Emerging microbiological trends in Candiduria.
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Candida↗
Biomedical subjects
Dilip Mathai
Publications and source records attributed to Dilip Mathai.
Treatment failure in typhoid fever with ciprofloxacin susceptible Salmonella enterica serotype Typhi.
Fluoroquinolones are considered the most effective drugs for the treatment of typhoid fever and hence are widely used in the empiric treatment of acute undifferentiated febrile illnesses in India. Recent reports of Salmonella enterica serotype Typhi (S. Typhi) strains with increasing minimum inhibitory concentration (MIC) of ciprofloxacin have raised the fear of potential treatment failures. In this case series of 109 consecutive patients hospitalized with typhoid fever (S. Typhi grown from blood), we documented clinical failure (fever persisting >6 days) in 25 of 46 (54.3%) adults who could be evaluated. Among these, eight (17.4%) had microbiological failure (S. Typhi recovered from blood after 6 days of ciprofloxacin therapy) despite adequate serum ciprofloxacin levels, and all required alternative drugs for treatment. These 8 S. Typhi strains, although susceptible to ciprofloxacin (MIC < 1 microg/mL) (NCCLS 2000), had MICs (median MIC 0.5 microg/mL) that were increased 15-fold compared to S. Typhi strains from patients with typhoid fever seen at our center in 1995 (median MIC 0.032 microg/mL), and were nalidixic acid resistant S. Typhi (NARST) (MIC > or =32 microg/mL). The poor treatment outcomes with ciprofloxacin therapy in patients infected with NARST strains that exhibit an increased ciprofloxacin MIC call for a need to revise the ciprofloxacin breakpoints for S. Typhi.
Adolescent↗
Evaluation of the in vitro activity of six broad-spectrum beta-lactam antimicrobial agents tested against recent clinical isolates from India: a survey of ten medical center laboratories.
The widespread use of beta-lactam antimicrobial agents as first-line therapy for the treatment of serious infections has led to the development of various resistances that have compromised the use of some agents. In certain countries, the lack of local or national surveillance programs limits the ability to detect these resistant strains and prevent their dissemination. A 10 medical center study in India was initiated to benchmark prevailing resistance rates for a range of bacterial pathogens to beta-lactams, and it found high rates of beta-lactamase-mediated resistance in Escherichia coli and Klebsiella spp. These rates included: cephalosporins (55.6-61.3% resistance), with extended-spectrum beta-lactamase (ESBL) phenotypes noted in over 60% of E. coli isolates and in Salmonella spp. (3.2-8.1%). Imipenem, a carbapenem, was the only antimicrobial agent tested with 100% activity against Enterobacteriaceae. Cefpirome was the most active of the tested cephalosporins, and all were fully active against methicillin-susceptible staphylococci with the exception of ceftazidime. Molecular and susceptibility characterization of 52 selected ESBL-producing strains showed a high level of co-resistance with aminoglycosides and fluoroquinolones, and clonal dissemination of resistant strains within medical centers. Collaborative studies, such as those presented here, can accurately detect changes in resistance patterns, and their continued use may help limit the further development and spread of bacterial resistances in India.
Anti-Bacterial Agents↗
A comparison of the antimicrobial activity of meropenem and selected broad-spectrum antimicrobials tested against multi-drug resistant Gram-negative bacilli including bacteraemic Salmonella spp.: initial studies for the MYSTIC programme in India.
The evolution in India of multi-drug resistant pathogens possessing extended-spectrum beta-lactamases (ESBLs) threatens to compromise the clinical utility of third-generation cephalosporins and monobactams. Using selected resistant strains from a recent Indian 10 centre surveillance study that measured the prevailing incidence of resistance to beta-lactam antibiotics, the potential clinical utility of meropenem was assessed against nine other antimicrobial agents. A total of 212 Gram-negative bacilli were tested, of which 125 were confirmed by reference methods to be ESBL-producers. Meropenem was the most active of the test antimicrobials against these strains and the rank order of susceptibility was meropenem (99.1% susceptible) > piperacillin/tazobactam (76.9%) > ciprofloxacin (42.5%) > aminoglycosides (34.4-39.6%) = other beta-lactams (30.0-39.6%). Of the tested strains only two (Acinetobacter spp. and Pseudomonas putida) showed an intermediate susceptibility (8 mg/l) to meropenem. Of the 57 tested strains of Salmonella spp., three had an ESBL phenotype, confirmed two of the strains. This study confirms the high levels of resistance to beta-lactams agents in India reported elsewhere and also demonstrates, for Escherichia coli and Klebsiella spp., high levels of co-resistance between the tested beta-lactam agents and ciprofloxacin and the aminoglycosides, gentamicin and tobramycin. However, carbapenems such as meropenem, remain a therapeutic option.
Anti-Bacterial Agents↗
Aetiology of prolonged fever in antiretroviral-naïve human immunodeficiency virus-infected adults.
BACKGROUND: Prolonged fever is a common symptom among human immunodeficiency virus (HIV) infected individuals, and is usually due to a cause that is easily treatable. Limited data are available regarding the causes of fever in HIV-infected Indian patients. In this paper, we have profiled the causes of prolonged fever in a cohort of HIV-infected Indian patients and have developed suitable algorithms to assist in an early diagnosis. METHODS: From February 1997 to October 1998 (20 months), 100 HIV-infected patients (age > 12 years) were evaluated for 100 episodes of prolonged fever (fever > 100 degrees F for more than 2 weeks in outpatients and > 3 days in inpatients). Patients with terminal acquired immunodeficiency syndrome (AIDS) were excluded. Patients were evaluated on the basis of the symptoms associated with prolonged fever and investigated according to pre-existing algorithms. RESULTS: Among such episodes of fever, infection was the major cause and included tuberculosis, especially the extra-pulmonary and disseminated forms (69%), cryptococcosis (10%) and Pneumocystis carinii pneumonia (7%). Other causes included bacterial pneumonia, amoebic liver abscess, disseminated histoplasmosis and cerebral toxoplasmosis. Patients were naïve for antiretroviral therapy and did not receive prophylaxis for opportunistic infections. The diagnostic yield of ultrasound of the abdomen (85%), fine-needle aspiration cytology of enlarged lymph nodes (75.6%) and bone marrow trephine biopsy (41.6%) were found to be high in our study. CONCLUSIONS: Tuberculosis is the commonest cause of prolonged fever in HIV-infected adults in India. Non-infectious causes were not seen in this series. We have suggested an algorithmic approach for establishing the cause of fever in these patients. In situations where laboratory evaluation does not reveal a cause for prolonged fever, a therapeutic trial with antituberculous therapy in selected patients is justified.
AIDS-Related Opportunistic Infections↗