Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

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A healthy vaginal microbiota is considered to be significant for maintaining vaginal health and preventing infections. However, certain vaginal bacterial commensal species serve an important first line of defense of the body. Any disruption of this microbial barrier might result in a number of urogenital conditions including aerobic vaginitis (AV) and bacterial vaginosis (BV). The health of the vagina is closely associated with inhabitant microbiota. Furthermore, these microbes maintain a low vaginal pH, prevent the acquisition of pathogens, stimulate or moderate the local innate immune system, and further protect against complications during pregnancies. Therefore, this review will focus on vaginal microbial "health" in the lower reproductive tract of women and on the physiological characteristics that determine the well-being of reproductive health. In addition, we explore the distinct versus shared characteristics of BV and AV, which are commonly associated with increased risk for preterm delivery.

Vaginal Microbiomes Associated With Aerobic Vaginitis and Bacterial Vaginosis.

Methicillin-resistant Staphylococcus aureus (MRSA) pose a significant health threat as they tend to cause severe infections in vulnerable populations and are difficult to treat due to a limited range of effective antibiotics and also their ability to form biofilm. These organisms were once limited to hospital acquired infections but are now widely present in the community and even in animals. Furthermore, these organisms are constantly evolving to develop resistance to more antibiotics. This results in a need for new clinically useful antibiotics and one potential source are the Streptomyces which have already been the source of several anti-MRSA drugs including vancomycin. There remain large numbers of Streptomyces potentially undiscovered in underexplored regions such as mangrove, deserts, marine, and freshwater environments as well as endophytes. Organisms from these regions also face significant challenges to survival which often result in the production of novel bioactive compounds, several of which have already shown promise in drug development. We review the various mechanisms of antibiotic resistance in MRSA and all the known compounds isolated from Streptomyces with anti-MRSA activity with a focus on those from underexplored regions. The isolation of the full array of compounds Streptomyces are potentially capable of producing in the laboratory has proven a challenge, we also review techniques that have been used to overcome this obstacle including genetic cluster analysis. Additionally, we review the in vivo work done thus far with promising compounds of Streptomyces origin as well as the animal models that could be used for this work.

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Streptomyces as a Prominent Resource of Future Anti-MRSA Drugs.

Bacterial vaginosis, candidal, trichomonal and Gonococcal vaginal infections are a major health problems associated with gynecologic complications and increase in replication, shedding and transmission of HIV and other STIs in women of reproductive age The study aimed at determining the prevalence of common vaginal infections and antimicrobial susceptibility profiles of aerobic bacterial isolates in women of reproductive age, attending Felegehiwot referral Hospital

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Common causes of vaginal infections and antibiotic susceptibility of aerobic bacterial isolates in women of reproductive age attending at Felegehiwot referral Hospital, Ethiopia: a cross sectional study

Nasal carriage of Staphylococcus aureus among hospital personnel is a common cause of hospital acquired infections. Emergence of drug resistant strains especially methicillin resistant S. aureus (MRSA) is a serious problem in hospital environment. Therefore, the aim of this study was to determine the nasal carriage rate of S. aureus and MRSA among Health Care Workers (HCWs) at Al Shifa Hospital, the major hospital in Gaza Strip. A cross sectional study was conducted on 200 HCWs. Nasal swabs were collected during February — April 2015, and cultured on blood and mannitol salt agar. The isolates were identified as S. aureus based on morphology, coagulase test, DNase test and mannitol salt agar fermentation. Disk diffusion antibiotic susceptibility tests were performed according to the guidelines of the Clinical and Laboratory Standards Institute. MRSA were confirmed by detection of the mecA gene by PCR. Out of the 200 healthcare workers, 62 (31%) carried S. aureus, of which 51 (82.3%) were MRSA. Therefore, 25.5% of all HCWs were identified as MRSA carriers. MRSA carriage rate was highest among nurses (30.4%) whereas the carriage rate among doctors was (16%). The majority of MRSA carriers were workers of internal medicine department and surgical wards (41.3 and 35% respectively). Out of the 51 MRSA isolates identified by oxacillin disc resistance, 40 were confirmed by PCR targeting the mecA gene. Penicillin showed the highest rate of resistance among MRSA and MSSA isolates (100%). The high rate of nasal MRSA carriage among healthcare workers found in this study is alarming and highlights the need for adjusted infection control measures to prevent MRSA transmission from HCWs to the vulnerable patient.

