scholarly journals High incidence of plasmid-mediated quinolone resistance genes among ciprofloxacin-resistant clinical isolates of Enterobacteriaceae at a tertiary care hospital in Puducherry, India

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e1995 ◽  
Author(s):  
Thiyagarajan Yugendran ◽  
Belgode Narasimha Harish
Keyword(s):  
Postgraduate Medical Education ◽  
Tertiary Care ◽  
Class Ii ◽  
Quinolone Resistance ◽  
Clinical Isolates ◽  
Class I ◽  
Care Hospital ◽  
Consumption Data ◽  
High Incidence ◽  
Jawaharlal Institute

Background.Plasmid-mediated quinolone resistance (PMQR) has received considerable attention recently. Data analysis in Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) revealed 75% of the Enterobacteriaceae isolates to be ciprofloxacin-resistant in 2012. Few reports regarding the prevalence of PMQR are available from India. Hence, the present study was carried out to ascertain the prevalence of PMQR genes among clinical isolates of ciprofloxacin-resistant Enterobacteriaceae in JIPMER.Methods.The study included 642 ciprofloxacin-resistant clinical Enterobacteriaceae isolates. JIPMER hospital’s annual consumption data for fluoroquinolones were retrieved from the Department of Pharmacy. The test isolates were screened for the presence ofqnr A,B,D,Sandaac(6′)-Ib-crgenes. PMQR-positive isolates alone were tested for the presence of class I (intI1) and class II (intI2) integrons. Randomly selected PCR amplicons were sequenced and analysed using MEGA software. A total of 30 PMQR strains chosen at random were assessed for the transferability of the PMQR genes.Results.A majority of the strains exhibited high MIC values with 106 strains exhibiting MIC values >256 µg/mL. Theaac(6′)-Ib-crgene had the highest prevalence at 64% (414) while,qnrBandqnrSgenes were present in 15% (97) and 10% (64) of the isolates respectively. None of the strains were positive forqnrAandqnrD. All PMQR-positive isolates were screened for class I (intI1) and class II (intI2) integrons. Class I integron was found to be predominant among the test isolates with a few of them carrying both the classes of integrons. Transferability of PMQR genes to transconjugants was identified.Conclusion.The incidence of PMQR genes in the tertiary-care setup of the JIPMER hospital was found to be high which could be probably due to the increased prescription of fluoroquinolones. Thus, there is a need for rational usage of fluoroquinolones.

scholarly journals High incidence of plasmid-mediated quinolone resistance genes among ciprofloxacin-resistant clinical isolates of Enterobacteriaceae at a tertiary care hospital in Puducherry, India

2016 ◽  
Author(s):  
Thiyagarajan Yugendran ◽  
Belgode Narasimha Harish
Keyword(s):  
Tertiary Care ◽  
Class Ii ◽  
Quinolone Resistance ◽  
Clinical Isolates ◽  
Class I ◽  
Care Hospital ◽  
Consumption Data ◽  
High Incidence ◽  
Increasing Trend ◽  
Clinical Breakpoints

Background: Plasmid-mediated quinolone resistance (PMQR) has received considerable attention recently. Data analysis in JIPMER revealed 75% of the Enterobacteriaceae isolates to be ciprofloxacin-resistant in 2012. Few reports regarding the prevalence of PMQR are available from India. Hence, the present study was carried out to ascertain the prevalence of PMQR genes among clinical isolates of ciprofloxacin-resistant Enterobacteriaceae in JIPMER. Methods: The study included 642 ciprofloxacin-resistant clinical Enterobacteriaceae isolates. JIPMER hospital’s annual consumption data for fluoroquinolones were retrieved from the Department of Pharmacy. The test isolates were screened for the presence of qnr A, B, D, S and aac(6’)-Ib-cr genes. PMQR-positive isolates alone were tested for the presence of class I (intI1) and class II (intI2) integrons. Randomly selected PCR amplicons were sequenced and analysed using MEGA software. A total of 30 PMQR strains chosen at random were assessed for the transferability of the PMQR genes. Results: Majority of the strains exhibited high MIC values with 106 strains exhibiting MIC value ˃256µg/mL. The aac(6’)-Ib-cr gene had the highest prevalence at 64% (414) while, qnrB and qnrS genes were present in 15% (97) and 10% (64) of the isolates respectively. None of the strains were positive for qnrA and qnrD. All PMQR-positive isolates were screened for class I (intI1) and class II (intI2) integrons. Class I integron was found to be predominant among the test isolates with a few of them carrying both the classes of integrons. Transferability of PMQR genes to transconjugants was identified. Discussion: PMQR genes were found to exhibit an increasing trend of prevalence among the clinical isolates in this study. Thus, the need for rational usage of fluoroquinolones and reconsideration of their clinical breakpoints has arisen.

