Antibiotic Sensitivity Pattern Research Articles

PREVALENCE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF GRAM NEGATIVE BACILLI ISOLATED FROM URINARY TRACT INFECTIONS

The aim of the study was to find out the prevalence and antibiotic susceptibility pattern of Gram negative bacilli isolated from urinary tract infections. This cross-sectional study was conducted at the department of urology Lady reading hospital Peshawar from February 2021 to August 2023. Mid-stream urine samples were collected from individual having the symptoms of urinary tract infection and were processed and identified through various biochemical tests. Following CLSI recommendations, the isolated bacteria were screened for sensitivity to antibiotics. Kirby-Bauer disc diffusion method was used in the current study. Through MS Excel, data were analyzed. The Chi-square test was applied for calculating the p value (significant i.e. <0.05) and antibiotic resistant profiles of GNB isolated from urine samples. A total of 60000 urine samples were collected in which 65% (n=3900) patients were outdoor and 35% (n=2100) were hospitalized patients. Among them 20 % (n=1200) were culture positive. Among which 58% urine samples were from outdoor patients and 42% samples were from hospitalized patients. E.coli, Klebsiella pneumonia, P. aeruginosa and Acinetobacter baumannii were the Gram negative bacilli (GNB) isolated in our study. The most prevalent (72%) GNB was E. coli. Pseudomonas aeruginosa isolated from indoor patients’ urine samples showed high resistance. The antibiotic sensitivity pattern of K. Pneumonia was same as E.coli both in out and indoor patients. The .Acinetobacter baumannii resistance pattern was quite lower observed as 85% in Nitrofurantoin (F), 80% in Ampicillin (AMP) and 11% in Fosfomycin (FOS) respectively in urine samples of indoor as compare to outdoor patient. The most prevalent GNB observed in our study were E. coli, Klebsiella pneumonia, P. aeruginosa and Acinetobacter baumannii involved in UTIS. The choice of antibiotic for its treatment were Fosfomycin, Piperacillintazobactam, Cefoperazone-sulbactam, Amikacin and Nitrofurantoin.

Incidence, Risk Factors and Microbiological Profile of Ventilator Associated Pneumonia Patients in ICU in Tertiary Care Hospital

Background: VAP, or ventilator-associated pneumonia, is one of the most common ICU-acquired diseases and a significant cause of mortality among Intensive Care Unit patients. Infectious illnesses are currently underestimated in the South Asian Region, which has limited health resources.
 Objective: To examine the incidence of VAP, risk factors associated and the microbiological profile in ICU patients in tertiary care hospitals.
 Methods: A total of 114 patients under mechanical who satisfied all inclusion criteria were selected. Detailed history, investigations were undertaken. The diagnosis of VAP was made according to clinical and laboratory findings (as per CDC criteria) and incidence was derived from the number of patients developing VAP out of the total number of patients on ventilatory support in ICU.
 Results: We included 114 patients in our study. Out of 114 patients, the majority were above 70 years age group Mean age of study population was 61.29±13.42 years. Out of 114, 80 patients i.e. 70.2% were males and 34(29.8%) were females. Male: female ratio was 2.3:1. Klebsiella Pneumonia was a commonly observed organism in cultures i.e. 30.7%, followed by Pseudomonas Aeruginosa in 27.2% and Acinetobacter Baumani in 19.3%. Antibiotic sensitivity pattern of Klebsiella Pneumonia showed resistance to Carbapenemase in 20(57.1%) cases and to ESBL in 15(42.9%) cases. Death rate in our study was 17.5%
 Conclusion: The outcome of VAP depends on rapid identification of the causative microorganism. Empirical therapy based on knowledge of the most prevalent microorganisms and their resistance pattern has an impact on lowering morbidity and mortality, shortening the length of hospital stay, lowering of treatment expenses, and prevents the development of MDR bacteria in patients with VAP.

Study of Antibiotic Sensitivity and Resistance Pattern of Bacterial Isolates in Intensive Care Unit Setup of a Tertiary Care Hospital

Study of Antibiotic Sensitivity and Resistance Pattern of Bacterial Isolates in Intensive Care Unit Setup of a Tertiary Care Hospital

A Clinical Study on Microbiological Profile in Tracheostomy Wounds.

