Antibiotic Sensitivity Pattern of Carbapenem-Resistant Pseudomonas Aeruginosa

Objective: To determine the sensitivity of Carbapenem-resistant Pseudomonas aeruginosa (CARP) with the panel of antibiotics according to Clinical and Laboratory Standards Institute (CLSI) 2020 guidelines. Study Design: Cross-sectional study. Duration and Place of Study: Armed Forces Institute of Pathology, Rawalpindi from Pakistan, Apr to Sep 2020. Methodology: All samples received at the Microbiology Department during the study period were included. Various samples such as blood, pus, sputum, Endobronchial washing (EBW), non-directed bronchial lavage (NBL), tissue and urine were processed in the laboratory. Samples were inoculated on appropriate culture media, and bacteria were identified according to their colony morphology, Gram staining characteristics and biochemical tests. Antibiotic susceptibility testing was performed using the Kirby Bauer Disk Diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) 2020 guidelines. However, for susceptibility to Colistin, the agar dilution method was performed. Results: In our study, fifty-five Carbapenem-resistant Pseudomonas aeruginosa were isolated. Out of these fifty-five isolates,thirteen (23.6%) were sensitive to Tazocin, seven (12.7%) were sensitive to Ceftazidime, fourteen (25.4%) were sensitive to Gentamicin, 7(12.7%) were sensitive to Cefepime, (12.7%) to Aztreonam, 10(18.2%) were sensitive to Amikacin, 7(12.7%) to Ciprofloxacin, 6(11%) to Levofloxacin and forty-two (76.4%) were sensitive to Colistin. Conclusion: The susceptibility of Carbapenem-resistant Pseudomonas aeruginosa to all the antibiotics tested in this study was low. Isolates displayed the highest susceptibility to Colistin.Keywords: Antibiotic susceptibility profile, Carbapenems, Carbapenem-resistant Pseudomonas aeruginosa (CRPA), Disk diffusion technique.

Molecular Detection of Chlamydia Trachomatis in Patients with Pelvic Inflammatory Disease Visiting a Tertiary Care Hospital in Pakistan

Objective: To detect the frequency of Chlamydia trachomatis in urine samples of women with Pelvic Inflammatory Disease visiting a tertiary care hospital using a Polymerase Chain Reaction assay and find an association between different risk factors. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Army Medical College/National University of Medical Sciences Rawalpindi Pakistan, from Mar 2018 to Jan 2019. Methodology: Over eleven months, 60 diagnosed urine samples of married females with pelvic inflammatory disease between the ages of 14-49 years were included in the study. DNA of Chlamydia trachomatis from urine samples was extracted manually using the commercially available kit. It was detected by performing a real-time Polymerase Chain Reaction assay using a forward primer (5’-CATGAAAACTCGTTCCGAAATAGAA-3’) and a reverse primer (5’-TCAGAGCTTTACCTAACAACGCATA-3’) of sequence mentioned above for amplification of target sequences, of the Chlamydia trachomatis. Results: Out of sixty cases included in this study, Chlamydia trachomatis DNA was detected in 12 cases (20%), and 48 cases (80%) were negative. So, the frequency of Chlamydia trachomatis in our study population was estimated at 20%. In addition, age, socioeconomic status, education and no of sexual partners were all risk factors were evaluated for their role in acquiring infection. Conclusion: Females having Chlamydia trachomatis infection and other sexually transmitted infections are at an increased risk of developing Pelvic Inflammatory disease due to the presence of risk factors and the asymptomatic nature of the disease.

MULTIPLEX POLYMERASE CHAIN REACTION (PCR) FOR THE DETECTION OF NEISSERIA GONORRHOEAE AND THE QUINOLONE RESISTANCE GENE IN PAKISTAN

Objective: To detect Neisseria gonorrhoeae from the urine of male patients reporting with active urethral discharge using multiplex polymerase chain reaction (PCR). And the simultaneous detection of the quinolone resistance determining region (QRDR) on the Neisseria gonorrhoeae gene using multiplex polymerase chain reaction. Study Design: Cross sectional study. Place and Duration of Study: Microbiology department, Army Medical College Rawalpindi Pakistan, from Mar to Dec 2018. Methodology: Male patients with active urethral discharge with no past history of antibiotic use for urethral discharge were included in study and patients without active urethral discharge and history of antibiotic use for urethral discharge were excluded. Urine of patients of active urethral discharge was collected and multiplex polymerase chain reaction was done by using two forward primers along with common reverse primer. Results: In this study 24 (40%) of patients who presented with active urethral discharge were positive for gonorrhea. However Quinolone Resistance Determining Region is detected in 17 (70.83%) of cases and only 7 (29.17%) were sensitive to ciprofloxacin. Conclusion: The multiplex polymerase chain reaction is very efficient and effective method for the simultaneous detection of Neisseria gonorrhoeae and status of isolate susceptibility to ciprofloxacin. And in Pakistan ciprofloxacin cannot be used as first line drug for the treatment of gonorrhea.

