Browsing by Author "Wijesooriya, L.I."

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Analysis of antibiotic sensitivity pattern of clinically significant Staphylococcus aureus at a Base Hospital, Sri Lanka
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Jayawardana, G.P.C.; de Silva, S.H.N.A.
INTRODUCTION: Staphylococcus aureus. is a major organism that causes skin and soft tissue infections. Moreover, it causes an array of other infections. It is treated with flucloxacillin/cloxacillin. However, a significant proportion of S. aureus has developed resistance to flucloxacillin/cloxacillin; hence, they are termed as MRSA. Though MRSA is likely to present in hospital settings, it has crept to the community as well. Accordingly, the number of MRSA infections is increasing.OBJECTIVE: To analyze theantibiotic sensitivity (ABST) pattern of clinicallysignificant S. aureus. METHOD: A retrospective, cross-sectional study was conductedover one year from 01/08/2017 to 31/07/2018involving patients infectedwith S. aureus in Base Hospital, Wathupitiwala. Demographic & clinical data & ABST results were analyzed. ABST (John Stokes method) was performed for chloramphenicol, ciprofloxacin, erythromycin, fusidic acid, linezolid, co-trimoxazole, gentamicin, clindamycin, teicoplanin & vancomycin. MRSA was identified using cefoxitin disc. The ABST pattern of MSSA was compared with that of MRSA. Statistical analysis was done via the R programming language (level of significance P<0.05). RESULTS: Of 210 patients,48 % (101/210) were males while 52% (109/210) were females. In study cohort,88.1% (185/210) was inpatients & the rest (11.9% - (25/210)) was outpatients. Of the isolated S. aureus, 42.9% (90/210) were from pus, 14.8% (31/210) from blood, 29.5% (62/210) from sputum & 12.4% (26/210) from urine. As per ABST, 69.1% (145/210) was MRSA & 31% (65/210) was MSSA. Sensitivity of MSSA was 84.6% (11/13) for chloramphenicol, 62.3% (33/53) for gentamicin, 55.8% (29/52) for ciprofloxacin, 68.9% (31/45) for clindamycin, 45.7% (21/46) for erythromycin, 84.2%(16/19) for nitrofurantoin, 69.2%(27/39) for fusidic acid, 92.1%(35/38) for linezolid, 74.6%(41/55) for co-trimoxazole, 84.6%(33/39) for teicoplanin & 92.3%(60/65) for vancomycin. Sensitivity of MRSA was 83.3% (20/24) for chloramphenicol, 35.6% (32/90) for gentamicin, 24.6% (30/122) for ciprofloxacin, 34.1% (42/123) for clindamycin, 8.0% (9/112) for erythromycin, 75%(12/16) for nitrofurantoin,65.8%(73/111) for fusidic acid, 99%(96/97) for linezolid, 58.9%(76/129) for co-trimoxazole, 87%(80/92) for teicoplanin & 98.5%(134/136) for vancomycin. Sensitivity of MRSA was significantly low compared to the sensitivity of the MSSA against erythromycin (P = 0.000), ciprofloxacin (P = 0.000), clindamycin (P = 0.000) & gentamicin (P = 0.002). CONCLUSION: Skin & soft tissue infections were the most common infections caused by S. aureus. MRSA rates were alarmingly high in the study cohort. Less than 50% of MRSA were sensitive to erythromycin, ciprofloxacin, gentamicin, & clindamycin and it was significantly low compared to the sensitivity of MSSA against same antibiotics. Vancomycin and linezolid are effective empiric antibiotics for both MSSA & MRSA.
Analysis of Clinically Significant Acinetobacter Spp Isolated from a Base Hospital (BH) of Sri Lanka during a One-Year Period
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Jayawardana, G.P.C.; de Silva, S.H.N.A.
Introduction: Acinetobacter spp are potential opportunistic pathogens. Being a water-trophic organism, it stays in humidifier water, sink basins, suction apparatus, disinfectant fluids etc. Number of cases due to Acinetobacter spp are increasing globally & locally. Treatment of Acinetobacter infections is a great challenge due to its resistance to most antibiotics. However, awareness about antibiotic sensitivity (ABST) pattern of the organism would streamline empiric antibiotic therapy. Objective: To identify the burden & ABST pattern of Acinetobacter spp isolated duringa one-year period. Method: A descriptive, cross-sectional study was carried out involving patients with clinically significant Acinetobacter infection at BH, Wathupitiwala from 01/08/2017 to 31/07/2018. The number of Acinetobacter spp identified from the total number of positive cultures obtained during the same period was analyzed. Demographic& clinical data of patients infected with Acinetobacter spp were also analyzed. ABST (John-Stokes method) of Acinetobacter spp were analyzed for gentamicin, amikacin, cefotaxime, ceftazidime, ceftriaxone, cefepime, cefoperazone-sulbactam, piperacillin-tazobactam, ampicillin-sulbactam, ticarcillin-clavulanic acid, ciprofloxacin, levofloxacin, co-trimoxazole, meropenem& polymyxin B. Results: Of 920 total bacterial cultures performed over the study period, 44% (404/920 - urine samples, 26% (238/920) - sputum, 23% (215/920) - pus & wound swabs & 7% (63/920) - blood. Of positive blood cultures, 7% (5/63) were by Acinetobacter. Of the total, satisfactorily taken sputum samples, 21% (65/238) were positive for Acinetobacter. Acinetobacter positivitywas 7% (17/215) from pus & wound swabs. None (0/404) of the urine samples grew Acinetobacter. Of 87 patients, who had Acinetobacter infections, all were inpatients while 56.3% were males & 43.7% were females. Age distribution; 0% children (<12 years), 68.9 % adults (12- 65 years) & 31.1% elderly (>65 years) patients. As per ABST, sensitivity was 4.5% for cefotaxime, 6.9% for ceftriaxone, 9.2% for ticarcillin-clavulanic acid & ceftazidime each, 12.6% for cefepime, 16% for gentamicin & ciprofloxacin each, 14.9% for piperacillin-tazobactam & meropenem each, 16.1% for levofloxacin & co-trimoxazole each, 17.2% for ampicillin-sulbactam, 25.3% for amikacin, 60.9% for cefoperazone-sulbactam, & 94.2% for polymyxin B. Conclusion: Most Acinetobacter spp were recovered from respiratory samples indicating its preponderance to cause respiratory tract infections. Most Acinetobacter infections were from inward, adult, males. A great majority of Acinetobacter spp were sensitive to polymyxin B. Only about 2/3rd of isolates were sensitive to cefoperazone-sulbactam & sensitivity was <25% for commonly used cephalosporins, carbapenems, quinolones, aminoglycosides, co-trimoxazole, & beta-lactam – beta-lactam inhibitor combinations
Antimicrobial properties of nonantibiotic agents for effective treatment of localized wound infections: A mini review
(Sage Publications, 2022) Wijesooriya, L.I.; Waidyathilake, D.