Tracheostomy is a surgical procedure in an emergency setting to relieve the upper airway obstruction by creating an opening in the anterior part of trachea. It can also be done electively to wean off from a ventilator, during an elective surgery and clearance of pulmonary secretions. This study was a retrospective analysis of microbiological profile, antibiotic sensitivity & resistance pattern in patients with a tracheostomized wound. A retrospective review of the microbiological profiles of all adult patients who underwent a tracheostomy was conducted between May 2022 and May 2023 at our hospital. Based on the tracheostomy indications, patients were allocated under obstructed and non-obstructed group. Any patient with at least one positive sample was followed up quarterly for a year. The first culture result obtained was recorded at least one month following the last antibiotic dose in each quarter. Out of the 65 tracheal aspirate results obtained from 58 patients (mean age, 57.5 ± 16.48 years), the most common procedure and indications were surgical tracheostomy (72.4%) and non-obstructed causes (74.1%), respectively. Moreover, 47.7% of the culture results indicated Pseudomonas aeruginosa, which showed significantly different proportions across the quarters (p = 0.006). Among obstructed patients, P. aeruginosa was the most common (35%), followed by methicillin-resistant Staphylococcus aureus (MRSA; 23.5%). The colonization was predominantly by gram negative bacteria Acinetobacter species, P. aeruginosa & Klebsiella pneumoniae and fungal species like Candida albicans followed by Aspergillus niger and non-Albicans candida.

Laparoscopic Port Site Infection: A Review of Its Management of 100 Cases Studies

Introduction: The advent of laparoscopic surgery has transformed the landscape of surgical interventions, providing patients with the benefits of reduced trauma, shorter recovery times, and improved cosmetic outcomes. As this minimally invasive approach continues to gain popularity across various surgical disciplines, it is essential to address the associated challenges and complications that may arise. Aim of the Study: The aim of this study was to analyze the microbial distribution and antibiotic sensitivity patterns in laparoscopic port site infections. Methods: A prospective observational study was conducted on a cohort of 100 patients who underwent laparoscopic procedures at MH Samorita Medical College & Hospital, Hi Tech Surgicare Hospital & piles Centre, Savar Specialized Hospital, Lab Zone Hospital Savar, Dhaka, Bangladesh from Jan 2016 to Dec 2023. The study focused on identifying cases with culture-positive laparoscopic port site infections. Result: The Laparoscopic cholecystectomy being analyzed by Cholelithiasis, Acute cholecystitis, Ch. Cal. Cholecystitis, Empyema GB, and GB polyp. For Cholelithiasis, 33.3% of males and 40.5% of females had this condition. Regarding Acute cholecystitis, it was found in 20.0% of males and 16.7% of females. Majority 36.7% were 40 – 50 years in age group for male and 30.9% were in 40 – 50 years in age group for female respectively. Out of the total 100 patients in the study, 71% patients tested positive for port site infection. Conclusion: In conclusion, the insights gained from our study provide a foundation for advancing the management of laparoscopic port site infections.

Characteristics of Urinary Tract Infections and the Use of Cranberry Products in Patients With Urinary Diversions: A Narrative Review.

The aim of this narrative literature review was to summarize evidence regarding bacteriuria and urinary tract infections (UTIs) in patients living with a urinary diversion and the use of cranberry products for the prevention of these infections. We searched for articles in the English language and available in full text to address the role of cranberry products in the management of UTIs in those with urinary diversions. We searched the electronic databases of MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials between January 2003 and December 2023. Thirty-two elements were read in full and 9 elements that evaluated UTIs and/or the role of cranberries in preventing UTIs are included in this narrative review. Research indicates no significant difference in UTI rates, microbiology, or antibiotic sensitivity and resistance patterns between the different types of urinary diversions (orthoptic diversions, ileal conduit diversions, and continent cutaneous diversions). Similar to persons with an intact urinary tract, Escherichia coli (a prevalent coliform bacteria) was the most prevalent pathogen resulting in symptomatic UTIs. In addition, we found that E. coli strains persisted in urinary diversions involving reconstructed intestinal segments for prolonged periods of time despite antibiotic treatment. We found sparse evidence suggesting that cranberry products are effective for the prevention of UTIs after ileal conduit urinary diversion. There are inconsistencies in the definition of bacteriuria in the literature making it difficult to compare findings among the studies. Clinical guidance discussing the optimal method for obtaining a urine specimen from a urinary diversion and its management is limited. Research studies on the use of cranberry products to treat UTIs in persons living with a urinary diversion are urgently needed.

Are we ushering into the pre-antibiotic era: alarming trends of antibiotic resistance in chronic otitis media in a tertiary care hospital in Delhi, India

Background: Chronic otitis media is an infection of the middle ear cleft for at least 12 weeks or more. It has a high prevalence rate in India pertaining to factors like malnutrition, overcrowding and poor hygiene. Thanks to greats like Paul Ehrlich and Alexander Fleming, Antimicrobials are a powerful and readily available form of treatment for this disease. Methods: In this study we re-evaluated the changing trends in bacteriological profile of COM and the antibiotic sensitivity pattern to most of the currently available antibiotics in a tertiary care hospital in India. Results: Most common pathogens found in our study were Pseudomonas aeruginosa, Staphylococcus aureus, Proteus mirabilis, Proteus vulgaris, Enterococcus, Escherichia coli and Morganella morganii. A declining pattern in the sensitivity towards commonly used antibiotics with an alarming increase in MRSA was observed. Conclusions: The trends observed in our study warrant an urgent need for antibiotic policies, judicious use of antibiotics and vigilance in our hospitals.

