Journal of Medical Microbiology and Infectious Diseases
Year:2024 | Volume:12 | Issue:2|Papers Count:8

During the COVID-19 pandemic, there has been a resurgence of mucormycosis, a rare and opportunistic fungal infection, with India reporting a particularly notable increase in incidence. Mucormycosis is a life-threatening condition that requires prompt diagnosis and treatment to prevent high mortality rates and severe sequelae. It is caused by the inhalation of spores from ubiquitous filamentous fungi belonging to the order Mucorales. Individuals with compromised immune systems or underlying conditions, such as diabetes, ketoacidosis, and neutropenia, are particularly vulnerable to infection. The risk and severity of mucormycosis are exacerbated by several factors, including corticosteroid therapy, prolonged intensive care stay, and the use of ventilators. Additionally, contaminated oxygen humidifiers pose a significant risk. Effective management of mucormycosis in critically ill COVID-19 patients relies on early diagnosis, optimization of predisposing factors, timely antifungal treatment, surgical debridement, and adjuvant therapies. Imaging modalities such as contrast-enhanced CT scans and MRI are crucial for guiding surgical debridement and assessing disease extent. This review article provides a comprehensive overview of the clinical pathogenesis, risk factors, diagnosis, treatment, and challenges associated with mucormycosis in COVID-19 patients, summarizing the latest findings in this field

Introduction: The COVID-19 pandemic has significantly impacted global health, and vaccines have been crucial in mitigating severe outcomes. However, the effect of type 2 diabetes on vaccine-induced immune responses is not fully understood. This study aims to analyze SARS-CoV-2 antibody levels in individuals with type 2 diabetes and compare them to individuals without diabetes to elucidate the complex interactions between diabetes and immune responses. Methods: At GMC Srinagar, India, a study involving 299 healthcare workers reviewed their vaccination status, SARS-CoV-2 infection history, and diabetes status. Blood samples were analyzed for HbA1c and IgG antibodies using ELISA and chemiluminescence assays. Descriptive and inferential statistics were used to analyze demographic data and compare groups. Results: More than two-thirds of the participants had prior COVID-19 infections, and vaccination rates were high. Diabetes significantly impacted antibody levels, with diabetic individuals showing lower IgG titers compared to non-diabetic individuals. Age and gender also influenced antibody levels: individuals aged 41-50 and 51-60 had higher anti-S antibody titers than younger age groups (t-test = 52. 603, df = 15, P < 0. 001). Males exhibited higher anti-S antibody titers compared to females (t-test = 7. 483, df = 5, P = 0. 007). Booster doses of the vaccine significantly enhanced antibody responses. Conclusion: This study highlights the impact of diabetes, age, gender, and vaccination history on SARS-CoV-2 antibody levels in healthcare workers. Diabetic individuals had lower antibody titers, while age and gender differences also affected antibody responses. These findings suggest the need for personalized vaccination strategies, especially for diabetic healthcare workers, to optimize COVID-19 prevention and ensure effective immunity

Introduction: Hospitals are breeding grounds for multidrug-resistant (MDR) bacteria, posing treatment challenges and increasing the risk of spreading "superbugs. " This study investigates the prevalence of colistin-resistant bacteria, a last-resort antibiotic, in wastewater from tertiary hospitals in Enugu, Nigeria. Methods: Twenty wastewater samples were collected over three months from two tertiary hospitals in Enugu. A standardized protocol by the American Public Health Association (APHA) was followed. Samples were collected aseptically from key drainage points and transported to the lab within 2 hours. Bacteria were isolated using the pour-plate method and characterized by morphological and biochemical tests, including Catalase, Oxidase, and Glucose Fermentation. Antibiotic susceptibility was assessed using Kirby-Bauer disc diffusion, and colistin resistance was confirmed via broth microdilution. Multiplex PCR detected mcr genes indicating plasmid-mediated resistance. Data were analyzed using SPSS version 23 with Chi-Square and ANOVA tests at a significance level of P < 0. 05. Results: Gram-negative bacteria were isolated from 63. 1% of samples, with Klebsiella spp. being the most prevalent, accounting for 24. 6%. Colistin resistance was phenotypically observed in E. coli (83%), Klebsiella spp. (75%), and Pseudomonas aeruginosa (100%). Genotypically, E. coli harbored mcr-1 (17%) and mcr-3 (83%), while all Klebsiella and Pseudomonas isolates carried multiple mcr genes. Additionally, these bacteria showed resistance to multiple antibiotics, including Septrin, Gentamycin, and Ceftriaxone. Conclusion: The significant presence of colistin-resistant bacteria, especially E. coli and Klebsiella, poses a public health concern, potentially leading to treatment failures and spreading resistance genes. Stricter monitoring of hospital wastewater is necessary to identify emerging resistance trends and improve antibiotic practices in hospitals