ABSTRACT: Wounds present serious health problems in humans and animals. Importantly, if left untreated, wounds invariably lead to long-term morbidity. The inappropriate use and costs of antibiotics place significant challenges globally and affect the health budgets of many countries. Though some antibiotics are administered systemically, treatment of localized infections, in particular, chronic wound infections, does not need such therapy-this would minimize development of antibiotic resistance. Of these measures, nanoparticles of silver, ZnO, and gold seem to give promising results against common wound pathogens while having few limitations. Chemical components of essential oils, which are extracted from different plants, have been shown to act against common wound pathogens. Plant extracts have shown different mechanisms in biofilm elimination. Chlorhexidine and chlorine derivatives act as wound antiseptics. Attempts with biological agents such as maggots have also been shown to provide anti-infective as well as mechanical removal of wound debris. Honey, including those obtained from bees, has a wide coverage against wound pathogens. Glycerin and hypertonic saline are anti-infective through the concentration-dependent killing of pathogens. Hyperbaric oxygen acts against many wound pathogens, in particular anaerobes. This review is focused on nonantibiotic attempts for the cure of localized infections, in particular, chronic wounds with common wound pathogens. KEYWORDS: antibiotic resistance; diagnosis; nonantibiotic measures; wound infection.
The Bacteriological Profile of Ear Infections: An Analysis from a Secondary Health Care Center of Sri Lanka
(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Wijesooriya, L.I.; Jayawardana, G.P.C.; de Silva, S.H.N.A.; Karunasekara, H.C.I.
Introduction: Bacteria responsible for ear infections are diverse. Therefore, the treatment of such infections needs to be guided by the antibiotic sensitivity data. To prevent shift into the chronic form which leads the burden of morbidity and increased healthcare cost. Having a microbiological profile of ear infections with its antibiotic sensitivity pattern would minimize the burden. Objective: To find out the bacteriological profile and their antibiotic resistance pattern in patients with ear infections Methodology: A descriptive cross-sectional study was conducted prospectively from 01.10.2018 to 30.09.2019 involving sixty-two patients with clinically diagnosed otitis media or otitis externa by the . Organisms responsible were identified and their antibiotic sensitivity was recorded. Antibiotic sensitivity data of the most common organisms were analyzed. Data related to demography, clinical history and previous antibiotic therapy were noted. The level of significance was considered as P<0.05. Results: Of the sixty-two patients, 63% (39/62) had otitis externa whereas 37% (23/62) had otitis media. The difference was not significant statistically (P = 0.096). In 97% (60/62) of patients, the ear infection was unilateral and in 3% (2/62), it was bilateral. In 48% (30/62) of patients, the current presentation was the first episode, in 27% (17/62), it was the second, in 16% (10/62), it was the third and in 8% (5/62), it was beyond the third episode. In 89% (55/62), patients were treated with empirical antibiotics whereas, in 11% (7/62), the samples were obtained before antibiotics. Of the organisms causing ear infections, Pseudomonas–32% (20/62), Staphylococcus aureus–25% (15/62), Candida spp 12% (8/62), other fungal spp-3%, (2/62) Coliforms-3% (2/62), Proteus spp- %, (1/62), Streptococcus pneumoniae-2%, (1/62), mixed bacterial growth in 2% (1/62) and no bacterial growth in 19%, (12/62). According to ABST of Pseudomonas spp sensitivity was 85% (17/62) for piperacillin-tazobactam, 80% (16/62) for ceftazidime, 75% (15/62) for meropenem, 75% (15/62) for cefoperazone-sulbactam, 70% (14/62) for ticarcillin–clavulanic acid, 70% (14/62) for amikacin, 50% (10/ 62) for gentamicin, 50% (10/62) for Ciprofloxacin and 40% (8/62) for norfloxacin. Of the S. aureus, 66.7% (10/15) were methicillin-sensitive (MSSA) and 33.3% (5/15) were Methicillin-resistant (MRSA). According to ABST of MSSA, sensitivity was 100% for gentamicin, chloramphenicol, fusidic acid, teicoplanin and vancomycin, 90% (9/10) for clindamycin, 80% for co-trimoxazole, 70% (7/10) for ciprofloxacin, 60% (6/10) for erythromycin and 50% (5/10) for norfloxacin. Of MRSA, all were sensitive for vancomycin, teicoplanin and fusidic acid, 60% (3/5) were sensitive for clindamycin and none were sensitive for gentamicin, chloramphenicol, co-trimoxazole, ciprofloxacin, erythromycin and norfloxacin. Conclusion: Of ear infections, there was no significant difference between otitis externa and otitis media in proportions. Almost all had unilateral infections. Pseudomonas spp were the predominant bacterium identified and the S. aureus was the second. More than 75% of the Pseudomonas spp were sensitive to piperacillin-tazobactam, ceftazidime, meropenem and cefoperazone-sulbactam. The sensitivity was <50% for gentamicin and norfloxacin. MSSA was sensitive to most antistaphylococcal antibiotics. However, MRSA was sensitive only for limited antistaphylococcal antibiotics.
