Objective: Not only has the prevalence of enteric fever due to Salmonella paratyphi A increased over the last decade, there has also been a change in common presenting symptoms and antibiotic sensitivity pattern of these organisms. Knowledge of the existing epidemiology of the disease is essential for a rational approach to treat the same. Hence the present study was done to establish the existing epidemiology of enteric fever due to Salmonella paratyphi A-their common presenting symptoms and antibiotic sensitivity pattern-at our setting. Material & Methods:This prospective study was conducted in MS Ramaiah Hospitals, Bangalore between January 2008 and December 2008. Patients admitted to the hospital with clinical suspicion of enteric fever and whose blood culture grew paratyphi A were included in the study. Common presenting symptoms and signs were recorded in these patients and the sensitivity patterns of the causative organisms were studied. The difference in their response to Ciprofloxacin and Ceftriaxone was studied. The analysis was done using the statistical software package-SPSS Version 16. The difference in the defervescence period was calculated by 2-way Independent two-sample t-test. Results:A total 32 patients were included in the study. Fever and hepatomegaly were the most common symptom and sign among the study subjects. All isolates were susceptible to commonly used antibiotics except for Nalidixic acid. The mean defervescence period was shorter in patients treated with Ceftriaxone as compared to those treated with Ciprofloxacin (p<0.002). Conclusion:We report a change in the presentation and antibiotic sensitivity of paratyphi A infection as compared to existing literature. Ceftriaxone is a better drug as choice as it has shorter defervescence time.
Between May and June 2002, we recorded an outbreak of Septic Arthritis in neonates due to Extended Spectrum ß-Lactamase producing Klebsiella pneumoniae at our neonatal intensive care unit. The confirmed cases were then followed up to look for long term morbidities associated with the infection. We analyzed the microbiological and epidemiological features of the outbreak and the various measures implemented to ward off the same. We also studied the long term morbidities associated with nosocomial infection.All neonates admitted to the NICU during this period were screened and those with clinico-microbiological evidence of septic arthritis were included in the study. Microbiological screening of the environment, personnel, patients and their attendants were conducted and 85 different environmental sites were sampled. Six neonates were confirmed to have septic arthritis after an average NICU stay of 10.00±3.16 days. Culture of synovial fluid grew K. pneumoniae. All isolates had similar biochemical and antibiotic resistance pattern suggestive of clonality of infection. Plasmid analysis of these samples revealed a single plasmid (35.8MD) in all the isolates. Similar K. pneumoniae strain with the same plasmid was isolated from the water samples which was stored Implications of noscomial infection on long term morbidity Kempegowda et al. and used for hand washing. During the nine year follow up period, three neonates recovered completely, one developed dislocation of the joint and two were lost to follow up. Our study demonstrates the need for a comprehensive infection control measure and intensive monitoring of the NICUs for the ESBL producing K. pneumoniae.
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