Background
Globally metronidazole and carbapenem resistance in anaerobic organisms is increasing necessitating continuous surveillance to guide selection of empirical treatment. In this study we have determined metronidazole resistance in anaerobes using MIC Evaluator strips (M.I.C.E strips). Carbapenem resistance was evaluated only in metronidazole resistant isolates.
Material and methods
The study was conducted at the Aga Khan University (AKU) Hospital laboratory, Karachi, Pakistan (2014–2017). Metronidazole and imipenem resistance was evaluated using M.I.C.E strips and minimum inhibitory concentrations (MICs) were interpreted using Clinical Laboratory Standards Institute (CLSI) criteria. Clinical details including demographics, prolonged hospital stay, malignancy, transplant, dialysis, diabetes, site of infection and outcome were analyzed for association with metronidazole resistance.
Results
Of the 223 clinically significant isolates, 39 (17.5%) were metronidazole resistant (excluding the inherently resistant organisms; for example
Cutibacterium
species). Imipenem resistance was determined in 29 metronidazole resistant isolates and of these 7 (24.1%) were found to be resistant. Proportion of metronidazole resistant strains was highest amongst
Bacteroides
species. A significant increase in metronidazole resistance from 12.3% in 2010–2011 to 17.5% in the current study was found. Carbapenem resistance also emerged in the period 2014–2017.
Isolates from malignancy and transplant patients showed lower odds of developing metronidazole resistance (0.003(95% CI: 1.7–17.9)). Prolonged hospital stay was not associated with metronidazole resistance (1.1((95% CI: 0.5–2.5)).
Conclusion
The rising trend of metronidazole resistance and emergence of carbapenem resistance in anaerobic bacteria is alarming. Continued surveillance with strengthening of laboratory capacity regarding anaerobic susceptibility testing is urgently needed in Pakistan.
Actinomycosis is a rare infectious disease that presents as three entities, cervico-facial, abdominal and genital, with cervico-facial being the commonest. Due to its subacute presentation and indolent course, abdominal actinomycosis is difficult to diagnose and is often confused with malignancy. We present a case of an elderly diabetic with no known other risk factors of the disease with complaints of right sided abdominal swelling and presence of abdominal mass on imaging, diagnosed post operatively as a case of abdominal actinomycosis, on histopathology. Abdominal actinomycosis should be considered in differentials in cases with abdominal masses. Diabetes Mellitus is not an established risk factor for development of abdominal actinomycosis. Studies are required to link its association with the disease.
doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1724
How to cite this:Memon RA, Shafquat Y, Yaqoob N. Abdominal actinomycosis in an elderly diabetic. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S98-S100. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1724
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