A Case of Urinary Tract Infection Caused by Providencia stuartii in a Sterile Mid-Stream Urine Sample
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Siriwardana, S.R.
Introduction: Urinary tract infections (UTI) are frequently caused by enterobacteria and most commonly caused by Escherichia coli both in the community and hospital settings. UTIs are diagnosed microbiologically by culturing mid-stream urine sample in non-catheterized patients. Significant bacteriuria is defined as having pure growth of >105 colony forming units/ml of urine. Treatment of UTIs is guided by antibiotic sensitivity testing of the isolated pathogen. Herewith, we report a case of upper UTI with no growth in midstream urine sample. Case report: A 65-year-old male was admitted to a Private Hospital, Ragama with high spiking fever and left, low backache for four days. His past medical history was unremarkable and renal calculi were not known previously. On examination, he was febrile but systemic examination was uneventful except left loin tenderness. Urine full report was normal except having red cells of 10-5/high power filed. Blood and urine cultures were sterile. Serum creatinine was rising (2.9, 3.01, 4.16 mg/dL). Full blood count showed leukocytosis (11,400–15,900/ mm3) - with neutrophilia (75%-87%). His C-reactive protein levels were rising at 81,93,133 mg/L. Abdominal ultrasound scanning revealed dilated pelvicalyceal system filled with echogenic debris, suggestive of pyonephrosis. Further, left upper ureter was dilated due to obstruction by a 10mm sized calculus. Ultrasound-guided percutaneous nephrostomy (PCN) was performed and a 7F pigtailed catheter was inserted. Drain fluid was cultured on blood and MacConkey agar and incubated overnight at 370C yielding a heavy growth of Gram-negative bacilli, which were oxidase negative. The pathogen was identified into species level using the RapID™ ONE system as Providencia stuartii. As per antibiotic sensitivity test, the organism was resistant to amoxicillin, gentamicin, cefuroxime, cefotaxime, co-amoxiclav, ciprofloxacin, ceftazidime, co-trimoxazole, piperacillin-tazobactam, and ticarcillin-clavulanic acid. It was sensitive only to amikacin, imipenem & meropenem. The patient was treated with intravenous ceftriaxone 1g (only one dose) and intravenous ciprofloxacin 400mg twice a day for 2 days. However, the patient did not improve clinically. Since the pathogen was resistant to empiric therapy, the patient was treated with meropenem 1g 8 hourly for one week and the patient had an uneventful recovery. Conclusion: It is important to note that UTI is a possibility even though urine culture is sterile since bacterial cultures may be negative due to many reasons. Hence, it is important to probe with other means of investigations such as interventional procedures to evacuate possible foci of infection and obtain relevant samples for microbiological identification to confirm the clinical diagnosis and thereby streamline antibiotic therapy
Case report: Edwardsiella tarda Sepsisfollowing Abortion.
(In: Proceedings of the International Postgraduate Research Conference 2017 (IPRC – 2017), Faculty of Graduate Studies, University of Kelaniya, Sri Lanka., 2017) Wijesooriya, L.I.; Weerawardana, A.; Mohamed, R.
Edwardsiella tarda is a Gram negative bacterium of Family Enterobacteriaceae - primarily a pathogen of fish. Human infections with E. tarda are rare. Reports of E. tarda septicemia is exceptional (<5%) with mortality of 44.6%. We report a case of E. tarda sepsis following an abortion. Case report A 31 year old female patient (P3C2) with period of amenorrhea of 12 weeks and 2 days was admitted with a history of lower abdominal pain and vaginal bleeding for 1 day with a similar episode 1 week prior. Patient was febrile with 1010F on admission. Her past medical history was uneventful except gestational diabetes. Hematological investigations on admission revealed WBC–17.5X103/UL with 80.0% granulocytes and CRP-52 mg/L. Abdominal ultrasound scanning found aborting fetus. Patient was started with empirical antibiotics as intravenous cefuroxime, metronidazole and gentamicin. Blood culture developed turbidity, 24 hours after incubation and grew Gram negative, motile bacillus on blood, chocolate and MacConkey agar as non-lactose fermenter. Moderate amount of H2S production was in Kligler Iron Agar (KIA)with acid butt and alkaline slant. Isolate was urease negative and indole positive. It was identified as E. tarda and was sensitive to most of the antibiotics: amikacin, cefotaxime, ceftazidime, cefuroxime, ciprofloxacin, co–amoxiclav, gentamicin and netilmicin but was resistant to polymyxin as per Stokes‘ comparative disc diffusion method. Evacuation of Retained Products of Conception was done 2 days following admission. Following antibiotics, patient was afebrile and improved clinically. Parenteral antibiotics were continued for one week, patient had uneventful recovery and was discharged with one week of oral antibiotics.
Comparison of four low-cost carbapenemase detection tests and a proposal of an algorithm for early detection of carbapenemase-producing Enterobacteriaceae in resource-limited settings
(Public Library of Science, 2021) Kumudunie, W.G.M.; Wijesooriya, L.I.; Wijayasinghe, Y.S.
ABSTRACT: Rapidly progressing antibiotic resistance is a great challenge in therapy. In particular, the infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are exceedingly difficult to treat. Carbapenemase production is the predominant mechanism of resistance in CRE. Early and accurate identification of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is extremely important for the treatment and prevention of such infections. In the present study, four phenotypic carbapenemase detection tests were compared and an algorithm was developed for rapid and cost-effective identification of CP-CRE. A total of 117 Enterobacteriaceae (54 CP-CRE, 3 non-CP-CRE, and 60 non-CRE) isolates were tested for carbapenemase production using modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), Carba NP test (CNPt), and CNPt-direct test. The overall sensitivity/specificity values were 90.7%/92.1% for MHT, 100%/100% for mCIM, 75.9%/100% for CNPt, and 83.3%/100% for CNPt-direct. OXA-48-like enzymes were detected with 93.2% sensitivity by MHT and >77.3% sensitivity by two Carba NP tests. MHT could only detect half of the NDM carbapenemase producers. CNPt-direct exhibited enhanced sensitivity compared to CNPt (100% vs 25%) for detection of NDM producers. Considering these findings we propose CNPt-direct as the first test followed by mCIM for rapid detection of CP-CRE. With this algorithm >80% of the CP-CRE could be detected within 24 hours from the time the sample is received and 100% CP-CRE could be detected in day two. In conclusion, mCIM was the most sensitive assay for the identification of CP-CRE. CNPt-direct performed better than CNPt. An algorithm consisting CNPt-direct and mCIM allows rapid and reliable detection of carbapenemase production in resource-limited settings.
