of common fungal isolates and their susceptibility patterns. This information will be useful for health planners and policy makers, as early institution of appropriate antifungal treatment can be life saving. Key words: Mycoses, Antifungal susceptibility testing, CandidaJayaprada R, Nagaraja M, Sumanth Kumar GLS, Venkataramana B, Kalawat U. Common fungal isolates from routine clinical specimens -A two-year study from a tertiary care hospital in South India. J Clin Sci Res 2017;6:2-9. DOI: http:// dx

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Background: The emergence of multi and pan resistance among Gram negative bacteria in the last decade has forced the medical community in using infrequently used antimicrobials in treating these infections. Methods: The present study was designed to look into the activity of certain older antimicrobial agents against Gramnegative clinical isolates resistant to all common antibiotics including carbapenams. Members of enterobacteriaceae family, Acinetobacter species and Pseudomonas aeruginosa isolated and identified in our laboratory during 2011 were included in the study. The antimicrobial susceptibility testing was done as per Clincial and Laboratory Standards Institute (CLSI) guidelines by disc diffusion technique. Results: From January-December 2011, out of a total of 11,658 samples processed, 157 (1.3%) isolates of Gramnegative bacilli were resistant to all beta-lactams, carbapenem, fluroquinolones and aminoglycosides. E.coli was the predominant isolate (n=50; 31.8%) followed by Klebsiella (n=37, 23.6%); 28 (17.8%) isolates were acinetobacter species. P. aeruginosa constituted 17 separate isolates other than the above 157 isolates. Of the unconventional agents tested, polymyxin B was the most effective agent with 33.1% strains sensitive to it and another 5/17 (29.4%) of P. aeruginosa isolates. Other agents in the decreasing order of sensitivity were chloramphenicol (25.5%), tetracycline and nitrofurantoin (14%) each, and cotrimaxazole (5.7%). Conclusions: Our study has highlighted the importance of including certain not-so-common antimicrobials in the sensitivity panel, particularly while testing multidrug-resistant isolates since they still possess some degree of activity against such isolates and may prove useful in clinical setting.

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