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   Table of Contents - Current issue
Coverpage
July-December 2022
Volume 24 | Issue 2
Page Nos. 53-93

Online since Tuesday, December 13, 2022

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EDITORIAL ON SPECIAL ARTICLE  

Carbapenem resistance testing – A challenge in India p. 53
Ranganathan N Iyer
DOI:10.4103/jacm.jacm_26_22  
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SPECIAL ARTICLE Top

Detection and reporting of Carbapenemase producing Gram negative bacilli in Clinical Microbiology: A survey of practices in laboratories across India p. 55
Kavita Raja, Chiranjay Mukhopadhyay, Anup Kumar Shetty, Jily P Chinnan, J Sudarsana, Reena Anie Jose, N Saritha, C Ravindranath, G Goel, Chithra Valsan, Subha Sundaramoorthy, Sapna Joy, SG Sagila, Ramakrishna Pai Jakribettu, KL Sarada Devi, Dinoop Korol Ponnambath, Ashish Jithendranath, Kavitha R Dinesh, Roopika Berry, Ranganathan N Iyer, Anu P John, Sanjay Bhattacharya
DOI:10.4103/jacm.jacm_25_22  
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DRUG REVIEW Top

Beta-lactam beta-lactamase inhibitors p. 63
Sangeeta Joshi
DOI:10.4103/jacm.jacm_21_22  
Four new β lactam-β lactamase inhibitor (BL-BLI) combinations, namely ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam and imipenem-cilastatin-relebactam are currently approved by the Food and Drug Administration for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs) and two of them for hospital-acquired pneumonia/ventilator-associated pneumonia. The clinical trials of these antibiotics have shown them to be non-inferior to comparator antibiotics. These antibiotics have action against extended-spectrum beta-lactamase enterobacterales and Klebsiella pneumoniae carbapenemase producers. Some have action against OXA-48 producing Gram-negative bacilli. However, all the above BL-BLI antibiotics have no action against metallo-β lactamase-producing organisms. These are currently being used for the treatment of cUTI and cIAI caused by multidrug-resistant (MDR) Enterobacterales and MDR Pseudomonas aeruginosa.
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ORIGINAL ARTICLES Top

Vulvovaginal candidiasis: Clinical profile, species distribution and antifungal susceptibility pattern p. 71
Syeda Mariyah, Ranganathan N Iyer, Rekha Rao Jangam, Shruthi Kesireddy
DOI:10.4103/jacm.jacm_24_22  
INTRODUCTION: Vulvovaginal candidiasis (VVC) is a common problem seen in women and 70%–75% of women experience VVC at least once in their lifetime. The relative incidence of vaginitis caused by non-albicans Candida (NAC) species is increasing which poses a problem as NAC is less susceptible to fluconazole which is commonly used for the treatment of VVC. In this study, we determined the species distribution of Candida isolates causing VVC and the antifungal susceptibility pattern of these isolates to fluconazole. MATERIALS AND METHODS: A prospective study was done in a tertiary care hospital in Hyderabad, South India (August 2019–December 2020), on 500 women with suggestive clinical features and culture-confirmed VVC. Five hundred Candida strains isolated from the vaginal swab of these women were speciated and fluconazole antifungal susceptibility testing (AFST) was done by broth microdilution technique (CLSI guidelines) for 103 isolates. The following fluconazole concentrations were tested: 0.125 μg/ml, 0.25 μg/ml, 0.5 μg/ml, 1 μg/ml, 2 μg/ml, 4 μg/ml, 8 μg/ml, 16 μg/ml, 32 μg/ml and 64 μg/ml which encompassed the clinical breakpoint concentrations and the expected results for the quality control strains. RESULTS: The majority of the women (93%) with VVC were in the reproductive age group (21–40 years). The most common presenting symptoms were vaginal discharge (66.4%) and pruritus (26.6%). The most common predisposing factor for VVC was pregnancy (44.8%). Candida albicans (62.8%) was the most common species isolated, followed by Candida glabrata (27.2%). Overall fluconazole susceptibility was 57%. About 72.2% of C. albicans were fluconazole susceptible. CONCLUSION: VVC has a wide clinical presentation with non-specific signs and symptoms. Diagnosis based only on signs and symptoms leads to over treatment. Thus, culture confirmation is crucial for the accurate diagnosis and to detect VVC caused by NAC which is less susceptible to fluconazole. Fluconazole AFST on these isolates would help in developing local antibiograms and to monitor resistance trends.
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Antifungal susceptibility profile and biofilm production of Candida spp. isolated from catheterised patients with urinary tract infection p. 76
Parthasarathy Kamini, Thayanidhi Premamalini, Kanagasabapathi Karthika, Sukumar Bavadharani
DOI:10.4103/jacm.jacm_12_22  
BACKGROUND: Candida species, which are present as normal flora in healthy individuals, are known to cause opportunistic infections with high rates of mortality, especially in immunocompromised individuals. Urinary tract infection (UTI) is the most common type of nosocomial infection, and about 10%-15% of them are due to Candida species. Catheter-associated infections due to Candida spp. are mainly due to biofilm formation. OBJECTIVE: This study aims to speciate Candida isolates from catheterised patients with UTI infection and to compare the antifungal susceptibility pattern with their biofilm production. MATERIALS AND METHODS: A total of 55 Candida species were isolated from the urine samples of catheterised patients with UTIs over a period of nine months. Patients' demographic details and risk factors were collected. All the isolates were identified and confirmed by routine phenotypic and genotypic techniques. The rare species that could not be identified by routine techniques were identified by sequencing the internal transcribed spacer region. Biofilm production was detected by tube method, and the antifungal susceptibility testing was done by broth microdilution method (CLSI M27-A3 guidelines). RESULTS: In our study, 55 Candida species were identified, among which the most predominant species was found to be Candida tropicalis 23 (42%). Among 48 biofilm producers (87.2%), only 2 (4.1%) isolates of Candida albicans and 3 (6.2%) isolates of C. tropicalis were resistant to Amphotericin B and Fluconazole. The MIC values for Amphotericin B, Fluconazole and Itraconazole were high in both Candida auris (2) and Candida lusitaniae (1), although one isolate of each species was a potent biofilm producer. In Candida catenulata (4), three isolates had high MIC value for Amphotericin B and two isolates had high MIC value for Itraconazole and three isolates produced biofilm.
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CASE REPORTS Top

