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Introduction: India is a Canine Rabies endemic country. In India every 30 minutes a life is lost ... more Introduction: India is a Canine Rabies endemic country. In India every 30 minutes a life is lost due to Rabies. The dog is the main reservoir and transmitter of rabies. Dog to human ration is 1:36 . There is an overall rate of 2 dog bites per second in India.In Greater Hyderabad stray dog population is over 3 lakhs , the civic body has been able to vaccinate only 1.69 lakhs. Reports of dogs mauling children comes every day from various parts of the city . In Hyderabad dog population is kept under check by sterilising dogs. Objective: To determine the incidence and analysis of animal bite cases among paediatric age group attending Govt. Anti Rabies Vaccine Clinic- Institute of Preventive Medicine- Hyderabad, Telangana State and to adopt measures to prevent recurrence. Among the victims of animal bites in children , the most vulnerable age group, sex distribution , type of animal, the day which the victims attended the clinic and the most common site of bite on body were analysed. Ma...

International Journal of Scientific Research

Ventilator-associated pneumonia (VAP) is one of the commonest nosocomial infection occurring in m... more Ventilator-associated pneumonia (VAP) is one of the commonest nosocomial infection occurring in mechanically ventilated patients in the intensive care unit (ICU). It occurs in 9% to 27% of patients receiving continuous mechanical ventilation. This prospective study was done for the period of one year to determine the etiological agents of VAP and assess their antibiotic susceptibility patterns. Semi-quantitative culture of endotracheal aspirates of ventilated patients was done. In our study, Incidence of VAP was found to be 33.47%. Among the causative agents, Pseudomonas spp (44.45%) and Klebsiella spp (22.22%) were found to be the commonest etiological agents in patients with VAP. The mortality rate in our study was 16.04%. Combined approaches of rotational antibiotic therapy and education program might be beneficial to fight against these MDR pathogens and will help to decrease the incidence of VAP INTRODUCTION: Ventilator associated pneumonia, an important form of hospital acquired (HAP), specially refers to pneumonia developing in a mechanically ventilated patient for more than 48 hours after tracheal intubation or tracheostomy.1 It is commonly classified either as Early-onset VAP (occurring within 96 hours of start of MV) and Late-onset VAP (occurring after 96 hours of MV). VAP occurs in 9 to 27 % of patients intubated for longer than 48 hours. 1,2,3 Early onset VAP which occurs during the first four days of MV, usually is less severe, associated with a better prognosis and is more likely to be caused by an antibiotic sensitive bacteria. Late onset VAP, which occurs after five or more days after initiation of MV, is caused by multidrug resistant pathogens and is associated with increased morbidity and mortality. 4 VAP requires a rapid diagnosis and initiation of the appropriate antibiotic treatment, since many studies have shown that the delayed administration of appropriate antibiotic therapy in patients with VAP has been associated with excess hospital mortality. Similarly, the timely prescription of an antibiotic regimen that is inappropriate for the microorganism(s) causing VAP has been associated with a significantly greater risk of death .5 VAP can be caused by a wide spectrum of bacterial pathogens, which may be polymicrobial especially in immunocompromised hosts. Common pathogens include aerobic gram-negative bacilli, such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Acinetobacter species.6 Infections due to grampositive cocci, such as Staphylococcus aureus are more common in patients with diabetes mellitus and head trauma.2 It results in high mortality and morbidity, prolonged duration of hospital stay, and also increased cost of hospitalisation. During the past several decades, numerous studies had focused on the crucial role of the endotracheal tube (ETT) in the pathogenesis of ventilator-associated pneumonia. Accurate data on etiological agents and the epidemiology of VAP are limited by the lack of a ‘Gold Standard’ for diagnosis. However, regardless of the diagnostic technique used, there have been dramatic variations in the distribution of pathogens and drug resistance patterns. The duration of mechanical ventilation increases the risk of infection. Cook et al7 reported a cumulative increased risk of VAP with time, with 3% per day in the first week of mechanical ventilation, 2% per day in the second week and 1% per day in the third week. Risk factors : 8 Major risk factor is mechanical intubation Factors that enhance colonization of oropharynx: Administration of antibiotics