scholarly journals High incidence of plasmid-mediated quinolone resistance genes among ciprofloxacin-resistant clinical isolates of Enterobacteriaceae at a tertiary care hospital in Puducherry, India

2016 ◽  
Author(s):  
Thiyagarajan Yugendran ◽  
Belgode Narasimha Harish
Keyword(s):  
Tertiary Care ◽  
Class Ii ◽  
Quinolone Resistance ◽  
Clinical Isolates ◽  
Class I ◽  
Care Hospital ◽  
Consumption Data ◽  
High Incidence ◽  
Increasing Trend ◽  
Clinical Breakpoints

Background: Plasmid-mediated quinolone resistance (PMQR) has received considerable attention recently. Data analysis in JIPMER revealed 75% of the Enterobacteriaceae isolates to be ciprofloxacin-resistant in 2012. Few reports regarding the prevalence of PMQR are available from India. Hence, the present study was carried out to ascertain the prevalence of PMQR genes among clinical isolates of ciprofloxacin-resistant Enterobacteriaceae in JIPMER. Methods: The study included 642 ciprofloxacin-resistant clinical Enterobacteriaceae isolates. JIPMER hospital’s annual consumption data for fluoroquinolones were retrieved from the Department of Pharmacy. The test isolates were screened for the presence of qnr A, B, D, S and aac(6’)-Ib-cr genes. PMQR-positive isolates alone were tested for the presence of class I (intI1) and class II (intI2) integrons. Randomly selected PCR amplicons were sequenced and analysed using MEGA software. A total of 30 PMQR strains chosen at random were assessed for the transferability of the PMQR genes. Results: Majority of the strains exhibited high MIC values with 106 strains exhibiting MIC value ˃256µg/mL. The aac(6’)-Ib-cr gene had the highest prevalence at 64% (414) while, qnrB and qnrS genes were present in 15% (97) and 10% (64) of the isolates respectively. None of the strains were positive for qnrA and qnrD. All PMQR-positive isolates were screened for class I (intI1) and class II (intI2) integrons. Class I integron was found to be predominant among the test isolates with a few of them carrying both the classes of integrons. Transferability of PMQR genes to transconjugants was identified. Discussion: PMQR genes were found to exhibit an increasing trend of prevalence among the clinical isolates in this study. Thus, the need for rational usage of fluoroquinolones and reconsideration of their clinical breakpoints has arisen.

scholarly journals High Level Plasmid-Mediated Quinolone Resistance in Clinical Infections at a Tertiary Healthcare Institution in South-West Nigeria

2021 ◽  
Author(s):  
Abiodun Ronke Ojewuyi ◽  
Babatunde Odetoyin ◽  
Aaron Oladipo Aboderin
Keyword(s):  
Tertiary Care ◽  
Wide Distribution ◽  
Quinolone Resistance ◽  
Clinical Isolates ◽  
Care Hospital ◽  
Cross Sectional ◽  
Diffusion Technique ◽  
High Prevalence ◽  
Tertiary Healthcare ◽  
High Level

Abstract Background Plasmid-mediated quinolone resistance (PMQR) has become a growing clinical concern worldwide. Recent reports from Nigeria revealed that qunolone resistant clinical isolates have become commomplace. However, few reports regarding the prevalence of PMQR are available. Hence, this study aimed to determine the prevalence of PMQR genes in qunolone resistant clinical isolates from a tertiary care hospital in Nigeria. Methods This was a cross-sectional hospital based study involving 390 non-repetitive Gram negative bacilli from diverse clinical infections. The isolates were characterized by the MicrobactTM identification kit and their susceptibility patterns determined by the Kirby-Bauer disc diffusion technique. All quinolone resistant isolates were investigated for the carriage of PMQR genes by multiplex polymerase chain reaction (PCR). Data analysis was with appropriate descriptive and inferential statistics.Results The isolates were distributed as Escherichia coli (n=121; 31.0%), Klebsiella species (n= 112;28.7%), Pseudomonas aeruginosa (n=59;15.1%), Proteus species (n=43;11.0%), Salmonella species (n=6;1.3%) and others. They were commonly resistant to nalidixic (62.6%), co-amoxiclav (57.7%); norfloxacin (52.3%), ofloxacin(52.1%) and ciprofloxacin(51.0%), but were least resistant to imipenem; (n=36; 9.2%). Out of 244 isolates that were resistant to at least one quinolone, 180 (73.8%) harboured one or more PMQR gene with a high prevalence of efflux-mediating determinants (qepA, 22.5%; oqxAB, 21.1%), and the aminoglycoside acetyltransferase (aac(6’)-Ib-cr, 19.7%). Proportionately low level of target-protecting determinants; qnrB, 13.2%; qnrS, 8.7%; qnrA, 5.9%; qnrD, 4.5% and qnrC, 4.2% were found in these isolates.Conclusion There is high level quinolone resistance and wide distribution of PMQR genes in clinical isolates in Nigeria with a preponderance of Efflux-mediating determinants and the aminoglycoside acetyltransferase. This emphasizes the need for regular resistance surveillance and antimicrobial stewardship to guide the appropriate and judicious use of antibiotics.

