Antimicrobial Resistance Pattern of Extensively Drug Resistant Carbapenemase Producing Enterobacteriaceae

Carbapenems, often agents of last resort for multidrug resistant bacterial infections are now threatened by widespread dissemination of carbapenem-resistant Enterobacteriaceae (CRE). Production of carbapenemases remain the most clinically important mechanism of carbapenem resistance in Enterobacteriaceae. The objective of this study was to determine the antibiogram pattern of carbapenemase producing Enterobacteriaceae. A cross sectional study was conducted at department of Microbiology and Immunology, BSMMU from September 2018 to August 2019. A total of 145 CRE isolates from different clinical samples were studied.Antimicrobial susceptibility was examinedby disk diffusion method and MIC of colistin by broth microdilution method. Resistant carbapenemase genes NDM and OXA-48 were identified by polymerase chain reaction. Out of 145 CRE isolates, 104 were NDM, 73 were OXA-48and 34 isolates were both NDM and OXA-48 co-producers. All the NDM and OXA-48 carbapenemase producing isolates were 100% resistant to meropenem, imipenem, ertapenem, ceftriaxone, ceftazidime, cefotaxime, cefuroxime, amoxicillin + clavulanic acid and piperacillin + tazobactam. Resistance rates of reserved antimicrobials to treat CRE isolates were also alarming. Thirty seven percent, 9.6% and 5.5 % of OXA-48 carbapenemase producers and 26.0%, 10.6% and 2.9% of NDM carbapenemase producers were resistant to colistin, polymyxin B and tigecycline respectively.Among the carbapenemase producing isolates, 16.6% (24) were multidrug resistant (MDR), 82.1% (119) were extensively drug resistant (XDR) and 1.3% (2) isolates were pan drug resistantwhich highlights the emerging therapeutic challenge for these superbugs. Bangladesh J Med Microbiol 2019; 13 (2): 7-10

Antimicrobial Stewardship: Laboratory to Clinical Microbiology: A Road Map

Antimicrobial stewardship refers to a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics and decreasing unnecessary costs. While clinical microbiologists with clinical pharmacists are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture, and guidance in the pre analytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. Bangladesh J Med Microbiol 2019; 13 (2): 25-29

COVID 19; Unpredicted Destiny

not available Bangladesh J Med Microbiol 2019; 13 (2): 1-3

Antimicrobial Resistance Pattern of Enterobacter Species Isolated from Different Clinical Specimens in a Tertiary Care Hospital of Bangladesh

The present study was undertaken to determine the antimicrobial resistance pattern of Enterobacter species to guide the clinician in selecting the best antimicrobial agent for an individual patient. A total of 50 clinical isolates of Enterobacter species were collected from different clinical specimens at the microbiology laboratory of BSMMU between August, 2018 and September, 2019. The two main species of Enterobacter, E.cloacae and E.aerogenes were identified by biochemical tests. Antimicrobial susceptibility testing was performed by Kirby Bauer disc diffusion method and reported according to CLSI guidelines. Majority (56%) of the isolated Enterobacter were E.cloacae, 40% were E.aerogenes and 4% were other species. The Enterobacter isolates showed relatively high resistance rates to the cephalosporins including cefoxitin (82%), cefixime (62%), ceftazidime (46%) and ceftriaxone (46%). Resistance to the carbapenems and aminoglycosides was relatively low. The high resistance rates of Enterobacter species to multiple antibiotics makes it necessary for antimicrobial susceptibility testing to be conducted prior to antibiotic prescription. Bangladesh J Med Microbiol 2019; 13 (2): 3-6

Correlation Between Endoscopic and Histological Findings of Dyspeptic Patients and their Association with Helicobacter Pylori Infection