Delayed anxiety and depressive morbidity among dengue patients in a multi-ethnic urban setting: first report from Sri Lanka
(BioMed Central, 2018) Gunathilaka, N.; Chandradasa, M.; Champika, L.; Siriwardana, S.; Wijesooriya, L.I.
BACKGROUND: Although the physical consequences of dengue are well documented, delayed psychological co-morbidities are not well studied to date. Therefore, the objective of the present study was to determine the prevalence of depressive, anxiety and stress symptoms among past dengue patients. METHODS: A community-based, case-control study in a multi-ethnic urban setting was conducted in Sri Lanka involving adults who were diagnosed to have dengue fever by a positive dengue IgM antibody response between 6 and 24 months ago. Self-administered Depression, Anxiety and Stress Scale (DASS-21), Centre for Epidemiological Studies Depression Scale (CESD-20) and a structured clinical interview by a psychiatrist were done in the patients and in an age and gender-matched control group. RESULTS: Fifty-three participants each in the patient (mean age 42.9 years, SD 15.5) and control (mean age 41.6 years, SD 15.3) groups were surveyed. The ages ranged from 18 to 70 years and 64.2% were females. The majority (90.6%; n = 48) of the individuals had been diagnosed with dengue fever followed by dengue haemorrhagic fever (9.4% n = 5). Denguepatients had higher DASS-21 mean depressive scores (means 11.7/9.4, SD 6.4/4.0, t = 2.2, p = .028), anxiety scores (means 10.7/7.2, SD 6.8/1.8, t = 3.6, p = .0005), stress scores (means 12.0/8.8, SD 5.3/3.5, t = 3.6, p = .0004) and CESD-20 scores (means 16.1/11.7, SD 9.4/7.3, t = 2.6, p = .008) than controls. The DSM-5 depressive disorder was clinically detected by the psychiatrist among 15.1 and 7.5% in patient and control groups (OR 2.1; CI .5-7.7; p = .22). Limitations: a limitation is the small sample size. CONCLUSION: Patients with past dengue had significantly higher depressive, anxiety and stress symptoms than the control group according to the DASS-21 and CESD-20 tools. To our knowledge, this is the first report on delayed psychological morbidity related to dengue. This may warrant healthcare professionals to incorporate mental counselling for dengue patients.
A Descriptive Study on Antibiotic Resistant, Clinically Significant Coliform Species Isolated from the Patients at Colombo North Teaching Hospital (CNTH), Ragama, Sri Lanka
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Namalie, K.D.; Sunil-Chandra, N.P.
Introduction: Antibiotic resistance (AR) is a great therapeutic challenge globally and locally today. The rate of development of AR is far ahead compared to the discovery of a new class of antibiotics, which has not been successful in last three decades. Of the antibiotic resistant coliforms, extended spectrum beta-lactamase producers (ESBLP) play a key role in life threatening infections. Moreover, emergence of carbapenem-resistant Enterobacteriaceae (CRE) has further limited the effective therapeutic options. Objective: To investigate the AR of clinically significant Enterobacteriaceae isolated from patients in a tertiary healthcare setting. Method: A descriptive, cross-sectional study was conducted involving patients with coliform infections at CNTH from 01/03/2018 to 31/08/2018. Demographic details, clinical data & antibiotic sensitivity test (ABST) patterns were analyzed. ABST was performed according to John-Stokes method & ESBLPwere identified by the keyhole method. Resistance to either meropenem or imipenem is used to identify CRE. Statistical analysis was done via R programming language (level of significance P<0.05). Results: Of the 200 coliforms, 85.5% (171/200) were from inpatients & the rest were from outpatients. Of the studied patients, 53.5% (107/200) were females & 46.5% (93/200) were males. Of the Enterobacteriaceae spp isolated, 48.5% (97/200) were from urine, 34.5% (69/200) from pus / wound swabs, 9.5% (19/200) respiratory samples, 3% (6/200) sterile fluids & stents, & 3% (6/200) from blood & CVP tips. As per ABST, about 90% were resistant to ampicillin. Resistance was 61-70% against cefuroxime (oral), ciprofloxacin & nalidixic acid, 60% for amoxiclav, 41-50% for cefotaxime, cefuroxime (intravenous), co-trimoxazole, levofloxacin, norfloxacin & ofloxacin, 31-40% for cefepime, ceftazidime, ceftriaxone & nitrofurantoin, 21-30% for gentamicin & piperacillin tazobactam & 0-10% for amikacin & meropenem. Of the coliforms, 29% (58/200) were ESBLP & 8% (16/200) were CRE. None of the ESBLP was CRE. Of CRE, 37% (10/16) were resistant to amikacin. However, 93.8% (15/16) of CRE were colistin sensitive. Conclusion: Majority of the isolates represented infections of the inward patients & there was no statistically significant difference between male & female proportions. Coliforms were detectedmostly from urine. Majority (>50%) of clinically significant Enterobacteriaceae were resistant to most of the oral antibiotics namely cefuroxime, ciprofloxacin, nalidixic acid & amoxiclav. Of the oral antibiotics, nitrofurantoin has the lowest resistance against Enterobacteriaceae. None of the antibiotics had 100% sensitivity against Enterobacteriaceae. Results indicate that ESBLP can be safely treated with carbapenems. Colistin will be an effective empiric antibiotic for CRE.