Antibiotic Sensitivity Patterns in Pediatric Enteric Fever: A Cross-Sectional Study at a Tertiary Care Hospital in Bangladesh

Background: This cross-sectional study aimed to investigate the antibiotic sensitivity patterns among pediatric patients with enteric fever at the Department of Paediatrics, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, during the period from July 2005 to June 2006. The primary objective was to identify the prevalent antibiotic sensitivities in order to enhance the efficacy of treatment strategies for typhoid fever in children. Methods: Ninety-eight suspected cases of enteric fever, aged between 2 and 12 years, were selected from admissions to the above-mentioned hospital. Blood culture and sensitivity testing were performed for Salmonella typhi and paratyphi. Demographic information, pre-admission antibiotic usage, and sensitivity profiles to various antibiotics, including Ceftriaxone, Cefixime, Chloramphenicol, Ciprofloxacin, Azithromycin, Amoxicillin, Imipenem, Nalidixic acid, and Ampicillin, were analyzed. Results: The majority of patients (62.2%) were in the 5-9 years age group, and males constituted 61.22% of the study population. Blood cultures revealed 71.44% sensitivity for Salmonella typhi and 28.57% for paratyphi. Among the antibiotics tested, Ceftriaxone exhibited 100% sensitivity, followed by Cefixime (80.2%), Chloramphenicol (78.57%), Ciprofloxacin (65.20%), Azithromycin (60%), Amoxicillin (54.6%), Imipenem, Nalidixic acid (Intermediate sensitive, 56.3%), Ciprofloxacin (Intermediate sensitive, 25%), and Ampicillin (Intermediate sensitive, 18.8%). Nearly half of the patients (47.3%) received antibiotics before admission, and 43.8% of culture-positive patients had a history of pre-admission antibiotic use. Conclusion: The study concludes that understanding antibiotic sensitivity patterns is crucial for successful typhoid fever treatment in children. Ceftriaxone and Cefixime emerged as highly effective, while the unnecessary use of antibiotics prior to admission may influence sensitivity patterns. This information underscores the importance of judicious antibiotic prescribing practices to ensure optimal therapeutic outcomes in pediatric enteric fever cases.
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Bacterial Isolates from Diabetic Foot Ulcer with Antibiotic Sensitivity Pattern

A cross-sectional, descriptive study was carried out in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh, between October 2014 and September 2015, to determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcer. A total of 130 patients of diabetic foot ulcer were included in the study according to inclusion and exclusion criteria. Samples of pus were collected from those patients and sent for culture and sensitivity tests. Out of 130 cases, the highest number of patients 55(42.4%) were in 50-59 years age group. The mean age was 60.1±9.8 years. Most of the patients (70%) were male. 90(69.2%) samples yielded growth, while 40(30.8%) did not show any bacterial growth. Out of those 90 samples with growths, 112 bacteria were isolated. Of them, 59(52.7%) organisms were gram-positive, while 28(25%) were gram-negative and 25(22.3%) organisms were both gram-positive and gram-negative. Out of 59 gram-positive isolates, 35(59.3%) were S. aureus, 18(30.5%) were Enterococci, and 6(10.2%) were Streptococci. In 28 gram-negative isolates, 15(53.7%) were E. coli, 6(21.4%) were Pseudomonas, 4(14.2%) were klebsiella, and 3(10.7%) were proteus. Regarding antibiotic sensitivity, all gram-positive bacteria (100%) were sensitive to vancomycin. S. aureus was 80% sensitive to ceftriaxone, 71.4% to flucloxacillin, 65.7% to clavulanic acid, 54.2% to ampicillin, 48.5% to amoxicillin, and 28.5% to cotrimoxazole. Enterococci spp. was 61.1% sensitive to ceftriaxone, 33.3% to clavulanic acid, (27.7%) to ampicillin, and 16.6% to both amoxicillin and cotrimoxazole. Streptococcus spp. showed 83.3% sensitivity to ceftriaxone, 66.6% to flucloxacillin, 33.3% to clavulanic acid, and 16.6% to cotrimoxazole. Among gram-negative bacteria, E. coli was found to be sensitive to imipenem (100%), ceftriaxone (86%), amikacin (100%), cefuroxime (73.3%), ampicillin (33.3%), ciprofloxacin (60%), and gentamycin (60%). Pseudomonas was found to be sensitive to imipenem (50%), ceftriaxone (66.6%), amikacin (83.3%), and cefuroxime (66.6%). Klebsiella was found to be sensitive to imipenem (100%), ceftriaxone (75%), amikacin (75%), cefuroxime (50%), and ciprofloxacin (25%). Proteus was found to be sensitive to imipenem (100%), ceftriaxone (66.6%), amikacin (66.6%), cefuroxime (33.3%), ciprofloxacin (66.6%), and gentamycin (66.6%). CBMJ 2024 January: vol. 13 no. 01 P: 89-94

Detection of phylogrouping, adhesin, and extended spectrum β-lactamases genes in hospital acquired uropathogenic Escherichia coli isolates.

