RAJIV GANDHI UNIVERSITY OF HEALTH SCINCES, …
|RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE |
|ANNEXURE-II |
|PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION |
| | | |
|1 |NAME OF THE CANDIDATE AND ADDRESS (IN BLOCK LETTERS) |DR. SANTHOSH.B.GADADAVAR |
| | |POST GRADUATE STUDENT, |
| | |DEPT OF MICROBIOLOGY, |
| | |KIMS, HUBLI - 22 |
| | | |
|2 |NAME OF THE INSTITUTION |KARNATAKA INSTITUTE OF |
| | |MEDICAL SCIENCES, |
| | |HUBLI-580 022. |
| | | |
|3 |COURSE OF STUDY AND SUBJECT |M. D. MICROBIOLOGY |
| | | |
|4 |DATE OF ADMISSION TO COURSE |30TH JUNE 2010 |
|5 |TITLE OF THE TOPIC |“COMMUNITY AND HOSPITAL ACQUIRED GRAM NEGATIVE UROPATHOGENS: |
| | |MICROBIOLOGICAL PROFILE, ESBL AND AMP-C BETA LACTAMASE |
| | |PRODUCTION” |
|6 |BRIEF RESUME OF THE INTENDED WORK: |
| | |
| |6.1 NEED FOR THE STUDY: |
| |DESPITE THE WIDESPREAD AVAILABILITY OF ANTIBIOTICS, URINARY TRACT INFECTION REMAINS THE MOST COMMON BACTERIAL INFECTION IN |
| |THE HUMAN POPULATION IN BOTH HOSPITAL AND COMMUNITY SETTING.1 IN GENERAL, ESCHERICHIA COLI, KLEBSIELLA, PROTEUS, PSEUDOMONAS,|
| |ENTEROBACTER AND ACINETOBACTER SPECIES ETC HAVE BEEN REPORTED TO CAUSE URINARY TRACT INFECTION.2,3,4 |
| |The etiology of urinary tract infections and the antibiotic resistance of uropathogens has been changing over the past years |
| |both in community and nosocomial infections.5,6 Production of Extended Spectrum Beta Lactamases (ESBL) and Amp-C beta |
| |lactamases are the most common mechanisms of antimicrobial resistance in Gram negative bacilli.3 |
| |ESBL producing strains have spread to the community whereas Amp-C harbouring strains are still limited to the hospital.7 |
| |There is a paucity of data regarding ESBL and Amp-C beta lactamase production among uropathogens. Besides it is important to |
| |understand the extent of spread of these isolates in the community so as to formulate corrective measures. |
| |Hence the following study is conducted to find and compare antimicrobial resistance pattern, incidence of ESBL and Amp-C beta|
| |lactamase production among Gram negative uropathogens of community and hospital origin at Karnataka Institute of Medical |
| |Sciences Hospital , Hubli. |
| | |
| | |
| |6.2. REVIEW OF LITERATURE : |
| |A STUDY DONE BY ALLAN RONALD SHOWED THAT ESCHERICHIA COLI REMAINS THE PREDOMINANT UROPATHOGEN (80%) ISOLATED IN ACUTE |
| |COMMUNITY-ACQUIRED UNCOMPLICATED INFECTIONS, FOLLOWED BY STAPHYLOCOCCUS SAPROPHYTICUS, KLEBSIELLA, ENTEROBACTER AND PROTEUS |
