Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item Use of antimicrobials in obstetric practice – A Narrative review(Sri Lankan Society for Microbiology, 2020) Patabendige, M.; Herath, R.P.; Athulathmudali, S.R.; Wijesooriya, W.R.P.L.I.ABSTRACT: Improvement of the outcome of infectious diseases by early and appropriate antimicrobial therapy is of paramount importance in any clinical discipline. Special considerations need to be given for the use of antimicrobial agents in obstetric practice, as it relates to the safety of both the mother and the fetus. However, their use and misuse are associated with significantly increasing antibiotic resistance. The objective of this review was to provide a useful overview for the practicing obstetrician, of current recommendations for the use of antibiotics in common situations related to pregnancy and the postpartum period. KEYWORDS: Antibiotic use, Obstetrics, Maternal health, Sepsis in pregnancy, Postpartum sepsis.Item Detection, identification, and antimicrobial susceptibility of Campylobacter spp. and Salmonella spp. fromfree-ranging Nonhuman Primates in Sri Lanka(Wildlife Disease Association, 2019) Tegner, C.; Sunil-Chandra, N.P.; Wijesooriya, W.R.P.L.I.; Perera, B.V.; Hansson, I.; Fahlman, A.ABSTRACT: Infections with Campylobacter spp. and Salmonella spp. are the most frequently reported causes of human bacterial enteritis. Warm-blooded animals, including livestock, pets, and wildlife, can be carriers of the bacteria and may contaminate the environment and food products. The present study investigated the occurrence of Campylobacter spp. and Salmonella spp. in fecal pat samples from free-ranging toque macaques (Macaca sinica) and tufted gray langurs (Semnopithecus priam) collected in March-May 2015 in Sri Lanka. In 58 samples from toque macaques, Campylobacter jejuni was isolated in 10 (17%), Campylobacter coli in four (7%), and Salmonella enterica subsp. enterica serovar Virchow in two (3%). None of the bacteria were isolated in the 40 samples from tufted gray langurs. Pulse-field gel electrophoresis and multilocus sequence typing identified six profiles and four clonal complexes of C. jejuni. The isolated Campylobacter spp. showed varying susceptibility to antimicrobial substances. All Campylobacter spp. isolates were susceptible to chloramphenicol, erythromycin, florfenicol, gentamicin, and streptomycin. Four of the C. jejuni were resistant to at least one of the following: ampicillin, ciprofloxacin, nalidixic acid, and tetracycline, and one of the isolates was multidrug resistant. All four C. coli were resistant to ampicillin, whereas the two Salmonella Virchow strains were susceptible to all antibiotics tested. The presence of Campylobacter spp. and Salmonella spp. in toque macaques may have an impact on the conservation of endangered primates and public health in Sri Lanka. KEYWORDS: Campylobacter spp .; Antimicrobial resistance; PFGE; Salmonella spp; conservation; nonhuman primates.Item Antimicrobials in Gynaecological practice(Sri Lanka college of Obstetricians & Gynaecologists, 2017) Patabendige, M.; Herath, R.P.; Wijesooriya, W.R.P.L.I.Surgical site infections are a common complication of Gynaecological surgeries. Up to 8-10% of Gynaecological patients undergoing an operative procedure will develop a surgical site infection. In surgeries with high rates of post-operative infection, antibiotic prophylaxis can play a major role in improving outcomes. In addition there are many indications where antimicrobial treatment is necessary in day-to-day Gynaecological practice. This review summarizes the available medical literature to assess the indications and appropriate antimicrobials for common circumstances in Gynaecological practice.Item Antibiotic sensitivity pattern for non-beta lactam antibiotics and carbapenems in extended-spectrum beta-lactamase (ESBL) producing uropathogens versus non-ESBL producing uropathogens(Sri Lankan Society for