Indian Journal of Public Health, 2012

Indian Journal of Public Health, 2012

Indian Journal of Otology, 2012

Chronic Suppurative Otitis Media (CSOM) is one of the common ear diseases which can cause many co... more Chronic Suppurative Otitis Media (CSOM) is one of the common ear diseases which can cause many complications if not treated properly. This study was done to determine isolates causing CSOM and their antibiotic susceptibility pattern. The study was carried out from November 2014 to April 2015. Ear swabs were collected & cultured from one hundred and twenty patients with CSOM attending the ENT Out Patient Clinic in Al-Hillah Teaching hospital. The specimens were cultured The isolated organisms were identified by standard microbiological methods. The antibiotic susceptibility testing of the isolates was done using the Kirby-Bauer disc diffusion method.CSOM was less common among elderly and women. Pseudomonas aeruginosa was the most common isolated bacteria (37.5%) followed by Staphylococcus aureus (20.83%), and Streptococcus pneumoniae (16.67%).The most effective antibiotics in this study were ciprofloxacin and ceftazidime , whereas the highest resistance levels were observed for trimethoprim, carbenicillin, lincomycin and erythromycin.

BMC Infectious Diseases, 2012

The newer beta βlactamases namely extended spectrum β-lactamases, AmpC β-lactamases and Metallo- ... more The newer beta βlactamases namely extended spectrum β-lactamases, AmpC β-lactamases and Metallo- βlactamases have emerged as a cause of antimicrobial resistance in gram negative bacteria.The presence of ESBL and AmpC β lactamases in a single isolate reduces the effectiveness of βlactam- βlactamase inhibitor combination while Metallo-β lactamases confer resistance to Carbapenems. Klebsiella spp was the commonest isolate (28.47%) followed by E.coli (26.48%), Other isolates were Pseudomonas aeruginosa (19.54%), Enterobacter spp (8.92%), Acinetobacter spp (8.92%) and Citrobacter spp (7.64%). Gram negative isolates were tested for ESBL by DDST and PCDDT. 272 out of 706 gram negative isolates were ESBL producers. ESBL production was seen more in E.coli followed by Klebsiella spp and pseudomonas aeruginosa. They were tested for Amp C production by Amp C – Disc test. 73 out of 706 isolates were inducible Amp C producers. AmpC production was seen more in Acinetobacter spp. MBL detection was done using Imipenem – EDTA combined disc test. 65 out of 706 isolates were MBL producers. MBL Production was seen more in E.coli. Co-expression of newer β lactamases like ESBL, AmpC, MBL were found to be more in Acinetobacter spp and Enterobacter spp.The coexistence of different classes of β-lactamases in a single bacterial isolate may pose diagnostic and treatment challenges. The AmpC producing organisms can act as a hidden reservoir for the ESBLs. Also, the high-level expression of the AmpC β-lactamases may mask the recognition of the ESBLs and it may result in a fatal and an inappropriate antimicrobial therapy. The high prevalence of these organisms in the ICUs emphasizes the need for an early detection of the β-lactamase producing organisms by simple screening methods, which can help in providing an appropriate antimicrobial therapy and in avoiding the development and the dissemination of these multidrug resistant strains.

Hand hygiene is a milestone of infectious disease control and its promotion has been recognized a... more Hand hygiene is a milestone of infectious disease control and its promotion has been recognized as an important public health measure. Due to constant relationship with patients, nurses play a paramount role in proper execution of hand hygiene. A study was conducted to assess the knowledge of nursing students and their performance was measured before and after the workshop. The knowledge score regarding hand hygiene was significantly improved from 4.34±1.5 to 8.84±0.9. Emphasis on infection control to lower hospital acquired infections (HAI) should be considered as an important aspect and must be included as educational priority.

Indian Journal of Mednodent and Allied Sciences

Candida dubliniensis diarrhea is an opportunistic infection in immunocompromised hosts. C.dublini... more Candida dubliniensis diarrhea is an opportunistic infection in immunocompromised hosts. C.dubliniensis shares many of its phenotypic characters with the more common pathogenic yeast Candida albicans. Differentiation of the two species is important in view of the antifungal resistance reported in C.dubliniensis. A 21 year old female patient presented with diarrhea, fever, shortness of breath to the casualty. She was diagnosed with Systemic lupus erythematosis few months back when she complained of redness of face, fever, and rash on trunk and was put on corticosteroid treatment. Wet mount examination of stool revealed the presence of Candida pseudohyphae. Culture on SDA was subjected for germ tube test and chlamydospore formation, which was positive. Sparse growth on SDA at 42°C and no growth at 45°C differentiated the species from C.albicans. The patient succumbed to the infection even when the antifungal treatment was started.

