Risk factors, causative organisms and sensitivity patterns of infective keratitis in a tertiary care hospital in Rawalpindi

Objective: To determine the risk factors, causative organisms, sensitivity patterns and treatment outcomes of infective corneal ulcers. Methods: The is a prospective cohort study carried out from January 2018 to December 2019 at the Department of Ophthalmology, Fauji Foundation Hospital (FFH) Rawalpindi. A total of 65 eyes of 65 patients of corneal ulcer meeting the inclusion criteria were evaluated and corneal scrapes were sent for microbiological assessment. Variables studied were age, gender, risk factors, onset and duration of symptoms, best corrected visual acuity (BCVA), treatment and complications. Results: Out of 65 eyes of 65 patients, 40 (61.5%) were females and 25 (38.4%) were males. Most common local risk factor was ocular surgery (29.2%) followed by ocular trauma (23.1%). Diabetes was present in 44.6% of the cases. Culture results after corneal scrapings were positive for 39 (60%) of the total samples, while 26 (40%) had no growth. Bacterial growth was present in 51.3% of eyes, fungal in 28.2% while 20.5% of the eyes were infected with polymicrobial organisms. Most common pathogens were Pseudomonas (25.6%) that were most sensitive to ciprofloxacin. By the end of the follow-up period 40 cases (61.5%) showed improvement. Conclusion: This study concluded that isolated Pseudomonas was the most common pathogen. Prompt diagnosis with culture sensitivity tests are very much needed in developing countries to avoid blindness due to keratitis. Keywords: Infective keratitis, risk factors, corneal ulcer, culture sensitivity.

Bacteriological profile, antibiotic susceptibility pattern and other factors related to neonatal meningitis: A cross-sectional hospital-based study from West Bengal

Background: Neonatal sepsis and meningitis is an important cause of neonatal mortality and morbidity especially in the developing countries. Bacteriological profile of meningitis and antibiotic sensitivity pattern may vary from one region to another. Aims and Objectives: We have planned this study to know the etiological agent of neonatal meningitis with its antibiotic sensitivity profile and to evaluate some other associated risk factors of meningitis. Materials and Methods: This observational, cross-sectional study was done for a period of 1 year in the SNCU and NICU of a district Medical College of West Bengal in neonates presented with clinical sepsis and meningitis. Sepsis screen, blood culture, cerebrospinal fluid (CSF) study, and culture sensitivity was done and recorded along with demographic data, clinical presentation, outcome, and other associated factors. Results: We found meningitis in 55 neonates out of 250 clinical sepsis. CSF culture was positive in 42 cases with Escherichia coli (30.9%), Klebsiella (26.1%), Staphylococcus aureus (16.6%), Acinetobacter (14.2%) and Coagulase negative Staphylococcus (CoNS 11.9%) as prevalent organism. E. coli and Klebsiella were mostly sensitive to Amikacin, Levofloxacin, and Colistin whereas less sensitive to Cefotaxime, Pipercilin-tazobactam or Meropenem and Acinetobacter showed good sensitivity only to Levofloxacin. Among the gram-positive organism, S. aureus and CoNS were only sensitive to Linezolid, Vancomycin, and Teicoplanin. Conclusion: This type of study should help to make a proper antibiotic policy for an institution so that the empirical first-line antibiotic can be started with good effect in cases of neonatal sepsis and meningitis before the arrival of culture sensitivity report.

Mycology of Otomycosis in Port Harcourt

Tropical climate favors the growth of fungal infection in the ear resulting in otomycosis. This study is aimed at determining the predisposing factors, symptoms, prevalence and demographic data of patients diagnosed with otomycosis. This is a 1 year prospective hospital based study, between June 2017 to June 2018 at University of Port Harcourt Teaching Hospital (UPTH), Rivers State, Nigeria. Clinical features, predisposing factors and examination findings were noted on the administered questionnaire. Patients were examined and specimen collected for microscopy, culture, sensitivity and mycological studies. Our results show isolated fungi were present in 34 out of 120 ear swabs of patients and in 5 out of 120 ear swabs from the control group. The prevalence of otomycosis was 2.7%, while the ear symptom with the highest frequency was itching (86.7%) and debris in ear canal (67.6%). Patients with positive growth constitute 53% females and 47% males. Age groups 10-29 and 40-49 years had the highest and lowest number of infected patients, respectively. Candida was the commonest organism isolated accounting for 61.8% followed by Aspergillus spp. (23.5%) and Penicillium (8.8%).