Microbiology, 2017) Wijesooriya, W.R.P.L.I.; Herath, Y.B.; Sugandhi, R.A.I.; Weerawardhana, A.; Ediriweera, D.S.INTRODUCTION AND OBJECTIVES: Urinary tract infections (UTIs) are frequent and predominantly caused by coliforms. ESBL producers are increasing in number limiting therapeutic options. It is therefore vital to institute precise, empiric antibiotic guidelines in order to prevent life-threatening urosepsis. The objective of this study was to compare antibiotic sensitivity (ABST) pattern of ESBL producers and non-ESBL producers against selected non-beta lactams and carbapenem antibiotics. METHODOLOGY: Retrospective analysis of ABST of significant urinary coliform isolates was done. STUDY SETTING: Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya and Base Hospital, Wathupitiwala, Sri Lanka. STUDY PERIOD: 01.01.2012 - 01.01.2016. STUDY GROUPS: ESBL producers and non-ESBL producers, 63 in each group. Sensitivity profiles of amikacin, gentamicin, netilmicin, nitrofurantoin, nalidixic acid, norfloxacin, ciprofloxacin, imipenem and meropenem were analyzed. Statistical analysis: R programming language. Level of significance P<0.05. RESULTS: ESBL producers were present in 63 patients, 36 (57.1%) of whom were females and 39 were inpatients (61.9%). Non-ESBL producers were isolated from urine of 63 patients, of whom 49 (77.8%) were females and 17 (26.9%) inpatients. Antibiotic sensitivity of ESBL producers ranged from 82.2% to 100% for netilmicin, amikacin, meropenem and imipenem, 65% for nitrofurantoin and from 14.8% to 32.1% for nalidixic acid, ciprofloxacin, norfloxacin and gentamicin. Antibiotic sensitivity of the non-ESBL producers ranged from 56.7% for nalidixic acid and from 76.8% to 85.1% for ciprofloxacin, nitrofurantoin, norfloxacin and gentamicin. CONCLUSION: A female predominance was noted in both non ESBL and ESBL producers but there was a significant dominance of ESBL producers in male patients. ESBL producers were significantly common amongst inpatients than outpatients. ESBL-producers had significantly high resistance against nalidixic acid, ciprofloxacin, norfloxacin and gentamicin compared to non-ESBL producers. However, more than 2/3rd of isolates in both groups were sensitive to nitrofurantoin.Item Teicoplanin non-susceptible coagulase-negative staphylococci in a large Australian healthcare network: Implications for treatment with vancomycin(Sri Lankan Society for Microbiology, 2017) Wijesooriya, W.R.P.L.I.; Kotsanas, D.N.; Korman, T.M.; Graham, M.INTRODUCTION AND OBJECTIVES: Coagulase-negative staphylococci (CoNS) are relatively low in virulence but some are increasingly recognized as agents of clinically important infections. Glycopeptides are the drugs of choice for treatment of methicillin-resistant CoNS infections. Our aim was to analyse the susceptibility profile of CoNS in our healthcare network from 2010-2012. METHODS: All CoNS with susceptibility results were analysed as two groups; teicoplanin-susceptible (Teico-S) and non–susceptible (Teico-NS). Analysis included results of other antistaphylococcal antibiotic susceptibilities, sample type (sterile, non-sterile), species and patient location (intensive care unit (ICU) vs non-ICU). RESULTS: Of the 1510 CoNS isolates with susceptibility results, 109 (7.2%) were non-susceptible to teicoplanin. Teicoplanin non-susceptibility was associated with non-susceptibility to ≥ 3 antistaphylococcal-antibiotics, detected more frequently from sterile samples compared to non-sterile samples and from ICU compared to ward patients. Staphylococcus epidermidis was the most common species recovered and was more likely to be Teico-NS. CONCLUSIONS: Teicoplanin non-susceptibility is associated with multi-resistance to ≥3 antistaphylococcal antibiotics. Clinicians should be aware that vancomycin resistance may be selected from Teico-NS strains.Item Reliability of cold agglutinin test (CAT) for the detection of patients with Mycoplasma pneumoniae pneumonia in hospitalized patients.