INTRODUCTION:Invasive pulmonary aspergillosis (IPA) is a major cause of morbidity and mortality in patients with hematological malignancies. In recent years, testing for values of galactomannan (GM) in serum and bronchoalveolar lavage (BAL) fluid has been investigated as a diagnostic test for IPA for such patients, but global experience and consensus on optical density (OD) cutoffs, especially for BAL galactomannan remains lacking.METHODS:We performed a prospective case–control study to determine an optimal BAL GM OD cutoff for IPA in at-risk patients. Cases were subjects with hematological diagnoses who met established revised definitions for proven or probable IPA established by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group (EORTC/MSG, 2008), without the use of BAL GM results. Exclusion criteria included the use of piperacillin/tazobactam and use of antifungals that were active against Aspergillus spp. before bronchoscopy. There were two control groups: patients with hematological diagnoses not meeting definitions for proven or probable IPA and patients with nonhematological diagnoses with no evidence of aspergillosis. Following bronchoscopy and BAL, GM testing was performed using the Platelia Aspergillus seroassay in accordance with the manufacturer's instructions.RESULTS:There were 51 cases and 20 controls. Cases had higher BAL fluid GM OD indices (ODIs) (mean: 1.27 and range: 0.4–3.78) compared with controls (mean: 0.26 and range: 0.09–0.35). Receiver operating characteristic analysis demonstrated an optimum ODI cutoff of 1.0, with high specificity (100%) and sensitivity (87.5%) for diagnosing IPA.CONCLUSIONS:Our results support BAL GM testing as a reasonably safe test with higher sensitivity compared to serum GM testing in at-risk patients with hematological diseases. A higher OD cutoff is necessary to avoid overdiagnosis of IPA.
Non fermenting gram-negative bacilli (NFGNB) are recently striving as uropathogens. The present study was conducted to isolate the common species of bacteria in NFGNB causing urinary tract infection (UTI) and its correlation with comorbid conditions and to study the antibacterial susceptibility pattern. This retrospective study was done at the diagnostic Microbiology laboratory of a tertiary care hospital. Urine samples were collected for the period of six months. These samples were plated on blood agar and MacConkey agar and incubated at 37°C for 18–24 hr under aerobic conditions. Identification of NFGNB was done by Gram staining and MALDI-TOF (Matrix- Assisted Laser Desorption/ Ionization- Time of Flight, Biomerieux- Diagnostics). Antibiotic sensitivity testing was done by Vitek® 2 system (Biomerieux- Diagnostics) using N 281 card. Data was analyzed using SPSS IBM version 16. Out of the total 16,413 non repetitive urine samples that were received in the laboratory, 318 had significant bacteriuria. NFGNB were identified in 108 (33.9%) of all the urine samples with significant bacteriuria. Prevalence of non-fermenters in our study was 0.6%. NFGNB were more frequently isolated in the females and also in the age group of more than 50 years. Eighty five (78.70%) had comorbid conditions. P. aeruginosa and A. baumannii were the most common organism isolated among NFGNB. Pseudomonas aeruginosa isolates showed high susceptibility to imipenem (80.2%) and amikacin (66.6%). NFGNB although seen frequently in females and in age group of 50 years and above, clinical correlation with comorbid condition is essential to label it as uropathogens. Amikacin or imipenem may be the empirical drug of choice.
Nocardia africana is a recently identified organism and has rarely been reported to cause mycetoma. Here we report the case of a 40-year-old woman who presented with discharging sinuses and nodules for the past 7 years along with few discrete axillary lymph nodes. Cultures and Maldi-TOF MS (Matrix-assisted laser desorption/ionization–time of flight mass spectrometry) method identified the causative organism as Nocardia africana/nova. The organism was acid-fast positive on modified Ziehl-Neelsen stain and Gram's stain revealed branched filamentous beaded gram-positive bacilli, while histopathology showed granulation tissue along with few ill-defined epithelioid cell granulomas, with giant cells. Based on the sensitivity report, the patient was started on tablet moxifloxacin and cotrimoxazole, and has shown considerable improvement at 2.5 months of follow-up.
BACKGROUND Streptococcal species are the cause of a variety of skin and soft tissue infections (SSTIs) some of which are severe and can be lifethreatening. There are currently 74 species under the genus Streptococcus. Streptococcus pyogenes is the most pathogenic bacterium in the genus Streptococcus. We wanted to assess pyogenic potential of different species Streptococcus and their drug susceptibility patterns. METHODS This is a retrospective descriptive study done from Jan 2017 to Nov 2017. Total enrolled pus samples were 3300. The samples were processed conventionally and antibiotic sensitivity testing (AST) of all isolates was performed by Kirby Bauer's disc diffusion method as per CLSI guidelines. RESULTS 4.63 % were culture positive for streptococcal isolates. Among streptococcal isolates, 128/153 (83.66%) were Enterococcus species, 12/153 (7.84%) were Streptococcus pyogenes and 10/153 (6.53%) were Streptococcus agalactiae and 3/153 (1.96%) were Streptococcus pneumoniae. For all Streptococcal isolates (153), 64% (102/160) were male patients and 36% (58/160) were female patients. Drug resistance is increasing for all the streptococcal species, and resistance to even high-end drugs like vancomycin was seen to be around 7.5% in Enterococcus spp. Almost one third of the isolates of Streptococcus pyogenes were resistant to Erythromycin and Gentamicin. No resistance was seen to Linezolid in any of the Streptococcal isolates. CONCLUSIONS Streptococcus species such as S. pyogenes, S. agalactiae and Streptococcus pneumoniae are seen to be increasing in SSTIs. Bacterial isolates exhibited high to moderate levels of resistance against different classes of antibiotics. A continuous inspection should be carried out to monitor the susceptibility of these pathogens and chose appropriate regimens both for prophylaxis and treatment of surgical wound infections. There is a need to create a viable antibiotic policy and draft guidelines to prevent or reduce undirected use of antibiotics, and conserve their effectiveness for better patient management. Consistent dialogue between the microbiology department and the surgeons is required for management of such cases.
Urinary tract infections (UTIs) are the leading cause of outpatient visits and nosocomial infections worldwide resulting in increased healthcare costs. Information about the disease-associated pathogens and their susceptibility profile is of paramount importance for choosing antimicrobials and containing the alarming rise in microorganisms’ drug resistance. This study aimed to investigate the prevalence of gram-negative and gram-positive uropathogens in hospitalized adult patients, considering their sensitivity profile. The study retrospectively analyzed 2099 urine samples received from December 2019 to May 2020. The isolates were identified by standard microbiological methods, and sensitivity testing was done following the Clinical and Laboratory Standards Institute (CLSI) guidelines (2019). Out of the 2099 samples tested, 212 were positive. The vast majority of samples (97.6%) was received from women. Escherichia coli (34.9%) was the most common gram-negative pathogen, while Enterococcus spp. (15.1%) prevailed among gram-positive organisms. Among gram-negative organisms, a high susceptibility was observed for aminoglycosides (amikacin, netilmicin), nitrofurantoin, and carbapenems, while a high resistance was found towards co-trimoxazole, fluoroquinolones, and cephalosporins. We confirmed that nitrofurantoin, a traditional oral drug, still demonstrates good activity against uropathogens. Thus, there is an urgent need to study uropathogens and their susceptibility patterns to control the inadvertent use of antimicrobials and the spread of multidrug-resistant strains.
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