There is a high prevalence of H. pylori infection in Bangladeshi population that causes site specific diseases which includes gastritis, gastric ulcer, duodenal ulcer and gastric carcinoma. The Cross sectional study was carried out in the Department of Microbiology and immunology, Bangabandhu Medical University (BSMMU), during the period of September, 2018 to July, 2019. Dyspeptic patients, who underwent endoscopic examination at the Department of Gastroenterology of Dhaka medical College and Hospital, who fulfilled the inclusion criteria were enrolled as study population. Collected gastric and duodenal biopsy specimens from 142 patients were categorized as H. pylori positive cases (34.5%) and H. pylori negative cases (35.2%) based on the case definition used in the study by RUT, Histology and ureC gene PCR. All of the laboratory works were performed at Department of Microbiology and Immunology except Histology which was performed at the Department of Pathology of BSMMU. Endoscopic findings significantly co-related with histological findings (p = 0.001). Highest rate of H. pylori infection was found in 76% of duodenal ulcer cases and lowest in Adenocarcinoma group being only 9% of total study population. H. pylori infection was positively associated with duodenal ulcer cases (p=0.014) and negatively with adeno carcinoma cases (p=0.002) in a statistically significant manner. Bangladesh J Med Microbiol 2019; 13 (2): 11-17

Challenges Presented by SARS-Corona Virus 2 to Global Health

Emerging and reemerging pathogens are global challenges for public health. In recent times, corona viruses have become the most important virus worldwide because of the occurrence of more than 2 thousand deaths caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China. Rapid spread of the infection occurred in many countries. However, most cases of mortality have occurred in China. The Center for Diseases Control and Prevention and World Health Organization maintain a website that is updated frequently with new cases of SARS-CoV-2 infection. Here we provide a brief introduction to corona viruses and also discuss the outbreaks of recently identified SARS-CoV-2. Bangladesh J Med Microbiol 2019; 13 (2): 18-24

Common Bacterial Causes of Urethritis in Men: Diagnosis and Treatment

not available Bangladesh J Med Microbiol 2019; 13 (1): 24-29

Detection of Drug Susceptibility to Azoles among Trichophyton rubrum Isolates by Disk Diffusion Method

Dermatophytes are filamentous fungi that cause tiniasis with high prevalence in tropical hot, humid and overcrowded countries like Bangladesh. Antifungal drug resistance among dermatophyte isolates are very common due to irrational and overuse of them. In vitro antifungal susceptibility test may help to select appropriate drug, optimize the therapy and monitor the emergence of drug resistance. This study was undertaken to isolate and identify different dermatophyte species from skin, nail and hair samples and to see the susceptibility pattern of azoles (fluconazole, miconazole and itraconazole) among one of the most common dermatophyte isolates (Trichophyton rubrum) by disk diffusion method. A total of two hundred and forty six patients clinically suspected of dermatophytosis attending in the outpatient department (OPD) of Dermatology and Venereology of BSMMU, Dhaka, were studied from September 2018 to August 2019. All the samples of skin, nail and hair were processed for direct microscopic examination and culture. The species of dermatophytes were identified by gross colony morphology, microscopic features and biochemical tests. Antifungal susceptibility was performed by disk diffusion (Neo-Sensitabs susceptibility testing modified for Dermatophytes) method in Sabouraud’s dextrose agar (SDA) media. Out of 246 specimens 27.2% were positive by microscopy, 28.9% were positive by culture and 26.0% were positive by both microscopy and culture. Tinea cruris (32.4%) was the most prevalent clinical type among all dermatophyte isolates. Among 71 culture positive isolates, T. rubrum (71.8%) was most prevalent followed by T. mentagrophytes (24.0%) and E. floccosum (4.2%). By disk diffusion method fluconazole was found as the most resistant drug (90.2%) against T. rubrum isolates and Itraconazole was the most sensitive (80.4%). Miconazole was found as most intermediate sensitive. Bangladesh J Med Microbiol 2019; 13 (1): 20-23

Simultaneous Detection of Seven Pathogens of Cervicitis Among Young Female Sex Workers by Multiplex Real Time PCR in Dhaka, Bangladesh