| |SPECIES.8 |
| | |
| | |
| |A STUDY DONE BY NEELAM TANEJA, POOJA RAO, JITENDER ARORA &ASHOK DOGRA FOUND THAT PRODUCTION OF EXTENDED SPECTRUM BETA|
| |LACTAMASE AND AMP-C BETA LACTAMASES ARE THE MOST COMMON MECHANISMS OF ANTIMICROBIAL RESISTANCE IN GRAM NEGATIVE BACILLI. IN |
| |THEIR STUDY 36.5% OF GRAM NEGATIVE URINARY ISOLATES WERE ESBL PRODUCERS. HIGHEST ESBL POSITIVITY WAS FOUND IN KLEBSIELLA |
| |SPECIES(51.2%) FOLLOWED BY ESCHERICHIA COLI(40.2%),ENTEROBACTER AEROGENES(33.4%) AND PSEUDOMONAS AERUGINOSA(27.9%). BOTH ESBL|
| |PRODUCERS AND NONPRODUCERS SHOWED HIGH DEGREE RESISTANCE TO BETA LACTAM ANTIBIOTICS. THIS STUDY ALSO REPORTED 53 ISOLATES TO |
| |BE POSITIVE FOR AMP-C BETA LACTAMASE.3 |
| | |
| |A STUDY DONE BY SUPRIYA S TANKHIWALE, SURESH V JALGAONKAR AT GOVT MEDICAL COLLEGE NAGPUR REPORTED 48.3% ESBL PRODUCERS AMONG |
| |GRAM NEGATIVE URINARY ISOLATES OF SYMPTOMATIC URINARY TRACT INFECTION CASES ATTENDING OR ADMITTED TO INDIRA GANDHI MEDICAL |
| |COLLEGE AND HOSPITAL.1 |
| | |
| |A STUDY BY NACHIMUTHU RAMESH, CHETTIPALAYAN S S AT BHARATIDARSHAN UNIVERSITY,TIRUCHIRAPALLI REPORTED ESCHERICHIA COLI, |
| |KLEBSIELLA, PSEUDOMONAS, ACINETOBACTER, PROTEUS, ENTEROBACTER, STAPHYLOCOCCUS SP, ENTEROCOCCUS, CITROBACTER, SERRATIA AS THE |
| |CAUSATIVE AGENTS OF URINARY TRACT INFECTIONS AND OBSERVED ESBL PRODUCTION IN 71.5% OF GRAM NEGATIVE BACILLI IN BOTH |
| |OUTPATIENTS AND INPATIENTS.9 |
| | |
| |A STUDY DONE BY S UZUNOVIC-KAMBEROVIC, D SARIC, S SESTIC AT CANTONAL HOSPITAL, BOSNIA& HERZEGOVINA FOUND 2.6% ESBL PREVALENCE|
| |IN COMMUNITY ACQUIRED URINARY TRACT INFECTIONS. ESCHERICHIA COLI WAS RESPONSIBLE FOR 62.3% OF THE INFECTIONS.10 |
| |A STUDY DONE BY RUBENS CLAYTON DA SILVA DIAS, ARMANDO ALVES BORGES-NETO ET AL AT A LARGE URBAN UNIVERSITY HOSPITAL IN BRAZIL |
| |OBSERVED PREVALENCE OF AMP-C BETA LACTAMASES IN 12% OF ESCHERICHIA COLI ISOLATES.11 |
| | |
| |IN A STUDY CONDUCTED BY VIKAS MANCHANDA AND NARENDRA P S AT GURU TEGH BAHADUR HOSPITAL, DELHI FOUND THAT ESBL PRODUCING |
| |STRAINS OF ESCHERICHIA COLI WERE ISOLATED FROM INPATIENTS AS WELL AS FROM OUTPATIENTS. IN CONTRAST ALL THE AMP-C HARBOURING |
| |ORGANISMS WERE FOUND ONLY IN CLINICAL SAMPLES FROM ADMITTED PATIENTS. THE OVERALL AMP-C PRODUCTION WAS NOTED IN 20.7% OF THE |
| |CASES. THE GRAM NEGATIVE BACILLI INCLUDED IN THE STUDY WERE NON-ENTERIC CLINICAL ISOLATES.7 |
| | |
| |6.3 OBJECTIVES OF STUDY : |
