BACKGROUNDInfection at or near surgical incisions within 30 days of an operative procedure, or within 1 year of an operation if a foreign body is implanted as part of the surgery is defined as a surgical site infection (SSI). They are the 2 nd most common cause of nosocomial infections. It has been estimated that SSI develops in at least 2% of hospitalised patients undergoing operative procedures. The incidence of Methicillin-Resistant Staphylococcus aureus (MRSA), extended spectrum betalactamase (ESBL) and metallobetalactamase (MBL) producing organisms have been steadily increasing over the past few years resulting in limitation of therapeutic options. MATERIALS AND METHODSIt is a descriptive study conducted from December 2014 to June 2016 at a tertiary care hospital, Bangalore. Samples were collected aseptically from the wound using sterile cotton swabs. Isolates were identified by conventional methods and their antibiogram pattern was studied by Kirby Bauer's disc diffusion method. Staphylococcus aureus when isolated was studied for MRSA using oxacillin and cefoxitin disc diffusion test. Gram-negative isolates resistant to cephalosporins and carbapenems during antibiotic susceptibility testing were studied for ESBL production using ceftazidime and cefotaxime disc diffusion test and MBL production using imipenem-EDTA combined disc test respectively using standard CLSI guidelines. All the statistical analysis was done by chisquare test using SPSS software. RESULTSOf 100 clinically diagnosed cases, 68 samples yielded growth of various bacterial isolates. 47 out of 56 cases (83.9%) from emergency surgeries and 21 out of 44 cases (47.7%) from elective surgeries were infected. Staphylococcus aureus was the most common organism isolated (32.9%) followed by Klebsiella pneumoniae (26.3%). MRSA was observed in 24% of Staphylococcus aureus isolates. ESBL production was observed in 23% of all Gram-negative isolates and MBL production was observed in 57% of all nil-fermenting Gram-negative isolates. CONCLUSIONSSIs are menacing problem for healthcare providers. The rise of MRSA, ESBL and MBL producing organisms and continuous change in the resistance pattern has made SSI a therapeutic challenge. Management of SSI involves lot of skill and treatment should be judiciously based on risk stratification. KEYWORDS SSI, MRSA, ESBL and MBL.HOW TO CITE THIS ARTICLE: Jain S, Gopi A, Samreen F, et al. Methicillin-resistant Staphylococcus aureus, extended spectrum betalactamase and metallobetalactamase production among organisms causing surgical site infections at a tertiary care hospital in Bangalore.

Fournier's gangrene (FG) is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal region and is usually secondary to polymicrobial infection. OBJECTIVESPresently, the literature regarding the spectrum of pathogens causing FG is limited. Hence, this study was undertaken to get a better understanding of (a) Microbial pathogens causing FG and (b) The clinical outcome. METHODSThe present study is a retrospective cohort study of the microbial pathogens isolated from FG patients admitted in a tertiary care centre. Data was collected from the hospital records of patients admitted with FG during June 2012 to November 2015. RESULTSA total of 55 male patients with FG were included in this study. The mean age of patient was 49.36 years. Out of 55 samples, 47-showed evidence of microbial growth, 12 samples showed mono-microbial and 35 samples showed poly-microbial growth. Among the cases included in the present study, anaerobic culture was requested for only 10 samples; 3 out of the 10 samples subjected to anaerobic culture yielded Bacteroides fragilis (B. fragilis). Klebsiella pneumoniae was the most common pathogen isolated (K. pneumoniae) (29/47, 61.70%), followed by Enterococcus faecalis (E. faecalis) (15/47, 31.91%), B. fragilis (3/10, 30%) and Escherichia coli (E. coli) (13/47, 27.65%). Gram negative organisms were highly susceptible to levofloxacin and piperacillintazobactam. Gram positive organisms were highly susceptible to linezolid (92%), vancomycin (84%) and tetracycline (68%). Major risk factors associated with FG were diabetes (43.6%) and obesity (40%). The mortality rate was 5.45%. CONCLUSIONFG is a rapidly progressive fulminant life threatening condition. Early diagnosis, aggressive surgical intervention and appropriate antimicrobial therapy may help to reduce the mortality rate.

BACKGROUND AND OBJECTIVETinea capitis is a superficial fungal infection of the hair follicle of scalp. The causative dermatophytes vary with social status and geographical distribution. The incidence is high in developing countries due to factors like poverty compounded by overcrowding, improper hygiene and illiteracy. Tinea capitis is the most common dermatophytes infection of childhood, especially in school going children. It is self-limiting disease of childhood and seldom extends beyond puberty. India being a tropical developing country with high temperature and humidity favours superficial cutaneous mycotic infections. The objective of this study was to isolate and identify the dermatophytes causing tinea capitis.

Toe web space infections are the most common superficial dermatoses of the feet. They are often unnoticed and progress to cause discomfort. There is lack of enough evidence on the microbiological profile and antifungal susceptibility pattern. Settings and Design: A prospective study was conducted between August 2015 to February 2017 in the Department of Microbiology at a tertiary care hospital. Methods and Material: 200 samples were collected from interdigital spaces of Dermatology outpatients and inpatients. Bacterial and fungal pathogens were isolated and identified using conventional laboratory techniques. Antifungal susceptibility testing was done to determine the Minimum inhibitory concentration (MIC) by E-test. A small representative sample of Fusarium isolates were subjected to speciation by PCR and their MIC was determined by broth microdilution method for comparison. Statistical analysis used: p value was determined by Chi square test using SPSS software. Results: Our study demonstrated a male preponderance of 59 %, mostly between 41 to 50 years. Both the feet were affected in 43/48 (89.5 %) of the diabetic patients, the fourth web space being commonly involved. 198/200 (99%) of the samples were positive for either bacterial or fungal growth. There were a total of 156 fungal and 204 bacterial isolates. Out of 156 fungal isolates, Candida spp 62 (39.7 %) and Fusarium spp 50 (32 %) were the most common isolated yeast and mould respectively and 38 (24.3 %) dermatophyte species were isolated. Results of E-test and broth microdilution were comparable. Voriconazole and amphotericin B had lower MIC. Out of 204 bacterial isolates, Staphylococcus aureus 56 (27.4 %) and Pseudomonas aeruginosa 44 (21.5 %) were the most common isolates. Conclusions: A good microbiological diagnosis would assist in the better alleviation of the symptoms and provide accurate treatment of web space infections.