Frequency and Antibiogram of Isolates from Surgical Units of a Tertiary Care Hospital in Quetta

OBJECTIVE

To determine the frequency and antibiogram of the isolates from infected patients in surgical units of a tertiary care hospital.

STUDY DESIGN

Cross-sectional, descriptive study.

PLACE AND DURATION OF STUDY

Department of Microbiology, Combined Military Hospital, Quetta, from March to October 2015.

METHODOLOGY

Clinical samples from the surgical units received in Department of Microbiology for culture and sensitivity were analyzed by Gram stain, culture and biochemical tests for identification of the isolates; and the antibiotic susceptibility was determined by modified Kirby Bauer disc diffusion method. Data was analyzed by Statistical Package for Social Sciences (SPSS) version 19.

RESULTS

The commonest isolate was Acinetobacter baumannii (22%) followed by Escherichia coli (20%), Pseudomonas spp. (15%) and Methicillin-resistant Staphylococcus aureus (MRSA) (11%). Acinetobacter baumannii showed highest susceptibility to doxycycline (41%), Enterobacteriaceae to meropenem (96%), Pseudomonas spp. to polymyxin-B (100%) and Gram positive bacteria to linezolid (100%). Seventy-two percent of the isolates were found to be multi-drug resistant.

CONCLUSION

There was a high infection rate in surgical patients with Acinetobacter baumannii, Eschericia coli, Pseudomonas spp. and MRSA being the commonest isolates. Acinetobacter baumannii showed highest susceptibility to doxycycline, Enetrobacteriaceae to meropenem, Pseudomonas spp. to polymyxin-B and Gram positive bacteria to linezolid.

Methicillin resistant coagulase negative staphylococcus: From colonizer to a pathogen

The objective of our study was to determine the frequency of methicillin resistance in coagulase negative Staphylococcus (CoNS) and to determine its in-vitro antimicrobial susceptibility to various other routinely used antibiotics. It was a cross sectional study conducted at the department of Microbiology, Army Medical College, Rawalpindi, Pakistan from June 2011 to May 2012. The organisms were identified on the basis of colony morphology, Gram staining, catalase, DNAase and slide/tube coagulase tests. The organisms were considered to be methicillin resistant when the diameter of zone of inhibition was less than 25mm around 30μg cefoxitin disc. Antibiotic sensitivity was determined using the Modified Kirby-Bauer disc diffusion method. From a total of 337 CoNS, 201 were methicillin resistant and were included in the study. All were resistant to Penicillin, followed by Erythromycin (93•1%), Ciprofloxacin (77%), Co-trimoxazole (74•8%), Gentamicin (68•3%), Clindamycin (51•06%), Tetracycline (44•6%), Fusidic acid (40%), Rifampicin (39•5%), Chloramphenicol (19•3%), Linezolid (2%), Minocycline (1•1%), and Vancomycin (0%). More than half of CoNS were methicillin resistant. Vancomycin is the only drug to which all of the MRCoNS were sensitive, with more than 98% of the isolates being sensitive to Linezolid and Minocycline.

IN VITRO SUSCEPTIBILITY PATTERN OF EXTENDED SPECTRUM β-LACTAMASE PRODUCING GRAM NEGATIVE BACILLI AGAINST TETRACYCLINES

BACKGROUND

Extended Spectrum β-lactamases (ESBLs) are emerging as common nosocomial pathogens and important cause of mortality and morbidity, if not treated properly. The need of the hour is to find effective treatment options for dealing with ESBL producing organisms. This study was aimed to evaluate in vitro susceptibility pattern of extended spectrum β-lactamase producers against tetracyclines.

METHODS

This descriptive cross-sectional study was carried out in the department of Microbiology, Army Medical College, Rawalpindi, National University of Sciences and Technology over a period of 6 months. Seventy eight non-duplicate isolates were included in the study. ESBL detection was done using Jarlier et al method. In vitro susceptibility of tetracyclines like tetracycline, doxycycline, minocycline and tigecycline was then tested using Modified Kirby Bauer disc diffusion method. The zones of inhibition were measured after completion of incubation period and interpreted as per CLSI and FDA guidelines.

RESULTS

Approximately 56.4% of the isolates were Escherichia coli, 28.2% were Klebsiella pneumoniae, 10.26% were Enterobacter species, and 2.6% were each Klebsiella oxytoca and Acinetobacter species. ESBLs were found to be most sensitive to tigecycline, intermediate in susceptibility to minocycline while least sensitive to doxycycline and tetracycline.

CONCLUSION

Among tetracyclines, tigecycline has best in vitro susceptibility against ESBL producing Gram negative rods.

