[Show abstract][Hide abstract] ABSTRACT: With more people being exposed to antibiotics, intestinal microflora faces constant pressure of antibiotic selection, which has resulted in the emergence of multidrug resistant strains. This may pose a severe problem as intestinal Enterobacteriaceae members are commonly implicated in human infections.
This surveillance study was undertaken to investigate the carriage of carbapenem-resistant Enterobacteriaceae (CRE) in the gastrointestinal tract among patients attending the outpatient clinic in a tertiary care center of East Delhi, India.
We performed a prospective surveillance study to screen 242 Enterobacteriaceae isolates for carbapenemase production from the stool samples of 123 outpatients attending a tertiary care hospital in East Delhi over a four-month period.
Twenty-four (9.9 per cent) isolates demonstrated carbapenemase activity among 242 screened Enterobacteriaceae isolates. Four stool samples had two isolates of different species, both eliciting this feature and therefore indicating presence of multiple carbapenem-resistant Enterobacteriaceae (CRE) isolates in a single sample.
Screening for carriage of CRE in stools of patients undergoing elective or emergency gastrointestinal surgical procedures, with haematological malignancies taking chemotherapy, or those planned for bone marrow transplantation can guide clinicians about gut colonisation of multidrug-resistant Enterobacteriaceae as these groups of patients are at risk of possible endogenous infection.
Australasian Medical Journal 01/2014; 7(2):64-67. DOI:10.4066/AMJ.2014.1926
[Show abstract][Hide abstract] ABSTRACT: With an increase in the number of population being exposed to antibiotics, the intestinal microflora has been facing a constant pressure of antibiotic selection which has resulted in emergence of multi drug resistant strains. This may pose a severe problem as intestinal Enterobacteriaceae members are most commonly implicated in human infections. This has been evident with the recent emergence and expression of novel genes like bla NDM-1 . We performed a pilot prevalence study to screen 242 Enterobacteriaceae isolates for carbapenemase activity from stool samples of 123 outpatients attending a tertiary care hospital of East Delhi in a one month period. Twenty four isolates demonstrated carbapenemase activity among 242 screened isolates. Four stool samples had two isolates of different species, both eliciting this feature indicating presence of multiple carbapenem resistant Enterobacteriaceae (CRE) isolates in a single sample. Introduction The human gastrointestinal tract has been known to be a reservoir of pathogens causing common infections like urinary tract infections (UTI), skin soft tissue infections (SSI's) and nosocomial infections.  With an increase in the population being exposed to healthcare facilities, antibiotics and their misuse, the profile of this resistance has demonstrated dynamism towards greater resistance towards high end antibiotics like carbapenems.  This has been demonstrated with the emergence of many different metallo beta lactamase genes like bla IMP , bla VIM , bla OXA , bla KPC and recently bla NDM in the family Enterobacteriaceae . This has also been evident from a recent study in which a strain causing UTI harbored the same bla NDM gene as the E. coli isolate from the patients intestinal tract. [2, 3] This has become a serious issue as members of family Enterobacteriaceae are associated with a majority of human infections with the intestinal microbiota as the major source. After being exposed to treatment by high end antimicrobials, these patients get colonized by such multi / pan drug resistant organisms. Post treatment, these patients become a potential source of such organisms causing community acquired infections.  Screening the intestinal isolates of family Enterobacteriaceae would not only provide us with a point prevalence data of potential multi drug resistant microbiota acting as possible reservoir in the community but also help us map areas with low to high prevalence of such carriage. CDC had issued guidelines for hospital surveillance of Carbapenem Resistance Enterobacteriaceae (CRE).  There are no Indian studies on screening of CRE in stool samples as a point prevalence data or statistics from different cohort of patients.  Routine laboratories culturing stool samples for diagnosing common clinical pathogens often overlook commensal enterobacteria which may harbor resistant phenotypes. Antibiotic overuse and improper sanitation and hygiene in urban slum areas can lead to rapid spread and large scale carriage of multi / pan drug resistant isolates in the intestinal microbiota, which would be a potential cause of endogenous and exogenous infections. [1, 4] The rise in resistance to carbapenems among clinical isolates of family Enterobacteriaceae has been evident from the unpublished database of our hospital where Imipenem resistance of 2.2, 6.6 and 19.2 percent in outpatients, wards and ICU's respectively has been observed in clinical isolates of family Enterobacteriaceae from April 2010 to July 2011. With this background we performed prospective point prevalence and a pilot study to evaluate the carriage of CRE's from Enterobacteriaceae isolates from stool samples of patients attending the outpatient clinics in a tertiary care center of East Delhi during one month duration. This was performed to observe carriage of CRE during a time period, irrespective of the patient symptoms or any history of present / previous antibiotic treatment.
[Show abstract][Hide abstract] ABSTRACT: The 'test and treat' policy is the recommended way to eradicate Helicobacter pylori in young patients with uninvestigated dyspepsia if the prevalence of H. pylori is high. India is considered to have a high prevalence of H. pylori. This observational study was conducted in order to discover the prevalence of H. pylori disease in uninvestigated dyspeptic patients, based on stool antigen test and immunoglobulin M (IgM) antibodies in the sera in order to ascertain the role of the 'test and treat' policy in this geographical area. Fifty patients (age <55 years) with uninvestigated dyspepsia presenting to surgery out-patient department of a tertiary teaching hospital in northern India were included in the study. Fifty healthy controls were also included. Dyspeptic patients with alarm symptoms were excluded from the study. Patients and controls were tested for IgM antibodies in their sera and H. pylori antigen in their stools. The positivity of the IgM antibody and H. pylori antigen in stools of the cases was 16% and 8%, respectively, while only 4% IgM positivity was found in the controls' samples. This study highlights the low prevalence of H. pylori in dyspeptic Indian patients. This indicates that initial proton pump therapy may be a better option than the 'test and treat' policy for young patients with uninvestigated dyspepsia.
Tropical Doctor 04/2012; 42(2):109-11. DOI:10.1258/td.2011.110411 · 0.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background / Purpose:
To compare the mobile phone microbiota from health care workers and individuals from community not exposed to health care set up and correlate the quantum of bacterial load with the type of mobile phone.To investigate the awareness of health care workers and general public about mobile phones as sources of transfer of infection.
The average bacterial colonization was higher in the health care workers, and within those, was highest among classical handsets, followed by QWERTY handsets. There was no significant difference in colonization percentage among the health care workers (36%) and community individuals (38%).
1st Global Forum on Bacterial Infections: Balancing Treatment Access and Antibiotic Resistance 2011; 02/2012