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Nasal carriage of methicillin resistant Staphylococcus aureus among health care workers at Al Shifa hospital in Gaza Strip.

Staphylococcus aureus is a frequent cause of infections in both the community and hospital. Methicillin-resistant Staphylococcus aureus continues to be an important nosocomial pathogen and infections are often difficult to manage due to its resistance to multiple antibiotics. Healthcare workers are important source of nosocomial transmission of MRSA. This study aimed to determine the nasal carriage rate of S. aureus and MRSA among healthcare workers at Universal College of Medical Sciences and Teaching Hospital, Nepal and to determine antibiotic susceptibility pattern of the isolates. A cross-sectional study involving 204 healthcare workers was conducted. Nasal swabs were collected and cultured on Mannitol salt agar. Mannitol fermenting colonies which were gram positive cocci, catalase positive and coagulase positive were identified as S. aureus. Antibiotic susceptibility test was performed by modified Kirby-Bauer disc diffusion method. Methicillin resistance was detected using cefoxitin disc diffusion method. Of 204 healthcare workers, 32 (15.7 %) were nasal carriers of S. aureus and among them 7 (21.9 %) were carrier of MRSA. Overall nasal carriage rate of MRSA was 3.4 % (7/204). Highest MRSA nasal carriage rate of 7.8 % (4/51) was found among nurses. Healthcare workers of both surgical wards and operating room accounted for 28.6 % (2/7) of MRSA carriers each. Among MRSA isolates inducible clindamycin resistance was observed in 66.7 % (2/3) of erythromycin resistant isolates. High nasal carriage of S. aureus and MRSA among healthcare workers (especially in surgery ward and operating room) necessitates improved infection control measures to be employed to control MRSA transmission in our setting.

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Nasal carriage of methicillin resistant Staphylococcus aureus among health care workers at a tertiary care hospital in Western Nepal

Introduction: Infectious vaginitis which includes bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomoniasis are common disorder in women. Both vaginitis and urinary tract infection (UTI) during pregnancy have risk to lives of both the mother and fetus. Present study was done to assess type of vaginitis and to evaluate the risk of UTI in pregnant women with BV. Methods: Cross sectional descriptive study of 230 pregnant women was done from 1 st July to 30 th December 2010 at Paropakar Maternity and Women’s Hospital Thapathali, Kathmandu, Nepal. Duplicate High Vaginal Swab and urine sample were collected from each patient. BV was diagnosed using Amsel’s criteria. VVC was determined by culture on Sabouraud Dextrose Agar and Candida albicans was identified by Germ tube test. Trichomoniasis was detected by observing motile trophozoites under microscope. Diagnosis of UTI was made when there were at least 10 5 organisms/ml of urine. Results: Out of 230 patients, 92 were positive for infectious vaginitis and 32 had UTI. Among 92 infected patients, BV and VVC were found in 36(39.13%) and 28(30.43%) respectively while mixed infection was found in 28(30.43%) of the infected patients. UTI was more than twice common among in pregnant women with BV than without it (p<0.05). Conclusion: Hence, BV was the most common vaginitis among pregnant women and women with BV are at increased risk for UTIs. We recommend all pregnant women during antenatal checkup should be screened for the presence of BV and UTI.

Study on types of vaginitis and association between bacterial vaginosis and urinary tract infection in pregnant women

Objective: This study aimed to determine prevalence of inducible and constitutive clindamycin resistance among clinical S. aureus isolates and also study their association with methicillin resistance. Methods: A cross-sectional study including 140 non-duplicate isolates of S. aureus was done. Isolates were identified by standard microbiological methods and methicillin resistance was detected by cefoxitin disc diffusion method. Inducible clindamycin resistance was detected by D-test. Results: Prevalence of inducible and constitutive clindamycin resistance was 12.10% and 7.90% respectively. Constitutive and inducible resistance was associated with MRSA. An unusual phenotype, erythromycin sensitive and clindamycin resistance, was detected in 2 MRSA isolates. Conclusions: Inducible and constitutive clindamycin resistance is low in our setting. Constitutive and inducible resistance was associated with MRSA. However the trends in resistance vary in different places. D-test reporting should be done routinely which will allow clinicians to opt for clindamycin judiciously and avoid potential treatment failure. Keywords: Clindamycin resistance, MLSBi, D-test, MRSA, Nepal

