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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 11 | Issue 2
Page Nos. 53-88

Online since Monday, May 27, 2019

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EDITORIAL  

State of the globe: Antimicrobial resistance: Are we ready? p. 53
Sunil Kumar Raina
DOI:10.4103/jgid.jgid_56_19  
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POLICY PAPER Top

Fighting antimicrobial resistance: Status paper with action points by organized medicine academic guild p. 54
Sunil Kumar Raina, Sagar Galwankar, Akshay C Dhariwal, Ramesh Bhatt, Raman Kumar, Ishwar Gilada, Praveen Aggarwal, S Vimal Krishnan, Santosh Soans, RP Srivastva, Udhay Bodhankar
DOI:10.4103/jgid.jgid_26_19  
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ORIGINAL ARTICLES Top

Antimicrobial resistance profile and Nim gene detection among Bacteroides fragilis group isolates in a university hospital in South India p. 59
Shashidhar Vishwanath, Padmaja Ananth Shenoy, Kiran Chawla
DOI:10.4103/jgid.jgid_116_18  
Introduction: Members of Bacteroides fragilis group are the most frequently isolated anaerobic pathogens in the clinical laboratory from diverse infection sites. The objective of this study was to characterize B. fragilis isolates from various clinical specimens, to analyze their susceptibility profile toward most common anti-anaerobic antimicrobials, and to study the frequency of nim gene determining resistance to nitroimidazoles. Methods: Specimens processed for anaerobic culture between January 2013 and December 2015 were analyzed. Isolates of B. fragilis group were identified and speciated by mass spectrometry. β-lactamase production was detected using nitrocefin disks. Agar dilution and antimicrobial gradient diffusion methods were performed to study their susceptibility profile. The isolates were screened for nim gene by conventional gel-based polymerase chain reaction. Results: A total of 57 isolates of B. fragilis group were studied. The commonly isolated species was B. fragilis (73.7%), followed by Bacteroides thetaiotaomicron (8.8%), Bacteroides vulgatus (8.8%), and others. Most of the isolates were recovered from deep-seated abscesses (47.4%). All isolates were found to be β-lactamase producers. Metronidazole (Mtz) resistance was observed in 4 (7%) isolates. Higher rate of resistance was observed toward clindamycin (31.6%). None of the isolates tested were found resistant to chloramphenicol, piperacillin-tazobactam, and meropenem. nim genes were present in 4 (11.4%) B. fragilis isolates (n = 35). Conclusions: Resistance to the most commonly used empirical anti-anaerobic drugs including Mtz was noted in the isolates of B. fragilis group. Routine anaerobic cultures when indicated and continual surveillance of antimicrobial resistance among the anaerobic bacterial pathogens is essential.
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Effect of temperature and altitude difference on tuberculosis notification: A systematic review p. 63
Yalemzewod Assefa Gelaw, Weiwei Yu, Ricardo J Soares Magalhães, Yibeltal Assefa, Gail Williams
DOI:10.4103/jgid.jgid_95_18  
Background: Ecological factors are important indicators for tuberculosis (TB) notification. However, consolidation of evidence on the effect of altitude and temperature on TB notification rate has not yet been done. The aim of this review is to illustrate the effect of altitude and temperature on TB notification rate. Methods: Electronic searches were undertaken from PubMed, EMBASE, and Scopus databases. Hand searches of bibliographies of retrieved papers provided additional references. A review was performed using the Meta-analysis Of Observational Studies in Epidemiology guideline. Results: Nine articles from various geographic regions were included in the study. Five out of nine studies showed the effect of altitude and four articles identified temperature effects. Results showed that TB notification rates were lower at higher altitude and higher at a higher temperature. Conclusion: This review provides qualitative evidence that TB notification rates increase with temperature and decrease with altitude. The findings of this review will encourage policymakers and program managers to consider seasonality and altitude differences in the design and implementation of TB prevention and control strategies.
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Empiric antibiotic therapy in the treatment of community-acquired pneumonia in a general hospital in Saudi Arabia p. 69
Jaffar A Al-Tawfiq, Hisham Momattin, Kareem Hinedi
DOI:10.4103/jgid.jgid_84_18  
Background: Guideline-based empiric antimicrobial therapy is recommended for the treatment of community-acquired pneumonia (CAP). In this study, we evaluate the pattern of empiric antibiotics of CAP patients. Materials and Methods: Patients with CAP were retrieved from the health information unit using the International Classification of Diseases, Ninth Revision. The electronic pharmacy database was used to retrieve prescribed antibiotics and the duration of therapy for each antibiotic. Results: A total of 1672 adult patients were included in the study and 868 (52%) were male. Of all the patients, 47 (2.8%) were admitted to the intensive care unit (ICU). The most frequently used antibiotics were levofloxacin (68.12%), ceftriaxone (37.7%), imipenem-cilastatin (32.5%), and azithromycin (20.6%). The mean days of therapy of each of these antibiotics were 3.2, 2.8, 4.4, and 2.9, respectively. A combination therapy of levofloxacin and imipenem-cilastatin was prescribed for 355 (21.8%) of non-ICU patients versus 20 (60.6%) of ICU patients (P = 0.0007). Imipenem-cilastatin was prescribed for 518 (31.8%) of non-ICU patients versus 25 (56.8%) of ICU patients (P = 0.0009). Levofloxacin was prescribed for 1106 (68%) of non-ICU patients versus 33 (75%) of ICU patients (P = 0.412). Ceftriaxone use decreased significantly from 40.9% in 2013 to 25.9% in 2016 (P = 0.034). In addition, levofloxacin use increased from 63.7% to 75% (P = 0.63). Conclusion: The most commonly used antibiotics were levofloxacin, ceftriaxone, imipenem-cilastatin, and azithromycin. The data call for further refinement and prospective audit of antibiotic use in CAP, especially in non-ICU settings.
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A prospective study on impact of early initiation of antiretroviral therapy in human immunodeficiency virus-positive adults on immunological status and adverse events p. 73
Vikas Kumar, Jatinder Singh
DOI:10.4103/jgid.jgid_160_18  
Introduction: Antiretroviral therapy (ART) is a lifelong commitment for human immunodeficiency virus infection (HIV)-positive patients. The patients may develop early adverse drug reactions (ADRs) during the first 3 months of treatment, especially when they have advanced HIV disease with low CD4 counts. Materials and Methods: The present study was a prospective observational study that took place from January 2017 to July 2017 at ART center, Government Medical College, Amritsar, Punjab, India. The primary objective of the study was to evaluate ADRs to ART and immunological status in HIV-positive patients. The patients received ART regimens as per the National AIDS Control Organization guidelines. The sample included both ART-naïve and ART-experienced HIV-positive patients. The causality of reported ADRs assessed according to the World Health Organization guidelines. The study was conducted after taking approval from the Institutional Ethics Committee, Government Medical College, Amritsar, and informed consent from the patients. Data were analyzed statistically using Chi-square test, and P < 0.05 was considered statistically significant. Results: Out of total 350 patients screened during study period, 84 patients reported with confirmed ADRs. The most widely used treatment regimen was tenofovir + lamivudine + efavirenz (59.52%). Central nervous system (19.05%)-, renal (14.29%)-, and immune reconstitution inflammatory syndrome (14.29%)-related ADRs were mostly reported. The causality assessment revealed insignificant P value (Chi-square = 8.656 and P = 0.07), with 19.05% probable and 80.95% possible ADRs. Conclusions: The CD4 count <200/μl at the initiation of ART and treatment duration <1 year proved to be predictors for ADRs. Early initiation of ART in HIV-positive patients can improve immunological status and decrease in the incidence of ADRs.
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The largest American study comparing transient elastography and the aminotransferase-to-platelet ratio index score, two noninvasive tests for liver fibrosis staging in HIV/HCV coinfected patients p. 80
Jason Dazley, Elaine Szabela, A Adebara, Prerak Shukla, Raymund Sison, Jihad Slim
DOI:10.4103/jgid.jgid_10_16  
Objective: Elastography has become the standard of care of diagnostic approaches for liver disease, particularly when dealing with hepatitis C. There areno studies in the inner-city populations of Newark, New Jersey, that describe the comparison of noninvasive markers, such as FibroScan andaminotransferase-to-platelet ratio index (APRI) scoring. Methods: Using a chart review method, we used a case-control study method of gathering and analyzing the data, using P < or = 0.05 as a significant variable. Results: The outcome of this study indicates that the FibroScan may be a better marker than the APRI score for the staging of liver disease when a patient has hepatitis B or C with or without HIV/AIDS. Conclusions: This may be a benchmark study to further enhance our understanging of the utility of the fibroscan.
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CASE REPORTS Top