scholarly journals High Level Plasmid-Mediated Quinolone Resistance in Clinical Infections at a Tertiary Healthcare Institution in South-West Nigeria

2020 ◽  
Author(s):  
Abiodun Ronke Ojewuyi ◽  
Babatunde Odetoyin ◽  
Aaron Oladipo Aboderin
Keyword(s):  
Tertiary Care ◽  
Wide Distribution ◽  
Quinolone Resistance ◽  
Clinical Isolates ◽  
Care Hospital ◽  
Cross Sectional ◽  
Diffusion Technique ◽  
High Prevalence ◽  
Tertiary Healthcare ◽  
High Level

Abstract Background Plasmid-mediated quinolone resistance (PMQR) has become a growing clinical concern worldwide. Recent reports from Nigeria revealed that qunolone resistant clinical isolates have become commomplace. However, few reports regarding the prevalence of PMQR are available. Hence, this study aimed to determine the prevalence of PMQR genes in qunolone resistant clinical isolates from a tertiary care hospital in Nigeria. Methods This was a cross-sectional hospital based study involving 390 non-repetitive Gram negative bacilli from diverse clinical infections. The isolates were characterized by the MicrobactTM identification kit and their susceptibility patterns determined by the Kirby-Bauer disc diffusion technique. All quinolone resistant isolates were investigated for the carriage of PMQR genes by multiplex polymerase chain reaction (PCR). Data analysis was with appropriate descriptive and inferential statistics.Results The isolates were distributed as Escherichia coli (n=121; 31.0%), Klebsiella species (n= 112;28.7%), Pseudomonas aeruginosa (n=59;15.1%), Proteus species (n=43;11.0%), Salmonella species (n=6;1.3%) and others. They were commonly resistant to nalidixic (62.6%), co-amoxiclav (57.7%); norfloxacin (52.3%), ofloxacin(52.1%) and ciprofloxacin(51.0%), but were least resistant to imipenem; (n=36; 9.2%). Out of 244 isolates that were resistant to at least one quinolone, 180 (73.8%) harboured one or more PMQR gene with a high prevalence of efflux-mediating determinants (qepA, 22.5%; oqxAB, 21.1%), and the aminoglycoside acetyltransferase (aac(6’)-Ib-cr, 19.7%). Proportionately low level of target-protecting determinants; qnrB, 13.2%; qnrS, 8.7%; qnrA, 5.9%; qnrD, 4.5% and qnrC, 4.2% were found in these isolates.Conclusion There is high level quinolone resistance and wide distribution of PMQR genes in clinical isolates in Nigeria with a preponderance of Efflux-mediating determinants and the aminoglycoside acetyltransferase. This emphasizes the need for regular resistance surveillance and antimicrobial stewardship to guide the appropriate and judicious use of antibiotics.

scholarly journals An Overview of Orthodontic Patients Visiting in a Tertiary Care Hospital in Northern Region of Bangladesh

KYAMC Journal ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 92-97
Author(s):  
Md Shahidul Islam ◽  
Rubayet Alam Prodhan ◽  
Rifat Rezwana ◽  
Gazi Ikhtiar Ahmed
Keyword(s):  
Tertiary Care Hospital ◽  
Periodontal Diseases ◽  
Tertiary Care ◽  
Epidemiological Data ◽  
Class Ii ◽  
Northern Region ◽  
Class I ◽  
Care Hospital ◽  
Orthodontic Patients ◽  
Bangladeshi Population