(Sri Lankan Society for Microbiology, 2016) Wijesooriya, W.R.P.L.I.; Suni-Chandra, N.P.; Perera, J.INTRODUCTION: M. pneumoniae is one of the causative agents of primary atypical pneumonia. This infection causes 20-40% of community acquired pneumonia and is associated with an array of extra-pulmonary manifestations. There is a need for a rapid diagnostic test in order to prescribe prompt and appropriate antibiotic therapy. Even though isotype specific antibody testing provides definitive diagnosis, paired sera testing does not help in real time diagnosis. Cold agglutinins detectable by the Cold Agglutination Test (CAT) appear and disappear early in infection compared to long lasting specific antibodies that are detectable by specific immunoassays. Although there are some reports suggesting CAT is unreliable, it is being often used to diagnose M. pneumoniae pneumonia in Sri Lankan clinical settings. The aim of the current study was to evaluate the use of CAT as a bed-side screening test for early diagnosis of M. pneumoniae pneumonia compared to ELISA for detection of specific antibodies in the Sri Lankan context. METHODS: Ninety seven clinically and radiologically confirmed patients with pneumonia were enrolled in the study. CAT was performed on acute stage sera. A CAT titer ≥1/32 was considered as positive. Isotype specific M. pneumoniae ELISA with paired sera was compared with CAT results. RESULTS: Mycoplasma pneumonia was confirmed in 15 of the 97 patients in the study using Mycoplasma specific IgM and 4 fold rise in titre. Of these, 3 were positive by the CAT. The sensitivity and specificity of the CAT compared to IgM/4fold rise in IgG detection were 20% (3/15) and 81.7% (67/82) respectively. Negative and positive predictive values of the CAT compared to ELISA were 84.8% (67/79) and 16.7% (3/18) respectively. CONCLUSION: CAT is not a reliable screening test compared to specific antibody detection by isotype ELISA for the detection of M. pneumoniae pneumonia due to its low sensitivity and positive predictive values.Item Analysis of urine culture isolates from seven laboratories of Sri Lanka: National Laboratory Based Surveillance of Sri Lanka College of Microbiologists in 2014(Sri Lankan Society for Microbiology, 2016) Jayatilleke, S.K.; Patabendige, G.; Dassanayake, M.; Karunaratne, G.K.D.; Perera, J.; Perera, R.R.D.P; Wijesooriya, W.R.P.L.I.; Sunil-Chandra, N.P.; Kottahachchi, J.; Athukorala, D.; Dissanayake, T.INTRODUCTION: National Laboratory Based Surveillance of Antimicrobial Resistance in urinary isolates conducted by the Sri Lanka College of Microbiologists was started in 2011 in collaboration with the Ministry of Health of Sri Lanka. METHODS: Pooled susceptibility data of urine culture isolates with a colony count of ≥105 CFU/ml from samples of non-catheterised patients received in 2014 were analysed using WHONET 5.6 software. RESULTS: The majority of the isolates (3975/4979:79.8%) were Gram negative enteric organisms, commonly known as coliforms. The other bacterial isolates identified were Enterococcus spp. (254), Pseudomonas spp. (194), coagulase negative staphylococci (59), Staphylococcus aureus (36), Acinetobacter spp. (35) and Group B β-haemolytic streptococci (18). The coliforms isolated from adults attending outpatient clinics (n=277) had 55.2% susceptibility to cephalexin and cephradine, 54% to amoxycillin/clavulanic acid, 65.1% to nitrofurantoin, 48.3% to norfloxacin, 63.4 % to cefotaxime, 86.4% to gentamicin, 97.4% to imipenem and 100% to meropenem. The isolates from adult hospitalized patients (n=1297) had 39.5% susceptibility to cefotaxime, 87.9% to meropenem, 62.6% to gentamicin and 31.9% to ciprofloxacin. Coliforms isolated from paediatric outpatients (n=182) had 58.5% susceptibility to cephalexin and cephradine, 58.5% to amoxycillin/clavulanic acid, 80% to nitrofurantoin, 85% to cefotaxime, 86.5% to gentamicin and 89.7% to meropenem. Those