A case of lipotourism-associated multidrug-resistant Mycobacterium abscessus infection p. 83
Rose Anne Lee, Robin Wigmore
DOI:10.4103/jgid.jgid_148_17  
Rapidly growing mycobacteria have become increasingly recognized as pathogens implicated in surgical site infections that can be both difficult to diagnose and treat with an evolving understanding of both intrinsic and acquired resistance patterns. As common environmental commensal organisms that can colonize water supplies, they are of particular concern in the setting of a growing medical tourism industry. We present a case of a 49-year-old woman who acquired a highly multidrug-resistant Mycobacterium abscessus skin and soft-tissue infection after cosmetic abdominoplasty that required radical surgical debridement and 6 months of intravenous therapy to eradicate. This case highlights the challenges in the management of M. abscessus infections including delay to diagnosis and resistance patterns that are likely to become more common despite antibiotic stewardship efforts.
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LETTERS TO EDITOR Top

Anemia in pregnant women with Hepatitis B viral DNA in Port Harcourt, Nigeria p. 86
Theodora P Etu-Efeotor, Hannah E Omunakwe
DOI:10.4103/jgid.jgid_147_18  
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Anthrax-based epidemiological surveillance in Western Mexico p. 87
Salvador Valle-Reyes, Tiburcio Lizama-Munguía, Jorge A Salazar-Barragán, José B Soto-Castellan, Erika J Verján-Carrillo, Francisco Espinoza-Gómez, Perla A Rios-Flores, Gabriel Ceja-Espíritu, Iván Delgado-Enciso, Uriel A López-Lemus
DOI:10.4103/jgid.jgid_102_18  
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008