| |TO ISOLATE AND IDENTIFY THE GRAM NEGATIVE UROPATHOGENS AMONG COMMUNITY AND HOSPITAL ACQUIRED URINARY TRACT INFECTIONS. |
| |TO FIND AND COMPARE THE ANTIMICROBIAL SUSCEPTIBILITY PATTERNS OF THE ISOLATED GRAM NEGATIVE UROPATHOGENS AMONG COMMUNITY AND |
| |HOSPITAL ACQUIRED URINARY TRACT INFECTIONS. |
| |TO FIND AND COMPARE THE INCIDENCE OF ESBL AND AMP-C BETA LACTAMASE PRODUCING UROPATHOGENS AMONG COMMUNITY AND HOSPITAL |
| |ACQUIRED URINARY TRACT INFECTIONS |
| |MATERIALS AND METHOD |
| | |
| |SOURCE OF DATA : |
| |URINE SAMPLES OF ADULTS COLLECTED FROM INPATIENT AND OUTPATIENT DEPARTMENT OF |
| |Karnataka Institute of Medical Sciences Hospital, Hubli. |
| | |
| | |
| |7.2 Methods of collection of data: |
| |Period of study: December 2010-November 2011 |
| | |
| |DESIGN OF STUDY: CROSS SECTIONAL STUDY. STATISTICAL ANALYSIS WILL BE DONE USING CHI-SQUARE TEST. |
| | |
| |INCLUSION CRITERIA: |
| |ONLY ADULT PATIENTS WITH SUSPECTED URINARY TRACT INFECTION. |
| |FOR HOSPITAL ACQUIRED URINARY TRACT INFECTION, URINE SAMPLE |
| |FROM INPATIENT ADULTS ADMITTED FOR NOT LESS THAN 3 DAYS(72 |
| |HOURS) WITH CLINICAL SUSPICION OF URINARY TRACT INFECTION.12 |
| |FOR COMMUNITY ACQUIRED URINARY TRACT INFECTION, URINE SAMPLES |
| |FROM OUTPATIENT ADULTS WHO WERE NOT HOSPITALIZED OR RESIDING IN A LONG TERM CARE FACILITY FOR MORE THAN 14 DAYS BEFORE THE |
| |ONSET OF SYMPTOMS.12 |
| |ONLY GRAM NEGATIVE UROPATHOGENS WILL BE INCLUDED. |
|7 |EXCLUSION CRITERIA: |
| |PEDIATRIC PATIENTS. |
| |ISOLATES OTHER THAN GRAM NEGATIVE BACILLI. |
| |REPEAT ISOLATES FROM SAME PATIENT. |
| |SIZE OF STUDY SAMPLE: |
| |GRAM NEGATIVE UROPATHOGENS ISOLATED IN DEPARTMENT OF MICROBIOLOGY, KARNATAKA INSTITUTE OF MEDICAL SCIENCES HOSPITAL, HUBLI IS|
| | |
| |APPROXIMATELY 28-30/MONTH I.E; 336-360/YEAR. SO ALL THE CASES AS PER INCLUSION CRITERIA WILL BE INCLUDED WITH A NUMBER |
| |RESTRICTED TO100 SAMPLES EACH OF COMMUNITY ACQUIRED AND HOSPITAL ACQUIRED UROPATHOGENS. |
| | |
| | |
| |D)METHOD : |
| | |
| |SAMPLE COLLECTION: |
| |COMMUNITY ACQUIRED UTI : 2ML MIDSTREAM URINE SAMPLE WILL BE COLLECTED UNDER ASEPTIC PRECAUTIONS FROM ADULT PATIENTS |
| |PRESENTING AT OUTPATIENT DEPARTMENT. |
| |HOSPITAL ACQUIRED UTI :2ML MIDSTREAM URINE SAMPLE OR URINE SAMPLE FROM CATHETER TUBE WILL BE COLLECTED UNDER ASEPTIC |
| |PRECAUTIONS FROM INPATIENTS WITH CLINICAL SUSPICION OF UTI. |
| | |
| |PROCESSING OF SAMPLE: |
| |URINE SAMPLES WILL BE PROCESSED AND INTERPRETED AS PER THE STANDARD PROTOCOL.13 SAMPLES WILL BE CULTURED ON BLOOD AGAR AND |
