scholarly journals ENTERIC BACTERIA IN FECAL SAMPLES OF EURASIAN GRIFFON VULTURES

2014 ◽  
Vol 6 (2) ◽  
pp. 45-53
Author(s):  
Dubravka Milanov ◽  
Dragan Fabijan ◽  
Bojana Prunić ◽  
Maja Velhner ◽  
Tamaš Petrović
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Susceptibility ◽  
Salmonella Enterica ◽  
Susceptibility Testing ◽  
Enteric Bacteria ◽  
Antimicrobial Susceptibility Testing ◽  
Salmonella Spp ◽  
Fecal Samples ◽  
E Coli

Fecal samples originating from 15 Eurasian griffon vultures were collected during June 2012 in the territory of special nature reservation Uvac and examined for presence of enteric bacteria Escherichia coli and Salmonella spp. Salmonellas were isolated from five samples (33.3%) and serologically typed as Salmonella enterica subsp. enterica ser. Veneziana. E. coli was isolated from four samples (26.6%). Antimicrobial susceptibility testing revealed resistance to one and more antibiotics only in E. coli isolates.

Antimicrobial Resistance in Campylobacter, Salmonella, and Escherichia coli Isolated from Retail Grain-Fed Veal Meat from Southern Ontario, Canada

2011 ◽  
Vol 74 (8) ◽  
pp. 1245-1251 ◽  
Author(s):  
ANGELA COOK ◽  
RICHARD J. REID-SMITH ◽  
REBECCA J. IRWIN ◽  
SCOTT A. McEWEN ◽  
VIRGINIA YOUNG ◽  
...  
Keyword(s):  
Public Health ◽  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Tetracycline Resistance ◽  
Antimicrobial Susceptibility Testing ◽  
E Coli ◽  
Testing Resistance ◽  
Resistance Patterns

This study estimated the prevalence of Salmonella, Campylobacter, and Escherichia coli isolates in fresh retail grain-fed veal obtained in Ontario, Canada. The prevalence and antimicrobial resistance patterns were examined for points of public health significance. Veal samples (n = 528) were collected from February 2003 through May 2004. Twenty-one Salmonella isolates were recovered from 18 (4%) of 438 samples and underwent antimicrobial susceptibility testing. Resistance to one or more antimicrobials was found in 6 (29%) of 21 Salmonella isolates; 5 (24%) of 21 isolates were resistant to five or more antimicrobials. No resistance to antimicrobials of very high human health importance was observed. Ampicillin-chloramphenicol-streptomycin-sulfamethoxazole-tetracycline resistance was found in 5 (3%) of 21 Salmonella isolates. Campylobacter isolates were recovered from 5 (1%) of 438 samples; 6 isolates underwent antimicrobial susceptibility testing. Resistance to one or more antimicrobials was documented in 3 (50%) of 6 Campylobacter isolates. No Campylobacter isolates were resistant to five or more antimicrobials or category I antimicrobials. E. coli isolates were recovered from 387 (88%) of 438 samples; 1,258 isolates underwent antimicrobial susceptibility testing. Resistance to one or more antimicrobials was found in 678 (54%) of 1,258 E. coli isolates; 128 (10%) of 1,258 were resistant to five or more antimicrobials. Five (0.4%) and 7 (0.6%) of 1,258 E. coli isolates were resistant to ceftiofur and ceftriaxone, respectively, while 34 (3%) of 1,258 were resistant to nalidixic acid. Ciprofloxacin resistance was not detected. There were 101 different resistance patterns observed among E. coli isolates; resistance to tetracycline alone (12.7%, 161 of 1,258) was most frequently observed. This study provides baseline prevalence and antimicrobial resistance data and highlights potential public health concerns.

scholarly journals Antibiotic Resistance among Escherichia coli Isolates from Hospital Wastewater Compared to Community Wastewater

Water ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 3449
Author(s):  
Cristina-Mirabela Gaşpar ◽  
Ludovic Toma Cziszter ◽  
Cristian Florin Lăzărescu ◽  
Ioan Ţibru ◽  
Marius Pentea ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Antimicrobial Susceptibility Testing ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Hospital Wastewater ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli

This study aimed to compare the antibiotic resistance levels of the indicator bacteria Escherichia coli in wastewater samples collected from two hospitals and two urban communities. Antimicrobial susceptibility testing was performed on 81 E. coli isolates (47 from hospitals and 34 from communities) using the disc diffusion method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodology. Ten antibiotics from nine different classes were chosen. The strains isolated from the community wastewater, compared to those from the hospital wastewater, were not resistant to gentamicin (p = 0.03), but they showed a significantly higher susceptibility—increased exposure to ceftazidime (p = 0.001). Multidrug resistance was observed in 85.11% of the hospital wastewater isolates and 73.53% of the community isolates (p > 0.05). The frequency of the presumed carbapenemase-producing E. coli was higher among the community isolates (76.47% compared to 68.09%) (p > 0.05), whereas the frequency of the presumed extended-spectrum beta-lactamase (ESBL)-producing E. coli was higher among the hospital isolates (21.28% compared to 5.88%) (p > 0.05). The antibiotic resistance rates were high in both the hospital and community wastewaters, with very few significant differences between them, so the community outlet might be a source of resistant bacteria that is at least as important as the well-recognised hospitals.

scholarly journals Characterization and Antimicrobial Susceptibility Profiles of Bacteria Isolated from Various Specimens among Mary Begg Health Facilities

2021 ◽  
Vol 11 (5) ◽  
pp. 41-52
Author(s):  
Stephen Mwisiya Mubita ◽  
Wila Simbile ◽  
Barbara Mulunda
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Bacterial Infections ◽  
Susceptibility Testing ◽  
Health Facilities ◽  
Antimicrobial Susceptibility Testing ◽  
E Coli ◽  
Susceptibility Profiles

Background: The ever-increasing magnitude of antimicrobial resistance encountered in human pathogens has led to limited treatment options for bacterial infections, consequently reducing antimicrobial efficacy while increasing treatment costs, morbidity, and mortality. In clinical setup, laboratory-based in vitro antimicrobial susceptibility testing is the cornerstone for guiding therapy and enables the monitoring of antimicrobial resistance trends. Aim: To characterize the distribution of bacteria isolated from various specimens and their antibiotic susceptibility profiles in Mary Begg Health facilities. Material & Methods: This was a retrospective, cross-sectional, quantitative, descriptive study that involved the review of 569 laboratory files from three Mary Begg Health facilities from the period of January 2019 to June 2020. A systematic random sampling method was used and SPSS version 21.0 was used for data analysis. Results: The distribution of bacteria based on Gram stain reaction found that most bacteria that were isolated were Gram negative bacilli, 79.5% (171/215). The most common bacterium isolated was Escherichia coli, 46.5% (100/215) followed by Staphylococcus aureus, 12.1% (26/215) and Klebsiella pneumoniae, 17 7.9% (17/215). The study found that E. coli was highly resistant to amoxicillin (95.0%), Ampicillin (90.0%) and Cotrimoxazole (77.0%), respectively. In contrast, E. coli was highly sensitive to Amikacin (96.0%), Ertapenem (91.0%) and Ceftriaxone (80.0%) S. aureus species isolated were sensitive to Gentamicin (65.4%) and Clindamycin (46.2%) but highly resistant to Cotrimoxazole (80.8%). Conclusion: The most frequent isolates were Escherichia coli followed by Staphylococcus aureus and majority of them were from urine specimens. Key words: Antimicrobial, Resistant, Antimicrobial Resistance, Antimicrobial susceptibility testing, Mary Begg Health services.

scholarly journals Prevalence and Antimicrobial Resistance of Foodborne Pathogens in Sentinel Dairy Farms