Introduction: Non-fermenting Gram-negative bacilli (NFGNB), particularly the Acinetobacter baumannii complex (ABC) and Pseudomonas aeruginosa, are common causes of infections in both hospitalized patients and outpatients, posing significant clinical and therapeutic challenges. The primary objective of this study was to conduct a comprehensive analysis of NFGNB, specifically ABC and P. aeruginosa, isolated from pus specimens obtained from both hospitalized patients and outpatients. Methods: This study investigated the antibiotic resistance patterns of NFGNB, focusing on ABC and P. aeruginosa, isolated from pus samples collected from both hospitalized patients and outpatients. The isolates were tested for multidrug resistance (MDR) and extensive drug resistance (XDR) using standardized microbiological protocols. The data were analyzed using descriptive statistics to summarize the findings. Results: Out of 1234 pus samples received, 117 (9. 5%) NFGNB were isolated, accounting for 30% of the total Gram-negative bacilli (GNB) isolates. The majority of NFGNB (82. 9%, n = 97/117) were isolated from inpatients, with surgical site infections being the most common clinical condition (33. 3%, n = 39/117). Among the NFGNB isolates, P. aeruginosa was the predominant species (76. 9%, n = 90/117), followed by A. baumannii (22. 2%, n = 26/117). Antimicrobial susceptibility testing revealed that 37. 7% (n = 34/90) of P. aeruginosa isolates were MDR and 13% (n = 12/90) were XDR, while 65% (n = 17/26) of A. baumannii isolates were MDR and 26. 9% (n = 7/26) were XDR. Conclusion: This study highlights the emergence of NFGNB as significant nosocomial pathogens, exhibiting a high degree of resistance to commonly used antibiotics. The findings underscore the urgent need to enhance and strictly implement effective antibiotic stewardship policies, including the development of new antibiotic regimens and antimicrobial resistance surveillance programs, to combat the growing resistance of nosocomial pathogens and ultimately improve patient outcomes

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) has a high prevalence in hospital settings in India and imposes a serious economic burden on healthcare resources. Understanding the local prevalence and evolving antimicrobial resistance patterns of MRSA is crucial for guiding effective treatment strategies. This study aims to determine the prevalence, clinico-demographic profile, and antibiotic susceptibility patterns of MRSA and methicillin-susceptible Staphylococcus aureus (MSSA) isolates. Methods: This retrospective study analyzed Staphylococcus aureus isolates collected between June 2021 and May 2023 from blood, pus, sterile body fluids, respiratory, and urine samples at the Microbiology laboratory of Mahatma Gandhi Hospital. Isolates were identified as S. aureus and tested for methicillin resistance using the Vitek 2 Compact system, which employs an advanced colorimetry method for identification and determines the minimum inhibitory concentration (MIC) using a broth microdilution method for antimicrobial susceptibility testing. Results: Of the 481 Staphylococcus aureus isolates analyzed, 264 (55%) were identified as MRSA. Among the MRSA isolates, the most common source was pus/wound infections (59%), followed by bloodstream infections (22%). MRSA isolates showed a susceptibility rate of 56% to gentamicin and 45% to clindamycin, but only 14% to ciprofloxacin. However, 55% of MSSA isolates were resistant to ciprofloxacin. All MRSA isolates were susceptible to daptomycin, teicoplanin, vancomycin, and linezolid. Conclusion: Our findings underscore the need for continuous MRSA surveillance and emphasize tailoring local antibiotic guidelines based on resistance patterns. Targeted antimicrobial stewardship programs and reinforced infection control protocols, especially for pus/wound infections, are crucial to curb the spread of resistant strains