It has been interesting to compare the levels of antimicrobial resistance and the virulence characteristics of uropathogenic Escherichia coli (UPEC) strains of certain phylogenetic groups. The purpose of this study was to identify the frequency of phylogenetic groups, adhesin genes, antibiotic sensitivity patterns, and extended spectrum-lactamases (ESBLs) genes in hospital-acquired UPEC. After UPEC isolation, the disc diffusion method was used to assess its susceptibility to antibiotics. Combination disc testing confirmed the existence of ESBL producers. Polymerase chain reaction (PCR) was used to detect genes for adhesin and ESBLs. One hundred and twenty-eight E. coli were isolated which had the highest resistance to tetracycline (96%) followed by cefoxitin (93%), cefepime (92%), ceftazidime (79%), aztreonam (77%) and sulfamethoxazole-trimethoprim (75%). About 57% of isolates were phenotypically ESBLs positive and they were confirmed by PCR. B2 phylogroup (41%) was the most frequent in E. coli isolates then group D (30%), group A (18%), and lastly group B1 (11%). ESBLs genes were more significantly prevalent in phylogroups B2 and D than other phylogroups (P < 0.001). Regarding adhesin genes, both fim H and afa were more significantly associated with group B2 than other groups (P < 0.009, < 0.032), respectively. In ESBL-positive isolates, both genes were more significantly detected compared to negative ones (P < 0.001). Phylogroups B2 and D of UPEC are important reservoirs of antimicrobial resistance and adhesion genes. Detection of ESBL-producing E. coli is important for appropriate treatment as well as for effective infection control in hospitals.

Prevalence of bacterial isolates and change in their antibiotic susceptibility patterns in urinary tract infections- A five year retrospective study

Urinary Tract Infection (UTI) continues to be one of the commonly occurring infections in medical practice despite the widespread availability of antibiotics. Presence of risk factors like elderly age, diabetes, immune-suppression, and other comorbidity pose a challenge in its treatment. Over the years, the etiology and antibiotic resistance of the uropathogens has been inconsistent. Therefore, it is important to determine the causative agents of UTI and their resistance patterns locally, in each region, so that appropriate empiric therapy can be started before the culture and antibiotic sensitivity results are available. This study aims to highlight the prevalence of uropathogens and determine the antibiotic sensitivity pattern over the period of five years.The urine samples from patients with suspected urinary tract infections (UTI) received in the laboratory at Nanavati Max Super speciality hospital were processed by standard protocol from January 2018 to December 2022. Antibiotic susceptibility test for the bacterial isolates was carried out by the VITEK2 automated system and interpreted as per CLSI guidelines. The data collected over the study period of five years was interpreted by using the WHO Net Antibiotic Susceptibility Surveillance Software in February 2023. From a total of 8068 urine samples received over five years, uropathogens were isolated in 4209 (52.16%) samples. E.coli was the most common isolate causing UTI, with prevalence of 380(46.7%) in 2018 and 480(50.6%) in 2022 of total samples. Amongst gram positive organisms, a rise in Enterococcus species was seen from 41(5%) in 2018 to 87(9%) in 2022, with significantly fewer Staphylococcus species isolated, from 32(4%) in 2018 to 7(0.7%) in 2022. The Enterobacteriaceae showed high sensitivity to Amikacin, Tigecycline and Meropenem all throughout the study. However, rise in resistance to Nitrofurantoin and Fosfomycin, antibiotics commonly used for UTIs, was observed. Also the prevalence of Extended Spectrum of Beta lactamase (ESBL) producers decreased from 213(36%) to 127(17%) with a rise in Carbapenemase producing Enterobacteriaceae from 48(8%) to 298(40%) over the five years study period.Amongst Lactose Nonfermenting gram negative bacilli only 32 % were sensitive to Carbapenems and 37% sensitive to Aminoglycosides.By 2022, Enterococcus species showed an increase in sensitivity to Nitrofurantoin (27%), High level Aminoglycosides (37%), Fluoroquinolones (25%) and Ampicillin (37%).The change in antibiotic sensitivity patterns over time and rise in resistance to antibiotics commonly used in empirical treatment of UTIs warrants the need for regular surveillance, so the physicians can be updated regarding the most prevalent organism and its susceptibility and the empirical treatment for UTIs can be modified accordingly. This can help curb indiscriminate use of antibiotics and development of antibiotic resistance.