Epidemiology of multidrug-resistant Enterobacteriaceae in Sri Lanka: First evidence of bla KPC harboring Klebsiella pneumoniae.
(Elsevier., 2020) Kumudunie, W.G.M.; Wijesooriya, L.I.; Namalie, K.D.; Sunil-Chandra, N.P.; Wijayasinghe, Y.S.
BACKGROUND: Extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE) and carbapenem-resistant Enterobacteriaceae (CRE) are disseminated worldwide posing a serious public health concern. Although, the presence of ESBL-PE and CRE in Sri Lanka has been reported, the prevalence is unknown. This study aimed to provide up-to-date epidemiological data on multidrug-resistant Enterobacteriaceae and to characterize the molecular determinants of carbapenemase-producing Enterobacteriaceae (CPE) in Sri Lanka.METHODS: A prospective cross-sectional study was conducted at a tertiary care hospital in Sri Lanka between December 2017 and February 2018. ESBL-PE and CRE were identified by disc diffusion method. Carbapenemase production was determined by carbapenem inactivation method and the presence of selected carbapenemase genes were detected by PCR. RESULTS: Five hundred and ninety-three Enterobacteriaceae were isolated from variety of clinical samples. Overall prevalence of ESBL-PE and CRE were 26.0% (n = 154) and 9.6% (n = 57), respectively. The highest rate of ESBL-PE (30.8%) was found in urine samples, while the highest occurrence of CRE (20.8%) was seen in respiratory specimens. The most common CRE species identified was K. pneumoniae (n = 46, 80.7%), followed by C. freundii (n = 4, 7.0%), E. coli (n = 3, 5.3%), P. rettgeri (n = 2, 3.5%), E. cloacae (n = 1, 1.7%), and K. aerogenes (n = 1, 1.7%). Carbapenemase production was observed in 54 (94.7%) of CRE isolates. Fifty eight carbapenemase encoding genes were identified in 54 CPE. The most prevalent carbapenemase gene was blaOXA-48-like (n = 48, 88.9%), followed by blaNDM (n = 8, 14.8%), and blaKPC (n = 2, 3.7%). CONCLUSIONS: This study reports an alarming rate of CRE and the emergence of blaKPC harboring K. pneumoniae in Sri Lanka. The need for preventive measures is highlighted to limit the spread of these difficult-to-treat bacteria in the country. KEYWORDS: Carbapenem resistance; Carbapenemase; ESBL; Enterobacteriaceae; KPC; Sri Lanka.
Evaluating the Antibiotic Properties of Bee Honey as Against Common Pathogenic and Antibiotic Resistant Bacteria Found in Wound Infections
(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Wijesooriya, L.I.; Abeysundara, S.
Introduction: Antibiotics have largely been effective in treating bacterial infections. However, inappropriate use of antibiotics has led to extensive antibiotic resistance globally. In addition, no new classes of antibiotics are available to counter the dramatic rise of antibiotic resistance. This has led to unorthodox methods in treating antibiotic-resistant bacterial infections. One of these methods is the use of bee honey, which has been used since ancient times. Objective: The objective of the present study was to determine the effectiveness of bee honey against common pathogenic bacteria in wound infections Methodology: Common bacterial wound pathogens viz. Streptococcus pyogenes, Streptococcus agalactiae, methicillin resistant Staphylococcus aureus (MRSA), Escherichia coli (extended-spectrum beta-lactamases producing), Klebsiella pneumoniae, Acinetobacter spp, and Enterococcus spp were selected for the study. Suspensions of 0.5 McFarland strength of S. pyogenes was streaked on blood agar and the others were streaked on Muller Hinton agar. Sterile, 1"x1" size, single gauze layer, soaked with commercially available pure Bee honey (100%) was placed on the center of each inoculated plate and incubated overnight at 37 oC. On following day, each piece of gauze was removed aseptically. Presence of live bacteria from the site where gauze was removed from each plate was checked by streaking on blood agar. The same place where gauze was removed was repositioned with new, sterile gauze layer soaked with bee honey. All plates were incubated at 37 oC. Same procedure was continued until no growth was observed. Control tests were done in parallel using same sized gauze without bee honey. Sterility of bee honey was previously confirmed by inoculation on blood agar. The experiment was repeated two times. Results: Following repeat applications of bee honey, there was no bacterial growth from plates inoculated with S. pyogenes and S. agalactiae after two applications, Acinetobacter spp - three, MRSA – four, K. pneumoniae, E.coli and Enterococcus spp - five and Pseudomonas spp – six applications. There was no inhibition of bacterial growth in the control plates. Conclusion: Antibacterial effect of bee honey against S. pyogenes and S. agalactiae was highly satisfactory with clearance of the organisms with only two applications whereas it was satisfactory against MRSA, Acinetobacter spp. Klebsiella spp, E.coli and Enterococcus spp and longest duration of application was needed for Pseudomonas spp. These in vitro anti-bacterial test results suggest that bee honey has effective antibacterial property against common wound pathogens with varying duration of application
Exploring the Cause of an Outbreak of Neonatal Sepsis Following Ventilator-Associated Pneumonia in a Base Hospital, Sri Lanka
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Jayaratna, H.S.; Wanasinghe, D.S.
