BACKGROUND:Carbapenems show excellent activity against resistant uropathogens, and they are the antibiotics of choice for urinary tract infections (UTIs). The choice of carbapenem prescription is strongly influenced by antimicrobial susceptibility testing (AST) report. With the publication of recent AST guidelines by the European Committee on AST (EUCAST), we were curious to evaluate the difference in results between Clinical and Laboratory Standards Institute (CLSI) and the EUCAST guidelines for the interpretation of carbapenems.METHODS:During a period of 1 year, midstream urine specimens received in the laboratory were cultured by conventional techniques and 2932 of them grew significant colony counts of Escherichia coli. Out of them, 501 E. coli isolates which were resistant to at least six first-line antibiotics were further subjected to second-line antimicrobials imipenem and meropenem, reported by E-tests (bioMerieux, France). The E-test results were interpreted by both CLSI 2016 and EUCAST 6.0 (2016) guidelines. Weighted kappa was used to determine absolute agreement, and McNemar's Chi-square test was used to test the difference in proportions of susceptibility between two methods, respectively.RESULTS:Taking CLSI guidelines as a gold standard, there was 100% sensitivity in a susceptible category by the EUCAST guidelines for both the carbapenems. Weighted kappa showed good and moderate agreement between them for imipenem and meropenem, respectively. However, McNemar Chi-square test in the nonsusceptible category between the two tests was 9.38% and 33.03% for imipenem and meropenem, respectively, and they were highly significant (P < 0.001).CONCLUSIONS:A laboratory can follow EUCAST guidelines as well and the guidelines are more useful in urinary concentrated antibiotics such as carbapenems. Further other antibiotics need to be evaluated by both these guidelines.
The diagnosis of cryptosporidiosis among HIV positive patients has been the focus of many studies worldwide. However, there is a paucity of data on HIV negative immunocompromised patients like post-renal transplant recipients and those with haematological malignancies. Stool microscopy, the conventional method of diagnosis, is fraught with difficulties like cumbersome sample processing and subjective interpretation. Enzyme linked immunosorbent assay (ELISA), on the other hand, is quicker and easier. The present study was conducted in a tertiary care and super speciality hospital of north India. Stool specimens from HIV negative immunocompromised patients were subjected to both modified acid fast staining for oocysts of Cryptosporidium and ELISA for detection of Cryptosporidium copro-antigen, over a period of six years. Of the 637 specimens evaluated, 97 (15.23%) samples were positive for Cryptosporidium by both techniques; 25 (3.92%) specimens were positive by ELISA and negative by microscopy, 14 (2.20%) specimens were positive by microscopy but negative by ELISA, while 501 (78.65%) specimens were negative for Cryptosporidium by both techniques. Significant correlation was observed as a measure of agreement (Kappa test value 0.795) between modified ZN stained microscopy and ELISA for the detection of Cryptosporidium oocysts. The sensitivity, specificity, positive and negative predictive value of ELISA, keeping stool microscopy as gold standard were 87.38%, 95.25%, 87.39% and 97.28% respectively. We conclude that ELISA may be used as a reliable substitute for microscopy in setups where the case load is higher or expertise in special staining techniques is not available. The cost of the kit can be justified if the sample load is sufficiently high or if immunocompromised patients form a significant patient population.
Introduction. Species of the genus Chryseobacterium are emerging healthcare-associated pathogens, often colonizing the hospital environment. There are no clear guidelines available for antimicrobial susceptibility of this organism. In this report we present the first case, to our knowledge, of simultaneous central-line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) due to Chryseobacterium gleum from India.
Case presentation. A 62 years old man with a history of a road traffic accident 1 month previously was referred to our center for further management. He developed features of sepsis and aspiration pneumonia on day 3 of admission. Four blood cultures (two each from central and peripheral lines) and two tracheal aspirate cultures grew pure yellow colonies of bacteria. Both matrix assisted laser desorption ionization time of flight mass spectrometry, (MALDI-TOF MS; bioMérieux, Marcy-L'Etoile, France,) and BD Phoenix (BD Biosciences, Maryland, USA) identified the organism as C. gleum. However, BD Phoenix failed to provide MIC breakpoints. The isolates of C. gleum both from blood and tracheal aspirate showed identical susceptibility patterns: resistant to cephalosporins and carbapenems and susceptible to ciprofloxacin, levofloxacin, amikacin, trimethoprim+sulfamethoxazole, piperacillin–tazobactam, cefoperazone–sulbactam, doxycycline, minocycline and vancomycin. Following levofloxacin therapy, the fever responded within 48 h and procalcitonin levels decreased without removal of the central line or endotracheal tube. However, the patient developed sudden cardiac arrest on day 10 of treatment and could not be resuscitated.
Conclusion. Rapid and accurate identification of C. gleum in the laboratory, preferably based on MALDI-TOF, is essential for guiding therapy. C. gleum responds well to fluoroquinolones without the need to remove indwelling catheters.
Background:Chryseobacterium indologenes is a hospital environment contaminant and can cause healthcare-associated infections.Methods:Patients with C. indologenes infections in a tertiary care center in North India for 6 months were evaluated for susceptibility patterns, comorbidities, mechanical devices, risk factors, and treatment outcomes. The organism was provisionally identified phenotypically, and identification was confirmed by the BD Phoenix automated microbiology system. Minimum inhibitory concentration values of antibiotic susceptibility were determined.Results:A total of 12 isolates of C. indologenes were recovered from 11 patients. Five patients had C. indologenes bloodstream infection (BSI), one had ventilator-associated pneumonia (VAP), and one had both BSI and VAP. In four others, the organism was isolated from the catheterized urinary tract. All VAP and BSI patients were admitted to the Intensive Care Units and mechanically ventilated; all had central lines and history of colistin therapy during the past 15 days. The common underlying risk factors were diabetes, hypertension, and coronary artery disease.Conclusions:C. indologenes infections are increasing because of higher use of carbapenems and colistin, to which it is intrinsically resistant.
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