Clinico-Microbiological Analysis of Toxigenic Clostridium difficile from Hospitalised Patients in a Tertiary Care Hospital,Mangalore, Karnataka,India

Purpose: Prevalence of Clostridium difficile, an anaerobic, Gram-positive, spore-forming bacillus, is very much underestimated in India. The present study was intended to assess the burden of toxigenic C. difficile in hospitalised patients with clinically significant diarrhoea and analysis of their clinical picture. Materials and Methods: This cross-sectional study was conducted in a tertiary care teaching hospital, South India, from January 2012 to December 2014. Stool samples were collected consecutively from 563 inpatients from various wards. The prevalence of toxigenic C. difficile was determined by toxigenic culture and a two-step algorithm. The clinical spectrum of these patients was also analysed. Associated pathogens were identified using standard procedures. Statistical analysis was done by frequency, percentage, Chi-square test and z-test. Results: Out of the 563 stool samples analysed, the prevalence of toxigenic C. difficile was 12.79% and that of non-toxigenic C. difficile was 10.83%. The prevalence of toxigenic C. difficile among oncology patients was highly significant (HS). Antibiotic treatment, prolonged hospital stay and underlying diseases/conditions were the risk factors which were HS, and fever was the significant clinical feature among the patients. Escherichia coli was the predominant associated pathogen isolated (18.47%). Conclusion: The presence of toxigenic C. difficile in our locality is a matter of concern. Constant supervision, appropriate treatment and preventive measures are crucial in controlling C. difficile infection.     

注射用头孢西丁钠安全性试验研究

目的评价注射用头孢西丁钠的安全性。方法采用静脉注射血管刺激性、肌肉注射刺激性、过敏试验和溶血试验。结果注射用头孢西丁钠注射不引起血管和肌肉刺激性,亦不引起过敏和溶血。结论头孢西丁钠临床静脉和肌肉注射给药安全。     

In vitro activity of cefoxitin and imipenem against Mycobacterium abscessus complex

The in vitro activity of cefoxitin and imipenem was compared for 43 strains of the Mycobacterium abscessus complex, mostly isolated from cystic fibrosis patients. The MICs of imipenem were lower than those of cefoxitin, although the number of imipenem-resistant strains was higher according to the CLSI breakpoints. Strain comparisons indicated that the MICs of cefoxitin were significantly higher for Mycobacterium bolletii than for M. abscessus. The MICs of both β-lactams were higher for the rough morphotype than for the smooth morphotype. The clinical impact of the in vitro difference between the activity of imipenem and that of cefoxitin remains to be determined.     

腹膜透析液中头孢西丁钠的稳定性考察

目的:考察注射用头孢西丁钠在25℃和37℃的腹膜透析液中的稳定性。方法:采用高效液相色谱法测定配伍液中头孢西丁钠的质量,并考察配伍液外观和pH值的变化。结果:头孢西丁钠与腹膜透析液配伍后8h内其外观、pH值及其质量均无明显变化。结论:头孢西丁钠在25℃和37℃的腹膜透析液中是稳定的;临用前须将腹膜透析液的温度温至37℃后再加入头孢西丁钠,以减少高温下头孢西丁钠的降解,确保安全用药。     

四种初筛试验检测耐甲氧西林葡萄球菌的评价

目的评价四种初筛试验检测耐甲氧西林葡萄球菌(MRS)的价值。方法收集临床分离金黄色葡萄球菌100株、凝固酶阴性葡萄球菌51株,分别进行头孢西丁纸片、MHA中添加4%NaCl的头孢西丁纸片、MHA中添加2%NaCl的苯唑西林纸片、苯唑西林-盐琼脂,以PBP2a胶乳凝集作为MRS检测标准,按CLSI2006版标准操作和判读结果。结果对于金黄色葡萄球菌,头孢西丁纸片、MHA中添加4%NaCl的头孢西丁纸片、MHA中添加2%NaCl的苯唑西林纸片、苯唑西林-盐琼脂检测MRS灵敏度和特异性分别为96.3%和100.0%、85.2%和100.0%、77.8%和100.0%、92.6%和94.5%,其中2株苯唑西林-盐琼脂24h未生长但延长至48h生长,48h内敏感性100.0%;对于凝固酶阴性葡萄球菌,四种方法检测MRS灵敏度和特异性分别为97.8%和80.0%、95.6%和80.0%、95.6%和80.0%、100.0%和80.0%(P>0.05)。结论四种方法均能可靠检测MRS,头孢西丁纸片和苯唑西林-盐琼脂具有较高应用价值。     