Introduction: Hospital-acquired infections (HAIs) are defined as infections which were not present or incubating at the time of admission but occur during the process of care in a hospital or other healthcare facility. HAIs are one of the major causes of the increasing number of mortality and morbidity in hospitals. Ventilator-associated pneumonia (VAP) has been identified as one of the four common types of nosocomial (HAI) infections. VAP is defined as parenchymal lung infection occurring more than 48 hours after initiation of mechanical ventilation and nebulization. Though VAP starts as local infection, it could complicate into sepsis. An outbreak of sepsis was reported in seven babies, who were admitted and ventilated at the premature baby care unit (PBU) of Base Hospital, Wathupitiwala within a period of three weeks since 30th July 2017. Objective: To identify the causative agent/s of the outbreak of neonatal sepsis occurred in PBU, Base Hospital, Wathupitiwala. Method: Blood culture isolates, which were detected within 24 hours of incubation at BacT/Alert automated blood culture system from seven affected babies, were tested further to identify whether the neonatal sepsis occurred due to a common pathogen. Initial Gram staining and oxidase test were followed by species-level identification using RapID NF plus system (remel RapID system). In brief, pure cultures of causative organisms were grown on blood agar after incubation at 370C for 24 hours. Testing was performed according to the manufacturer’s instructions. Six-digit microcode obtained at the end of the test was interpreted using electronic RapID compendium (ERICTM) database to obtain species-level identification. Further biochemical tests (catalase test, oxidation & fermentation (OF) of glucose & lactose) were performed to refine the diagnosis. Results: All seven, blood cultures grew Gram-negative, oxidase positive bacilli. All blood culture isolates got the same identification via RapID NF plus system with the same microcode (400216). Interpretation via ERICTM database suggested three possible organisms as Pseudomonas pseudoalcaligenes, Pseudomonas stutzeri and Burkholderia cepacia. Further biochemical tests namely positive catalase test, growth on MacConkey agar, green coloration of glucose well in RapID NF plus system and positive OF test for glucose and lactose, confirmed the diagnosis of the isolates as B. cepacia. Conclusion: The aetiological agent for the outbreak of neonatal sepsis was identified as B. cepacia. Since all babies had the risk factor of being ventilated, there was a possibility of having the source related to ventilator equipment, solutions, drugs etc. It is important to investigate for possible source/s of an outbreak in order to curtail it as early as possible.
Hand Washing Practice among Intern House Officers (IHOs) during Working Hours at Colombo North Teaching Hospital (CNTH), Ragama.
(In: Proceedings of the International Postgraduate Research Conference 2017 (IPRC – 2017), Faculty of Graduate Studies, University of Kelaniya, Sri Lanka., 2017) Kendawala, A.; Kodithuwakku, A.; Kondasinghe, N.; Kaumadie, N.; Karunathilaka, S.; Wijesooriya, L.I.
Contaminated hands of healthcare workers (HCWs) are known to crosstransmit microorganisms causing hospital-acquired infections (HAIs). Hence, hand hygiene (HH) is the simplest and the most effective method to prevent HAIs. Therefore, all HCWs needs to adhere to recommended hand washing (HW) practices provided adequate HW facilities. Amongst HCWs, IHOs would have direct contact with patients mostly. Objective: To describe HW practice in IHOs and facilities available for effective HH in CNTH, Ragama. Methodology: Descriptive cross sectional study was conducted from 01.06.2017–31.09.2017 involving 2168 HW opportunities of 50 IHOs in 22 wards of CNTH. HH practices were assessed against WHO defined criteria; five opportunities for HH and six-steps in HW technique. HH facilities were assessed by evaluating availability of water supply, washing agent (soap), disposable hand towels and alcohol hand rub. Sink: bed ratio and display of poster with HW steps near sinks were noted.
Incidental Extra Spinal Findings in Magnetic Resonance Imaging of Spine: Beyond the Focus.
(In: Proceedings of the International Postgraduate Research Conference 2017 (IPRC – 2017), Faculty of Graduate Studies, University of Kelaniya, Sri Lanka., 2017) Siriwardana, S.R.; Herath, S.; Wijesooriya, L.I.
Magnetic resonance imaging (MRI) of the spine is a special imaging modality to evaluate various symptoms in spine including low back pain. However, extra spinal incidental findings (IF) which detect additionally during the MRI might influence the management of the patient. Objective: To describe IF detected during MRI spine and to emphasize the importance of identification of those. Methodology: Five patients who underwent MRI spine for back pain were selected and imaging appearances of various IFs were discussed.GE MR 360 advance 1.5-tesla MRI machine was used for the imaging. Results: Case 1: Thirty-seven year old female patient was evaluated for chronic neck pain. Sagittal T1W and T2W images show moderate size cystic lesion on posterior fossa of the brain. Follow-up MRI brain showed a moderate size arachnoid cyst causing indentation to the cerebellum. Case 2:Sixty-seven year old female patient was assessed for low back pain (LBP).T2W sagittal and coronal images showed 3.7 cm size oval shape mass medial to the right kidney. The mass was identified as an accessory kidney in follow-up contrast computed tomography (CT). Case 3:Thirty-eight year old female patient was assessed for LBP. Sagittal T1W, T2W and STIR images showed moderate size cystic mass with internal fat, fluid and low intensity nodules suggestive of calcium. MRI lumbar spine was uneventful. Subsequent surgery and histology revealed the mass as a dermoid cyst. Case 4:Forty- five year old male patient was evaluated for LBP. Sagittal T2W and Coronal STIR images showed uncomplicated left side pelvic kidney. Follow-up ultrasound scan too confirmed the diagnosis. Case 5:Eighty-three year old male patient presented with back pain and lower limb weakness. Sagittal and axial T2W images showed multiple spinal metastasis and coronal STIR images showed incidentally detected pleural based lung mass as a primary lesion.
Mycoplasma pneumoniae DNA detection and specific antibody class response in patients from two tertiary care hospitals in tropical Sri Lanka
(Microbiology Society, 2018) Wijesooriya, L.I.; Kok, T.; Perera, J.; Tilakarathne, Y.; Sunil-Chandra, N.P.
