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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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.Item Factors associated with urinary tract infections caused by extended spectrum beta-lactamase (ESBL) producing organisms in Sri Lanka(Elsevier, 2016) Fernando, S.; Luke, N.; Wickramasinghe, S.; Sebastiampillai, B.; Gunathilake, M.; Miththinda, N.; Silva, S.; Premaratna, R.BACKGROUND: Urinary tract infections (UTI) caused by extendedspectrum beta-lactamase (ESBL)-producing organisms are a major burden in clinical practice. Hospitalization in the past 3 months, antibiotic treatment in the past 3 months, age over 60 years, diabetes mellitus, Klebsiella pneumoniae infection, previous use of second or third-generation cephalosporins, quinolones or penicillins are known associations and risk factors for ESBL-UTI. METHODS & MATERIALS: A descriptive study was conducted over a period of 6 months from January - July 2015 recruiting patients with UTI caused by ESBL producing organisms, who were admitted to the Professorial Medical unit, Colombo North Teaching Hospital, Ragama Sri Lanka in order to identify risk factors and associations. Data were obtained using a pre-tested interviewer administered questionnaire and from relevant medical records after obtaining informed written consent. RESULTS: 52 patients were recruited; males 30 (57.7%), mean (SD) age 64.1(.12.6)years. Of them, 46 (88.5%) had diabetes mellitus, 32 (61.5%) had hypertension and 10 (19.2%) had chronic liver disease as comorbidities.20 (38.5%) had ultrasonographic evidence of acute pyelonephritis. At presentation16 (30.8%)had biochemical and/or ultrasonographic evidence of chronic or acute on chronic kidney disease. History of constipation was observed in 18 (34.6%), hospitalization during the past 3 months was seen in 24(46.2%)and history of urinary catheterization in 16(30.8%). Features of obstructive uropathy such as hydronephrosis, hydroureter and prostatomegaly were seen in 4 (7.7%) patients each. Antibiotic treatment within the past 3 months was observed in 32(61.5%);penicillins in 18(34.6%), 3rd generation cephalosporins in 16(30.8%),quinolones in 14(26.9%) and 2nd generation cehalosporins in 12 (23.1%). 18 (34.6%) had received more than one antibiotic within the past 3 months. 8(15.4%)patients studied were on prophylactic antibiotics for recurrant UTIs. None of them had recent Klebsiella pneumonia. CONCLUSION: Similar to other studies,diabetes mellitus, recent antibiotic treatment, hospitalization and catheterization were observed in our patients with ESBL-UTI. The fact that only 53.8% patients had received antibiotics at community level and 38.5% patients had never received antibiotics prior to developing ESBLUTI suggest high prevalence of ESBL producing organisms at community level.