Biliary tract infections and their Microbiological Spectrum- A study from coastal region of Southern India

Objective: Biliary tract infections include cholangitis and cholecystitis. They are associated with high morbidity and mortality in elderly patients with co-morbid disease. The present study was undertaken to determine the microbial aetiology causing biliary tract infections and also to study their antimicrobial resistance profile.Materials & methods: A retrospective study was conducted from January 2011 to December 2016 at the Enteric Diseases Division, Kasturba Medical College Hospital, Manipal. Patients with biliary tract infections admitted in tertiary referral health care hospital, Manipal were included for the study. Aerobic and anaerobic bacteriological and fungal aetiology of biliary tract infections were recorded along with their antimicrobial resistance profile.Results: Out of 307 bile samples sent for aerobic culture and susceptibly testing 187 (60.91%) were positive for culture, of which Escherichia coli (44.4%) was the predominant aetiology followed by Klebsiella pneumoniae (27.3%). Among the 14 samples sent for anaerobic culture, 5 (35.75%) specimens showed growth, of which Bacteroides fragilis group was found to be the predominant anaerobe. Among the 201 bacterial pathogens tested for their antimicrobial susceptibility, 108 (53.73%) isolates were resistant, out of which 9 were PDR Enterobacteriaceae with 12 ESBL strains. All the Candida species were susceptible to fluconazole with the exception of C. glabrata and C. krusei. All the anaerobic isolates were found to be susceptible to Metronidazole.Conclusions: The high rate of bacterial infection particularly gram-negative bacteria was recorded. It is necessary that antimicrobial therapy be initiated when culture or the clinical conditions reports caution. Routine aerobic and anaerobic culturing of bile samples with biliary tract infections are imperatively necessary. With the emergence of multidrug resistant pathogens and change in the microbiological spectrum of biliary tract infections, there is a need for the empirical antimicrobial therapy in every clinical setting.

Download Full-text

The prevalence of the iutA and ibeA genes in Escherichia coli isolates from severe and non-severe patients with bacteremic acute biliary tract infection is significantly different

Gut Pathogens ◽

10.1186/s13099-021-00429-1 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Mahoko Ikeda ◽

Tatsuya Kobayashi ◽

Fumie Fujimoto ◽

Yuta Okada ◽

Yoshimi Higurashi ◽

...

Keyword(s):

Escherichia Coli ◽

Tract Infection ◽

Biliary Tract ◽

Iron Acquisition ◽

Tertiary Care ◽

Care Hospital ◽

Biliary Tract Infection ◽

E Coli ◽

Severe Group ◽

Tract Infections

Abstract Background Although Escherichia coli is the most frequently isolated microorganism in acute biliary tract infections with bacteremia, data regarding its virulence are limited. Results Information on cases of bacteremia in acute biliary tract infection in a retrospective study was collected from 2013 to 2015 at a tertiary care hospital in Japan. Factors related to the severity of infection were investigated, including patient background, phylogenetic typing, and virulence factors of E. coli, such as adhesion, invasion, toxins, and iron acquisition. In total, 72 E. coli strains were identified in 71 cases, most of which primarily belonged to the B2 phylogroup (68.1%). The presence of the iutA gene (77.3% in the non-severe group, 46.4% in the severe group, P = 0.011) and the ibeA gene (9.1% in the non-severe group, and 35.7% in the severe group, P = 0.012) was significantly associated with the severity of infection. Among the patient characteristics, diabetes mellitus with organ involvement and alkaline phosphatase were different in the severe and non-severe groups. Conclusions We showed that bacteremic E. coli strains from acute biliary tract infections belonged to the virulent (B2) phylogroup. The prevalence of the iutA and ibeA genes between the two groups of bacteremia severity was significantly different.

Download Full-text

Antimicrobial Resistance Patterns in Clinical Isolates of Enterobacteriaceae from a Tertiary Care Hospital, Kathmandu, Nepal

Nepalese Medical Journal ◽

10.3126/nmj.v1i2.21578 ◽

2018 ◽

Vol 1 (2) ◽

pp. 74-78

Author(s):

Ram Prasad Adhikari ◽

Subha Shrestha ◽

Junu Richhinbung Rai ◽

Ritu Amatya

Keyword(s):