PURPOSE: Respiratory tract infections are a major cause of global morbidity and mortality. Pneumonia is the ninth leading cause of mortality in Sri Lanka. Atypical pathogens cause about one-fifth of community-acquired pneumonia, while Mycoplasma pneumoniae accounts for about 50 %. This study aimed to determine the seroprevalence of M. pneumoniae respiratory tract infections in Sri Lanka while attempting to understand the relationships between the serology and PCR. METHODOLOGY: Paired sera from 418 adult patients (pneumonia, n=97; bronchitis, n=183; pharyngitis, n=138) and 87 healthy controls were studied. IgM, IgG and IgA antibodies were tested by M. pneumoniae enzyme-linked immunosorbent assay (ELISA). Positive IgM and or IgG seroconversion was considered to be seropositive. M. pneumoniae DNA were tested by PCR in age and gender-matched seropositives and seronegatives. RESULTS: M. pneumoniae IgG was in 14.4 % (14/97), 6.0 % (11/183) and 1.5 % (2/138) of pneumonia, bronchitis and pharyngitis patients, respectively, whilst IgM was in 6.2 % (6/97), 1.1 % (2/183) and 0 % (0/138), respectively. Amongst the pneumonia seropositives, 64.7 % (11/17) showed IgG alone, 17.5 % (3/17) showed IgM alone and 17.5 % (3/17) showed IgM and IgG. Amongst the bronchitis seropositives, 84.6 % (11/13) had IgG alone and 15.4 % (2/13) had IgM alone. In the pharyngitis seropositives, only IgG was detected 100 % (2/2). M. pneumoniae DNA was in 52.2 % (12/23) of seropositives and 15.4 % (4/26) of seronegatives. In pneumonia or bronchitis patients, specific DNA was in 77.8 % (7/10) and 50 % (6/12) of patients, respectively. M. pneumoniae DNA was not found in pharyngitis patients. Of the seropositive PCR-negative pneumonia patients, 66.7 % (2/3) showed IgG alone and 33.3 % (1/3)showed IgM alone. In bronchitis patients, 83.3 % (5/6) showed IgG alone and 16.7 % (1/6) showed IgM alone. Of the seronegative PCR-positive patients, 16.7 % (2/12) had pneumonia and 18.2 % (2/11) had bronchitis. CONCLUSION: The serological evidence for M. pneumoniae infection in Sri Lanka comprised the following prevalences: 17.5 % (17/97), 7.1 % (13/183) and 1.4 % (2/138) in adults with pneumonia, bronchitis or pharyngitis, respectively. M. pneumoniae DNA was in 52.2 % (12/23) of seropositives and 15.4 % (4/26) of seronegatives. IgG was predominant in PCR positives and negatives.
An Observational Study on Urinary Catheterization with Emphasis on Infection Control Practices
(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Wijesooriya, L.I.; Jayawardana, G.P.C.; Rupasinghe, R.A.L.S.
Introduction: Urinary tract infections (UTI) are predominant nosocomial infections. Of them, catheter-associated UTI (CA-UTI) is prevailing. Of the reasons behind CA-UTI, factors associated with catheterization plays a vital role. Identification of such reasons would scrutinize the preventive measures of CA-UTI. Objective: To find out the compliance with standards in the urinary catheterization. Methodology: A descriptive-cross-sectional study was conducted observing hundred urinary catheterizations done at a secondary-care hospital in Sri Lanka during 01-10-2018 to 15-10-2019. The study was conducted through the hospital infection control nurse. Study observations, including measures taken before, during and after each catheterization were recorded. The observations were assessed against the catheterization guidelines provided in the infection control manual of Sri Lanka. The level of satisfaction in each measure was considered when the correct measure was followed in >75% of catheterizations. Results: Of the 100 catheterizations, 85 were from wards, 11 in the preliminary care unit and four in the intensive care unit. Before the catheterization, patients’ privacy was secured in 96% of patients. Healthcare worker (HCW) was introduced by himself/herself to the patient in none of the catheterizations. In all cases, patients’ details were confirmed with the patient records (name, age, admission number) in the bed head ticket. In 64% of patients, they were inquired for relevant allergies (plaster, povidone or latex). In 86% of cases, HCW explained the catheterization procedure to patients and obtained verbal consent. Requirements for the procedure were checked in the catheterization tray in 97% of cases. Washing hands with soap and water and wear sterile gloves were observed in 66% of catheterizations. Catheterization was done by a medical officer in 55% and 45% was done by a nurse. However, the cleaning of patients’ genital area before catheterization was done by a medical officer in 9%, nurse in 32% and a laborer in 59% of patients. During the procedure, the urethra was lubricated with sterile anesthetic gel in 34% and the catheter was lubricated with anesthetic gel in all catheterizations. After catheterization, the catheter bulb was inflated with the ideal volume of water in all cases and the catheter was anchored to thigh securely with plaster in 87%. Urine bag kept below the level of the bladder in all cases. Following catheterization, the patents’ perineal area was cleaned in 31% of patients. In 96% of catheterizations, HCWs washed hands after the procedure. Documentation of procedure in the BHT was done in none. Conclusion: Satisfactory measures were taken in the pre-catheterization stage as explaining the procedure to the patient, obtain consent and verify patient details. However, measures were unsatisfactory as inquiring about relevant allergies, wash hands, and wear sterile gloves before the procedure. Though trained personnel did the catheterization, the same person did not do the cleaning of the perineal area, which is very important. After catheterization, cleaning of the perineal area was not performed in majority and recording of the procedure was not satisfactory at all.
A Pilot Study on Antibiotic Prescription by General Practitioners in Ragama Medical Officer of Health (MOH) area, Western Province, Sri Lanka
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Perera, D.P.; Dissanayake, D.M.D.P.; Wijenayake, D.L.C.D.; Siriwardana, S.R.
