The Indian Practitioner

Abstract

Introduction: In recent years, resistance to carbapenems due to metallobetalactamse production is increasing. The genes (IMP and VIM) responsible for metallo beta-lactamase (MBL) production may be chromosomally or plasmid mediated and hence poses a threat of spread of resistance by gene transfer among the Gram-negative bacteria. Therefore early identification and treatment of infections with MBL producers becomes essential.

Screening of MBL is not done as routine in our laboratory. The present study was therefore undertaken to know the incidence of MBL producing bacteria in our set up.

Aims: To study incidence of metallo-beta-lactamase (MBL) producers among nonfermenters.

Material and Methods: 315 P. aeruginosa and 170 Acinetobacter species were isolated from blood and pus samples and evaluated for carbapenem resistance and MBL production by imipenem-EDTA disc method. The inhibition zone with imipenem-EDTA disc were <14 mm for MBL-negative isolates and >17 mm for MBL-positive isolates. MBL production was confirmed by E test strip containing imipenem (4- 256 μg/ml) and imipenem(1-64 μg/ml) plus EDTA.100/10 μg).

Results: Of 315 isolates of P. aeruginosa and170 isolates of Acinetobacter, of the total 315 P. aeruginosa 265 were isolated from pus and 50 from blood cultures and out of the total 170 of Acinetobacter spp120 from pus and 50 from blood cultures were isolated. Piperacillin/tazobactam and Imipenem were the most effective antibiotics for NFGNB.

Out of the 50 Imipenem resistant isolates tested, 9 (18%) were found to be MBL producers.

Conclusions: Identification of MBL production is mandatory for making appropriate choice of antibiotics. This enables to relook into the antibiotic policy, create awareness and strengthen infection control to prevent the further spread of MBL producers.

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Abstract

Introduction: Malaria is endemic in India and constitutes a major public health challenge. Submicroscopic infection during pregnancy might be associated with increased risk of adverse pregnancy outcomes including low birth weight babies and maternal anaemia. Simple and easy to use malarial diagnostic tools with adequate sensitivity such as rapid diagnostic tests will help in accurate diagnosis and prompt treatment of pregnancy associated malaria and help in averting adverse pregnancy outcomes.

Aim: To assess testing methods available at a public hospital for diagnosis of malaria in pregnancy and discuss the use of appropriate test for diagnosis of malaria.

Material and methods: Data was analysed of pregnant women admitted in antenatal care (ANC ) ward with fever for period between January 2009 and December 2009 retrospectively with respect to demography of patients, slide positivity, Rapid malaria antigen test(RMAT) positive . Malaria PV/PF antigen card test by Accucare was used.

Results: Of the total ANC admissions 2880 in our hospital in the year 2009, 189 pregnant women were admitted with fever (6.5%) in our ANC ward. The standard protocol in our institute is to send peripheral smear (PS) for MP for all such cases and start presumptive therapy with chloroquine if symptoms suggestive of malaria. PS MP was positive in 28/189 i.e. 14.8%. Those who had persistent fever especially if PS for MP is negative were tested by RMAT (135 cases). Of those, 40 were positive 21.2 %.Utility and comparison of the tests will be discussed.

Conclusion: PS for MP is gold standard for diagnosis and gives additional information regarding type of parasite and density however it is requires expertise. RMAT is available, easy to perform and it is recommended that all RMAT are followed-up with microscopy to confirm the results and if positive, to quantify the proportion of red blood cells that are infected.

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