Bacterial Isolation from Wound Swab and Pus with their Antibiotic Susceptibility Pattern in a Tertiary Care Hospital of Bangladesh

Background: Wound infection is a global health problem, plays an important role in development of chronicity, delaying wound healing associated with long hospital stay. Objective: This study was aimed to identify the bacterial pathogens present in infected wounds and characterize their resistance profile to the most common antibiotics used in the therapy. Methods: This observational study was conducted from January, 2023 to June, 2023 in a tertiary care hospital in Dhaka, Bangladesh. A total of 220 wound swabs and pus samples were collected from the outpatient and inpatient department of this hospital with skin and soft tissue infection. Samples were inoculated on appropriate media and cultured and the isolates were identified by standard procedure as needed. Antimicrobial susceptibility testing was done by disc diffusion method according to ‘The Clinical Laboratory Standard Institute Guidelines’. Results: Out of 220 cases 165(75%) were Male and 55(25%) were female. Majority of the patients 77(35%) were in the age group of 21-31 years. Of the total 220 isolates, 156(70.91%) were culture positive cases. Among the isolated organisms, predominant bacteria was Pseudomonas spp 76(48.22%) followed by Klebsiella 27(17.31%), Escherichia coli 19(12.18%), Proteus 13(8.33%), Staphylococcus aureus 12(7.69%) and Acinetobacter 9(5.77%). Among the gram negative isolates, Pseudomonas was highly sensitive to colistin(88.15%), followed by piperacillin-Tazobactam(77.63%)and Imipenem(50%) and low sensitivity found in ceftriaxone(14.47%), Amoxiclav(13.16) and Clotrimoxazole (13.16%). Klebsiella found sensitive to colistin (90.47%), Piperacillin-Tazobactam (85.71%), Imipenem (76.19%), Gentamycin (71.43%). Escherichia coli shows low sensitivity to almost all the drug except Imipenem (94.74%), Piperacillin-Tazobactam (84.21%) and colistin(84.21%). Stapylococcus aureus show sensitivity to linezolid (100%), vancomycin (91.67%) and Ciprofloxacin (61.67%). Conclusion: Antibiotic sensitivity pattern of various isolates will guide for appropriate selection of the antibiotic against wound infection and reduce the spread of resistance bacteria. Bangladesh Heart Journal 2024; 39(1): 38-43

Pathogen-wise Clinical Profile, Outcome and Antibiotic Sensitivity Profile of Septic Newborns in Level III Neonatal Intensive Care Unit of a Tertiary Teaching Hospital: A Retrospective Study

Introduction: Culture positive sepsis remains to be a leading cause of death in Neonatal Intensive Care Unit (NICU) mainly among preterm and low birth weight newborns. The objective was to analyze the initial signs of sepsis, antibiotic sensitivity, and outcome of septic newborns in NICU. Methods: The demographic data, initial clinical features at suspicion of sepsis, diagnosis, laboratory abnormalities, pathogen isolated and antibiotic sensitivity patterns of the septic neonates, and their outcome were documented from their case records. Results: A total of 161 culture positive septic newborns, 76.4% were preterm and 54 died of sepsis (33.54%). Early and late onset sepsis was seen in 56 and 109 neonates, respectively. The initial clinical findings at suspicion of sepsis which had a statistical significance were tachycardia in Escherichia coli and Pseudomonas sepsis, hyperglycemia in Burkholderia, fever in Candida, sclerema in Klebsiella pneumoniae (KP), and seizures in E. coli sepsis. The cerebrospinal fluid culture positive newborns commonly presented with apnea, poor perfusion, and lethargy. Raised C reactive protein was seen in a higher proportion of newborns with Candida (60%) sepsis and E. coli (50%) sepsis. Severe thrombocytopenia was seen in 53%–62% newborns with gram-negative and fungal sepsis. Metabolic acidosis was seen in all gram-negative sepsis neonates, particularly in &gt;80% cases of Klebsiella and Candida sepsis. Mortality was highest and statistically significant in KP (55.4%) and Citrobacter koseri (55.6%) sepsis ( p = .004). The statistically significant risk factors for mortality included neonates with raised C Reactive Protein (CRP). Most of the gram-negative pathogens were sensitive to colistin and aminoglycosides and resistant to carbapenems. Conclusion: Observing the initial clinical features at suspicion of sepsis may help predicting the likely pathogen awaiting the final blood/CSF culture report and knowing the antibiotic sensitivity profile of commonly isolated organisms in our NICU helps in the selection of a rational empirical antibiotic.

