Comamonas testosteroni (formally Pseudomonas testosteroni) is common environmental bacterium that is not part of the human microbiome. Since its identification as a human pathogen in 1987, numerous reports have drizzled in, implicating this organism for various infections. Although these organisms are of low virulence, some of their obscurity perhaps is due to the incapability of clinical laboratories to identify them. Most of the reported cases are bloodstream infections. We report a case of gastroenteritis caused by this organism in a 65-year-old female with colostomy in situ.
Penetrating injuries of the foot are a common presenting complaint in the emergency department. The residents of the underdeveloped world are especially prone to suffer such injuries as barefoot walking is still common. However, a relatively common injury that occurs in the shod feet is the "Nail-Slipper injury". A metal nail penetrates through the rubber sole of the footwear introducing the rubber piece into the soft tissue of the foot. As the nail is removed the piece remains behind often leading to delayed manifestations. This article describes the various delayed manifestations of this injury. A leading question for the antecedent injury of this kind should be asked from all patients with such presentations, especially in the urban setting.
Methicillin resistant Staphylococcus aureus has become endemic in India with the prevalence ranging from 25% in the west India to 50% in south India. Clindamycin therapy is a useful alternative to treatment of such infections. However, bacterial resistance to this drug has been known to occur through various mechanisms with variable prevalence in different geographical regions and among Methicillin Sensitive (MSSA) and Methicillin Resistant Staphylococcus aureus (MRSA). The most common being MLSB (Macrolide, Lincosamide and Streptogramin B) resistance mediated by erm genes. While constitutive MLSB resistance is easily picked up by routine antimicrobial disc diffusion susceptibility tests, the inducible MLSB resistance is only picked u p by D zone test. MATERIAL AND METHODSWe evaluated 343 clinical isolates of Staphylococcus aureus for MLSB resistance phenotypes using D zone test. Identification of Staphylococcus aureus isolates was done by standard biochemical techniques and then subjected to routine susceptibility testing by Kirby Bauer's disc diffusion method on Mueller Hinton agar plates. RESULTSAll isolates were resistant to penicillin. 61.23% (210) were MRSA and 38.77% (133) were MSSA. Among the MRSA isolates 49.5% and 7.14% isolates showed cMLSB and iMLSB resistance respectively, whereas among 133 MSSA isolates 8.27% and 2.26% isolates showed cMLSB and iMLSB resistance respectively. DISCUSSIONThe present study revealed a high prevalence of cMLSB in our region. Also prevalence of cMLSB and iMLSB resistance in MRSA is higher than that in the MSSA isolates showing that the distribution of MLSB resistance phenotypes varies among MSSA/MRSA isolates and among different geographical regions. Overall, we found 43.33% clindamycin resistance among MRSA and 10.5% resistance among MSSA isolates. We suggest clindamycin should be used as a therapeutic drug with caution for Staphylococcal infections and recommend that the D zone test should be used as a routine screening procedure to evaluate inducible clindamycin resistance in Staphylococcus aureus to overcome any subsequent treatment failure.
In view of the reported emergence of vancomycin resistance in MRSA from the state and the country as a whole we evaluated the pattern of culture and sensitivity on 160 samples from Orthopaedic Department over a period of one year between Nov 2014 and Nov 2015. These belonged to 111 males and 49 females with different aetiologies. Using standard protocols for the culture, 84 (52%) samples grew no organisms while Staph aureus was grown in 43 samples (26.8%) and gram negative organism in 28 and 5 samples grew mixed organism. Out of these 43 isolates of Staph aureus, MRSA was grown in 32 (74.4%) and MSSA in 11 (25.6%). These belonged to 23 (71.8%) males and 9 (28.1%) females. Majority of MRSA were grown from the patients of acute osteomyelitis and operated fractures (63.3%). Linezolid showed highest sensitivity (100%) followed by Vancomycin (96.8%), Clindamycin (37.5%), erythromycin (21%), Amikacin (21%), Levofloxacin (9.3%), cotrimoxazole (9.3%) and ciprofloxacin (3.1%). By diffusion method 6 positive cultures depicted doubtful sensitivity pattern for vancomycin (18.75%). However, on further analysis using MIC only one isolate (3.3%) showed intermediate resistance to vancomycin; 12 cultures (37.5%) were sensitive to vancomycin and linezolid only. The presence of vancomycin resistance calls for a watchful approach towards these infections and an extensive study to better define the problem. KEYWORDSMRSA, Vancomycin Resistance. HOW TO CITE THIS ARTICLE:Farooq S, Kawoosa AA, Mumtaz MU. Current sensitivity pattern of MRSA (methicillin resistant staph aureus) in a tertiary care orthopaedic hospital in Kashmir (J&K).
ICU-acquired infections are a challenging health problem worldwide as the patient’s immunity is already compromised and these infections are usually caused by MDR pathogens. In ICUs inanimate surfaces and equipment may be contaminated by bacteria. Cross-transmission of microorganisms from inanimate surfaces may have a significant role for ICU-acquired infections. Contamination may result from HCWs hands or by direct patient shedding of bacteria. This study was conducted to determine the rate of bacterial contamination on environmental surfaces and health care workers of ICU our hospital. Swabs from healthcare workers and surrounding environmental surfaces were collected randomly from Adult Intensive care units. Bacterial isolates were identified by standard microbiological techniques. Antibiotic sensitivity testing was performed by Kirby Bauer disc diffusion method and data was analyzed. A total of 35 samples were collected, of which 29 (82.8 %) samples yielded positive bacterial growth. Of these 29-positive growth, 10 (34.1%) were from hand swabs of HCWs, 10(34.1%) were from nasal swabs and 9(31.0%) were from environment. Seven different bacterial isolates were identified. Coagulase Negative Staphylococcus (CONS) 10(28.5%), MRSA 5(14.2%) and Klebsiella spp 5(14.2%) accounted for majority of the isolates followed by MSSA 3(8.5%), Pseudomonas spp 1(2.8%), E.coli 1(2.8%) and ASB 4(11.4%).
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