Introduction: Antibiotic usage in healthcare has increased dramatically over past few decades. In parallel, bacteria have developed antibiotics resistance (AR) making a great challenge in healthcare. However, antibiotic misuse is a key behind AR. Therefore, strict regulation of antibiotic use is mandatory to minimize the development of AR. Hence, antibiotics are color-coded as red (Circular No. 01-56/2016, Ministry of Health, Sri Lanka), orange and green light antibiotics according to the level of authorization. However, these circulars and national antibiotic guidelines are mainly focusedinhospital practice. Hence, it is important to understand the current antibiotic prescription at general practitioner (GP) level. Objective: To study antibiotic prescription patterns of GPs in Ragama MOH area, Western Province, Sri Lanka. Methods: A cross-sectional, descriptive study was piloted involving 100 antibiotic prescribing encounters. (Total sample number was six hundred according to the WHO manual on “how to investigate drug use in health facilities”). Six randomly selected general practitioners, registered in general practitioners’ registry, published by College of General Practitioners of Sri Lanka, and practicing in Ragama MOH area were involved for the study which was conducted from May – August 2017. Data were collected from patients, using a pre-tested, interviewer-administered questionnaire. Demographic and clinical data of patients &details of antibiotic prescription as type, dose, frequency and duration were analyzed. Results: Of 100 antibiotic prescriptions, 23% for children (<12-65 years), 64% for adults (12-65 years) and 13% for elderly (>65 years) patients. Antibiotic prescription; 69% for respiratory tract infections (RTI), 12% skin infections 7% digestive tract infections, 2% urinary tract infections (UTI) and 10% for other infections. Common antibiotics prescribed for RTIs were amoxicillin (27.5%), Cephalexin (24.6%), followed by amoxiclav (17.4%), azithromycin (14.5%), clarithromycin (11.6%) cefixime (2.9%) & levofloxacin (1.4%). Ciprofloxacin was prescribed for digestive tract infections, UTI& sinusitis. All antibiotics were prescribed as per recommended doses and frequencies. Duration of antibiotics prescribed for RTI ranged from 3-15 days; in 29.4%, it was for 5 days, in 25% and 17.5% it was for 3 & 4 days respectively. In 33.8% prescriptions, duration of antibiotic therapy was more than 5 days. Conclusion: RTIs were the commonest condition for which antibiotics were prescribed. The most common antibiotics prescribed for RTIs were amoxicillin & cephalexin. A considerable number of prescriptions for RTIs was less than the minimum treatment duration recommended in the national guideline for empirical and prophylactic use of antimicrobials. Use of ciprofloxacin, (orange light antibiotic) and levofloxacin (red light antibiotic) has been noted in general practice.
A Single-Center Study on Intravenous Cannulation
(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Wijesooriya, L.I.; Jayawardana, G.P.C.; Rupasinghe, R.A.L.S.
Introduction: Of the nosocomial infections, bloodstream infections are vital since it has potential to ends up with sepsis, which has high mortality. Of the hospital-acquired bloodstream infections, a significant proportion is associated with intravenous (IV) cannulation. Objective: To find out the compliance with the protocol for IV cannulation in practice. Methodology: A descriptive cross-sectional study was conducted observing a hundred IV cannulation done at a secondary care hospital, Sri Lanka following approval from hospital administration from 01-10-2018 to 30-10-2019. The study was conducted through an infection control nurse with no prior notice to the relevant ward/unit. Observations were recorded and the procedure was checked against the IV cannulation guidelines stated in the infection control manual of Sri Lanka. Results: Of the 100 cannulations procedures, 90 were from wards and 10 from the preliminary care unit and four from the intensive care unit. In none of the procedures, the healthcare worker (HCW) himself or herself was introduced to the patient. In all procedures, physicians’ recommendation for cannulation was checked and patient details were verified with bed head ticket. Allergy for plaster or povidone-iodine was inquired in 70%. The cannulation procedure was explained to the patient in 83%. The patients’ preference as to which arm the cannula should insert was inquired in 28% of patients. Patients’ non-dominant arm was used for cannulation in 52% and patients’ dominant hand was used for cannulation in 48%. The selected insertion site was disinfected with 70% alcohol and allowed to dry in 24%. After cleaning, the tentative puncture site was touched by HCW in 58% cannulation and not so in 42%. Following the procedure, the cannula was secured with plaster in all calculations. The cannula was flushed with normal saline in 89% of cannulation procedures. Entry ports of cannula kept closed when not in use in 94%. The clinical waste following cannulation was disposed into an appropriate bin in 96%. The date of cannula insertion was labeled on the plaster over cannula in 69% and it was not labeled in 31%. After the procedure, hand washing was performed by 44% and not at 56%. The patient was thanked for the compliance in 24% of cannulation and not so in 76%. In all cannulation procedures, the procedure was not recorded in patient records. Conclusion: Before cannulation, verification of patient details and the physician’s recommendation was highly satisfactory. However, the cleaning of the cannulation site before the procedure was highly unsatisfactory. Flushing the cannula, which is against the guidelines, was observed in 89%. Securing the cannula was satisfactory but label the date of cannulation was poor and recording of the cannulation was not observed following any cannulation. Waste disposal following cannulation was satisfactory. Ethics relating to patient handing such as explain the procedure to the patient was satisfactory but introduce the HCW by himself/herself to the patient, obtain consent,
Study on Hepatitis B immunization and Antibody Level in Health Care Workers, District Base Hospital, Wathupitiwala
(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Wijesooriya, L.I.; Jayawardana, G.P.C.; Rupasinghe, R.A.L.S.
Introduction Hepatitis B virus (HBV) is a blood born pathogen leading to cirrhosis and hepatocellular carcinoma. It is transmitted mainly through contaminated blood or blood products from an infected person. It has the highest potential to transmit though prick injuries as one in three infected punctures. Therefore, health care workers (HCWs) are at great risk of contracting the infection during patient care. Hence, HBV immunization and having protective antibody levels are mandatory for HCWs.
Study on Knowledge, Attitudes and Practices Regarding Dengue Fever in a Cohort of Advanced Level Students in Sri Lanka.
(In: Proceedings of the International Postgraduate Research Conference 2017 (IPRC – 2017), Faculty of Graduate Studies, University of Kelaniya, Sri Lanka., 2017) Wijesooriya, L.I.; Hitige, D.G.; Herath, Y.B.; Sugandhi, R.A.I.; Siriwardana, S.R.
Dengue is a leading healthcare challenge in Sri Lanka. In 2015, 29,777 dengue cases were reported and this increased by 85.2% (55150 cases) in 2016. Last 10 months of year 2017 reported 158854 suspected dengue cases. Of them, about 30% were children of 519 years. Schoolchildren of advanced level (A/L) (Grade-12&13) are influential and useful on dengue control activities in schools.