Prescription Pattern of Antimicrobial Agents in Various Dental Clinics at Malabar Region of Kerala, South India

Antimicrobial agents (AMAs) are among the most commonly prescribed drugs in dental practice. However inappropriate prescribing and irrational use of antimicrobial agents without prior culture and sensitivity tests, inadequate duration, dosing etc. have been identified as major factors contributing to the emergence of antibiotic resistance, which is an ongoing challenge in all over the world. A total of 1900 patients were screened and out of which 1748 patients were selected based on the inclusion and exclusion criteria for the study after taking consent. This study shows that the majority of patients attended in these clinics were female, 1020 (58.35%) and majority of patients (717) comes under age group 21-40 (41.02%) followed by age group by ≤ 20 (32.43%). This study established that most commonly recommended antimicrobial agents were amoxicillin, followed by amoxicillin-clavulanate and metronidazole. The antimicrobial agents like Ciprofloxacin, Cefixime, Tetracyclines, Azithromycines were also used but in less extent. This study also revealed that the selection of antimicrobials was not confirmed with culture and sensitivity tests in all cases, which may negatively influence bacterial resistance profile.

Evaluation of a phenotypic, point-of-care solution for the detection and quantitative antibiotic susceptibility testing for lower Urinary Tract Infection

Background Urinary tract infections (UTIs) are one of the most common bacterial infections seen in primary care. The current standard for the definitive diagnosis of a UTI is culture and sensitivity testing of a mid-stream urine sample at a clinical laboratory; however, this technique is costly, labour intensive and is not directly relevant clinically - typically taking 2-3 days to yield a result. Study design and Objective This is a nonexperimental cross-sectional study. The aim of this study was to evaluate the efficacy of U-treat, a bioluminescent approach for rapid detection of bacteriuria and quantitative determination of the antimicrobial susceptibility profiles of uropathogens in clinical urine specimens - in under an hour. Method The evaluation was carried out in two UK-based Medical Centres using urine samples from patients presenting with symptoms of a UTI (n=249). The U-treat technology is a two test, two reagent process. Test 1 detects the presence of a bacterial UTI > 104 bacteria/mL (5-10 minutes). Test 2 produces quantitative antibiotic susceptibility (<50 minutes). Only urine samples testing positive for bacteria in Test 1 underwent Test 2 (n=82). U-treat results were compared retrospectively against reference laboratory culture and sensitivity findings. The influence of the technology on patient treatment outcomes was also analysed. Results Relative to reference laboratory analysis, Test 1 showed a sensitivity of 97.1% and specificity of 92.0%. (PPV: 89.3%; NPV: 97.8%). Test 2 produced an overall sensitivity (measurement of true susceptibility) of 94.1% (Predictive value: 96%) and an overall specificity (measurement of true resistance) of 90.5% (Predictive value 86.4%). Analysis of treatment data demonstrated that had the physicians had access to U-treat results at the point of care, the percentage of patients treated successfully would have risen from 68.3% to 92.7%. Conclusion U-treat represents the first technology, world-wide, capable of providing UTI treatment data to physicians at the point of care, in less than 60 minutes.

Bacteriological profile and the sensitivity patterns of culture positive organisms in COVID-19 positive patients