| |MCCONKEY AGAR AND INCUBATED OVERNIGHT AT 370C. ALL SPECIMENS REVEALING SIGNIFICANT BACTERIURIA WILL BE FURTHER IDENTIFIED BY|
| |RELEVANT BIOCHEMICAL TESTS. |
| | |
| |ANTIMICROBIAL SUSCEPTIBILITY TESTING WILL BE DONE AS PER CLSI GUIDELINES.14 PRESENCE OF ESBL WILL BE DETECTED BY PHENOTYPIC |
| |CONFIRMATORY TEST BY DISK DIFFUSION METHOD USING DISKS CONTAINING 30µG OF CEFTAZIDIME WITH AND WITHOUT 10µG OF CLAVULANIC |
| |ACID ON MUELLER-HINTON AGAR. ESBL PRODUCTION IS INFERRED IF THE INHIBITION ZONE INCREASES BY 5MM TOWARDS CEFTAZIDIME PLUS |
| |CLAVULANIC ACID IN COMPARISON TO 3RD GENERATION CEPHALOSPORIN DISK ALONE. 14 |
| |SCREENING FOR AMP-C BETA LACTAMASE WILL BE DONE USING30µG CEFOXITIN DISK AND ISOLATES WITH REDUCED SUSCEPTIBILITY TO |
| |CEFOXITIN WILL BE TESTED FOR AMP-C BY MODIFIED THREE DIMENSIONAL TEST. A CLEAR DISTORTION OF CEFOXITIN INHIBITION ZONE(>5MM)|
| |WILL BE INTERPRETED AS A POSITIVE RESULT FOR AMP-C PRODUCER.11 |
| |STATISTICAL ANALYSIS WILL BE DONE . |
| | |
| |7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE CONDUCTED ON PATIENTS (OR) |
| |ANIMALS SPECIFY. |
| |NO, THE URINE SAMPLES RECEIVED IN THE MICROBIOLOGY LABORATORY WILL BE UTILIZED FOR STUDY. NO ADDITIONAL INVESTIGATION OR |
| |INTERVENTION WILL BE CONDUCTED ON THE PATIENT. |
| | |
| | |
| |7.4 HAS ETHICAL CLEARANCES BEEN OBTAINED FROM ETHICAL COMMITTEE OF YOUR |
| |INSTITUTION IN CASE OF 7.3 ? |
| |‘YES’, ETHICAL CLEARANCE HAS BEEN OBTAINED FROM ETHICAL COMMITTEE OF KIMS , HUBLI. |
| | |
| | |
|8 |LIST OF REFERENCES : |
| | |
| |TANKHIWALE S S, JALGAONKAR S V, AHAMAD S & HASSANI U. EVALUATION OF EXTENDED SPECTRUM BETA LACTAMASE IN URINARY ISOLATES :|
| |INDIAN J MED RES DECEMBER 2004;120:553-556 |
| | |
| |AKRAM M, SHAHID M AND KHAN A U. ETIOLOGY AND ANTIBIOTIC RESISTANCE PATTERNS OF COMMUNITY-ACQUIRED URINARY TRACT INFECTIONS |
| |IN J N M C HOSPITAL ALIGARH, INDIA: ANN CLIN MICROBIOL ANTIMICROB 2007,VOL6(1). |
| | |
| | |
| |TANEJA N, RAO P, ARORA J & DOGRA A. OCCURRENCE OF ESBL & AMP-C BETA LACTAMASES & SUSCEPTIBILITY TO NEWER ANTIMICROBIAL |
| |AGENTS IN COMPLICATED UTI: INDIAN J MED RES, JANUARY 2008;127:85-88 |
| | |
| |TABIBIAN J H, GORNBEIN J, HEIDARI A ET AL. UROPATHOGENS AND HOST CHARACTERISTICS. J CLIN MICROBIOL DECEMBER 2008;46(12): |
| |3980-3986. |
| | |
| |NEU H C. URINARY TRACT INFECTIONS. AM J MED 1992;92(4A):63-70 |
| | |
| |SCHAEFFER A J. URINARY TRACT INFECTIONS IN ELDERLY. EUR UROL 1991;19:2-6 |
| | |
