Browsing by Author "de Silva, S.H.N.A."

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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
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.