2021 ◽  
Vol 3 (5) ◽  
pp. 67-71
Author(s):  
S. A. Baluka ◽  
L.N. Musisi ◽  
L. S. Y. Buyinza ◽  
F. Ejobi
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Campylobacter Jejuni ◽  
Foodborne Pathogens ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Dairy Farms ◽  
Antimicrobial Susceptibility Testing ◽  
Beta Lactamase ◽  
Fecal Samples

Dairy cattle are common carriers of important foodborne pathogens. Escherichia coli, Salmonella and Campylobacter jejuni are among the commonest causes of foodborne diseases. The high prevalence of microbial infections is escalating antimicrobial usage in human health and for growth promotion and prophylaxis in animal health. Overuse of antimicrobials is increasing antimicrobial residues in animal source foods and accelerating antimicrobial resistance. The study collected 184 samples from 33 dairy farms and assessed the prevalence of Escherichia coli, Salmonella and Campylobacter jejuni and their AMR. Sample inoculation for bacterial isolation was by agar surface streaking method and broth dilution. Escherichia coli was isolated on Chromogenic Coliform agar at 37°C for 24 hour forming dark blue colonies confirmed by Indole, Methyl Red, Voges-Proskauer and Citrate biochemical tests. Escherichia coli antimicrobial susceptibility testing was done by a single disc diffusion method against eight standard antibiotics. Sensitive, Intermediate and Resistant system was used for reporting antimicrobial susceptibility testing results. Escherichia coli was isolated in 21.7% samples, Campylobacter jejuni and Salmonella were absent. Escherichia coli was isolated in fecal samples from 48.5% of study farms, 56.9% of fecal and 4.8% of water samples and not isolated in all milk samples tested. All Escherichia coli isolates were susceptible to gentamycin, ciprofloxacin, cefoxitin and cefotaxime but 9 were resistant to ampicillin, oxacillin, ceftazidime, and ceftriaxone, produced 4 penicillinase and 1 beta-lactamase while 4 didn’t exhibit any specific resistance mechanism. Aminoglycosides, quinolones, and furans showed no resistance. When stratified by sample, 7 fecal Escherichia coli isolates showed resistance compared to 2 water isolates. All fecal and water isolates were resistant to oxacillin. The majority of Beta-lactamase and penicillinase producing isolates were from fecal samples. Oxacillin was widely resisted hence it should not be used in routine treatment of bacterial infections to avoid treatment failures. All Escherichia coli isolates were susceptible to gentamycin, ciprofloxacin, cefoxitin and cefotaxime, 9 were resistant to ampicillin, oxacillin, ceftazidime, and ceftriaxone, produced 4 penicillinase and 1 beta-lactamase. Aminoglycosides, quinolones, and furans showed no resistance. There is a need to conduct continuous professional development training programmes for veterinarians and veterinary paraprofessionals to promote prudent use of antimicrobials. Access and use of gentamycin, ciproflaxacin, cefoxitin and cefotaxime by dairy farmers and unqualified people should be restricted to prevent or delay resistance to these four.

In-vitro-Aktivität von Mecillinam gegen Escherichia coli: Urinisolate von Patienten im niedergelassenen Versorgungsbereich in Deutschland

2017 ◽  
Vol 48 (03) ◽  
pp. 243-247 ◽  
Author(s):  
Michael Kresken ◽  
Barbara Körber-Irrgang ◽  
Kurt Naber
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Antimicrobial Susceptibility Testing ◽  
E Coli ◽  
European Committee ◽  
Fosfomycin Trometamol

