RESUMEN
Salmonella enterica serovar typhi causes one of the most common blood stream infections, the typhoid fever. However, it can cause pyogenic infections involving different sites as well. Extensively drug resistant (XDR) strains of Salmonella typhi are resistant to all first line anti-typhoidal drugs (chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole) as well as ciprofloxacin and ceftriaxone. XDR-strains were first reported from Pakistan in 2016, and since then the strains have been spreading. These XDR Salmonella cases not only pose a therapeutic challenge but also predispose to complications as a result of prolonged illness and delayed treatment. Here, we report a case of superficial thrombophlebitis at intravenous cannula site in a 49-year male, who was being treated for XDR-typhoid fever. To the best of our knowledge, thrombophlebitis of a superficial vein is an unusual complication of Salmonella typhi, not previously reported in literature. Key Words: Bacteremia, Thrombophlebitis, Extensively drug-resistant, Typhoid fever, Salmonella typhi.
Asunto(s)
Tromboflebitis , Fiebre Tifoidea , Antibacterianos/uso terapéutico , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Pakistán , Salmonella typhi , Tromboflebitis/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol , Fiebre Tifoidea/diagnóstico , Fiebre Tifoidea/tratamiento farmacológicoRESUMEN
OBJECTIVE: To compare the disk susceptibility pattern of healthcare acquired carbapenem-resistant enterobacteraceae with that of community-acquired isolates and their associated clinical presentations. METHODS: The cross-sectional study was conducted at the Department of Microbiology, Combined Military Hospital, and the Institute of Dentistry, Lahore, Pakistan, from November 2017 to July 2018. Patients with positive carbapenem-resistant enterobacteraceae cultures from clinical specimens were included. All the isolates were identified through conventional methods and standard biochemical tests. Antibiotic susceptibility testing was performed by Kirby Bauer Disk Diffusion method on Muller Hinton Agar plates. Data was analysed using SPSS 23. RESULTS: Of the 123 isolates identified, 97(79%) were healthcare acquired and 26(21%) were community-acquired. Statistically significant susceptibility patterns (p<0.001) of community acquired isolates were observed against cefoperazone-sulbactum and amikacin, while a low significance was observed with gentamycin (p<0.05). Significant results were obtained in case of colistin against both the groups (p<0.001). CONCLUSIONS: There was low antimicrobial resistance in community acquired carbapenem-resistant enterobacteraceae isolates.
Asunto(s)
Enterobacteriaceae Resistentes a los Carbapenémicos , Antibacterianos/farmacología , Estudios Transversales , Atención a la Salud , Humanos , Pruebas de Sensibilidad Microbiana , Pakistán/epidemiología , Centros de Atención TerciariaRESUMEN
OBJECTIVE: To find out the frequency and susceptibility pattern of multi-drug resistant (MDR) Pseudomonas aeruginosa in clinical specimens. STUDY DESIGN: Cross-sectional observational study. PLACE AND DURATION OF STUDY: Department of Microbiology, Army Medical College, National University of Sciences and Technology (NUST), Rawalpindi, from January to September 2010. METHODOLOGY: Routine clinical specimens were subjected to standard microbiological procedures and the isolates were identified to the species level. The antibiotics susceptibility was determined by Kirby Bauer Disc diffusion method and the results were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: The frequency of MDR Pseudomonas aeruginosa among all the Pseudomonas aeruginosa strains isolated was found to be 22.7%. These isolates were most sensitive to Colistin followed by Piperacillin-Tazobactam and Cefoperazone-Sulbactum. CONCLUSION: Increasing fequency of infections due to MDR Pseudomonas aeruginosa is an emerging threat in our set up which an be prevented by prescribing antibiotics judiciously and by adopting proper disinfection measures.
Asunto(s)
Antibacterianos/farmacología , Pruebas Antimicrobianas de Difusión por Disco/instrumentación , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/efectos de los fármacos , Cefoperazona/farmacología , Colistina/farmacología , Estudios Transversales , Pruebas Antimicrobianas de Difusión por Disco/métodos , Inhibidores Enzimáticos , Humanos , Ácido Penicilánico/análogos & derivados , Ácido Penicilánico/farmacología , Piperacilina/farmacología , Combinación Piperacilina y Tazobactam , Pseudomonas aeruginosa/aislamiento & purificación , Sulbactam/farmacologíaRESUMEN
OBJECTIVE: To compare the accuracy of Mueller-Hinton agar and Isosensitest agar using cefoxitin disc for detecting methicillin resistant Staphylococcus aureus using mecA gene PCR assay as gold standard. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from May 2006 to January 2007. PATIENTS AND METHODS: One hundred clinical isolates of Staphylococcus aureus were evaluated; 64 MRSA (methicillin resistant Staphylococcus aureus) and 36 MSSA (methicillin sensitive Staphylococcus aureus) by mecA PCR assay. All the isolates were tested with cefoxitin 30 microg disc using semi-confluent growth on Mueller-Hinton agar as well as on Iso-sensitest agar in ambient air at 35-37 degrees C after an overnight incubation as per recommendations of Clinical and Laboratory Standard Institute. RESULTS: Following diameters provided the best sensitivity and specificity without substantial overlapping between the zones of resistant and sensitive isolates; Mueller-Hinton agar: R < or = 20 mm (sensitivity 100% and specificity 100%), S > or = 22 mm (sensitivity 97.2% and specificity 100%), and Iso-sensitest agar: R < or = 26 mm (sensitivity 100% and specificity 100%), S > or = 26 mm (sensitivity 100% and specificity 100%). High accuracy was obtained with cefoxitin disc on both media. CONCLUSION: Performance of both media was equally convincing for reliable prediction of methicillin resistance in Staphylococcus aureus by placing cefoxitin 30 microg disc on either of these in routine susceptibility testing.