Multidrug Resistance ◽

Antimicrobial Resistance ◽

College Teaching ◽

Clinical Isolates ◽

High Rate ◽

Clinical Samples ◽

Care Hospital ◽

Beta Lactamases ◽

Extended Spectrum ◽

Extended Spectrum Beta Lactamases

Introduction: Multidrug resistance among Enterobacteriaceae is in increasing trend these days. The objective of this study was to determine the antibiogram of clinical isolates of Enterobacteriaceae with special reference to multidrug resistance and extended spectrum beta-lactamases production.Materials and Methods: A descriptive cross sectional study was conducted over a period of six months (February -July, 2017) in the microbiology laboratory of Nepal Medical College Teaching Hospital, Kathmandu, Nepal. A total of 936 bacterial isolates of Enterobacteriaceae from clinical specimens were processed for antimicrobial susceptibility testing and screened for multidrug resistance. ESBL production was detected among potential isolates by combination disk diffusion test.Results: The rate of multidrug resistance and extended spectrum beta-lactamases production was 54.2% and 23.8% respectively. Of the total ESBL producers 92.4% were multidrug resistance. The rate of multidrug resistance and extended spectrum beta-lactamases production were higher in organisms isolated from clinical samples collected from inpatients. High rate of multidrug resistance and extended spectrum beta-lactamases production was seen in E. coli (54.4% & 27.7%), Klebsiella spp. (67.1% & 28.2%) and Citrobacter spp. (70.3% & 10.9%). The antimicrobial resistance rate was highest against ampicillin (76.7%) followed by cefixime (54. 0%), ceftazidime (51.5%), ceftriaxone (51.0%), cotrimoxazole (48.7%), ciprofloxacin (43.9%) and ofloxacin (41.1%).Conclusions: Multidrug resistance is common among Enterobacteriaceae. These bacteria have high rate of resistance against commonly used groups of antibiotics like cephalosporins and quinolones. Continuous monitoring, surveillance of antimicrobial resistance, proper infection control and practices are important to combat with these issues.

Download Full-text

Current Status of Outpatient Parenteral Antimicrobial Therapy (OPAT) At a University-Affiliated Acute-Care Hospital in The Republic of Korea

10.21203/rs.3.rs-960331/v1 ◽

2021 ◽

Author(s):

Eunjeong Heo ◽

Yoonhee Choi ◽

Hyung-sook Kim ◽

Hyung Wook Namgung ◽

Eunsook Lee ◽

...

Keyword(s):

Antimicrobial Therapy ◽

Tertiary Care ◽

Management Program ◽

Republic Of Korea ◽

Current Status ◽

Care Hospital ◽

Outpatient Parenteral Antimicrobial Therapy ◽

The Republic ◽

Tract Infections

Abstract Objectives The aim of this study was to describe current status of outpatient parenteral antimicrobial therapy (OPAT) at a tertiary care hospital in the Republic of Korea. Methods This retrospective study was conducted on outpatients and referral patients who had a prescription of parenteral antibiotics from July to December 2019. We reviewed the prescribed antimicrobials, the indication of antimicrobial therapy, where patients administered antimicrobial injection and management of pre- and post- prescriptions. Results Of the 577 episodes included in this study, 399 (69.2%) were delivered by referral model, 178 (30.8%) by outpatient model. About 70% of OPATs were prescribed in the pulmonology, infectious diseases, orthopedics, gastroenterology, and hematology departments. Five antibiotics (ertapenem (26.0%), ceftriaxone (12.8%), kanamycin (11.8%), amikacin (10.1%), and cefazolin (8.5%)) accounted for 69.2% of the total OPATs. Urinary tract infections (27.3%), respiratory infections (20.8%), and intra-abdominal infections (15.9%) are the most frequent indications of OPAT. After prescription, there were 295 (73.9%) follow-up visits in referral model and 150 (84.3%) in outpatient model (p<0.05). Laboratory tests necessary for monitoring were totally performed in 274 (47.5%). Conclusions We found that significant number of OPAT was prescribed, follow-up visits were not performed in about a quarter of episodes, and laboratory monitoring was not fully conducted in more than half of the cases. Therefore, it is necessary to establish an appropriate management program for OPAT. Considering limited resources and the distribution of OPAT prescriptions, it may be effective to select frequently used antibiotics or frequently prescribed departments and start the program for them.

Download Full-text

Study of Extra intestinal E.coli and their resistant pattern in a tertiary care hospital of Bangladesh.

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v11i1.51945 ◽

2017 ◽

Vol 11 (1) ◽

pp. 10-13

Author(s):

Jannatul Ferdous ◽

Taslima Begum ◽

Taslima Akter ◽

Mohammad Murshed ◽

Noor Jahan ◽

...