ZusammenfassungDie Behandlung der akuten unkomplizierten Zystitis soll entsprechend nationaler und internationaler Leitlinien primär mit Fosfomycin-Trometamol, Nitrofurantoin, Nitroxolin oder Pivmecillinam erfolgen. Die weitaus meisten ambulant erworbenen Harnwegsinfektionen werden durch Escherichia coli verursacht. Pivmecillinam (X-SYSTO®) ist das oral verfügbare Prodrug des Penicillin-Derivats Mecillinam, das seit März 2016 wieder auf dem deutschen Markt zur Verfügung steht. Das Ziel der Studie war, den Anteil der Mecillinam-resistenten Stämme bei E. coli-Isolaten vor der Einführung von X-SYSTO® in Deutschland zu ermitteln.Im Rahmen einer In-vitro-Studie wurden die minimalen Hemmkonzentrationen (MHK) von Mecillinam für 494 E.-coli-Urinisolate (einschließlich multiresistenter Stämme) bestimmt. Die Bakterienisolate waren im Zeitraum Oktober bis Dezember 2013 in 25 Laboren von Patienten aus dem niedergelassenen Bereich gesammelt worden. Die Bewertung der Erregerempfindlichkeit als Mecillinam-sensibel (MHK ≤ 8 mg/l) bzw. resistent (MHK > 8 mg/l) erfolgte mithilfe der Grenzwerte des European Committee on Antimicrobial Susceptibility Testing (EUCAST).Die Konzentrationen von Mecillinam, die zur Hemmung von 50 % bzw. 90 % der getesteten Isolate benötigt wurden, betrugen 1 und 4 mg/l für Isolate mit dem Extended-Spektrum-β-Laktamase-Phänotyp und 0,25 und 4 mg/l für die übrigen Isolate. Insgesamt wurden 98 % der Isolate als Mecillinam-sensibel und 2 % als resistent bewertet.Die Ergebnisse stützen die Empfehlung, Pivmecillinam als eine primäre Option zur Erstlinientherapie der akuten unkomplizierten Zystitis zu betrachten.

scholarly journals Antimicrobial susceptibility testing results from 13 hospitals in Viet Nam: VINARES 2016–2017

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Tien Viet Dung Vu ◽  
◽  
Marc Choisy ◽  
Thi Thuy Nga Do ◽  
Van Minh Hoang Nguyen ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Data Entry ◽  
Sampling Bias ◽  
Antimicrobial Susceptibility Testing ◽  
Viet Nam ◽  
Salmonella Spp ◽  
Invasive Infections ◽  
Shigella Spp ◽  
Analyse Data

Abstract Objective To analyse data from 2016–17 from a hospital-based antimicrobial resistance surveillance with national coverage in a network of hospitals Viet Nam. Methods We analysed data from 13 hospitals, 3 less than the dataset from the 2012–13 period. Identification and antimicrobial susceptibility testing data from the clinical microbiology laboratories from samples sent in for routine diagnostics were used. Clinical and Laboratory Standards Institute 2018 guidelines were used for antimicrobial susceptibility testing interpretation. WHONET was used for data entry, management and analysis. Results 42,553 deduplicated isolates were included in this analysis; including 30,222 (71%) Gram-negative and 12,331 (29%) Gram-positive bacteria. 8,793 (21%) were from ICUs and 7,439 (18%) isolates were from invasive infections. Escherichia coli and Staphylococcus aureus were the most frequently detected species with 9,092 (21%) and 4,833 isolates (11%), respectively; followed by Klebsiella pneumoniae (3,858 isolates – 9.1%) and Acinetobacter baumannii (3,870 isolates – 9%). Bacteria were mainly isolated from sputum (8,798 isolates – 21%), blood (7,118 isolates – 17%) and urine (5,202 isolates – 12%). Among Gram-positives 3,302/4,515 isolates (73%) of S. aureus were MRSA; 99/290 (34%) of Enterococcus faecium were resistant to vancomycin; and 58% (663/1,136) of Streptococcus pneumoniae proportion were reduced susceptible to penicillin. Among Gram-negatives 59% (4,085/6,953) and 40% (1,186/2,958) of E. coli and K. pneumoniae produced ESBL and 29% (376/1,298) and 11% (961/8,830) were resistant to carbapenems, respectively. 79% (2855/3622) and 45% (1,514/3,376) of Acinetobacter spp. and Pseudomonas aeruginosa were carbapenem resistant, respectively. 88% (804/911) of Haemophilus influenzae were ampicillin resistant and 18/253 (7%) of Salmonella spp. and 7/46 (15%) of Shigella spp. were resistant to fluoroquinolones. The number of isolates from which data were submitted in the 2016–2017 period was twice as high as in 2012–2013. AMR proportions were higher in 2016–2017 for most pathogen-antimicrobial combinations of interest including imipenem-resistant A. baumannii, P. aeruginosa and Enterobacterales. Conclusions The data show alarmingly high and increasing resistant proportions among important organisms in Viet Nam. AMR proportions varied across hospital types and should be interpreted with caution because existing sampling bias and missing information on whether isolates were community or hospital acquired. Affordable and scalable ways to adopt a sample- or case-based approach across the network should be explored and clinical data should be integrated to help provide more accurate inferences of the surveillance data.

