RESUMEN
BACKGROUND: The dwindling antibiotic reserve owing to augmented drug-resistant bacteria is a major handicap for treating physicians. Klebsiella pneumoniae, a gram-negative encapsulated member of the Enterobacteriaceae family, is one such pathogenic bacteria. Carbapenemase-producing Klebsiella pneumoniae is globally recognized as one of the most critical bacterial threats to public health due to its extremely limited treatment options. Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections pose therapeutic challenges due to simultaneous resistance to various other groups of antibiotics. In this study, we have evaluated the synergistic effect of fosfomycinagainst CRKP isolates when used in combination with colistin by applying the Checkerboard method. METHODS: A laboratory-based prospective study was conducted in the Department of Microbiology, JSS Hospital, Mysuru, for a period of one year after obtaining ethical clearance. Klebsiella pneumoniae isolates obtained from clinical samples were screened for carbapenem resistance by the VITEK-2 compact system (bioMérieux, Marcy-l'Étoile, France). The minimum inhibitory concentration (MIC) of colistin and fosfomycin was individually ascertained by broth microdilution (BMD). Finally, the synergistic activity of the fosfomycin-colistin combination was determined by the BMD-based Checkerboard method. RESULTS: Among the 50 CRKP isolates, 36 (72%) isolates showed synergism, eight (16%) isolates showed indifference and six (12%) isolates showed partial synergism, while none of them showed additivity and antagonism by the Checkerboard method. These results are found to be statistically significant (chi-square value of 116.204 and p-value of < 0.00001). CONCLUSION: This study showed a promising in-vitro synergy between the drugs fosfomycin and colistin by Checkerboard BMD testing protocol. Colistin being a reserve antibiotic, monotherapy comes with the limitations of higher chances of resistance as well as toxicity, which can be overcome by combination therapy, thereby decreasing CRKP-associated mortality rates and delivering holistic patient benefit.
RESUMEN
Aims: Epidermophyton, Microsporum and Trichophyton are the genera of dermatophytes causing superficial mycoses. These infections are on rise due to increase in immunocompromised patients and favorable environmental conditions in countries like India. The present study was undertaken to identify dermatophytes causing superficial fungal infection by microscopy and culture techniques which helps in accurate diagnosis and appropriate treatment of cases. Methodology and results: Samples were collected from affected sites after cleaning the affected surface with 70% alcohol. All samples were microscopically examined for presence of hyphal structures by digesting in 10% to 40% KOH solution. All samples were inoculated into Sabouraud dextrose agar with chloramphenicol and Sabouraud dextrose agar with cycloheximide and chloramphenicol and incubated at room temperature for four weeks. Tease mount technique and slide culture technique were used for identification of dermatophytes. One hundred and ten samples from clinically suspected dermatophytoses which includes 77(70%) from male and 33(30%) from female patients were processed for identification of dermatophytes. Samples were subjected to microscopy and culture. In 61 samples (54.54%) fungal hyphae were seen by direct microscopic examination (KOH). Fifty six samples (50%) yielded dermatophyte growth in culture. Trichophyton rubrum was the predominant species isolated followed by T. violaceum and T. mentagrophytes. Conclusion, significance and impact of study: Accurate and rapid diagnosis of superficial fungal infection is essential for proper management of cases. Direct microscopy is very good method for routine diagnosis, however culture remains gold standard.