Efficacy of Antimicrobials Against Multidrug-Resistant Acinetobacter baumannii from Patients in a Tertiary Care Hospital

Introduction: In just two decades Acinetobacter baumannii has attained considerable importance, evolving from an insignificant organism to a leading pathogen especially in intensive care unit settings globally. Treatment options are already very limited and have almost run out due to the rapid emergence of antimicrobial resistance. Evaluation of antimicrobials that are currently in use to determine their effectiveness against multidrug-resistant (MDR) strains and developing newer options is of utmost importance. We thus set out to determine the efficacy of routinely used antibiotics against MDR A. baumannii. Materials and Methods: This was a cross-sectional study conducted at the Department of Microbiology, Army Medical College, National University of Medical Sciences (Rawalpindi, Pakistan) from December 2015 to June 2016. The organisms were identified on the basis of colony morphology, gram staining, catalase, oxidase, motility test, and API (analytical profile index) 20NE. The organisms were considered to be MDR when the isolate was found to be resistant to at least one agent in more than three antimicrobial groups. Antibiotic sensitivity was determined using the modified Kirby-Bauer disc diffusion method according to Clinical Laboratory Standards Institute (CLSI) guidelines. Results: The 77 isolates were found to have good sensitivity to tigecycline (94.8%) and minocycline (80.5%). Most of the isolates were resistant to other routinely used antibiotics. Conclusion: A few antibiotics, tigecycline and minocycline, are still effective against these MDR A. baumannii. We need to remain up to date regarding the efficacy of antibiotics to effectively treat patients with these MDR bacteria.

The Role of Visual Merchandising in Impulse Buying Behavior: An exploration from the lens of young adult consumers

The study was conducted to identify the relationship between young adult consumer’s impulse buying behavior and visual merchandising. Five techniques of visual merchandising which are window display, store layout, lighting, promotional signage and brand name was considered in the study to determine the effect. A convenient sampling technique was used to gather data. The young adult consumer’s including male and female (N=290, age range between 16 to 35 years) was considered for data gathering. To study the variables, questionnaire is adapted from different author’s (Rook & Fisher, 1995),(Bhalla & Anuraag, 2010),(Wanninayake & Randiwela, 2007),(Dua & Karolia, 2008),(Bhatti & Latif, 2014). Stepwise regression showed that five dimensions of visual merchandising window display, store lay out, lighting, promotional signage and brand name effect young adults consumers’ impulse buying behavior directly. Findings also indicate that Visual merchandising has turned out to be an essential variable nowadays to attract consumers and to increase sales.

Implications of direct amplification for measuring antimicrobial resistance using point-of-care devices

Antimicrobial resistance (AMR) is recognized as a global threat to human health. Rapid detection and characterization of AMR is a critical component of most antibiotic stewardship programs. Methods based on amplification of nucleic acids for detection of AMR are generally faster than culture-based approaches but they still require several hours to more than a day due to the need for transporting the sample to a centralized laboratory, processing of sample, and sometimes DNA purification and concentration. Nucleic acids-based point-of-care (POC) devices are capable of rapidly diagnosing antibiotic-resistant infections which may help in making timely and correct treatment decisions. However, for most POC platforms, sample processing for nucleic acids extraction and purification is also generally required prior to amplification. Direct amplification, an emerging possibility for a number of polymerases, has the potential to eliminate these steps without significantly impacting diagnostic performance. This review summarizes direct amplification methods and their implication for rapid measurement of AMR. Future research directions that may further strengthen the possibility of integrating direct amplification methods with POC devices are also summarized.

Unusual behavior in children--foreign object in tooth: a report of two cases

Background

The chance of discovering foreign object in a root canal is more commonly seen in children. Foreign objects may act as a potential source of infection, which may hinder the complete debridement of root canal. Although the main etiology being an accidental insertion, there are other possibilities such as self-injurious habits which should be ruled out.

Case Details

The present article describes two case of foreign object in root canal, their possible etiology and management modalities. The first case reports a usual case of staple pin in root canal of primary teeth. The second case was a broken pin inside anterior permanent teeth. The cases reported highlight the need for proper diagnosis and early management.

Conclusion

This case report highlights the need for proper understanding of the etiology in management of foreign body in root canal system.