scholarly journals Antimicrobial susceptibility and diarrheagenic diagnosis of Escherichia coli and Salmonella enterica isolated from feral pigeons (Columba livia) captured in Fortaleza, Brazil

2018 ◽  
Vol 38 (11) ◽  
pp. 2150-2154 ◽  
Author(s):  
Ruben V. Horn ◽  
Windleyanne G.A. Bezerra ◽  
Elisângela S. Lopes ◽  
Régis S.C. Teixeira ◽  
Isaac N.G. Silva ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Clavulanic Acid ◽  
Antimicrobial Susceptibility ◽  
Salmonella Enterica ◽  
Columba Livia ◽  
Susceptibility Test ◽  
Antimicrobial Susceptibility Test ◽  
E Coli ◽  
Feral Pigeons

ABSTRACT: This study aimed to isolate Escherichia coli and Salmonella enterica from captured feral pigeons in Fortaleza, Brazil, and, in addition to evaluate the antimicrobial susceptibility profiles and diagnose diarrheagenic E. coli strains. Pigeons were captured in four public locations in Fortaleza with three techniques. Individual cloacal swab samples were collected and submitted to bacterial isolation, biochemical identification and antimicrobial susceptibility test. Disk diffusion technique was used with twelve antibiotics. E. coli strains were submitted to DNA extraction followed by PCR to diagnose five diarrheagenic pathotypes. A total of 124 birds were captured. One bird was positive for Salmonella enterica (0.81%) and 121 (97.58%) were positive for E. coli. Among these, 110 isolates were submitted to antimicrobial susceptibility test and 28.18% (31/110) presented resistance to at least one antibiotic. Resistance to azithromycin was the most frequent (21.82%), followed by tetracycline (10.91%) and sulfamethoxazole with trimethoprim (8.9%). Multidrug resistance, calculated as a resistance to at least 3 antimicrobial classes, was identified in 3.64% (4/110) of strains. The maximum number of antimicrobial classes to which one strain was resistant was seven. Results demonstrated nine different resistance profiles and the most frequent was tetracycline and sulfamethoxazole with trimethoprim (4 strains), followed by chloramphenicol, azithromycin, tetracycline and sulfamethoxazole with trimethoprim (3 strains). Amoxicillin with clavulanic acid and tobramycin presented lowest levels of antimicrobial resistance, to which none of the tested strains were resistant. A single strain was positive for the eltB gene, which is a diagnostic tool to identify the Enterotoxigenic E. coli (ETEC) pathotype. None of the other investigated genes (stx1, stx2, estA, eaeA, ipaH, aatA and aaiC) were identified. The single isolate of S. enterica was a rough strain of Salmonella enterica subsp. enterica, but serotype identification was not possible. However, this isolate presented resistance to amoxicillin, amoxicillin with clavulanic acid, tetracycline and sulfamethoxazole with trimethoprim. Therefore, captured feral pigeons of Fortaleza presented a low prevalence of S. enterica and diarrheagenic E. coli. Considering the investigated pathogens, our results suggest a good health status and a low public health risk. However, important antimicrobial resistance profiles were identified.

scholarly journals Antimicrobial resistance pattern of extended-spectrum β-lactamase-producing Escherichia coli isolated from fecal samples of piglets and pig farm workers of selected organized farms of India