Aeromonas veronii biovar sobria causing infected walled-off pancreatic necrosis: A rare infectious complication of chronic pancreatitis p. 84
Ranganathan N Iyer, Rekha Rao Jangam, Bharat Kumar Nara, Uma Karri
DOI:10.4103/jacm.jacm_13_22  
We report a rare case of infected walled-off pancreatic necrosis in a diabetic patient with chronic pancreatitis caused by Aeromonas veronii biovar sobria. Aeromonads are ubiquitous organisms found mainly in aquatic environments. Infection may occur after the ingestion of contaminated seafood/water, massive aquatic exposure during near-drowning events or by exposure of an abraded wound to the bacteria. The clinical manifestations of Aeromonas infections are mostly gastrointestinal infections, bacteraemia and skin and soft-tissue infections. Intraabdominal infections due to Aeromonas are uncommon with pancreatic infections being even rare.
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Fungal sternal wound infection following coronary artery bypass graft surgery – A rare case of surgical site infection p. 87
Rosmi Jose, Iswarya Babu, Chithra Valsan
DOI:10.4103/jacm.jacm_19_22  
Sternal wound infections following cardiac surgery by fungus are not common. Here, we report a case of Aspergillus sternal wound infection following coronary artery bypass graft (CABG) surgery. Elderly diabetic and hypertensive female patient presented with non-healing chest wound three and half months after CABG surgery. Aspergillus flavus was isolated from the pus sample from the sternal wound site. The patient was treated with surgical debridement and oral voriconazole for six weeks and she became asymptomatic and the wound completely healed on follow-up.
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'TB or not TB' – A rare case of primary tuberculosis of the breast p. 90
Anna Rachel Menezes, Queennie Elizabeth Jacob, Sarath Chandra Sistla
DOI:10.4103/jacm.jacm_20_22  
Tuberculosis (TB) of the breast remains a rare entity that commonly leads to disseminated cold abscesses and the spread of infection, especially in endemic regions like India. Its presentation, a firm nodule, with or without pain leading to ulceration and discharge, mimics various mammary pathologies, including malignancy, mycotic abscesses and granulomatous mastitis, and is, therefore, easily misdiagnosed. We present a case of primary TB of the breast with an abdominal cold abscess in a patient who complained of ulceration in the left breast, having a previous four-year history of a breast lump. Purulent discharge from the ulceration and abscess was positive for TB in a Cartridge-Based Nucleic Acid Amplification Test. She was also incidentally found to have a cold abscess in the superficial fascia in the left iliac fossa. The patient was treated with antitubercular drugs under the National TB Elimination Program. She is currently in her fourth month of treatment and has experienced a resolution of symptoms.
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