Tuberculosis in Children in a Pediatric Hospital in Mexico

Tuberculosis (TB) remains a global problem and a diagnostic challenge, especially in pediatrics. The aim of this study was to describe the clinical, microbiological, radiological, and histopathological data of TB in children. A 7-year retrospective and descriptive cohort study that included 127 patients under 18 years of age with diagnosis of active TB was conducted from 2011 to 2018 in a pediatric hospital. Tuberculosis was microbiologically confirmed using Ziehl–Neelsen (ZN) staining, culture or polymerase chain reaction (PCR) in a total of 94 (74%) cases. Thirty-three cases were defined as probable TB based on tuberculin skin test result and epidemiological evaluation. The TB forms found were lymph node (39.3%), bone (15.7%), lung (13.6%), and meningeal TB (8.6%). The most common symptoms were fever (48.8%) and adenopathy (45.6%). History of contact was established in 34.6%. Positive ZN staining (sensitivity 30%) and culture (sensitivity 37%) were found in 29% and 37.7% of subjects, respectively. About 64.5% depicted abnormal chest X-ray. Xpert MTB/RIF® (PCR) was positive in 9.4% and biopsy was compatible in 52.7% of these samples. It is fundamental to have laboratory and epidemiological evaluation that support the diagnosis of the disease in children and thus, define its management; since, in most cases, early microbiologic confirmation is lacking.

Role of routine urine culture in predicting asymptomatic bacteriuria in pregnancy and the prevalence of asymptomatic bacteriuria in pregnant women - Our experience

Asymptomatic bacteriuria (ASB) in pregnancy can flare into frank pyelonephritis and sepsis if untreated due to the low immunity. Apart from causing morbidity in mothers it affects the foetus by increasing the incidence of prematurity and IUGR. The present study was undertaken to determine the prevalence of ASB in the pregnant women attending Ante natal clinic and the significance of routine urine culture. : Total 310 pregnant women attending the antenatal OPD were enrolled in the study over a period of 10 months. Inclusion criteria included all pregnant women attending antenatal OPD without any urinary symptoms or history of fever. Exclusion criteria included frank UTI symptoms like fever, dysuria, increased frequency of urine, any history of intake of antibiotics, any urinary tract anomaly or renal calculi. Their midstream urine sampling was collected and subjected to both microscopy and culture sensitivity; standard microbiological method was used. The prevalence of ASB was found to be 11.29% and was maximum in second trimester (54.2%). The study revealed routine urine culture is a sensitive test to diagnose ASB. The commonest bacterium isolated was Escherichia coli (51.4% cases) and the most effective antibiotic was Nitrofurantoin. The neonatal outcomes are discussed in the text while no perinatal deaths were recorded during the period of study. No direct association of asymptomatic bacteriuria with anaemia and preeclampsia was found, but odds ratio was more than one. The study highlights that asymptomatic bacteriuria is a common occurrence in pregnant women, including urine culture as a part of routine investigation in antenatal patients can help diagnose this condition. Prompt treatment of ASB can prevent any obstetric complication arising from the flareup of asymptomatic bacteriuria in pregnancy and thus reduce maternal and foetal morbidity.

Culture Sensitivity Patterns and Outcome of Liver Abscess in Children Admitted at a Tertiary Care Hospital in North India

BACKGROUND Liver abscess has been recognised since the time of Hippocrates. Liver abscess is defined as collection of purulent material in liver parenchyma. They are usually caused by bacterial and amoebic infections, and less commonly, by other protozoal and helminthic organisms. Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. The purpose of this study was to evaluate culture sensitivity pattern (Blood & Pus) of liver abscess in children. METHODS This prospective observational study was conducted in the Department of Paediatrics, Chacha Nehru Bal Chikistalaya, Delhi from July 2016 –to August 2017. This study has got Institutional Ethics Committee approval (Regd No: IEC/MAMC/78, Dt: 26/07/2016). All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children. Their clinical characteristics, radiological features, laboratory data, clinical management, and outcomes were analysed. RESULTS In our study, out of 70 patients, 3.2 % patients showed growth in the blood culture. Organsims isolated were Methicillin resistant Staphylococcus aureus (MRSA) 1.4 % (1), Salmonella typhi 1.4 % (1), staphylococcus coagulase negative 1.4 % (1). Out of 70 patients of liver abscess enrolled in the study, 36 patients underwent aspiration of pus from the abscess. Out of 36 aspirated cases, gram positive cocci was identified in 1 (1.4 %) patient. In our study, no acid fast bacilli was identified and no fungal culture showed growth of organism. Out of 70 cases of liver abscess, 10 were found to be amoebic liver abscess. In our study, all the 70 patients were started on empirical antibiotics. Out of 70 patients, surgical intervention was done in 36 patients. In our study all the patients were started on empirical antibiotics according to hospital protocol. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Organisms recovered from liver abscesses vary greatly. Surgical drainage has been the traditional mode of treatment of pyogenic liver abscess, but this was replaced by IV broad-spectrum antibiotics and imaging-guided percutaneous drainage. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Culture-Sensitivity, Children