Indian journal of public health

Serum resistance is an important virulence marker in uropathogenic E. coli (UPEC) but its pattern... more Serum resistance is an important virulence marker in uropathogenic E. coli (UPEC) but its pattern with respect to commensal gastrointestinal strains is less studied. We compared the serum resistance pattern of UPEC with commensal strains in stool samples from healthy individuals. A total of 40 isolates of UPEC (test) and intestinal E. coli (control) each was obtained from patients of all age groups with symptomatic UTI infections and healthy individuals respectively. Bacterial suspension of E. coli was mixed with serum and incubated at 37°C and the viable count was determined at 0, 1, 2 and 3 hours, followed by surface plating on MacConkey agar. The percentage of strains and the mean viable colony counts in both groups were compared using the χ 2 and unpaired t-test to ascertain the statistical significance in serum resistance pattern. Sixty percent of the test strains exhibited significant growth at 3 hours incubation respectively with serum compared to 12.5% for the control strains. (p value <0.0001). The mean colony count of the test strains (0.91 ± 0.27 x 10 5 CFU/mL) was significantly higher than the control strains (0.53 ± 0.35 x 10 5 CFU/mL) at 3 hours. (p value =0.0015). Serum resistance pattern in UPEC is an important virulence marker and is expressed significantly more commonly compared to commensal strains from gastrointestinal tract.

Indian Journal of Otology

bacteria which can produce both primary and post-operative ear infections. The indiscriminate, ha... more bacteria which can produce both primary and post-operative ear infections. The indiscriminate, haphazard and hay-hearted use of antibiotics and the poor follow up of the patients have resulted in the persistence of low-grade infections. The changes in the microbiological flora following the advent of sophisticated synthetic antibiotics have increased the relevance of the reappraisal of the modern day flora in CSOM, and their in-vitro antibiotic sensitivity pattern is very important for the clinician to plan a general outline of treatment for a patient and can minimize complications that may require surgery for a chronically discharging ear. [3] The study of bacteriology and drug sensitivity is necessary to enable the treating family

Introduction: India is a Canine Rabies endemic country. In India every 30 minutes a life is lost ... more Introduction: India is a Canine Rabies endemic country. In India every 30 minutes a life is lost due to Rabies. The dog is the main reservoir and transmitter of rabies. Dog to human ration is 1:36 . There is an overall rate of 2 dog bites per second in India.In Greater Hyderabad stray dog population is over 3 lakhs , the civic body has been able to vaccinate only 1.69 lakhs. Reports of dogs mauling children comes every day from various parts of the city . In Hyderabad dog population is kept under check by sterilising dogs. Objective: To determine the incidence and analysis of animal bite cases among paediatric age group attending Govt. Anti Rabies Vaccine Clinic- Institute of Preventive Medicine- Hyderabad, Telangana State and to adopt measures to prevent recurrence. Among the victims of animal bites in children , the most vulnerable age group, sex distribution , type of animal, the day which the victims attended the clinic and the most common site of bite on body were analysed. Ma...