Use of antibiotics without proper confirmation carries risk of over use of antibiotics. It is associated with certain side effects like loss of natural bacterial flora present in the human body. It can lead to resistance to the bacteria due to irrational use of antibiotics. Present study was carried out to study the bacteriological profile and the sensitivity patterns of culture positive organisms in COVID-19 positive patients.Hospital based cross-sectional study was carried out from March 2021 to June 2021 in the Department of Microbiology, Malla Reddy Institute of Medical Sciences (MRIMS), Hyderabad in 38 samples. These samples were referred from General Medicine Department. Culture and sensitivity was done in all cases. Majority of subjects belonged to the age group of 20-29 years (31.6%). The proportion of males (57.9%) was more than the proportion of females (42.1%). Most common co-morbidity was diabetes seen in 21.1% of the cases. was the most common organism found in four cases. Incidence of secondary bacterial infection in COVID-19 patients in the present study was 39.5%. Among the antibiotics studied in COVID-19 patients, amikacin, ciprofloxacin, imipenem, piperacillin-tazobactum, nitrofurantoin and chloramphenicol were found to be highly sensitive to most of the organisms. Antibiotics like cefepime, ampicillin, ceftazidime and cotrimoxazole were resistant to most of the organisms.Based on the study findings, we conclude that antibiotics like amikacin, ciprofloxacin, imipenem, piperacillin-tazobactum, nitrofurantoin and chloramphenicol can be used in most of the patients with COVID-19.Antibiotics should be used with caution especially in patients with COVID-19. Antibiotics like amikacin, ciprofloxacin, imipenem, piperacillin-tazobactum, nitrofurantoin and chloramphenicol can be used in most of the patients with COVID-19 while awaiting the results of culture and sensitivity. In all cases where physicians are in dilemma culture and sensitivity is highly recommended.

Culture and sensitivity patterns of bacteriological agents in children admitted to a tertiary care hospital

Background: Culture from various infected body fluids is one of the commonly used investigations to establish the etiology of infections and helps clinicians to select appropriate antimicrobial therapy. This study is aimed to determine the culture and sensitivity patterns of bacteriological agents grown in children admitted to a tertiary care center. Patients and methods: This descriptive cross-sectional study was conducted at the Department of Pediatric Medicine, The Children’s Hospital and the Institute of Child Health, Lahore from April 2019 to December 2019. All admitted children of age £ 15 years who fulfilled the criteria of systemic inflammatory response syndrome and sepsis were enrolled in the study. Blood and other body fluids were cultured in appropriate medium as indicated. Profile of microorganisms grown and their sensitivity patterns were noted and recorded on a predesigned data sheet. Statistical analysis was performed by SPSS v.22. Results: A total of 500 patients were enrolled in the study. Eighty-three of them (16.6%) had growth of different microorganisms on culture and were further analyzed. Total 58 of these 83 (69.87%) were <5 years of age, Male to female ratio was 1.2:1. Blood culture was positive in 36 patients (43.37%). Cultures from throat swabs, sputum and tracheal secretions showed growth of organisms in 15 (18.10%), while cerebrospinal fluid culture was positive in 14 (16.87%) and urine culture in 11 (13.25%). Microorganism isolated were: Klebsiella spp. (15.66%), Salmonella spp. (14.45%), Escherichia coli (13.25%), Staphylococcus aureus (12.04%), Acinetobacter (12.04%), Streptococcus pyogenes (10.84%), Pseudomonas aeruginosa (10.84%), Enterobacter spp. (7.23%) and Stenotrophomonas maltophilia (3.61%). Klebsiella spp. and E. coli showed resistant to various antibiotics including penicillin, co-amoxiclav, cephalosporin, fluoroquinolones and nalidixic acid. Salmonella spp. was mostly sensitive to meropenem and azithromycin. Staphylococcus aureus was sensitive to cephalosporin, amikacin, vancomycin and linezolid. Conclusion: Commonest micro-organism isolated were Klebsiella spp., Salmonella spp., Escherichia coli, Staphylococcus aureus and Streptococcus pyogenes. Resistance to commonly used antibiotics was observed in most cultures, which is a whistle blower against inappropriate use of these drugs.

Emerging antibiotic resistance pattern of urinary tract infection (UTI) due to Escherichia Coli (E.Coli).