In vitro Efficacy of Meropenem, Colistin and Tigecycline Against the Extended Spectrum Beta-Lactamase Producing Gram Negative Bacilli

OBJECTIVE

To compare the in vitro efficacy of meropenem, colistin and tigecycline against extended spectrum Betalactamase producing Gram negative bacilli by minimal inhibitory concentration.

STUDY DESIGN

Cross-sectional descriptive study.

PLACE AND DURATION OF STUDY

Department of Microbiology, Army Medical College, National University of Sciences and Technology, Rawalpindi, from June to December 2010.

METHODOLOGY

Routine clinical specimens were subjected to standard microbiological procedures and the isolates were identified to species level. Extended spectrum β-lactamase producing Gram negative bacilli were detected by Jarlier disc synergy method and confirmed by ceftazidime and ceftazidime-clavulanate Etest. Minimum Inhibitory Concentration (MIC(90)) of meropenem, colistin and tigecycline was determined by Etest (AB BIOMERIUX) and the results were interpreted according to the manufacturer's instructions and Clinical and Laboratory Standards Institute guidelines and Food and Drug Authority recommendations. Results were analyzed by using Statistical Package for the Social Sciences version 20.

RESULTS

A total of 52 non-duplicate extended spectrum Beta-lactamase-producing Gram negative bacilli were included in the study. The MIC(90) of tigecycline (0.75 µg/ml) was lowest as compared to the meropenem (2 µg/ml) and colistin (3 µg/ml).

CONCLUSION

Tigecycline is superior in efficacy against the extended spectrum Beta-lactamase producing Gram negative bacilli as compared to colistin and meropenem.

Frequency and antibiogram of vancomycin resistant enterococcus in a tertiary care hospital

OBJECTIVE

To determine the frequency of Vancomycin Resistant Enterococcus (VRE) in a tertiary care hospital of Rawalpindi, Pakistan.

STUDY DESIGN

Observational, cross-sectional study.

PLACE AND DURATION OF STUDY

Department of Microbiology, Army Medical College, Rawalpindi, from May 2011 to May 2012.

METHODOLOGY

Vancomycin resistant Enterococcus isolated from the clinical specimens including blood, pus, double lumen tip, ascitic fluid, tracheal aspirate, non-directed bronchial lavage (NBL), cerebrospinal fluid (CSF), high vaginal swab (HVS) and catheter tips were cultured on blood agar and MacConkey agar, while the urine samples were grown on cystine lactose electrolyte deficient agar. Later the antimicrobial susceptibility testing of the isolates was carried out using the modified Kirby-Bauer disc diffusion method on Mueller Hinton agar.

RESULTS

A total of 190 enterococci were isolated. Of these, 22 (11.57%) were found to be resistant to vancomycin. The antimicrobial sensitivity pattern revealed maximum resistance against ampicillin (86.36%) followed by erythromycin (81.81%) and gentamicin (68.18%) while all the isolates were 100% susceptible to chloramphenicol and linezolid.

CONCLUSION

The frequency of VRE was 11.57% with the highest susceptibility to linezolid and chloramphenicol.

Evaluation of different phenotypic methods for detection of amp C Beta-lactamase producing bacteria in clinical isolates

OBJECTIVE

To compare the sensitivity and specificity of different phenotypic methods for detection of Amp C betalactamase producing bacteria.

STUDY DESIGN

Analytical study.

PLACE AND DURATION OF STUDY

Department of Microbiology, Army Medical College / National University of Sciences and Technology (NUST), Islamabad, Pakistan, from June 2010 to December 2010.

METHODOLOGY

A total of 150 clinical isolates were screened for presence of Amp C beta-lactamase by using the cefoxitin disc. The confirmatory methods evaluated were inhibitor based assay (boronic acid), Amp C disc test and Amp C Etest. Three dimensional enzyme extract assay was used as the reference method for determining the sensitivity and specificity.

RESULTS

Among the total isolates tested, 62.8% bacteria showed the presence of Amp C beta-lactamase by standard three dimensional enzyme extract assay. Among the three methods compared, boronic acid disk test found out to be highly sensitive (88%) and specific (92%) for the detection of Amp C beta-lactamase producing bacteria.

CONCLUSION

Detection of Amp C production is crucial in order to establish the antibiotic therapy and to attain the favourable clinical outcomes. Implementation of simple tests like boronic acid disk tests in the laboratories will help to alleviate the spread of Amp C beta-lactamase harboring organisms.

Frequency and antibiogram of multi-drug resistant Pseudomonas aeruginosa

OBJECTIVE

To find out the frequency and susceptibility pattern of multi-drug resistant (MDR) Pseudomonas aeruginosa in clinical specimens.

