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Vijay S.,Jhalawar Medical College and Hospital
Journal of Clinical and Diagnostic Research | Year: 2016

Aim: To find out the prevalence of Lower Respiratory Tract Infection (LRTI) such as bacterial, fungal, mycobacterial infections etc. in patients with productive cough of duration less than 15 days and to rule out the patients having previous history of tuberculosis or having treatment of tuberculosis. Materials and Methods: Outdoor and Indoor patients of Department of Medicine and Chest & TB, SRG hospital and Jhalawar Medical College, Jhalawar were included. After sample collection the specimens were sent to the Microbiology department, for processing of Gram staining, Acid fast staining, KOH mount and bacteriological culture and sensitivity. Results: A total of 200 samples were obtained from the outpatient and inpatient Department of Medicine and Chest & TB of which 66% were male and 34% were female. Seventy seven percent of samples were culture positive for both single pathogen and mixed infection of which 56.5% were male and 20.5% were female as males are more at risk for LRTI. Klebsiella pneumoniae was the most prevalent pathogen (71/193), followed by coagulase positive Staphylococci i.e. COPS (43/193). More resistant pattern was found in coagulase negative Staohylococci (CONS) showed 61.11% Methicillin Resistant Staohylococci (MRS) incidence compared to 41.86% in COPS, also regarding Extended Spectrum Beta Lactamase (ESBL) production Escherichia coli showed incidence of 36.36% as compared to other gram negative bacilli. Pseudomonas aeruginosa was the most resistant organism found based on the antibiotic susceptibility pattern while Proteus mirabilis was the most sensitive organism. Conclusion: Lower respiratory tract infections can spread easily among community and indiscriminate use of antibiotics contributes to their therapeutic failure. Area-wise studies on antimicrobial susceptibility profiles are essential to guide policy on the appropriate use of antibiotics to reduce the morbidity and mortality and also to control the emergence of antimicrobial resistance in local area. © 2015, Journal of Clinical and Diagnostic Research. All rights Reserved.

Vijay A.,Jhalawar Medical College and Hospital
Journal of Clinical and Diagnostic Research | Year: 2015

Herpes Zoster is a common viral disorder, occurs due to reactivation of latent Varicella Zoster Virus (VZV) usually in adults or elderly patients, usually confined to a single dermatome. Herpes zoster duplex is a rare but well established entity which is simultaneous, occurring of herpes zoster at two different non contiguous dermatomes, can be unilateralis or bilateralis. Here we are reporting two cases of herpes zoster duplex bilateralis, in case-1 lesions occurs in two different distant dermatomes while in case-2 it appeared in a single dermatome but both sides were involved. Both the patients were healthy immuno-competent male. © 2015, Journal of Clinical and Diagnostic Research. All rights reserved.

Dalela G.,Jhalawar Medical College and Hospital | Sweta G.,Mahatma Gandhi Medical College and Hospital | Jain D.K.,Jhalawar Medical College and Hospital | Mehta P.,Jhalawar Medical College and Hospital
Journal of Clinical and Diagnostic Research | Year: 2012

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections in humans, both in the community as well as in the hospital settings. Worldwide, the data show that there is an increasing resistance among the organisms which cause UTI, to the conventional drugs. A study on the changing antibiotic resistance pattern is pertinent for an appropriate treatment and for the prevention and control of the different mechanisms of resistance. Aim: To find out the drug option for the treatment of UTI due to the presence of various clinical isolates in our geographical area, in the current scenario of increasing antimicrobial resistance, with special reference to ESBL, AmpC β-lactamase and MRSA production. Materials and Methods: A total of 184 clinical isolates from the urine of various patients who presented to the outpatient and inpatient departments of Jhalawar Medical College and Hospital, Jhalawar, Rajasthan, India, were studied from January 2011 to September 2011. The antimicrobial susceptibility to various drugs was studied by the disc diffusion method, by following the CLSI guidelines. Confirmation of the extended spectrum β-lactamase (ESBL), ampC β-lactamase and methicillin resistant Staphylococcus aureus (MRSA) production was done by the phenotypic confirmatory disc diffusion test (PCDDT), the ampC disk test (ADT) and the oxacillin E test respectively. Results: The antibiotic sensitivity pattern of the gram negative bacilli (GNB) revealed that the maximum sensitivity was seen for imipenem (95.1%), followed by cefoxitin (79.6%), piperacillin/tazobactum (71.8%), cefepime (71.8%), and amikacin (66.9%), and that of the gram positive cocci (GPC) showed that the maximum sensitivity was seen for vancomycin and linezolid (100%), followed by amikacin (95.2%), gentamicin (69.1%) and nitrofurantoin (61.9%). High resistance was seen against amoxycillin/clavulanate, co-trimoxazole, cefotaxime, doxycycline and norfloxacin. Overall, the prevalence of ESBLand ampC β-lactamase and the coexistence of the phenotype (ESBL+ ampC β-lactamase) and MRSA in the urinary isolates was found to be 66.9%, 21.1%, 3.5% and 42.4% respectively. Conclusion: Among the oral drugs, amoxycillin/clavulanic acid, norfloxacin, doxycycline and co-trimoxazole should no longer be considered as the first line drugs for the empirical treatment of clinically evident UTI, because of the very high resistance rates. Nitrofurantoin can be used as an alternative drug only after the sensitivity testing. Parentral drugs such as aminoglycosides, carbapenams and piperacillin/tazobactum can be the alternative choice for complicated UTI. Also, control measures which include the judicious use of antibiotics, antibiotic cycling, the implementation of appropriate infection control measures and the formulation of an antibiotic policy must be done, to prevent the spread of these strains.

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