Background: Malocclusion is still not considered as a dental problem because of more emphasis is given to the treatment of dental caries and periodontal diseases due to pain complained by patients. Objective: The study was conducted to find out the pattern of diseases of orthodontic patients visiting in a regional tertiary care hospital in northern area of Bangladesh. Materials and Methods: This snap-shot study was conducted on randomly selected 84 patients attended in the Department of Orthodontics & Dentofacial Orthopaedics, Dental unit Thengamara Mohila Sabuj Sangha (TMSS) Medical College and Hospital, Bogura from July 2016 to June 2017. All data were collected from patients’ history and clinical examination of the patients. Descriptive statistics were calculated using MS Excel from the collected data. Results: One third of the patients (33.33%) have normal over bite. Class I and Class II molar relationship are distributed as 44% and 53.5% respectively. Class I and Class II division 1 Incisor relationship is distributed as near about same, 44% and 34.52% respectively; and 14.29% have Class II division 2. Class I and Class II Canine relationship are distributed as near about same, 44% and 48.80% respectively. Forty four percent patients have normal over jet, 34.52% patients have increased over jet, and 7.20% patients have reversed over jet. Conclusion: The epidemiological data on the prevalence of malocclusion is an important determinant in planning appropriate levels of orthodontic services in the Bangladeshi population and further studies are required to provide accurate estimates of the orthodontic treatment. KYAMC Journal.2021;12(02): 92-97

Coexistence of Metallo Beta Lactamase Resistant Gene Variants Among Clinical Isolates in Tertiary Care Hospital

2021 ◽  
Vol 18 (4) ◽  
pp. 429-436
Author(s):  
Santhiya K. ◽  
Jayanthi S. ◽  
Ananthasubramanian M. ◽  
Appalaraju B.
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Medical Science ◽  
Geographical Location ◽  
Carbapenem Resistance ◽  
Clinical Isolates ◽  
Care Hospital ◽  
Detection Rates ◽  
Carbapenem Resistant ◽  
Global Threat

Background: Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a global threat with mortality risk ranging from 48%-71% worldwide. The emergence of MBL resistance is threatening as carbapenem is one of the last line antibiotics. A total 24 variants of NDM resistance raises a concern to the clinicians and epidemiologists worldwide. Objective: The study aims at identifying MBL resistance (NDM, IMP, VIM, GIM, SPM, and SIM) and its coexistence in clinical isolates in a single tertiary care center. Methodology: Forty five clinical isolates characterized phenotypically for Carbapenem resistance obtained from PSG Institute of Medical Science and Research (PSG IMSR), Coimbatore, between February to March 2018 were taken for analysis. Result: Out of the 45 Clinical isolates, 38 isolates (84%) were detected as MBL carriers. VIM, NDM, GIM, and SPM were the predominant resistance genes, with detection rates of 48.8%, 28.8%, 24.4%, and 22.2% respectively. Fifteen isolates were observed to harbor more than one MBL gene in coexistence. Two isolates - U42 and R714 (K. pneumoniae) were found to harbor all 5 MBL variants in combination. Conclusion: 33% of clinical isolates harboring multiple MBL variants is a concern in clinical settings. The presence of SPM and GIM gene amongst isolates in this geographical location within India is an indicator demanding continuous monitoring of these resistance determinants.

scholarly journals Susceptibility of Clinical Isolates of Staphylococcus aureus to Ceftaroline

2021 ◽  
Author(s):  
Harsha Sreedharan ◽  
KB Asha Pai
Keyword(s):  
Staphylococcus Aureus ◽  
Tertiary Care Hospital ◽  
Methicillin Resistance ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
The United States ◽  
Clinical Isolates ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Care Hospital

Introduction: Methicillin-Resistant Staphylococcus aureus(MRSA) infection is a major global healthcare problem, the prevalence of which varies from 25-50% in India. It is known to cause Skin and Soft tissue Infections (SSI), endovascular infections, endocarditis, pneumonia, septic arthritis, osteomyelitis, and sepsis. Vancomycin is the drug of choice for treating severe MRSA infections. Ceftaroline, a fifth-generation cephalosporin has been approved by the United States Food and Drug Administration (US FDA) for treating acute bacterial SSI caused by susceptible micro-organisms including MRSA, Community acquired respiratory tract infection, MRSA bacteremia and endocarditis. Aim: To assess the susceptibility of clinical isolates of S. aureusto ceftaroline, in a Tertiary Care Hospital. Materials and Methods: This prospective study was conducted in the Department of Microbiology of a Tertiary Care Hospital over a period of two months from June 2019 to July 2019. S.aureus isolates from various clinical samples were screened for methicillin resistance by disc diffusion method using cefoxitin disc and ceftaroline susceptibility of these isolates was assessed by E-strip method. The isolates were classified as ceftaroline susceptible, Susceptibility Dose Dependent (SDD) and ceftaroline resistant respectively as per CLSI guidelines. A descriptive analysis of the data was done and the results were presented as frequencies and percentages. Results: All the S.aureus isolates were found to be susceptible to ceftaroline. Methicillin Sensitive Staphylococcus aureus(MSSA) isolates had lower Minimum Inhibitory Concentration (MIC) when compared to MRSA. The highest MIC among MRSA was 0.5 μg/mL. Conclusion: Ceftaroline can be considered as an effective alternative for treatment of infections caused by MRSA.

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