IntroductionDiabetic foot infection is the most dreaded complication of diabetes mellitus and the commonest cause of hospitalization and limb amputation. Identification of the causative agent responsible for diabetic foot infection and the earliest initiation of appropriate antimicrobial therapy are vital for the control and prevention of the complication of diabetic foot ulcers. Therefore, we conducted this study to determine the bacteriological profile of diabetic foot ulcers and to detect methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL) producers in our institute. MethodologyDuring the study period, samples were collected from the foot ulcers of 100 patients at the Diabetic Outpatient Department. The samples were processed according to the standard laboratory protocol, and bacterial isolates were identified. Antibiotic susceptibility testing was performed using the modified Kirby-Bauer disk diffusion technique, and results were interpreted according to the Clinical and Laboratory Standards Institute guidelines (CLSI 2016). A phenotypic test for MRSA detection was performed using cefoxitin (30 μg) disk. ResultsThe highest incidence of diabetic foot ulcers was observed in patients aged 41-50 years. There were 83 men and 17 women, with a male to female ratio of 4.882. Of the 100 collected samples, 73 were positive for microbial growth, and 27 samples showed no growth. Of the 73 positive cultures, monomicrobial infection was found in 48 patients, and polymicrobial infection was found in 25 patients. Gram-positive pathogens were isolated from 34 patients, and gram-negative microbes were isolated from 64 patients. Among all collected isolates (n=100), Staphylococcus aureus was the most predominant organism and Acinetobacter species was the least common (only two isolates). Among the gram-negative bacteria, Pseudomonas aeruginosa was predominant. All the isolated gram-positive bacteria were susceptible to vancomycin. Gramnegative bacteria were highly susceptible to colistin with the exception of Proteus species which is intrinsically resistant to colistin and it is not reported for Proteus species. ESBL producers were primarily found among Klebsiella species isolates (22.22%). Among 29 S. aureus isolates, 8 (27.5%) were found to be MRSA producers. ConclusionBased on the bacteriological profile of diabetic foot ulcers, S. aureus among the gram-positive isolates and P. aeruginosa among the gram-negative isolates were the predominant pathogens. Infections caused by multidrug-resistant bacteria such as MRSA and ESBL producers have been reported with increasing frequency. According to the antibiotic susceptibility pattern, treatment can be initiated, continued, or altered, thereby reducing morbidity in patients with diabetic foot ulcers.

Background Timely initiation of antimicrobial therapy in patients with blood stream infection is absolutely necessary to reduce mortality and morbidity. Most clinical microbiology laboratories use conventional methods for identification and antimicrobial susceptibility testing (AST) that involve biochemical methods for identification followed by AST by disk diffusion. The aim of the current study is to assess the various errors associated with direct susceptibility testing done from blood culture broth using automated AST system-Vitek-2 compact compared with the reference method of AST done from bacterial colonies. Materials and Methods The study was conducted in a tertiary care public sector 2,200-bedded hospital in South India for a period of 6 months. The study involved positively flagged blood culture bottles that yielded single morphotype of Gram-negative organism by Gram stain. A total of 120 bacterial isolates were collected that consisted of consecutively obtained first 60 isolates of Enterobacteriaceae family (30 Escherichia coli and 30 Klebsiella pneumoniae) and consecutively obtained first 60 nonfermenters (30 Pseudomonas aeruginosa and 30 Acinetobacter baumannii). Vitek-2 AST was done from these 120 blood culture broth, following the protocol by Biomerieux, and results were obtained. Then, Vitek-2 was done from colonies (reference method) using appropriate panel for Enterobacteriaceae and nonfermenters, and results were obtained. Both the results were compared. Results Nonfermenters showed a better categorical agreement of 97.6%, as compared to Enterobacteriaceae, which showed 97%. Among Enterobacteriaceae, both E. coli and K. pneumoniae showed categorical agreement of 97% each. Conclusion The procedure of AST directly from blood culture broth represents a simple and effective technique that can reduce the turnaround time by 24 hours, which in turn benefits the clinician in appropriate utilization of antimicrobials for better patient care.

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Background: Shawarma, a popular meat-based fast food could be a source of foodborne outbreak due to non-typhoidal Salmonella (NTS). A clustering of acute gastrointestinal (GI) illness following intake of chicken shawarma occurred primarily among the staff and students of a tertiary care hospital in southern India. Methods: A case-control study was conducted among 348 undergraduate medical students (33 cases, 315 controls).  Data was collected using direct interviews and a simple online questionnaire. Epidemiological associations of GI illness were evaluated at three levels of exposure namely-eating food from any restaurant, eating food from the implicated food outlet, eating chicken shawarma from the implicated outlet. Results: Of 33 cases, 26 had consumed food from a particular food outlet, 4 from other outlets, and 3 did not report eating out. Consumption of food from the suspected food outlet was significantly associated with GI illness (odds ratio 121.8 [95% CI 28.41 to 522.66]; P<0.001); all the 26 cases who had eaten from the particular outlet had eaten chicken shawarma. By comparison, only one of the 315 controls had eaten this dish. Of the 27 persons (cases as well as controls) who had consumed chicken shawarma from the outlet, 26 were ill. Culture of stool samples from 10 affected individuals and implicated food item yielded Salmonella Enteritidis. Conclusions: Meat-based shawarma is a potential source of NTS infection. Food safety authorities should enforce guidelines for safe preparation and sale of shawarmas and similar products.