Introduction: Uropathogenic Escherichia coli (UPEC) is a leading cause of community-acquired and healthcare-associated infections, and antimicrobial resistance in UPEC poses significant challenges to managing these infections. This study aimed to investigate the molecular types of UPEC using enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) and analyze their resistance patterns in a tertiary care setting. Methods: A cross-sectional study was conducted at a tertiary care hospital, where 65 consecutive E. coli isolates from urinary specimens were collected. Isolates were identified biochemically and confirmed by 16S rRNA gene PCR. Antibiotic susceptibility testing was conducted following CLSI guidelines, and molecular typing was performed using ERIC-PCR. ERIC-PCR profiles were analyzed using PAST software version 4. 0, generating a dendrogram to visualize similarity among ERIC types. Fisher's exact test was used to determine if specific ERIC types were significantly associated with particular antibiotic resistance profiles. Results: The results showed that 95% of the isolates were resistant to at least two antibiotics, with 92. 3% being multidrug resistant (MDR). The highest resistance was observed against ampicillin, while no resistance was seen against colistin and tigecycline. The resistant isolates displayed 36 different antibiograms, indicating a significant degree of resistance variability. ERIC-PCR typing revealed 22 unique clusters at a similarity coefficient of approximately 70%, highlighting the genetic diversity of UPEC isolates in our setting. Conclusion: This study enhances the understanding of UPEC epidemiology in healthcare by revealing the molecular characteristics and resistance profiles of prevalent strains. The high occurrence of MDR UPEC and the absence of a correlation between ERIC types and antibiograms suggest adaptability and increased resistance. These results highlight the necessity for continuous surveillance to inform infection control measures and direct targeted interventions against the spread of MDR UPEC

Introduction: Burn wound infections are a significant cause of morbidity and mortality among burn patients. Understanding of the prevalent bacterial etiologies and their antimicrobial susceptibility patterns within a healthcare facility is crucial for optimizing management strategies. Methods: This retrospective descriptive study was conducted over a four-year period at the Department of Microbiology in a tertiary care facility. We analyzed swab and pus samples collected from burn wound patients admitted to the Department of Plastic Surgery. Demographic data, including age and gender, were collected. Positive bacterial cultures underwent Gram staining and culture for identification. Biochemical tests were used for species-level identification. Antimicrobial susceptibility testing was performed using the disk diffusion method according to CLSI guidelines. Statistical analyses were carried out using SPSS software version 23 employing the chi-square test. Results: Out of 750 swab and pus samples analysed, 556 (74. 1%) yielded positive bacterial cultures. Gram-negative bacteria predominated, accounting for 475 (85. 4%) isolates, while 81 (14. 6%) were Gram-positive. The most prevalent pathogens were Pseudomonas aeruginosa (175, 31. 47%), Klebsiella pneumoniae (100, 17. 99%), and Acinetobacter baumannii (68, 12. 23%). Notably, 80. 5% of P. aeruginosa isolates exhibited multidrug resistance (MDR). Among Staphylococcus aureus isolates, 37 (72. 7%) were methicillin-resistant (MRSA). Conclusions: Among all isolates, P. aeruginosa was the most prevalent bacterial pathogen. S. aureus was the most prevalent Gram-positive organism. 72. 7% of S. aureus isolates were MRSA. The high prevalence of multidrug-resistant P. aeruginosa and MRSA underscores the importance of implementing an antimicrobial stewardship program guided by local antibiograms.

Introduction: Superficial mycoses are a significant public health concern worldwide, especially in regions like India, due to their high disease burden and impact on quality of life. This study aimed to investigate the epidemiology of superficial fungal infections in a tertiary care hospital in Kashmir, examining their prevalence, etiological agents, anatomical involvement, and associated risk factors. Methods: A hospital-based cross-sectional study was conducted at the Government Medical College, Srinagar, Kashmir, from April 2019 to October 2020. A total of 672 patients with suspected superficial fungal infections were enrolled and analyzed using direct microscopy and culture techniques. Statistical analyses were performed using SPSS version 25. 0 and R version 4. 0. 2, employing descriptive statistics and chi-square/Fisher's exact tests for categorical associations. Results: Among 672 patients (mean age 42 ± 15 years, 52. 08% male), dermatophytosis was the most common superficial fungal infection (44. 64%), followed by candidiasis (29. 76%) and pityriasis versicolor (14. 88%). Pityriasis versicolor was more frequent in patients younger than 20 years old, while dermatophytosis and candidiasis were prevalent in those aged 20-59 years old. Non-dermatophyte fungi, including Candida species and non-dermatophyte molds, were more common in nail and skin samples. Candida albicans and Trichophyton mentagrophytes were the primary causative agents. Significant risk factors included diabetes, immunosuppression, antibiotic/corticosteroid use, the sharing of personal items, occupational exposure, excessive sweating, and tight clothing (P < 0. 05). Conclusion: This study underscores the substantial burden of superficial fungal infections, particularly dermatophytosis and non-dermatophyte mycoses in a tertiary care setting in Kashmir. Our findings emphasize the need for accurate identification of causative agents and associated risk factors to inform tailored antifungal therapy and preventive strategies