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Bacterial Pathogen ◽

Neonatal Meningitis ◽

Care Hospital ◽

College Hospital ◽

Common Cause ◽

Clinical Specimens ◽

Medical College ◽

Tract Infections

E.coli is one of the most important gram negative bacterial pathogen in human and can be subdivided into the following; (i) intestinal non-pathogenic, commensal variants (ii) Intestinal pathogenic isolates and (iii) extra intestinal pathogenic E.colior ExPEC isolates. ExPEC causes the vast majority of urinary tract infections (UTIs), is a leading cause of adult bacteremia and is the second most common cause of neonatal meningitis. The clinical specimens obtained from patients admitted in Holy Family Red Crescent Medical College Hospital (HFRCMCH) from January 2014 to December 2016. All laboratory works were performed in department of microbiology and immunology of HFRCMCH. The infection rate was maximum in urine (89%) followed by blood (5%), pus (5%) and others (1%). Most of the ExPEC were isolated from outdoor department 62.6%. ExPEC displayed higher resistance to many antibiotics like 75% resistant to Ampiciline , 55% resistant to Cotrimazole, 22% resistant to Gentamycin, 17% resistant to Nitrofurantoin, 55% resistant to Ciprofloxacin, 70% resistant to Ceftriaxone, 82% resistant to Cefalexin, 50% resistant to Azithromycin, 10% resistant to Amikacin, 48% resistant to Tetracycline, 7% resistant to Imipenem and 8% resistant to Meropenem. In conclusion, there were high resistant rate to commonly available antibiotics. It seems that appropriate and judicial use of antibiotics may help to control the evolving problem of drug resistance towards ExPEC. Bangladesh J Med Microbiol 2017; 11 (1): 10-13

Download Full-text

CTX-M-type Extended-Spectrum β-Lactamase Producing Enterobacteriaceae Isolated from Urine in a Tertiary Care Hospital, Kathmandu, Nepal

Anti-Infective Agents ◽

10.2174/2211352519666210422131526 ◽

2021 ◽

Vol 19 ◽

Author(s):

Mahesh Acharya ◽

Prabhu Raj Joshi ◽

Kamal Thapa ◽

Saroj Paudel ◽

Prativa Poudel ◽

...

Keyword(s):

Tertiary Care ◽

Hospital Setting ◽

Urine Samples ◽

High Rate ◽

Care Hospital ◽

E Coli ◽

Extended Spectrum ◽

Genes Encoding ◽

Global Increase ◽

Tract Infections

Background: Despite the global increase of CTX-M type extended-spectrum-β-lactamases (ESBLs) in recent years among Enterobacteriaceae isolates from urinary tract infections, little data is available from Nepal. Objective: This study was conducted to detect the genes encoding extended-spectrum β-lactamases among Enterobacteriaceae isolated from the urine samples in Nepal. Methods: A total of 148 Enterobacteriaceae isolates were collected in Annapurna Neurological Institute and Allied Sciences from urine samples from July 2016 to June 2017. ESBLs production was detected according to the Clinical and Laboratory Standards Institute (CLSI) recommended methods. PCR and sequencing were used for the detection of ESBL genes. Results: Overall 24.3% (36/148) of the study isolates were positive for ESBL production. E. coli was the predominant ESBL-producing organism (28.8%). ESBL-producing organisms showed a high rate of resistance to ceftazidime (58.4%), cefepime (91.7%), aztreonam (83.4%), and ciprofloxacin (80.6%). Also, 30.6% of ESBL-producing organisms were multi-drug resistant. All ESBL producers were CTX-M positive; other ESBL genes were not detected. The majority of the ESBL positive organisms produced CTX-M-15 (n= 31) and few organisms (n= 5) were CTX-M-27 producers. Conclusion: The present study shows that the predominant CTX-M type ESBL in our hospital setting is CTX-M-15.

Download Full-text

Gram-negative Organisms from Patients with Community-Acquired Urinary Tract Infections and Associated Risk Factors for Antimicrobial Resistance: A Single-Center Retrospective Observational Study in Japan

Antibiotics ◽

10.3390/antibiotics9080438 ◽

2020 ◽

Vol 9 (8) ◽

pp. 438 ◽

Cited By ~ 1

Author(s):

Naoki Kanda ◽

Hideki Hashimoto ◽

Tomohiro Sonoo ◽

Hiromu Naraba ◽

Yuji Takahashi ◽

...

Keyword(s):

