Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item 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.Item 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