Comparison of the antimicrobial activity and beta-lactamase resistance of cef otiam (CGP/14221 E) with that of cefotaxime,cefuroxime, cefoxitin and cephalothin

Summary

A study was carried out to compare the minimum inhibitory concentrations of cefotiam, cefotaxime, cefuroxime, cefoxitin and cephalothin against 355 strains of Gram-negative bacteria including Pseudomonas aeruginosa. Cefotiam was shown to be more active than cefuroxime, cefoxitin and cephalothin and equal to or slightly less active than cefotaxime. Study of the minimum bactericidal concentrations of cefotiam showed that the time required for eradication of the micro-organisms was rapid. It was found that cefotiam, cefotaxime, cefuroxime and cefoxitin were resistant to the hydrolysis caused by the constitutive beta-lactamases studied.     

LC-MS/MS法分析注射用头孢西丁钠中的有关物质

目的:建立LC-MS/MS法分析注射用头孢西丁钠中的有关物质。方法:采用Thermo Syncronis C18(4.6 mm×250 mm,5μm)色谱柱,以1%甲酸水溶液(A)-乙腈(B)为流动相,1.0 mL.min-1线性梯度洗脱分离;柱后分流,电喷雾离子化MS测定。采集有关物质的PDA谱、质谱母离子及子离子谱,并进行解析,推测有关物质的结构。结果:在所建立的条件下,头孢西丁钠及其有关物质分离良好,检测出15个有关物质,并对其进行结构解析。结论:建立的LC-MS/MS法能有效地分离分析头孢西丁钠及其有关物质,为注射用头孢西丁钠的质量控制和工艺优化提供了参考。     

Evaluation of cefoxitin prophylaxis for cesarean section

Prophylactic cefoxitin was evaluated in 101 patients undergoing cesarean section. A three-dose regimen of either cefoxitin or placebo was administered randomly in a double-blind manner, 46 patients receiving cefoxitin and 55 placebo, with the first dose given after the cord was clamped. In the placebo group, 29% of the patients developed pelvic or wound infection, compared to 4% in the cefoxitin group (P less than 0.003). No patient required re-operation, re-admission, or had a life threatening infection. Ten risk factors for infection were analyzed to help ascertain which patients would benefit from prophylaxis. Cefoxitin, with a broad spectrum of aerobic and anaerobic coverage, was found to be an effective and safe prophylactic agent when given to all patients undergoing cesarean section.     

Antimicrobial susceptibility testing of Mycobacteroides (Mycobacterium) abscessus complex,Mycolicibacterium (Mycobacterium) fortuitum,and Mycobacteroides (Mycobacterium) chelonae

The drug susceptibility of rapidly growing mycobacteria (RGM) varies among isolates. Treatment strategies similarly differ depending on the isolate, and for some, no clear strategy has been identified. This complicates clinical management of RGM. Following Clinical and Laboratory Standards Institute standard M24-A2, we assessed the susceptibility of 140 RGM isolates to 14 different antimicrobial drugs by measuring their minimal inhibitory concentrations (MICs). We also investigated the correlation of clarithromycin (CAM) MICs with the erm(41) and rrl gene mutations in the Mycobacteroides (Mycobacterium) abscessus complex, the rrl mutation in Mycobacteroides (Mycobacterium) chelonae, and the erm(39) mutation in Mycolicibacterium (Mycobacterium) fortuitum to determine the contribution of these mutations to CAM susceptibility. The five species and subspecies examined included 48 M. abscessus subsp. abscessus isolates (34.3%), 35 (25.0%) being M. abscessus subsp. massiliense, and two (1.4%) being M. abscessus subsp. bolletii. The M. abscessus complex accounted for 85 isolates (60.7%) in total, whereas 43 isolates (30.7%) were M. fortuitum, and 12 (8.6%) were M. chelonae. Our results demonstrated species-specific susceptibility to antimicrobials. In most cases, susceptibility to CAM could be predicted based on genetic pattern, but since one isolate did not fit that pattern, MIC values needed to be measured. Some isolates also exhibited rates of resistance to other drugs that differed from those previously reported in other locations, indicating that accurate identification of the bacterial isolate and use of the correct method for determining MIC are both important for the diagnosis of RGM.