International Postgraduate Research Conference (IPRC)

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Author: search.filters.author.Sunil-Chandra, N.P.

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    A Descriptive Study on Antibiotic Resistant, Clinically Significant Coliform Species Isolated from the Patients at Colombo North Teaching Hospital (CNTH), Ragama, 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.; Namalie, K.D.; Sunil-Chandra, N.P.
    Introduction: Antibiotic resistance (AR) is a great therapeutic challenge globally and locally today. The rate of development of AR is far ahead compared to the discovery of a new class of antibiotics, which has not been successful in last three decades. Of the antibiotic resistant coliforms, extended spectrum beta-lactamase producers (ESBLP) play a key role in life threatening infections. Moreover, emergence of carbapenem-resistant Enterobacteriaceae (CRE) has further limited the effective therapeutic options. Objective: To investigate the AR of clinically significant Enterobacteriaceae isolated from patients in a tertiary healthcare setting. Method: A descriptive, cross-sectional study was conducted involving patients with coliform infections at CNTH from 01/03/2018 to 31/08/2018. Demographic details, clinical data & antibiotic sensitivity test (ABST) patterns were analyzed. ABST was performed according to John-Stokes method & ESBLPwere identified by the keyhole method. Resistance to either meropenem or imipenem is used to identify CRE. Statistical analysis was done via R programming language (level of significance P<0.05). Results: Of the 200 coliforms, 85.5% (171/200) were from inpatients & the rest were from outpatients. Of the studied patients, 53.5% (107/200) were females & 46.5% (93/200) were males. Of the Enterobacteriaceae spp isolated, 48.5% (97/200) were from urine, 34.5% (69/200) from pus / wound swabs, 9.5% (19/200) respiratory samples, 3% (6/200) sterile fluids & stents, & 3% (6/200) from blood & CVP tips. As per ABST, about 90% were resistant to ampicillin. Resistance was 61-70% against cefuroxime (oral), ciprofloxacin & nalidixic acid, 60% for amoxiclav, 41-50% for cefotaxime, cefuroxime (intravenous), co-trimoxazole, levofloxacin, norfloxacin & ofloxacin, 31-40% for cefepime, ceftazidime, ceftriaxone & nitrofurantoin, 21-30% for gentamicin & piperacillin tazobactam & 0-10% for amikacin & meropenem. Of the coliforms, 29% (58/200) were ESBLP & 8% (16/200) were CRE. None of the ESBLP was CRE. Of CRE, 37% (10/16) were resistant to amikacin. However, 93.8% (15/16) of CRE were colistin sensitive. Conclusion: Majority of the isolates represented infections of the inward patients & there was no statistically significant difference between male & female proportions. Coliforms were detectedmostly from urine. Majority (>50%) of clinically significant Enterobacteriaceae were resistant to most of the oral antibiotics namely cefuroxime, ciprofloxacin, nalidixic acid & amoxiclav. Of the oral antibiotics, nitrofurantoin has the lowest resistance against Enterobacteriaceae. None of the antibiotics had 100% sensitivity against Enterobacteriaceae. Results indicate that ESBLP can be safely treated with carbapenems. Colistin will be an effective empiric antibiotic for CRE.
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    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.