Medical Inspection – Health Blog

Background and Collection of Isolates

From January 1, 2001 to December 31, 2002, R aeruginosa isolates were recovered from patients seen at various centers in Trinidad. Isolates were collected from community sources, (privately operated microbiology laboratories, general practitioners offices, outpatients clinics) and hospitals (specimens from the ICUs, surgical services, nursery, adult and pediatric medical wards, and the obstetric and gynecology wards) [See Acknowledgements], and then submitted to the Eric Williams Medical Sciences Complex Microbiology Laboratory (EWMSC). All isolates from community sources and other hospitals were received on Mueller-Hinton agar plates. Data obtained for each isolate were the patient’s age, sex, the source of the isolate, whether the patient was nonhospitalized or hospitalized in an ICU, surgical ward, or on a neonatal unit. Specimens with incomplete data were few and therefore were excluded from the study. The EWMSC is a fee-for-service, 560-bed tertiary hospital complex located in the northwestern part of Trinidad. Trinidad is about 4,828 km² in area and is the larger of the twin-island republic, Trinidad and Tobago, located about 11 km off the northern coast of Venezuela in South America. The population of the republic is about 1.25 million people.

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The prevalence of resistance of P aeruginosa strains to the nine antimicrobials tested was relatively low among hospital strains. Strains from community sources were fully sensitive to four of the nine drugs. No local or regional data could be found in the literature to which resistance rates among P aeruginosa could be compared. However, increasing resistance to the different antipseudomonal drugs particularly among hospital strains has been reported worldwide, and this presents a serious therapeutic problem in the management of diseases due to these organisms. Reports from Turkey have shown P aeruginosa resistance rates of 73.6% and 68.0% to piperacillin and gentamicin, respectively. In Russia, 79% and 75% of isolates were found to be resistant to generic piperacillin and gentamicin, respectively, while from Bangladesh, rates of resistance of 51.0% to tobramycin and 21.0% to ciprofloxacin tablet have been recorded.

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From 650 cultures that were received from participating centers, 554 (85.2%) were recovered on subculture and subsequently confirmed as P aeruginosa. All of the 554 isolates that were confirmed as P aeruginosa produced pyocyanin. Ninety-six of 554 (17.3%) of the isolates were recovered from the ICU, and 10.1% (56/554) from the nursery. Other inpatients services accounted for 288 isolates (52.0%%) and community isolates of P aeruginosa accounted for only 20.6% (114/554) of all isolates (Table 1). Respiratory tract isolates were the predominant source of P aeruginosa from the ICU and the nursery, whereas wounds were the principal source from other inpatients. More than 98% (112/114) of the community isolates of P aeruginosa were recovered from ear and urinary tract infections.

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INTRODUCTION

Pseudomonas aeruginosa is a ubiquitous organism frequently isolated from clinical specimens. Because these organisms are usually inherently resistant to many antimicrobial agents, treatment of pseudomonal infections is usually difficult, and mortality is usually high. This intrinsic resistance is mainly a result of the diffusion barrier of the bacterial outer membrane; amino-acid substitution in the target molecules, such as Gyr A and/or Par C, via point mutation in each genetic determinant; and antimicrobial inactivating enzymes. In most hospital environments, this inherent resistance is further complicated by mutations mediated via chromosomes and the acquisition of resistant genes from plasmids and transposons. One type of mutation simultaneously comprises generic penicillins, generic cephalosporins, and the generic fluoroquinolones, and enhances resistance to chloramphenicol and tetracyclines by accelerating multidrug efflux. Other mutations involve loss of the D2 porins that mediate carbapenem resistance, reduce uptake of aminoglycosides across the outer or cytoplasmic membrane, and inactivation by aminoglyco-sides-modifying enzymes. Recently, strains of P aeruginosa resistant to all antimicrobials except polymyxin В were reported. Genetic analyses of these strains identified two unique extended-spectrum beta-lactamase genes. One—bla (VIM-7)— encoded a metallo-beta-lactamase, and the other— bla (OXA-45)—encoded a class-D extended-spectrum beta-lactamase.

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Multiple risk factors are associated with cardiovascular disease in subjects with diabetes, including hypertension, hyperlipidemia, obesity, and microalbuminuria, which are the key components of MS. They have a risk of death from cardiovascular causes that is two- to six times that among persons without diabetes. Among white Americans, the age-adjusted prevalence of coronary heart disease (CHD) is twice as high among those with type-2 diabetes as among those without diabetes.

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A total of 218 subjects with type-2 diabetes were studied. The mean age of all the patients was 52 ± 5.8 years (range 36-62 years), consisting of 128 (58.7%) males and 90 (41.3%) females. The mean duration of disease was 8.5 ±7.1 years. The mean fasting blood glucose and two-hour postprandial blood glucose levels in the population were 5.4 ± 1.2mmol/l (range 4.3-6.2 mmol/1) and 7.9 ± 0.3mmol/l (range 7.4-8.5 mmol/1) respectively. The mean WHR was 0.97 and 0.96 in male and female subjects, respectively. The mean BMI was 25.5 ± 5.4 (males—23.4 ± 4.2; females—26.2 ± 5.7). Table 1 shows the baseline data of the subjects with and without MS.

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A total of 218 subsamples of consecutive patients with type-2 diabetes seen between September 1999 and August 2001, in both the medical outpatient department and the medical wards of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria were studied.

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