Risk Factors ◽

Nursing Home ◽

Urinary Tract ◽

Antimicrobial Resistance ◽

Urinary Tract Infections ◽

Strong Impact ◽

Care Hospital ◽

Gram Negative ◽

E Coli ◽

Tract Infections

A specific antibiogram is necessary for the empiric antibiotic treatment of community-acquired urinary tract infections (UTI) because of the global spread of antimicrobial resistance. This study aimed to develop an antibiogram specific for community-acquired UTI and assess the risk factors associated with community-acquired UTI caused by antimicrobial-resistant organisms. This cross-sectional observational retrospective study included patients with community-acquired UTI caused by Gram-negative rods (GNR) who were admitted to the emergency department at a tertiary care hospital in Ibaraki, Japan, in 2017–2018. A total of 172 patients were enrolled (including 38 nursing home residents). Of the 181 GNR strains considered as causative agents, 135 (75%) were Escherichia coli, and 40 (22%) exhibited third-generation cephalosporin resistance. Extended-spectrum β-lactamase (ESBL)-producing E. coli accounted for 25/40 (63%) of resistant GNR. Overall susceptibility rate of Enterobacterales was 92%, 81%, 100%, 75%, and 89% for cefmetazole, ceftriaxone, meropenem, levofloxacin, and trimethoprim–sulfamethoxazole, respectively. Residence in a nursing home (odds ratio (OR), 2.83; 95% confidence interval (CI), 1.18–6.79) and recent antibiotic use (OR, 4.52; 95% CI, 1.02–19.97) were independent risk factors for UTI with resistant GNR. ESBL-producing E. coli was revealed to have a strong impact on antimicrobial resistance pattern. Therefore, an antibiotic strategy based on a disease-specific antibiogram is required.

Download Full-text

Study of risk factors of acute respiratory infections in children admitted in a tertiary care hospital of Southern Maharashtra

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20173692 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3129

Author(s):

Alka C. Kaware ◽

Nitin H. Kamble ◽

S. K. Mangulikar

Keyword(s):

Risk Factors ◽

Respiratory Infections ◽

Tertiary Care ◽

High Morbidity ◽

Acute Respiratory Infections ◽

Care Hospital ◽

Care Centre ◽

Tertiary Care Centre ◽

History Of ◽

Tract Infections

Background: Acute respiratory infections (ARI) is an important cause of mortality and morbidity in children. In India, it constitutes 15% of under five deaths. Various risk factors are responsible for ARI in children. Study of risk factors will help to reduce the high morbidity and mortality due to ARI. The objectives were to study risk factors responsible for acute respiratory infections in children and to find out case fatality rate &/ outcome of acute respiratory infections ARI in children.Methods: A hospital based cross sectional study was done in 2013-14 in a tertiary care centre to study the risk factors associated with ARI in children. All the pediatric patients between 0-12 years admitted in a tertiary care centre at Solapur were enrolled in the study.Results: Acute respiratory tract infections (ARI) were more common in 1-4 years age group i.e. 57.31% (196). It was more common in males i.e. 64.33% (220) than females i.e. 35.67% (122). ARI was more common in lower socio-economic classes i.e. class V (50.58%), class IV (22.52%); in patients whose mothers were illiterate 43.28% and who had history of parental smoking 84.21%. Maximum patients of ARI were having history of overcrowding 75.73%, inadequate cross-ventilation 81.87% and use of smoky chullah 78.65% in their home. Statistically significant association found between ARI cases and these socio-demographic factors. 46.78% (160) were incompletely immunized and 16.37% (56) were not immunized at all. Only 36.84% (126) were completely immunized for their age. Maximum cases of ARI (50.88%) occurred in winter season followed by rainy season (26.90%). Outcome showed that 91.52% (313) were cured, while 1.75% (6) patients died due to ARI.Conclusions: The present study has identified various socio-demographic, nutritional and environmental risk factors for ARI which can be prevented by effective health education and an appropriate initiative taken by the government.

Download Full-text

Infections of Biliary Tract

10.5772/intechopen.100063 ◽

2021 ◽

Author(s):

Hema Prakash Kumari Pilli ◽

Vijayalakshmi Payala

Keyword(s):

Biliary Tract ◽

Early Identification ◽

Clinical Symptoms ◽

The Other ◽

High Morbidity ◽

Biliary Surgery ◽

Death Rates ◽

Ascending Infection ◽

Tract Infections ◽

Predisposing Conditions

Biliary tract infections include cholangitis and cholecystitis. They are associated with high morbidity and mortality in elderly patients with comorbid disease. The most common infecting organisms are Enterobacteriaceae ascending from the gastrointestinal tract, Gram-positive pathogens like Enterococci spp.; the infections are rarely caused by fungi, viruses, and parasites. The prime reason for biliary tract infections is the ascending infection due to the reflux of duodenal contents and also the blood-borne infection or infection spreading through the portal-venous channels. The other predisposing conditions causing biliary tract infections include critical illnesses such as trauma, burns, sepsis, HIV infection, immunosuppression, diabetes, non-biliary surgery, and childbirth. The infection is reduced by β-lactam antibiotics or their derivatives, cephalosporins, carbapenems, fluoroquinolones, etc. Empiric treatment with piperacillin/tazobactam or a cephalosporin with or without metronidazole is recommended for moderate and severe acute cholecystitis irrespective of whether there is growth by culture. Patients with severe cholecystitis are unfortunately difficult to identify properly, both clinically and radiologically, because clinical symptoms are unexpected, and imaging investigations are frequently ambiguous. However, there are significant differences in morbidity and death rates between individuals with mild cholecystitis and those with severe cholecystitis. Preventing related consequences requires early identification and effective therapy of individuals at risk of severe cholecystitis.

Download Full-text