International Journal of Scientific Research

Ventilator-associated pneumonia (VAP) is one of the commonest nosocomial infection occurring in m... more Ventilator-associated pneumonia (VAP) is one of the commonest nosocomial infection occurring in mechanically ventilated patients in the intensive care unit (ICU). It occurs in 9% to 27% of patients receiving continuous mechanical ventilation. This prospective study was done for the period of one year to determine the etiological agents of VAP and assess their antibiotic susceptibility patterns. Semi-quantitative culture of endotracheal aspirates of ventilated patients was done. In our study, Incidence of VAP was found to be 33.47%. Among the causative agents, Pseudomonas spp (44.45%) and Klebsiella spp (22.22%) were found to be the commonest etiological agents in patients with VAP. The mortality rate in our study was 16.04%. Combined approaches of rotational antibiotic therapy and education program might be beneficial to fight against these MDR pathogens and will help to decrease the incidence of VAP INTRODUCTION: Ventilator associated pneumonia, an important form of hospital acquired (HAP), specially refers to pneumonia developing in a mechanically ventilated patient for more than 48 hours after tracheal intubation or tracheostomy.1 It is commonly classified either as Early-onset VAP (occurring within 96 hours of start of MV) and Late-onset VAP (occurring after 96 hours of MV). VAP occurs in 9 to 27 % of patients intubated for longer than 48 hours. 1,2,3 Early onset VAP which occurs during the first four days of MV, usually is less severe, associated with a better prognosis and is more likely to be caused by an antibiotic sensitive bacteria. Late onset VAP, which occurs after five or more days after initiation of MV, is caused by multidrug resistant pathogens and is associated with increased morbidity and mortality. 4 VAP requires a rapid diagnosis and initiation of the appropriate antibiotic treatment, since many studies have shown that the delayed administration of appropriate antibiotic therapy in patients with VAP has been associated with excess hospital mortality. Similarly, the timely prescription of an antibiotic regimen that is inappropriate for the microorganism(s) causing VAP has been associated with a significantly greater risk of death .5 VAP can be caused by a wide spectrum of bacterial pathogens, which may be polymicrobial especially in immunocompromised hosts. Common pathogens include aerobic gram-negative bacilli, such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Acinetobacter species.6 Infections due to grampositive cocci, such as Staphylococcus aureus are more common in patients with diabetes mellitus and head trauma.2 It results in high mortality and morbidity, prolonged duration of hospital stay, and also increased cost of hospitalisation. During the past several decades, numerous studies had focused on the crucial role of the endotracheal tube (ETT) in the pathogenesis of ventilator-associated pneumonia. Accurate data on etiological agents and the epidemiology of VAP are limited by the lack of a ‘Gold Standard’ for diagnosis. However, regardless of the diagnostic technique used, there have been dramatic variations in the distribution of pathogens and drug resistance patterns. The duration of mechanical ventilation increases the risk of infection. Cook et al7 reported a cumulative increased risk of VAP with time, with 3% per day in the first week of mechanical ventilation, 2% per day in the second week and 1% per day in the third week. Risk factors : 8 Major risk factor is mechanical intubation Factors that enhance colonization of oropharynx: Administration of antibiotics

Indian Journal of Public Health, 2012

Indian Journal of Public Health, 2012

Indian Journal of Otology, 2012

Chronic Suppurative Otitis Media (CSOM) is one of the common ear diseases which can cause many co... more Chronic Suppurative Otitis Media (CSOM) is one of the common ear diseases which can cause many complications if not treated properly. This study was done to determine isolates causing CSOM and their antibiotic susceptibility pattern. The study was carried out from November 2014 to April 2015. Ear swabs were collected & cultured from one hundred and twenty patients with CSOM attending the ENT Out Patient Clinic in Al-Hillah Teaching hospital. The specimens were cultured The isolated organisms were identified by standard microbiological methods. The antibiotic susceptibility testing of the isolates was done using the Kirby-Bauer disc diffusion method.CSOM was less common among elderly and women. Pseudomonas aeruginosa was the most common isolated bacteria (37.5%) followed by Staphylococcus aureus (20.83%), and Streptococcus pneumoniae (16.67%).The most effective antibiotics in this study were ciprofloxacin and ceftazidime , whereas the highest resistance levels were observed for trimethoprim, carbenicillin, lincomycin and erythromycin.

BMC Infectious Diseases, 2012

The newer beta βlactamases namely extended spectrum β-lactamases, AmpC β-lactamases and Metallo- ... more The newer beta βlactamases namely extended spectrum β-lactamases, AmpC β-lactamases and Metallo- βlactamases have emerged as a cause of antimicrobial resistance in gram negative bacteria.The presence of ESBL and AmpC β lactamases in a single isolate reduces the effectiveness of βlactam- βlactamase inhibitor combination while Metallo-β lactamases confer resistance to Carbapenems. Klebsiella spp was the commonest isolate (28.47%) followed by E.coli (26.48%), Other isolates were Pseudomonas aeruginosa (19.54%), Enterobacter spp (8.92%), Acinetobacter spp (8.92%) and Citrobacter spp (7.64%). Gram negative isolates were tested for ESBL by DDST and PCDDT. 272 out of 706 gram negative isolates were ESBL producers. ESBL production was seen more in E.coli followed by Klebsiella spp and pseudomonas aeruginosa. They were tested for Amp C production by Amp C – Disc test. 73 out of 706 isolates were inducible Amp C producers. AmpC production was seen more in Acinetobacter spp. MBL detection was done using Imipenem – EDTA combined disc test. 65 out of 706 isolates were MBL producers. MBL Production was seen more in E.coli. Co-expression of newer β lactamases like ESBL, AmpC, MBL were found to be more in Acinetobacter spp and Enterobacter spp.The coexistence of different classes of β-lactamases in a single bacterial isolate may pose diagnostic and treatment challenges. The AmpC producing organisms can act as a hidden reservoir for the ESBLs. Also, the high-level expression of the AmpC β-lactamases may mask the recognition of the ESBLs and it may result in a fatal and an inappropriate antimicrobial therapy. The high prevalence of these organisms in the ICUs emphasizes the need for an early detection of the β-lactamase producing organisms by simple screening methods, which can help in providing an appropriate antimicrobial therapy and in avoiding the development and the dissemination of these multidrug resistant strains.