Use of Cephalosporin Type Antimicrobials in Infection Wards in Tertiary Hospital in West India

Background: Antibiotic resistance is exponentially increasing worldwide. Irrational prescription of antibiotic treatment contributes to the development of antibiotic resistance. Appropriate antibiotic use is vital in reducing the mortality caused by bacterial infections. Third generation cephalosporins are now considered as the backbone of antibiotic therapy for treatment of serious infections including those in hospitalized patients. These drugs are the commonly prescribed ꞵ-lactam antibiotics even before culture sensitivity reports arrive. Generation of resistance has been a growing concern for all clinicians and must be avoided at all costs. This drug utilization study was undertaken to understand the growing resistance acquired by the organisms against cephalosporins caused due to the superfluous and unrestrained use of cephalosporins in the medical wards of our institution. Objective: The study objectives were to assess: The cephalosporins generation which was most commonly prescribed The relevance of cephalosporins generations used in various diseases The shift or addition of other antimicrobials upon failure of cephalosporins treatment Methods: This was an observational study done amongst 350 patients admitted in infection wards of Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune over a period of one year between January 2019 to December 2019 after obtaining institutional ethical clearance. Data was analyzed and values were presented descriptively in number and percentage form. Results: Maximum usage of third generation cephalosporin was seen with ceftriaxone being the most commonly prescribed third generation cephalosporin in parenteral form (59.43%). Gender analysis revealed that males (60.28%) were prescribed more cephalosporins as compared to females (39.71%), whereas, frequent usage was seen in the age group 61 – 70 years. Bacteriological investigations were done in only 103 (29.42%) cases following which shift or addition of other antimicrobials was seen in 13 (3.71%) cases. Metronidazole was the most frequently co-prescribed with cephalosporins. Conclusion: Our study revealed extensive usage of third generation cephalosporin and the treatment regimens implemented in majority of the cases were without prior culture sensitivity test leading to irrational prescribing. Our study, along with the various other studies, would help in taking the corrective measures to curb the unnecessary use of antibiotics, and framing the guidelines for the doctors prescribing them.

A Case Report of Humerus Shaft Osteomyelitis Secondary to Local Skin Infection Treated with Saucerization.

Introduction:Osteomyelitis of the humerus shaft after local skin infection is rare clinical entity, all the principles of tibia and femur osteomyelitis are used in the humerus osteomyelitis. Early detection is best done by the magnetic resonance imaging. Surgical debridement and curettage with IV antibiotics gives good clinical outcome in the patient. Case Report:A 35-year-old female presented with discharging sinus over posterior aspect of the humerus for 1 year. Diagnosis done based on X-ray and clinical examination. The patient managed with local debridement and saucerization, on follow-up patient is doing all the daily activities and no sign of recurrence at 18 months post-operative. Conclusion:Local debridement saucerization and course of IV antibiotics according to culture sensitivity give good clinical outcome in cases of humerus osteomyelitis. Keywords:Humerus, osteomyelitis, bone infections, saucerization, antibiotics.

A rare case of extensively drug-resistant Salmonella typhi meningitis in a 9-year old: a case report

Meningitis caused by Salmonella typhi is rare and is generally seen in infants. We report a case of a 9-year-old boy with extensively drug-resistant S. typhi meningitis. The patient was diagnosed using a culture sensitivity test and successfully treated with meropenem. Culture sensitivity may be included in routine testing for the diagnosis of S. typhi especially in developing countries due to high burden of disease and emergence of drug resistance.