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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 Comparison of Three Carbapenemase Producing Enterobacteria (CPE) Detection Methods(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Kumudunie, W.G.M.; Wijayasinghe, Y.S.; Wijesooriya, W.R.P.L.I.; Sunil-Chandra, N.P.; Namalie, K.D.Introduction: The emergence of carbapenem resistant enterobacteria (CRE) is a critical and growing health threat, causing a failure of almost all the available antibiotics and limiting the effective therapeutic options. CRE has been reported all over the world including Sri Lanka. The carbapenem resistance in enterobacteria is mainly occurred due to the production of carbapenemases, the carbapenem inactivating enzymes. Therefore, accurate and timely detection of CPE is an important aspect to streamline the empiric antibiotic therapy. In this study, three CPE detection methods namely, Carba NP-rapid biochemical test, modified carbapenem inhibition method (MCIM) and modified Hodge test (MHT) were compared for the detection of CPE. Carba NP test is a rapid biochemical test that requires 2 hours or less. However, both MCIM and MHT require incubation of 18 – 24 hours. Objective: To compare theCarba NP-rapid biochemical test with the MCIM and MHT for the detection of CPE. Methodology: Fifty-eight clinically significant CRE isolates were recovered from clinical specimens from patients attended to North Colombo Teaching Hospital (NCTH)during December 2017 – February 2018. Antibiotic sensitivity testing for the screening of CRE was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Enterobacteria, resistant to at least one carbapenem antibiotic were considered as CRE. Carba NP test, MCIM and MHT were carried out for CRE isolates according to the CLSI guidelines. Statistical analysis was done using R programming language (level of significance P<0.05). Results: Of 58 CRE, 94.82% (55/58) were confirmed as CPE via both MCIM and MHT while 77.58% (45/58) were revealed as CPE by Carba NP test. There was a significant reduction of CPE detection by Carba NP method compared to MCIM and MHT(P=0.007). Conclusion: Of the three CPE detection methods, sensitivity was higher in MCIM and MHT compared to Carba NP – rapid biochemical test. Acknowledgement: Financial assistance by National Research Council, Sri Lanka (NRC 17-055) is acknowledged.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.