Diagnostic validation study of rapid urinary tract infection diagnosis kit at peripheral health facilities of West Bengal, India

Patients reporting to the outpatient departments of peripheral health care settings in India with symptoms of urinary tract infection (UTI) receive one or the other antibiotic before culture confirmation and out of the total culture confirmed UTI cases, in less than one third cases the prescribed antibiotics matches to the antibiotic sensitivity test result. Hence, in this study, an indigenous point-of-care (POCT) rapid diagnostic kit (Rapidogram) for UTI was validated against conventional urine culture and sensitivity to understand its possible applicability at peripheral health care settings. This cross-sectional study was conducted during November 2021 to June 2022 in OPDs of two peripheral hospitals. A sample size of 300 was calculated using prevalence of urinary tract infection (UTI) as 33% for sensitivity and specificity using Buderer’s formula. Urine specimens were collected following standard aseptic procedures from the recruited suspected UTI cases and transferred to laboratory maintaining the cold chain. The validation work up was done in two sections: lab validation and field validation. Out of 300 urine samples, 29 were found positive for the growth of UTI pathogen by both methods and 267 were found negative by both methods. Thus, the kit shows very high specificity (99.6%; 97.9–99.9%) and considerably high sensitivity (90.6%; 74.9–98.0%). We also observed higher PPV, NPV, test accuracy (> 96%). Diagnostic Odds Ratio and Youden index were respectively 2581 and 0.89. Clinical data showed that 44% of the suspected UTI cases were prescribed at least one antibiotic before urine test. Mostly they received Norfloxacin whereas the mostly identified organism E.coli was sensitive to Nitrofurantoin. In the context of absence of microbiology facility at peripheral setting and rampant empirical use of antibiotics in UTI, this highly specific and sensitive POCT for UTI may be used as it not only identifies the organism, also shows the antibiotic sensitivity pattern.

Microbial Profile and Antibiotic Sensitivity Pattern in Urinary Tract Infections among Children Attending a Tertiary Care Center, Idukki District, Kerala: A Cross-sectional Study

Introduction: Over the recent decades, the importance of Urinary Tract Infections (UTI) has been increasingly recognised in children. The occurrence of UTI during childhood may lead to acute and/or chronic consequences, such as impaired renal function, renal scarring, and hypertension. Due to the irrational use of antimicrobials, multidrug resistant bacterial strains are frequent. Hence, there is an urgent need for continuous surveillance of the microbiological profile of UTI. Aim: To investigate the microbial profile and antibiotic sensitivity pattern from the urine of paediatric patients suspected to have UTI in Idukki district, Kerala and to explore its association with seasonal variations. Materials and Methods: This clinical cross-sectional study was conducted in Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Idukki, Kerala, India, from January 2019 to December 2021. The study involved 882 paediatric patients in the age group 0-15 years with symptoms and signs suggestive of UTI. Data regarding age, gender, season, laboratory and culture results, and antibiotic sensitivity pattern were considered as variables of interest. Analysis was performed using mean and standard deviation for quantitative variables, and frequency and proportion for categorical variables. The statistical analyses were conducted using Statistical Package for Social Sciences (SPSS) version 20.0 and Microsoft Excel 2010. Results: The study involved 882 patients, of which 399 were males (45.2%) and 483 were females (54.8%) with a male-tofemale ratio of 0.8:1. The mean age of patients was four years, and a peak incidence was observed in children in the age group of 1-3 years, with 333 (37.8%) children. Microbial growth was observed in the urine of 325 (36.8%) patients. After excluding normal commensal perineal flora and insignificant bacteriuria, 233 samples had significant growth, with males accounting for 106 (45.5%) and females 127 (54.5%). The male-to-female ratio was 0.8 to 1. These samples mostly exhibited growth of aerobic bacteria (232, 99.6%) and Candida albicans (1, 0.4%). E. coli (106, 45.5%) was identified as the most predominant aetiological agent for paediatric UTI. Conclusion: The results of this study suggest that it would be advisable for paediatricians in Idukki district to refrain from using Ampicillin to treat cases suspected to have UTI. Preventive measures should be advised to all patients, with emphasis on urinary hygiene during the monsoon and winter seasons.

Microbiological Evaluation of Paediatric Chronic Haematogenous Osteomyelitis in a Tertiary Care Hospital in Northern India and its Association with Radiological Appearance: A Retrospective Study