Objective: To determine the emerging antibiotic resistance pattern of adult patients of MDR UTI cases caused by E.Coli. Study Design: Retrospective Data. Setting: Departments of Medicine and Obstetrics & Gynecology, Madinah Teaching Hospital / University Medical and Dental College, Faisalabad. Period: August 2016 to Sep 2018. Material & Methods: This retrospective study included 187 patients meeting the operational definition of multi-drug resistance cases of urinary tract infection caused by E. coli. All cases either male or female of age above 15 years with positive reports of urine culture and sensitivity for E.coli were included in the study. Along with the demographic variables urine WBC’s, results of urine culture and sensitivity were noted. Antibiotic sensitivity pattern of all the E.coli resistant UTI cases was analyzed. After identification of the microbe, antimicrobial sensitivity was accessed using Kirby–Bauer disc diffusion method on the Mueller–Hinton agar. The antimicrobial susceptibility test was performed against E. coli strains by using the following antibiotics: Piperacilin, Amoxicilin-Calvulanic, Pipmedic Acid, Cefipime, Ceftrixone, Cefuroxime, Cefoperazone-sulbactam, Ceftazidime, Cephradine, Ciprofloxacin, Ofloxacin, Levofloxacin, ofloxacin, Nitrofurantoin, Amikacin, Tombramycin, Gentamicin, Linezolid, Doxycycline, Sulphamethoxazole, Imipenem, Meropenem, Aztreonam in order to obtain an antibiogram. Results: In our data, 66.8% (n=125) were MDR UTI, and more than half of these cases were 63.2% (n=79) were females. Among the total 187 cases, 97.3% patients were resistant to most of the beta-lactam antibiotics, 95.7% were resistant to most of the quinolones and 68.4% were resistant to most of the aminoglycosides. Conclusion: This increasing antibiotic resistance is very alarming and steps should be taken to reduce the misuse of antibiotics. Studies should be done to control the risk factors leading to E. coli UTI. By following proper pharmacological guidelines, principles to use antibiotics and manage outpatient cases of UTIs, the incidence of MDR UTI can be controlled.

Bacteriological Profile and Antibiotic Sensitivity Pattern in Patients with Urinary Tract Infection in Janakpurdham, Nepal

Background: Urinary tract infections are most common bacterial infection in routine clinical practice. It is also most common nosocomial infection in many hospitals. Antibiotics are usually given empirically before urine culture reports available and treatment failure rate used to be significantly high. Study of causative agents and their antimicrobial sensitivity pattern are important factors helping formulating antibiotic policy. Generally, most common uropathogene is Escherichia Coli. Tertiary care hospitals, catering of already partially treated or mal treated patients as major chunk, may have varying etiologies and different sensitivity patterns. Objective: To study the culture and sensitivity patterns of urinary tract infections in patients presenting with urinary symptoms in local hospitals. Study design: A cross sectional study Materials and methods: Study was conducted at Madanta Research Clinic Private Limited from 12th march 021 to 12th September 021. Urine from cases suspected to have symptoms suggestive of UTI were send for bacteriological culture and sensitivity. Demographic profiles of each participant along with pathogen isolated, culture sensitivity pattern was documented. Data analysis was done in IBM spss 25. Results: A total 200 samples were selected for bacteriological culture and sensitivity out of which 32% were male and 68% were female. Around 50% of participants were in age group 20-40. There was no growth in 64% sample. Among positive samples (36%), E. coli (most common) was detected in 91.66%, Klebsiella was detected in 6.94%. Gentamicin, Amikacin and Nitrofurantoin were most common antibiotics sensitive to organisms in culture and Cephalosporins group of antibiotics are commonly resistant. Conclusions: coli is the most common organism isolated in urine culture in our region Janakpur. Cephalosporins are resistant in majority of cases where as Aminoglycosides like Amikacin, Gentamicin and Nitrofurantoin are found to be highly sensitive in most of positive cases.

Surgical Site Infections; A Study of Incidence, Risk Factors and Causative Organisms in Emergency Abdominal Surgeries

