A study on biofilm production and antifungal drug resistance among Candida species from vulvovaginal and bloodstream infections Sanyuktha Tulasidas,1 Pooja Rao,2 Sevitha Bhat,2 Radhakrishna Manipura1 1Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, India; 2Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal McGill Center for Infectious Diseases, Mangalore, Manipal, India Introduction: Candida species, one among the opportunistic fungi, has become a common pathogen causing vaginal thrush and nosocomial bloodstream infections (BSIs). This study aims to evaluate the prevalence and antifungal susceptibility of various Candida species and slime production by Candida species in BSIs and vulvovaginal candidiasis (VVC). Materials and methods: A total of 176 samples were collected for a period of 1 year. Antifungal susceptibility testing and biofilm production testing were performed by the Kirby-Bauer method and crystal violet assay, respectively. Results: Out of 176 samples, 74 (42%) were from BSIs and 102 (58%) were from VVC. The biofilm production was comparatively high in blood isolates, 55 (74%), than cervical isolates, 45 (44%). Increase in the trends of non-albicans Candida (NAC) species was seen in our setup. Good susceptibility rates were seen among Candida species, 82.38% to voriconazole and an increasing resistance pattern of 26.13% to fluconazole. Conclusion: Speciation of Candida becomes important as the prevalence of NAC is increasing. Antifungal susceptibility testing by the disk diffusion method is cost effective and should be adopted in routine testing as there is an increasing azole resistance, especially in invasive NAC infections. In this study, there was no correlation of antifungal drugs with the biofilm production. Keywords: biofilm, Candida, azoles, vulvovaginal, bloodstream infections

Outbreaks and prevalence of Methicillin resistant Staphylococcus aureus (MRSA) Nosocomial Infection (NI) among various populations have been well reported in literature, particularly those from developed countries. There is a paucity of information on carriage of MRSA in developing nations, including the carriage by critical healthcare givers who are potential transmitters. Present study was aimed at establishing the carriage rate of MRSA among healthcare workers in the critical care units of Kasturba Medical College Hospital, Mangalore, India and at formulating an MRSA control policy, based on the outcomes. We screened 200 healthcare workers in the critical care units of the Kasturba Medical College Hospital, Mangalore, India, for MRSA and vancomycin susceptibility of the isolates. Swabs taken from both anterior nares were transported, inoculated onto mannitol salt agar (MSA) and incubated aerobically at 37°C for 18-24 hours. Gram positive cocci in clusters, with positive catalase, coagulase and DNAse tests, were identified as S.aureus. Further categorization of S.aureus into MRSA was done by using cefoxitin disc diffusion method. Sensitivity to vancomycin was tested by vancomycin disc diffusion and vancomycin agar screen plating. The number of strains of S. aureus which was isolated from our 200 participants was 35, with a rate of 17.5% of the 35 isolates of S. aureus, 5 (14.3%) were MRSA. None of the S. aureus strains were vancomycin resistant. MRSA carriage among healthcare workers who were involved in the management of critically ill patients at Kasturba Medical College hospital, Mangalore, India was 2.5%, which is comfortably low. The existing infection control policy in our hospital seems to be effective and the same should be maintained.

Background: Multidrug resistance in Acinetobacter baumannii is constantly on the rise. There has also been an increase in the morbidity and mortality of patients with infection by the same pathogen. Aim: This study aimed to assess the patterns of antibiotic resistance exhibited by various clinical isolates of Acinetobacter baumannii, examine the risk factors associated, and investigate the prevalence of co-infecting pathogens and the clinical outcomes of the patients. Study Design: Retrospective cross-sectional study. Patients and Methods: Reports of 100 isolates of Acinetobacter baumannii obtained from patients admitted in two tertiary hospitals were used for the study. Identification and determination of antibiotic resistance patterns were done using Vitek2. The presence of probable risk factors was noted. The pattern of clinical outcomes of the patients and the prevalence of co-infecting pathogens were analyzed. Data analysis was done using descriptive statistics. Results: More than 50% of isolates showed resistance independently to imipenem and meropenem. Higher rates of susceptibility were observed with tigecycline (55%). Isolates obtained from patients in the intensive care unit (ICU) showed resistance to a more number of antibiotics than those in the wards and operation theatre. Seventeen percent of the isolates were associated with a co-infecting pathogen such as Pseudomonas, Enterococcus, Klebsiella, 87% of the patients were discharged, 12% expired, and 1% were shifted. A positive correlation was found between the duration of hospital stay and number of antibiotics to which the isolate was resistant. Conclusion: Multidrug resistance in Acinetobacter baumannii continues to be a menace. In this study, a large number of isolates exhibited resistance to carbapenems such as imipenem, meropenem, and ertapenem, thereby signifying the need for further research and the use of other antibiotics such as tigecycline, to which higher susceptibility was observed.

Tuberculosis (TB) remains one of the major causes of death from a single infectious agent worldwide. Its resurgence in 1990s is primarily due to co-infection with HIV and the emergence of multi-drug-resistant (MDR) strains. Our objectives in this study were demonstration and grading of acid-fast bacilli in smears from sputum specimens of clinically newly diagnosed pulmonary TB patients, isolation of the organism, speciation and drug susceptibility testing of Mycobacterium tuberculosis isolates to isoniazid (H), rifampicin (R), streptomycin (S), and ethambutol (E). Sputum specimens were collected from 150 patients. Smear examination was done after Ziehl-Neelsen staining. The specimens were cultured onto Lowenstein Jensen media after Petroff's method of concentration. The growth was identified as M. tuberculosis with standard tests. Sensitivity of 50 isolates of tubercle bacilli to anti-TB drugs H, R, S, E were determined by Resistance-Ratio method. Out of 150 sputum specimens examined, 62(41.3%) were smear positive. Out of these 62,56 grew on culture. 50 isolates of M. tuberculosis were picked up for drug susceptibility testing. Total of 31 (62%) were resistant to S, 14(28%) to H, 9(18%) to R, 6(12%) were resistant to E and 2 strains (4%) were resistant to H and R. From the small cohort, incidence of primary MDR-TB was found to be 4% in this region, which is within the expected range.

Objective: The incidence of community-acquired and hospital-acquired Staphylococcus aureus infections has been rising with increasing emergence of drug-resistant strains called methicillin-resistant S. aureus (MRSA). The main objective of this study was to determine the prevalence of carriage rate of MRSA among the interns of tertiary care teaching hospital in Mangalore.Methods: A total of 150 interns were participated, thereby swabs from both anterior nares were collected and processed for S. aureus. The isolated strains of S. aureus were screened for methicillin susceptibility by modified Kirby–Bauer method using cefoxitin (30 μg) disc. Further, antibiotic susceptibility testing for all isolates of S. aureus was also done against selected appropriate antibiotics. Vancomycin susceptibility testing for MRSA was done by E test.Results: The number of strains of S. aureus isolated from our 150 participants was 71 with a percentage rate of 47.3. Of the 71 isolates of S. aureus, one (1.4%) was MRSA. The overall MRSA carriage rate was 0.66%. The S. aureus and MRSA carriage rates recorded in this study were at par and significantly lower, respectively, when compared with other reported studies. It was observed that risk factors such as the use of antibiotics in the past 6 months and smoking were found to be statistically significant in nasal carriage status of S. aureus (<0.05). The only one isolate of MRSA was found to be sensitive to vancomycin, linezolid, and teicoplanin.Conclusion: It was concluded that the acquisition of S. aureus and MRSA would not be an occupational hazard for medical students of developing countries like India.