S A Lakshminarayana

Abstract

Introduction: Acinetobacter spp. is one of the most common opportunistic bacterial pathogen causing hospital acquired infections. Its extensive resistance spectrum has earned it a “red alert” label among human pathogens. The emergence of MBL production among Acinetobacter spp has proved a global threat due to its broad spectrum of activity and limited treatment options. Aims: To determine the prevalence of MBL among clinical isolates of Acinetobacter spp in a tertiary care hospital and to determine their antibiotic susceptibility pattern. Materials and Methods: 57 clinical isolates of Acinetobacter spp obtained over a period of 1 year was subjected to antibiotic susceptibility testing by Kirby Bauer disc diffusion method as per CLSI guidelines. The carbapenem resistant strains were screened for MBL production by Imipenem-EDTA Combined disc test and Double disc synergy test. MBL E-test was used for confirmation of MBL production. Results: Of the 57 isolates, carbapenem resistance was recorded in 39 isolates. Screening tests for MBL showed 24 to be positive by CDT and 16 to be positive by DDST. All 24 of the Acinetobacter spp isolates that tested MBL positive by the screening test showed positive result by E-test. The prevalence of confirmed MBL by E-test among Acinetobacter spp was found to be 42.2%. The MBL isolates, in addition to resistance to cephalosporins and carbapenems, showed statistically significant resistance to fluoroquinolones and aminoglycosides. Colistin was found to be 100% sensitive and hence may prove a possible therapeutic option. Keywords: Metallo -beta-lactamase, Acinetobacter, Combined dist test, Double disc synergy test, E-test.  

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Abstract

Introduction and Objectives: Onychomycosis, or fungal infection of the nail apparatus by dermatophytes or nondermatophytes, is more than just a cosmetic problem. Dermatophytes are known to cause 90% of toenail and atleast 50% of fingernail onychomycosis. Our study offers insight into the unique current epidemiological aspects of onychomycosis in our region, including the less known nondermatophytemolds;. Since histopathology of nail clippings using Periodic Acid Schiff is clearly an invaluable tool in diagnosing onychomycosis, we integrated and comparatively evaluated it with the tests of routine mycology for the same. Materials and Methods: Patients in Rajarajeswari Medical College and Hospital (a tertiary care hospital) presenting with clinically apparent onychomycosis were included in this study. Each specimen of subungual debris and nail clippings was divided into two portions- one for direct microscopy and the other for culture. Nail clippings alone were used for PAS staining. Results: The present study was carried out on 40 clinically suspected cases of onychomycosis in the Department of Microbiology, Rajarajeshwari Medical College and Hospital over a period of one year. Out of 40 samples, 14(35%) samples showed fungal elements in 20% KOH, in 12(30%) samples fungal culture was positive and 19(47.5%) were PAS stain positive. Out of 12 isolates, 5(41.6%) were dermatophytes and 7(58.4%) were nondermatophytes. Keywords: KOH, PAS, Dermatophytes, Nondermatophytes, Nail infection, Onychomycosis.

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