Background Surgical site infection (SSI) is the most commonly reported nosocomial infection. Surgical site infections are responsible for increase in cost, morbidity, and mortality related to surgical operations. Surveillance with information feedback to surgeons and other medical staff has been shown to be an important element in the overall strategy to reduce the numbers of SSIs. Objectives To determine the incidence and factors responsible for, causative micro-organisms and effective antibiotics for surgical site infections following emergency abdominal operations. Patients and methods a total of 252 patients were enrolled in the current study and were retrospectively followed till the tenth day post-operatively. Data collection sheets were filled in for all the patients. If any symptom or sign of infection appear during this period then proper investigation was instituted for the diagnosis of infection and to assess the type and severity of the infection. If any collection of pus identified it was drained out and sent for culture and sensitivity test. Proper antibiotic was given to every patient both preoperative and post-operative periods. Antibiotic was changed where necessary after getting the report of culture and sensitivity test. Results Surveillance of SSIs in the current study revealed an SSI incidence of 21.4%. The most frequent organisms detected by wound swab cultures were E. coli (55.5%), followed by Klebsiella and coagulase negative staphylococci, with the emergence of resistant strains like MDR, AMPC, ESBL strains. Sensitivity to antiobiotics showed Colistin, Polymyxin B, Vancomycin and Tigecycline to be fully functional, next in sensitivity was piperacillin tazobactam, then meropenem, followed by imipenem and amikacin. SSI was found to be increased with the advancement in age, Smoking cigarettes and HCV positive cases. The fourth post-operative day was the commonest day for the occurrence of SSI with discharge from the wound being the most prevalent sign. Conclusion A surveillance system for SSI with feedback of appropriate data to surgeons and hospital authorities is highly recommended to reduce the SSI rate General Surgical Departments at Ain Shams Specialized Hospital - Police Hospital and other Departments as well.

Eumycetoma Osteomyelitis Calcaneus in Adolescent; report of case and literature review

Background Mycetoma is the most common neglected disease in humans. It is a chronic, progressive, and destructive disease primarily caused by fungi or bacteria characterized by formation of dark pale grains commonly involve skin, soft tissue and rarely bone. Case presentation A 19 year old male patient with chronic right ankle pain, swelling and abscess formation for more than 1 year, patient was treated repeatedly with incision and drainage without any success. No X-ray, biopsy or swab for culture and sensitivity had been considered through the course of presentation. Patient was referred to Omdurman hospital where osteomyelitis secondary euomycetoma infection has been confirmed based on radiological and pathological assessment. Patient was treated surgically with aggressive debridement and bone curettage plus postoperative Itraconazole for 1 year. Conclusion Clinicians must consider osteomyelitis as important differential diagnosis during initial assessment Eumycetoma infection in adults. Aggressive bone curettage followed by regular X-ray follow up can be limb saving procedure in such cases.

Proportion of ophthalmia neonatorum following prophylaxis with azithromycin eye ointment in newborns at a tertiary care centre in Central Kerala

Background: The objective was to evaluate the proportion of ophthalmia neonatorum among 425 hospital born newborns who had received antibiotic eye prophylaxis within one hour of birth at a tertiary care centre in Central Kerala and to detect their causative organisms.Methods: The study design was an observational study done for a period of 10 months. A total of 425 term well newborn babies were included in the study. At delivery after the normal routine newborn care, babies were received azithromycin 1% eye ointment as prophylaxis for neonatal conjunctivitis in both eyes within one hour of birth. Babies were observed routinely during every vital monitoring for developing signs of neonatal conjunctivitis for the first 72 hours of life at hospital. During outpatient follow ups, 7 to 14 days and 14 to 28 days, these babies were examined for the presence of neonatal conjunctivitis. Babies having neonatal conjunctivitis were treated empirically with the same topical 1% azithromycin eye ointment after taking eye swab for culture and sensitivity in both eyes. The treatment has been modified based on the culture reports. Proportions were compared using Chi-square test with significance at p<0.05.Results: A total 15 (3.5%) of the 425 babies developed ophthalmia neonatorum. The most common isolate was Staphylococcus aureus which was 4 (26.7%) of all positive cultures followed by Escherichia coli 13.3%, Klebsiella pneumoniae 6.7%, Serracia marcescens 6.7%. None of the risk factors were found to be having association with conjunctivitis.Conclusions: This study concludes that a high proportion of neonatal conjunctivitis present despite eye antibiotic prophylaxis, though a greater reduction in cases has been shown when compared with no prophylaxis at our centre during the previous year. S. aureus was the most common causative organism isolated.