The prevalence of STIs related cervicitis in Bangladesh among female sex workers (FSWs) is quite high and among them young (≤ 24 years) FSWs are more sufferers. The aim of this study was to detect infectious agents of cervicitis including Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum in SWs of aged 10-24 years from endocervical swabs by multiplex real time PCR. A cross sectional study was done in collaboration with department of Microbiology, BSMMU, Dhaka and Save the Children, Bangladesh between March to December 2017 among sex workers enlisted to receive HIV prevention services at different drop in centers (DICs) in Dhaka.Total 105 SWs of aged between 10-24 years and clinically suspected as cervicitis, were enrolled for the study. Endo-cervical swabs were collected during examination and tested in dept of Microbiology, BSMMU by multiplex PCR and other tests for aforementioned pathogens. Data were collected by face to face interview using semi-structured questionnaire and clinical examinations were done using Casco’s vaginal speculum. Among the study population, 87 (82.9%) were between 20-24 years of age. On examination, out of 105, 67 (63.8%) patients had no cervical discharge, only 8 (7.6%) had muco-purulent discharge. Out of total, 95 (90.5%) patients were mPCR positive for at least one pathogen and only 3 (2.9 %) N. gonorrhoeae isolated by culture, 8(7.6%) cases of C. trachomatis were detected by DFA and 8 (7.6%) cases of T. vaginalis were detected by wet film. Among the mPCR positive (95) cases, 63(66.3%) patients had mixed infections and among them, M. hominis was the highest (76.2%) followed by U. urealyticum (49.2%). In the patients having ‘no’ (67) cervical discharge, 32 (48%) had M. homini sinfection followed by U. parvum (40%). Majority of FSWs had mixed infection and M.hominis was the highest. A high number of patients hadno cervical discharge though it is one of the diagnostic criteria for cervicitis in current syndromic management. In comparison to other available diagnostic tests, organisms were detected efficiently by multiplex PCR and could be advised routinely in such cases of mixed infection. Bangladesh J Med Microbiol 2019; 13 (1): 4-11

Mutational Analysis of Clarithromycin and Levofloxacin Resistance in Helicobacter pylori from Gastric Biopsy Specimens in a Tertiary Care Hospital in Dhaka, Bangladesh

Background: Clarithromycin and Levofloxacin are most frequently included in the standard triple therapies for H. pylori eradication in our country. Resistance to clarithromycin and fluoroquinolones are particularly related with treatment failure. Objectives: The objective of this study was to detect, clarithromycin and levofloxacin resistance associated with gene mutations in H. pylori directly from gastric biopsies using an allele specific primer-PCR (ASP-PCR) assay. Materials and Methods: Gastric biopsy specimens were collected from 143 adult dyspeptic patients, from Department of Gastroenterology, BSMMU and Dhaka Medical College Hospital (DMCH), during the period of March, 2018 to February, 2019. H. pylori was identified by rapid urease test, ureC gene by PCR, histological staining and culture. ASP-PCR was used to identify 23S rRNA gene and gyrA gene mutation predictive of clarithromycin and levofloxacin resistant H. pylori respectively. Results: H. pylori positive cases were 32.9% based on the case definition used in the study. Among 42 ureC positive H. pylori cases, point mutations in 23Sr RNA gene for clarithromycin resistance were detected only at A2142G position in 9 (21.4%) cases and gyrA gene mutations for levofloxacin resistance were detected in 16 (38.1%) cases. Only 1 (2.4%) case had mutation both in 23Sr RNA and gyrA gene. Conclusion: Those findings may guide toward the therapeutic choices in our country. PCR based diagnostic assays can be the alternative approach for rapid detection of antibiotic resistances of H. pylori directly from gastric biopsies, where culture and susceptibility tests are not routinely performed. Bangladesh J Med Microbiol 2019; 13 (1): 12-19