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Inducible and constitutive clindamycin resistance in Staphylococcus aureus: an experience from Western Nepal

Pseudomonas aeruginosa is an opportunistic pathogen that develops life-threatening infections in patients with immunological system defects like burn patients P aeruginosa is naturally resistant as well as able to get acquired resistance to effective antibiotics which lead to problematic conditions This study was designed to isolate P aeruginosa from burn patients and to evaluate drug susceptibility for determination of multidrug- resistant isolates of P aeruginosa Materials and Methods: A prospective study was carried out on the patients visiting Victoria Hospital, Kalasipalayan, Bangalore, India from Nov 15, 2010 to June 15, 2011 The pus sample was collected using sterile cotton swab from 100 patients with burn wound infections P aeruginosa was identified by standard bacteriological methods The drug susceptibility pattern using 12 different antimicrobial agents (Amikacin, Ciprofloxacin, Gentamicin, Cefotaxime, Imipenem, Meropenem, Cefoperozone, Tobramycin, Piperacillin/Tazobactum, Cefepime, Ceftazidime, and Norfloxacin) was performed for all the isolates using Kirby Bauer's Disc Diffusion Method Results: P aeruginosa were isolated from 17 clinical samples and all of these isolates were Multidrug Resistance P aeruginosa (MDRPa) Resistance rates to various antibiotics were as follows: Amikacin (471%) Ciprofloxacin (355%) Gentamicin (471%) Cefotaxime (765%) Imipenem (882%) Meropenem (941%) Cefoperozone (941%) Tobramycin (100%) Piperacillin/Tazobactum (824%) Cefepime (647%) Ceftazidime (706%) Norfloxacin (706%) Conclusion: Optimization of using antimicrobial agents and control of infection is recommended to prevent the increasing population of MDRPa in the new burn centre setting in this study

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Multi-drug Resistant Pseudomonas aeruginosa Isolated from Intensive Care Burn Unit

INTRODUCTION: Emergence and spread of antibiotic resistance in organisms causing skin and soft tissue infections (SSTIs) is posing a great therapeutic challenge. This study aimed to determine bacteriology of SSTIs and study antibiotic resistance among the isolates. MATERIAL AND METHODS: A retrospective analysis of 149 consecutive pus specimens received at microbiology laboratory of Universal College of Medical Sciences & Teaching Hospital, Bhairahawa over a period of 8 months from July 2012 to February 2013 was done. The bacterial isolates were identified by standard microbiological techniques and antibiotic susceptibility testing was done by Modified Kirby-Bauer method. RESULTS: Growth was seen in 92 (62%) specimens out of which 88 specimens yielded single isolate and 4 specimens yielded 2 isolates. Hence a total of 96 isolates were isolated. The commonest isolates were Staphylococcus aureus (n=39) followed by E. coli (n=11), Pseudomonas spp (n=11), Coagulase negative staphylococci (n=9), Klebsiella spp (n=6), Proteus spp (n=5), Streptococcus spp (n=4), Acinetobacter spp (n=1), and unidentified gram negative bacilli (n=10). Among gram positive cocci susceptibility to Amikacin was highest followed by vancomycin and gentamycin. Among gram negative bacilli aminoglycosides and ciprofloxacin susceptibility was high, however all E. coli isolates were ciprofloxacin resistant. Majority of isolates were resistant to amoxicillin, ceftriaxone and cotrimoxazole. CONCLUSION: In conclusion this study reports the commonest organism in SSTIs is S. aureus followed by E.coli and Pseudomonas spp. Continued monitoring of susceptibility pattern need to be carried out to detect the true burden of antibiotic resistance in organisms and prevent their further emergence by judicious use of drugs. DOI: http://dx.doi.org/10.3126/jucms.v1i3.8759 Journal of Universal College of Medical Sciences Vol.1(3) 2013: 18-21

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Sweety Upadhaya

Papers

Nasal carriage of methicillin resistant Staphylococcus aureus among health care workers at a tertiary care hospital in Western Nepal

Study on types of vaginitis and association between bacterial vaginosis and urinary tract infection in pregnant women

Inducible and constitutive clindamycin resistance in Staphylococcus aureus: an experience from Western Nepal

Multi-drug Resistant Pseudomonas aeruginosa Isolated from Intensive Care Burn Unit

Skin and Soft Tissue Infections: Bacteriological Profile and Antibiotic Resistance Pattern of Isolates