Introduction: Chronic osteomyelitis in the paediatric age group is a frequent complication of improperly treated acute haematogenous osteomyelitis, leading to devastating complications such as pathological fractures and deformities in affected children. There is a growing need to comprehend the disease process and develop improved treatment strategies. Aim: To evaluate bacterial culture and antibiotic sensitivity patterns in children and adolescents with chronic haematogenous osteomyelitis in North India and to explore associations between radiological patterns and antibiotic sensitivity. Materials and Methods: The present retrospective study was conducted in the Department of Orthopaedics of tertiary care centre, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, North India, from July 2018 to June 2020. Total 100 children and young adolescents with chronic osteomyelitis who reported to OPD of hospital with pus discharge from an extremity persisting for more than six weeks, along with radiological features indicative of chronic osteomyelitis. Parameters such as site of infection, illness duration, blood parameters, bacteriological culture reports, etc., were examined. Radiological evaluation was performed using the Beit CURE (BC) classification. Data were analysed and represented in the form of frequencies and percentages. The Chi-square test was used to compare proportions, with significance set at p-value&lt;0.05. Results: The median age of the study population was 13 years, there were 32 (32%) females and 68 (68%) males. The majority of cases (70%) belonged to the B1-B3 group. Staphylococcus aureus was responsible for 86 (86%) cases, followed by Pseudomonas aeruginosa in 7 (7%) cases. Out of the 86 Staphylococcus aureus (S. aureus) isolates, 58 (67.44%) were Methicillin-resistant Staphylococcus aureus (MRSA). Multidrug resistance was observed among gram-negative species, as well. Pseudomonas aeruginosa showed resistance to fluoroquinolones in 4 (57%) cases, aminoglycosides in 2 (28%) cases, and carbapenem in 1 (14%) case, which is considered highly effective in treating serious infections caused by multidrug resistant Gram-negative species. No significant association was found between drug sensitivity patterns and radiological features in the present study. Conclusion: Staphylococcus aureus remains the most predominant organism isolated from deep tissue cultures. Among S. aureus isolates, MRSA was the most frequently identified. Identifying the causative organism may be challenging in some cases. Among cases where the offending microbe was identified, drug resistance was widespread among both Gram-negative and Gram-positive specimens. No significant relationship was found between the radiological appearance of infected bone and the pattern of antibiotic resistance.

Current Status of Drug-resistant Patterns of Gram-positive Clinical Isolates Collected from Renowned Diagnostic Centers of Dhaka, Bangladesh

Background: Antimicrobial resistance is a serious concern and life threat in public health globally. Gram-positive clinical isolates are one of the leading etiological agents showing drug resistance traits. This study aimed to detect the antimicrobial resistance pattern of clinically isolated Gram-positive bacterial isolates collected from various renowned diagnostic centers of Dhaka city, Bangladesh. Methods: A laboratory-based cross-sectional study was conducted at the Microbiological Laboratory of the Department of Microbiology, Stamford University Bangladesh. A total of 104 clinical specimens (wound swab, pus, blood, urine, ear discharge, nasal swab, sputum, nipple discharge, breast milk, catheter tip, umbilical swab, and throat swab) from different age groups were collected from some renowned diagnostic centers of Dhaka city for analyzing the cultural and drug sensitivity patterns from January 2023 to April 2023. According to the study plan, only the Gram-positive bacteria were collected and transported to the laboratory of the Department of Microbiology, Stamford University Bangladesh following WHO guidelines, and the antimicrobial susceptibility tests were carried out by Kirby–Bauer disk diffusion method and the results were interpreted as per CLSI guidelines, 2022. Results: This study highlights the presence of Staphylococcus aureus (65.4%), Streptococcus spp. (23.1%), and Enterococcus spp. (11.5%) as causative agents of Gram-positive bacterial infections from overall 104 clinical specimens. Most of our isolates were found multidrug-resistant. For S. aureus isolates, cefixime (100%); for Streptococcus spp., doxycycline (95.83%); and for Enterococcus spp., amoxicillin (100%), cefixime (100%), colistin (100%), and cotrimoxazole (100%) were found to be the most ineffective drug when compared to other antibiotics. Conclusion: Our study portrayed the remarkable antibiotic resistance feature of Gram-positive bacterial isolates which is a matter of public health concern. It is necessary to carry out a continuous assessment of antibiotic sensitivity patterns of resistant Gram-positive bacteria; otherwise, it will become an uncontrollable problem not only in Bangladesh but also worldwide in the near future.

Genetic characterization of virulence and extended spectrum β-lactamase producing genes of Klebsiella pneumoniae isolated from bovine milk.

Mastitis associated Klebsiella pneumoniae species were isolated from bovine milk to characterize virulence genes (wabG and kfuBC) and extended spectrum β-lactamase (ESBL) genes (blaCTX-M-1, blaCTX-M-2, blaCTX-M-9, blaTEM, blaSHV and blaOXA). A total number of 325 bovine milk samples (195 raw and 130 mastitic milk specimens) collected from Banaskantha, a milk-shed district of Gujarat, India, were included in the study. A total number of 27 K. pneumoniae isolates were recovered, consisting of 17 (62.96%) isolates from raw milk and 10 (37.03%) isolates from mastitic milk samples, giving an overall prevalence of 8.31%. Antibiotic sensitivity patterns revealed that 20 out of 27 isolates were found to be multi-drug resistant. Based on combination disc diffusion test and HiCrome ESBL agar method, 20 (74.07%) and 25 (92.59%) isolates were detected as ESBL producers, respectively. Among virulence genes studied, presence of wabG (25/27; 92.59%) was higher than kfuBC (5/27; 18.51%). Beta-lactamase genes viz., blaSHV, blaTEM and blaCTX-M-1 were detected in 23/27 (85.18%), 3/27 (11.11%) and 2/27 (7.40%) of isolates, respectively; while, none of the isolates was found to be positive for blaCTX-M-9 and blaOXA-1 genes. Outcome of the study provided an insight into virulence genes and ESBL producing K. pneumoniae isolated from bovine milk samples in India.