Hand hygiene is a milestone of infectious disease control and its promotion has been recognized a... more Hand hygiene is a milestone of infectious disease control and its promotion has been recognized as an important public health measure. Due to constant relationship with patients, nurses play a paramount role in proper execution of hand hygiene. A study was conducted to assess the knowledge of nursing students and their performance was measured before and after the workshop. The knowledge score regarding hand hygiene was significantly improved from 4.34±1.5 to 8.84±0.9. Emphasis on infection control to lower hospital acquired infections (HAI) should be considered as an important aspect and must be included as educational priority.

Indian Journal of Mednodent and Allied Sciences

Candida dubliniensis diarrhea is an opportunistic infection in immunocompromised hosts. C.dublini... more Candida dubliniensis diarrhea is an opportunistic infection in immunocompromised hosts. C.dubliniensis shares many of its phenotypic characters with the more common pathogenic yeast Candida albicans. Differentiation of the two species is important in view of the antifungal resistance reported in C.dubliniensis. A 21 year old female patient presented with diarrhea, fever, shortness of breath to the casualty. She was diagnosed with Systemic lupus erythematosis few months back when she complained of redness of face, fever, and rash on trunk and was put on corticosteroid treatment. Wet mount examination of stool revealed the presence of Candida pseudohyphae. Culture on SDA was subjected for germ tube test and chlamydospore formation, which was positive. Sparse growth on SDA at 42°C and no growth at 45°C differentiated the species from C.albicans. The patient succumbed to the infection even when the antifungal treatment was started.

Indian journal of public health

Serum resistance is an important virulence marker in uropathogenic E. coli (UPEC) but its pattern... more Serum resistance is an important virulence marker in uropathogenic E. coli (UPEC) but its pattern with respect to commensal gastrointestinal strains is less studied. We compared the serum resistance pattern of UPEC with commensal strains in stool samples from healthy individuals. A total of 40 isolates of UPEC (test) and intestinal E. coli (control) each was obtained from patients of all age groups with symptomatic UTI infections and healthy individuals respectively. Bacterial suspension of E. coli was mixed with serum and incubated at 37°C and the viable count was determined at 0, 1, 2 and 3 hours, followed by surface plating on MacConkey agar. The percentage of strains and the mean viable colony counts in both groups were compared using the χ 2 and unpaired t-test to ascertain the statistical significance in serum resistance pattern. Sixty percent of the test strains exhibited significant growth at 3 hours incubation respectively with serum compared to 12.5% for the control strains. (p value <0.0001). The mean colony count of the test strains (0.91 ± 0.27 x 10 5 CFU/mL) was significantly higher than the control strains (0.53 ± 0.35 x 10 5 CFU/mL) at 3 hours. (p value =0.0015). Serum resistance pattern in UPEC is an important virulence marker and is expressed significantly more commonly compared to commensal strains from gastrointestinal tract.

Indian Journal of Otology

bacteria which can produce both primary and post-operative ear infections. The indiscriminate, ha... more bacteria which can produce both primary and post-operative ear infections. The indiscriminate, haphazard and hay-hearted use of antibiotics and the poor follow up of the patients have resulted in the persistence of low-grade infections. The changes in the microbiological flora following the advent of sophisticated synthetic antibiotics have increased the relevance of the reappraisal of the modern day flora in CSOM, and their in-vitro antibiotic sensitivity pattern is very important for the clinician to plan a general outline of treatment for a patient and can minimize complications that may require surgery for a chronically discharging ear. [3] The study of bacteriology and drug sensitivity is necessary to enable the treating family