STUDY DESIGN

Cross-sectional observational study.

PLACE AND DURATION OF STUDY

Department of Microbiology, Army Medical College, National University of Sciences and Technology (NUST), Rawalpindi, from January to September 2010.

METHODOLOGY

Routine clinical specimens were subjected to standard microbiological procedures and the isolates were identified to the species level. The antibiotics susceptibility was determined by Kirby Bauer Disc diffusion method and the results were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guidelines.

RESULTS

The frequency of MDR Pseudomonas aeruginosa among all the Pseudomonas aeruginosa strains isolated was found to be 22.7%. These isolates were most sensitive to Colistin followed by Piperacillin-Tazobactam and Cefoperazone-Sulbactum.

CONCLUSION

Increasing fequency of infections due to MDR Pseudomonas aeruginosa is an emerging threat in our set up which an be prevented by prescribing antibiotics judiciously and by adopting proper disinfection measures.

'Neurosis' and the personal social environment. The effects of a time-limited course of intensive day care

The Interview Schedule for Social Interactions (ISSI) was used to assess the social environment of 65 British inner-city patients suffering from severe neurotic disorder; all patients were offered a 12-week course of intensive day treatment with an educational and psychodynamic basis. Compared with a general population in Canberra, the neurosis sufferers had lower (morbid) scores on the ISSI for the extent and quality of their social relationships. Of the 34 subjects who completed treatment and attended for the post-treatment investigation, 21 attained a PSE score below the level for 'caseness'. Twenty-five subjects who attended for follow-up at 18-24 months had improved significantly on all four of the standard ISSI measures, although they had not done so immediately after treatment. This suggests that although symptoms may improve at the time of treatment, social relationships improve only over several months.

Ego analysis and the relativity of defense: technical implications of the structural theory

We suggest that it is recognition of the relativity of defense, of the fact that the same content can be either defense or wish, rather than recognition of unconscious defense, that distinguishes the structural from the topographic theory. The structural theory did not simply add to the topographic theory the recognition that defense can be unconscious; it represents a radical shift in the concept of defense and of the relation between defense and wish. Accordingly, ego analysis, as the technical approach generated by the structural theory, is not complementary or preliminary to id analysis, the technical approach generated by the topographic theory. We attempt to demonstrate that the two theories represent antagonistic paradigms, both theoretically and technically. We suggest that "defense before drive," the structural formula for interpretation, made ego syntonicity a crucial determinant in formulating interpretations, and assumed the relativity of defense. Accordingly, the structural revision made possible an equidistant position between defense and wish, reducing reliance on suggestion and establishing interpretive neutrality, which we distinguish from behavioral neutrality.

Social work and law in a foster care/adoption program

The push toward permanency planning has led to a blurring of distinctions between foster care and adoption, and consequent emotional and legal entanglements. The program described here was designed to emphasize cooperation between social workers and lawyers to safeguard the rights of all parties, and the authors discuss the pitfalls of casework with both biological and foster parents.

A method for studying the analysis of aspects of the patient's experience of the relationship in psychoanalysis and psychotherapy

We have described a coding scheme for obtaining an objective account of the analysis of resisted aspects of the patient's experience of the relationship with the therapist in single, audio-recorded sessions of psychoanalysis and psychotherapy. The focus is on what is often regarded as an important first step in the analysis of transference: the identification and exploration of the preconscious points of attachment of transference ideas in the here-and-now. Related to the scheme is the view that there is generally a plausible basis in the here-and-now for the patient's ideas about the therapist. The implications of that view for the concept of transference are discussed. Future directions for research are noted, including improving the reliability of the scheme and testing various hypotheses regarding how the particular step in technique assessed by the method affects other aspects of the process and outcome.

The analysis of the transference

Let me summarize. I distinguish between two major different relationships between transference and resistance. One is resistance to awareness of the transference and the other is resistance to resolution of the transference. I argue that the bulk of the analytic work should take place in the transference in the here and now. I detailed Freud's view that the transference should be encouraged to expand within the analytic situation. I suggested that the main technique for doing so, in addition to the analytic setup itself, is the interpretation of resistance to the awareness of transference by searching for the allusions to the transference in the associations not manifestly about the transference; that in making such interpretations one is guided by the connection to the actual analytic situation which every transference includes; that the major work in resolving the transference takes place in the here and now, both by way of examining the relation between the transference and the actuality of the analytic situation from which it takes its point of departure and the new experience which the analysis of the transference inevitably includes; and that, while genetic transference interpretations play a role in resolving the transference, genetic material is likely to appear spontaneously and with relative ease after the resistances have been overcome in the transference in the here and now. Working through remains important, and it, too, takes place primarily in the transference in the here and now.