2020 ◽  
Vol 13 (2) ◽  
pp. 360-363
Author(s):  
Shikha Tamta ◽  
Obli Rajendran Vinodh Kumar ◽  
Shiv Varan Singh ◽  
Bommenahalli Siddaramiah Pruthvishree ◽  
Ravichandran Karthikeyan ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Susceptibility Testing ◽  
Farm Workers ◽  
Resistance Pattern ◽  
Antibiotic Susceptibility Testing ◽  
M Gene ◽  
Fecal Samples ◽  
E Coli ◽  
Pig Farm

Background and Aim: Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli are gradually increasing worldwide and carry a serious public threat. This study aimed to determine the antimicrobial resistance pattern of ESBL-producing E. coli isolated from fecal samples of piglets and pig farm workers. Materials and Methods: Fecal samples from <3-month-old piglets (n=156) and farm workers (n=21) were processed for the isolation of ESBL-producing E. coli in MacConkey agar added with 1 μg/mL of cefotaxime. E. coli (piglets=124; farm workers=21) were tested for ESBL production by combined disk method and ESBL E-strip test. Each of the ESBL-positive isolate was subjected to antibiotic susceptibility testing. The ESBL-producing E. coli were further processed for genotypic confirmation to CTX-M gene. Results: A total of 55 (44.4%, 55/124) and nine (42.9%, 9/21) ESBL-producing E. coli were isolated from piglets and farm workers, respectively. Antibiotic susceptibility testing of the ESBL-positive E. coli isolates from piglets and farm workers showed 100% resistance to ceftazidime, cefotaxime, cefotaxime/clavulanic acid, ceftazidime/clavulanic acid, and cefpodoxime. A proportion of 100% (55/55) and 88.9% (8/9) ESBL-positive E. coli were multidrug resistance (MDR) in piglets and farm workers, respectively. On genotypic screening of the ESBL E. coli isolated from piglets (n=55), 15 were positive for the blaCTX-M gene and of the nine ESBL E. coli from farm workers, none were positive for the blaCTX-M gene. Conclusion: Although there was no significant difference in isolation of ESBL-producing E. coli between piglets and farm workers, the ESBL-positive E. coli from piglets showed relatively higher MDR than farm workers.

scholarly journals Microbial Profile of Various Catheter Tips among Hospitalized Patients

2018 ◽  
Vol 5 ◽  
pp. 32-38
Author(s):  
Pushpa Man Shrestha ◽  
Nisha Thapa ◽  
Navraj Dahal ◽  
Nabaraj Adhikari ◽  
Upendra Thapa Shrestha
Keyword(s):  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Descriptive Analysis ◽  
Multidrug Resistant ◽  
Antimicrobial Susceptibility Testing ◽  
Resistance Pattern ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Klebsiella Spp

Objectives: This study aimed to identify the microbiological profile of various catheter tips, and multidrug resistance pattern of extended spectrum β-lactamase (ESBL) producing E. coli and Klebsiella spp. isolates. Methods: A descriptive analysis of 263 catheter tip specimens processed for culture and antimicrobial susceptibility testing was carried out in B&B Hospital, Lalitpur. Five different types of catheter tips were analyzed for microbiological growth and antimicrobial susceptibility testing. Results: Among catheter tips, the highest percentage of microbial growth was observed in tracheostomy tip. Monomicrobial growth was recorded in 82.9% catheter tips and polymicrobial growth was observed in 17.1% tip samples. Of 180 isolates, gram negative rods (76.6%) followed by yeast (19.4%) and gram-positive cocci (3.9%) were isolated. Gram negative Acinetobacter spp. (25%) and Pseudomonas spp. (23.3%) and gram-positive Enterococcus spp. (2.2%) were the most frequently isolated bacteria. However, carbapenam was the most effective antibiotic for both groups. Conclusion: Of the total isolates tested, 61.4% were found to be multidrug resistant (MDR). Among gram negative rods, 22.2% E. coli and 27.3% Klebsiella spp. were confirmed as ESBL producer. It is recommended to apply standard protocol during insertion and removal of catheter which may help in managing nosocomial infection associated with catheters.

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