Bacterial and fungal infections are a major cause of morbidity and mortality among neutropenic patients. The choice of empiric antimicrobial regimen is based on susceptibility pattern of locally prevalent pathogens. From 64 febrile neutropenic patients with clinical sepsis, blood and other appropriate clinical specimens were processed to determine bacterial and fungal spectrum and their antimicrobial susceptibility pattern. Risk factors for developing sepsis were determined by case-control study. 68 organisms were recovered. Fifteen (22.05%) were Gram-positive cocci with predominance of methicillin Sensitive S. aureus (10.29%), 47 (69.11%) were Gram-negative rods with predominance of Klebsiella pneumoniae (30.88%) and four were Non albicans Candida. 81% and 60% of Klebsiella and E. coli were ESBL producers. All species of Candida were sensitive to amphoterecin B and voriconazole. Duration and extent of neutropenia, chemotherapy, immunosuppressive therapy, altered mucosal barriers and presence of central venous lines were statistically significant risk factors for developing sepsis. Gram-negative bacteria were the predominant isolates. The choice of therapy in neutropenic patients should be formulated based on local spectrum of microbes and local and regional resistance patterns.

BACKGROUND: Body fluids like ascitic fluids, pleural fluids, cerebrospinal fluids (CSF) etc. are sent for culture in a clinical microbiology laboratory to achieve etiological diagnosis. However the yield of such cultures is usually very low. So, ongoing monitoring of prevalent pathogenic organisms and their sensitivities help the clinicians institute therapy in absence of a culture report. AIMS: The study was done to identify the common pathogens isolated from body fluids along with their antimicrobial susceptibility pattern and also to evaluate the impact of enrichment on their culture positivity. SETTING AND DESIGN: A 3-month prospective analytical study was done in a tertiary care hospital. MATERIALS AND METHODS: A total of 333 Body fluids were processed; 103 of them were ascitic fluids, 71 pleural fluids, 139 CSF and 20 other fluids. They were processed by plating the direct sample and after enrichment. Enrichment was done by two methods: in SoyabeanCaesin digest broth (274 samples) and by BACTEC (59 samples).Isolates were identified by routine procedures & their antimicrobial susceptibility determined as per CLSI guidelines. The results were analyzed using Microsoft Excel® software using p<0.05 as the cut-off for significance. RESULTS: Gram negative isolate were obtained from 21.3% of the samples. The common isolates were Pseudomonas (20.7%), Acinetobacter (11.6%), Citrobacter (10.7%) and E. coli (10.7%). The antibiotics most effective against Gram negative pathogens were Gentamicin (47.5%), PipercillinTazobactam (51.6%), Amikacin (56.7%) and Cefoperazone-Sulbactam(65.3%). Gram positive isolates, obtained from 9% of the samples, mostly consisted of MSSA, Enterococcus and CONS, for which Ciprofloxacin (48%) followed by Cotrimoxazole (40%) and Erythromycin (28.6%) showed reasonable efficacy. The Culture positivity with direct plating, Soyabean-Caesin broth enrichment and BACTEC was 14.41%, 29.19% and 42.37% respectively. Increase in positivity by Soyabean-Casein broth was maximum for pleural fluids (12%) followed by ascitic fluids (11.6%) and CSF (11.52%).Using automated system the corresponding increases were 20.7%for ascitic fluids and 5.4%for pleural fluids. The mean time for identification using direct plating, enrichment method and BACTEC were 48 hours, 72 hours and 40 hours respectively. CONCLUSION: Gram negative isolates are commonly isolated pathogens from body fluids in our setup. Enrichment of body fluids improved yield of pathogens. In resource-poor settings simple enrichment in blood culture bottles can increase culture positivity of these precious samples.

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Background:Propolis is a resinous substance produced by honeybees which has many therapeutic properties because of its unique composition. It has been widely used since many years for different medicinal purposes.Aim:The aim of this study was to investigate the effects of one-stage full mouth disinfection (OSFMD) using 20% propolis hydroalcoholic solution in chronic periodontitis patients.Materials and Methods:Thirty patients diagnosed with chronic periodontitis and presenting three or more nonadjacent teeth with deep pockets were selected for the study. Clinical parameters including gingival index, plaque index, bleeding on probing, probing pocket depth, and clinical attachment level were recorded at baseline in all the patients followed by subgingival plaque sampling. All the thirty patients were randomly allocated into two groups; 15 patients (control group) were subjected to scaling and root planning (SRP) alone, and in remaining 15 patients (test group), SRP was done followed by OSFMD using 20% propolis hydroalcoholic solution after 24 h. All the patients were kept at periodic recall, and clinical and microbiological parameters were again taken at 4 weeks and 12 weeks.Results:There was a significant improvement for all the clinical parameters, with higher probing depth reduction and attachment gain in the test group when compared to the control group. Furthermore, the microbiological counts of the periodontopathogens were found to decrease considerably more in the test group.Conclusion:SRP followed by OSFMD with propolis extract after 24 h was more effective than SRP alone in chronic periodontitis patients.

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Introduction:Dermatophytosis is a common superficial mycosis causing significant cutaneous morbidity. In recent times, the prevalence of dermatophytosis is increasing. The dermatophyte infections spread easily and rapidly especially in low socioeconomic classes and thus warrant early therapy.Dermatophyte infections are commonly treated by topical antifungal drugs like clotrimazole, terbinafine, ketoconazole. But severe and chronic form of dermatophytosis requires treatment with systemic antifungal drugs like itraconazole, griseofulvin and terbinafine.There is emergence of antifungal resistant strains due to incongruous use of antifungals and poor antifungal policy. There are limited studies related to antifungal susceptibility testing (AFST). So present study was undertaken to determine mycological, clinical profile and antifungal Susceptibility testing ofdermatophytosis. Material & Methods: A prospective study was conducted on patients with superficial fungal infections over a period of 11 months (October 2018 to August 2019). Various samples like skin scrapings, scales, hair and nail clippings were processed by standard fungal culture methods. AFST was performed by using E-test strips (HiMedia) of fluconazole, itraconazole and terbinafine on Sabourauds dextrose agar plates and interpreted according to CLSI (M38A). Results: A total of 25 (23.8%) dermatophytes were isolated from 105 (skin 57, Nail 41, scales 11, Hair 6) samples. Out of 25 culture positive patients, 18 presented as tineacorporis, 3 as tineacruris, 3 onchomycosis, 1 each as tineacapitis&tinea incognito. T. tonsurans was most common dermatophyte 40% (N10), followed by T. rubrum 36% (N9), T. mentagrophytes 12% (N3) and M. canis 8% (N2) and T. megninii 4% (N1). AFST of all 25 isolates revealed that 21 isolates were sensitive to itraconazole (0.023 to 0.75 mcg/ml) wheras a single isolate of T. rubrum and T. tonsurans each were resistant. Two isolates of T.tonsurans showed lower MICs for itraconazole (0.023mcg/ml). For terbinafine (0.002-0.008mcg/ml), 14 isolates (56%) showed resistance with MICs >32 mcg/ml. For fluconazole (range 0.5-4 mcg/ml) only 3 isolates showed MIC in range while22 were resistant MICs >256mcg/ml. The results were communicated with dermatologists and appropriate changes were made in patient therapy. Conclusion: The emergence of resistant dermatophytesemphasises the need of antifungal drug susceptibility tests, antifungal stewardship and strong antifungal policy to enable the clinician to start suitable antifungals to avoid antifungal resistance and treatment failure.