from paediatric hospitalized patients (n= 663) had 64.6% susceptibility to cefotaxime, 90.5% to meropenem and 80.2% to gentamicin. CONCLUSION: Coliforms, the commonest category of organisms isolated had high resistance rate in hospitalized patients whereas the resistance was less in outpatients, especially in the paediatric age group.Item The silver lining of disposable sporicidal privacy curtains in an intensive care unit(Elsevier, 2014) Kotsanas, D.; Wijesooriya, W.R.P.L.I.; Sloane, T.; Stuart, R. L.; Gillespie, E. E.BACKGROUND: The environment is a well-known source of health care-acquired infection. Because of the known risk of contamination, patient privacy curtains require frequent changes to decrease the risk of spread from patients to curtain and visa versa. METHODS: Fourteen disposable sporicidal privacy curtains were tested from December 2012 to June 2013 while hanging in a busy intensive care unit. Significant bacterial pathogens were identified and total bacteria enumerated as colony-forming units. Antimicrobial activity of curtain swatches was also tested against a range of bacteria in the laboratory. Measurements were recorded as zone of inhibition and contact inhibition. A cost analysis to replace standard curtains with disposable sporicidal curtains was also undertaken. RESULTS: Cultures grew low numbers of skin and environmental microorganisms with no methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, or Clostridium difficile detected. Vancomycin-resistant enterococci were recovered in very low numbers from 2 curtains where vancomycin-resistant enterococci-infected patients had been located. Privacy curtains demonstrated antimicrobial activity against C difficile and 13 additional bacterial pathogens. CONCLUSION:We conclude that disposable sporicidal privacy curtains are cost-effective and best replaced at 6 months in a high-risk area such as an intensive care unit.Item Down the drain:carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks(Australasian Medical Publishing Co., 2013) Kotsanas, D.; Wijesooriya, W.R.P.L.I.; Korman, T.M.; Gillespie, E.E.; Wright, L.; Snook, K.; Williams, N.; Bell, J.M.; Li, H.Y.; Stuart, R.L.OBJECTIVES: Clinical utility of carbapenem antibiotics is under threat because of the emergence of acquired metallo-β-lactamase (MBL) genes. We describe an outbreak in an intensive care unit (ICU) possibly associated with contaminated sinks. DESIGN, SETTING AND PARTICIPANTS: Four clusters of gram-negative bacteria harbouring the MBL gene blaIMP-4 were detected in the ICU at Dandenong Hospital between November 2009 and July 2012. Epidemiological investigations were undertaken in order to identify a common point source. During September 2012, screening using rectal swabs for all ICU patients, and environmental swabs targeting all ICU hand washing sinks and taps were collected. Samples were cultured onto selective carbapenem-resistant Enterobacteriaceae (CRE) agar. Suspected CRE isolates were further characterised using the modified Hodge test and VITEK 2 and confirmed by polymerase chain reaction and sequencing of MBL genes. Clinical and environmental CRE isolates were typed by pulsed-field gel electrophoresis. RESULTS: Ten clinical isolates and one screening isolate of CRE (consisting of Klebsiella pneumoniae [5], Serratia marcescens [4], Enterobacter cloacae [1] and Escherichia coli [1]) were detected with the blaIMP-4 gene over the 30-03 period. S. marcescens was isolated persistently from the grating and drain of eight central sinks. Molecular typing confirmed that clinical and environmental isolates were related. Tap water cultures were negative. Several attempts to clean and decontaminate the sinks using detergents and steam cleaning proved unsuccessful. CONCLUSION: This report highlights the importance of identification of potential environmental reservoirs, such as sinks, for control of outbreaks of environmentally hardy multi-resistant organisms.