Bacteriuria Among Type 2 Diabetes Mellitus Patients Attending Ejisu Government Hospital in the Ashanti Region, Ghana.

Type 2 diabetes mellitus (T2DM) patients are at increased risk of infections, such as malignant otitis externa and rhinocerebral mucormycosis, with the urinary tract being the most affected (for example, emphysematous pyelonephritis commonly caused by Escherichia coli). Hence, this study assessed the prevalence of bacteriuria and antibiogram patterns of bacteria isolates among T2DM patients visiting the Ejisu Government Hospital in the Ashanti Region, Ghana. In this cross-sectional study, 58 patients visiting the hospital for routine healthcare were conveniently recruited after obtaining informed consent. Data on sociodemographic characteristics and medical history were obtained using pretested structured questionnaires. Mid-stream urine was collected for bacteria isolation and identification using standard bacterial culture and biochemical tests. Bacteria cultures ≥ 105 CFU/mL were considered significant bacteriuria. The antibiotic sensitivity patterns of the bacteria isolates were evaluated using the Kirby-Bauer disc diffusion method. Bacteriuria was recorded among 15.5% (9/58) of the patients, mainly those with no previous history (77.8%) and no symptoms (55.6%) of urinary tract infections (UTIs). E. coli (55.6%) and Klebsiella spp. (44.6%) were primarily isolated from the T2DM patients. All the bacteria isolates (E. coli and Klebsiella spp.) demonstrated the highest resistance to co-trimoxazole and tetracycline (55.6%) and a complete susceptibility to amikacin and levofloxacin (100%). However, 60% of the E. coli isolates and 25% of the Klebsiella isolates were multidrug resistant (MDR; resistant to at least one antibiotic agent in three or more antimicrobial categories). The study shows that T2DM patients have bacteria in their urine which are resistant to most common antibiotics, even among those with no history of UTIs; hence, routine bacterial culture and antibiotic sensitivity testing among T2DM patients is recommended for better patient management to reduce the co-morbidities of UTIs.

Prevalence of extended-spectrum beta-lactamases producing isolates obtained from patients of pediatric critical care unit in a tertiary care hospital

Background: Over the past decades, antibiotic-resistant Gram-negative bacteria commonly Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae have increased significantly. These microorganisms have great clinical importance because they increase hospital stay of the patients in the intensive care unit (ICU) leading to high morbidity and mortality. Because of their role in increasing morbidity and mortality, this study was performed to isolate extended-spectrum beta-lactamase (ESBL) producing Gram-negative bacilli screened by phenotypical method and further projected into molecular characterization by polymerase chain reaction. Aims and Objectives: The aims and objectives are to isolate the Gram-negative multidrug-resistant strains from clinically suspected bacterial infections in patients of neonatal, sick newborn, and pediatric ICU and to study antibiotic sensitivity pattern of isolated Gram-negative multidrug-resistant strains with special reference to molecular characterization. Materials and Methods: A total of 100 Gram-negative bacilli were isolated. Screening of ESBL positivity was done by double-disk synergy test (combined disc test method). Their antibiogram profile was interpreted. With the use of designed primers, 26 ESBL isolates each of E. coli and Klebsiella spp. were processed for molecular analysis of beta-lactamase family genes TEM and CTX-M. Results: Within the 100 samples, majority of the isolates (45%) were Klebsiella spp. and 40% was E. coli isolates. Highest ESBL-producing organisms were observed within E. coli (65%). Prevalence bla-TEM gene was highest followed by bla-CTX-M. These ESBL-producing organisms were found to be resistant to multiple classes of antibiotics. With extensive ESBL surveillance and proper usage of antibiotics, this threatening rise of antibiotic resistance can be mitigated. Conclusion: Gram-negative isolates showed high resistance to commonly used antibiotics. Significant proportions of them were MDR strains. Such high antibiotic resistance is associated with significant morbidity and mortality among pediatric population. MDR along with possession of ESBL associated resistance genes among Gram-negative bacilli pose a serious problem in therapeutic management of patients. Our study signifies that there is a high probability of Gram- negative bacilli to be multi-drug resistant and ESBL positive and earliest detection of such cases should be made.