| |MANCHANDA V AND SINGH N P. OCCURRENCE AND DETECTION OF AMP-C BETA |
| |LACTAMASES AMONG GRAM-NEGATIVE CLINICAL ISOLATES USING A MODIFIED THREE- |
| |DIMENSIONAL TEST AT GURU TEGH BAHADUR HOSPITAL, DELHI, INDIA. J ANTIMICROB |
| |CHEMOTHER 2003 ;51(2):415-418 |
| | |
| |RONALD A. THE ETIOLOGY OF URINARY TRACT INFECTIONS: TRADITIONAL AND EMERGING PATHOGENS. DIS MON2003; 49(2):71-82. |
| | |
| |RAMESH N, CHETTIPALAYAM S S ET AL. URINARY TRACK INFECTION |
| |AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF EXTENDED SPECTRUM OF BETA |
| |LACTAMASE PRODUCING CLINICAL ISOLATES. ADVAN BIOL RES 2008 ;2(5-6):78-82 |
| | |
| | |
| | |
| |UZUNOVIC-KAMBEROVIC S, SARIC D, SESTIC S. COMMUNITY-ACQUIRED URINARY TRACT INFECTIONS BY EXTENDED SPECTRUM OF BETA LACTAMASE |
| |-PRODUCING ENTEROBACTERIACEAE IN ZENICA-DOBOJ CANTON, BOSNIA AND HERZEGOVINA: MEDICINSKI GLASNIK, AUGUST 2006 ;3(2); 46-52 |
| | |
| |DA SILVA DIAS R C, ARMANDO ALVES BORGES-NETO ET AL. PREVALENCE OF AMP-C AND OTHER BETA-LACTAMASES IN ENTEROBACTERIA AT A |
| |LARGE URBAN UNIVERSITY HOSPITAL IN BRAZIL. DIAGN MICROBIOL INFECT DIS JAN 2008;60(1):79-87 |
| | |
| |JACOBS R A, GUGLIELMO B J, CHIN-HONG P V. COMMON PROBLEMS IN INFECTIOUS DISEASES AND ANTIMICROBIAL CHEMOTHERAPY. CURRENT |
| |MEDICAL DIAGNOSIS AND TREATMENT 2008 , 47TH EDN: 1103-1149 |
| | |
| | |
| |KONEMAN EW, ALLEN SD, JANDA WM, SCHRECKENBERGER PC, WINN WC JR, WOODS G, PROCOP G . COLOR ATLAS AND TEXTBOOK OF DIAGNOSTIC |
| |MICROBIOLOGY, 6TH EDITION PHILADELPHIA. LIPPINCOTT WILLIAMS AND WILKINS PUBLISHERS;2006. CHAPTER 2:82-87 |
| | |
| |CLINICAL AND LABORATORY STANDARDS INSTITUTE. PERFORMANCE STANDARDS FOR ANTIMICROBIAL SUSCEPTIBILITY TESTING; 17TH |
| |INFORMATIONAL SUPPLEMENT 2007. |
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| | |
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|9 |SIGNATURE OF THE CANDIDATE: | |
|10 |REMARKS OF THE GUIDE: | |
|11 |NAME AND DESIGNATION OF |DR.ASHA PATIL |
| |11.1 GUIDE |M.D. MICROBIOLOGY. |
| | |ASSOCIATE PROFESSOR , DEPARTMENT OF MICROBIOLOGY, |
| | |KIMS, HUBLI |
| |11.2 SIGNATURE: | |
| | | |
| |11.3 CO-GUIDE: | |
| |11.4 SIGNATURE: | |
| |11.5 HEAD OF THE DEPARTMENT: |DR.SHOBHA D. NADAGIR |
| | |M.D. MICROBIOLOGY. |
| | |PROFESSOR & HEAD, DEPARTMENT OF MICROBIOLOGY, |
| | |KIMS, HUBLI |
| |11.6 SIGNATURE: | |
| | | |
|12 |12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL: | |
| | | |
| |12.2 SIGNATURE: | |
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