Enterococci are Gram-positive cocci that are natural inhabitants of the gastrointestinal tract. They have become important nosocomial pathogens due to their intrinsic and acquired antibiotic resistance. This study found that Enterococcus faecalis was the most common species isolated from clinical specimens in two Saudi hospitals. Many isolates showed resistance to tetracycline, ciprofloxacin, and chloramphenicol. Vancomycin resistance was observed in 3.9% of isolates, with the VanA phenotype being most common. Pulsed-field gel electrophoresis identified identical clones of E. faecalis isolated from different hospital wards, suggesting intra-hospital transmission. The high resistance rates indicate a need for improved infection control and antibiotic steward
General discription about E coli.. Classification scheme of E coli. Pathogenecity of E coli. Pathological characters of E coli. slide contains animations and may not support in mobile.. Use laptop for full view
Cholera is a serious bacterial disease that usually
causes severe diarrhea and dehydration. The disease is typically spread through contaminated water.
Modern sewage and water treatment have effectively eliminated cholera in most countries. It’s still a problem in countries like Asia, America and Africa. Mostly in India.
Countries affected by war, poverty, and natural disasters have the greatest risk for a cholera outbreak.
Taxonomy:
class : Gamma Proteobacteria
Order: Vibrionales
Family: Vibrionaceae
Genus: Vibrio
Species: v.cholerae, v.parahaemolyticus,
v. vulnificus, v. alginolyticus
MORPHOLOGY:
Gram negative, actively motile, short, rigid curved bacilli
Resembling letter “V”
about 34 genus
most common in water
1.5µ X 0.2 -0.4 µ in size
polar flagellum , strongly aerobic
Smear – fish in stream appearance
PATHOGENESIS:
Source: Ingestion of contaminated water, food,
fruits and vegetables etc.,
Incubation periods: 1-5 days
Symptoms: Watery diarrhoea, vomiting, thirst, dehydration, muscle cramps
Complications: muscular pain, renal failure, pulmonary edema, cardiac arrhythrnias
DIAGNOSIS:
Specimen: stool sample, water sample(envt)
Microscopy: a) Hanging drop : +ve
b) Gram stain :-ve
Culture: Mac conkey Agar :colourless to light pink
TCBS : yellow colonies
Serology: serological tests are no diagnostic value
TREATMENT:
Adequate replacement of fluids and electrolytes.
Oral tetracycline reduces the period of vibrio excreation.
PREVENTION:
Drink and use bottled water
Frequent washing
Sanitary environment
Defecate in water
Cook food thoroughly
MOLECULAR TOOLS IN DIAGNOSIS AND CHARACTERIZATION OF INFECTIOUS DISEASES tawheedshafi
The future of the molecular diagnostics of infectious diseases will undoubtedly be focused on a marked increase in the amount of information detected with remarkably simplified, rapid platforms that will need complex software analysis to resolve the data for use in clinical decision-making.
General discription about E coli.. Classification scheme of E coli. Pathogenecity of E coli. Pathological characters of E coli. slide contains animations and may not support in mobile.. Use laptop for full view
Cholera is a serious bacterial disease that usually
causes severe diarrhea and dehydration. The disease is typically spread through contaminated water.
Modern sewage and water treatment have effectively eliminated cholera in most countries. It’s still a problem in countries like Asia, America and Africa. Mostly in India.
Countries affected by war, poverty, and natural disasters have the greatest risk for a cholera outbreak.
Taxonomy:
class : Gamma Proteobacteria
Order: Vibrionales
Family: Vibrionaceae
Genus: Vibrio
Species: v.cholerae, v.parahaemolyticus,
v. vulnificus, v. alginolyticus
MORPHOLOGY:
Gram negative, actively motile, short, rigid curved bacilli
Resembling letter “V”
about 34 genus
most common in water
1.5µ X 0.2 -0.4 µ in size
polar flagellum , strongly aerobic
Smear – fish in stream appearance
PATHOGENESIS:
Source: Ingestion of contaminated water, food,
fruits and vegetables etc.,
Incubation periods: 1-5 days
Symptoms: Watery diarrhoea, vomiting, thirst, dehydration, muscle cramps
Complications: muscular pain, renal failure, pulmonary edema, cardiac arrhythrnias
DIAGNOSIS:
Specimen: stool sample, water sample(envt)
Microscopy: a) Hanging drop : +ve
b) Gram stain :-ve
Culture: Mac conkey Agar :colourless to light pink
TCBS : yellow colonies
Serology: serological tests are no diagnostic value
TREATMENT:
Adequate replacement of fluids and electrolytes.
Oral tetracycline reduces the period of vibrio excreation.
PREVENTION:
Drink and use bottled water
Frequent washing
Sanitary environment
Defecate in water
Cook food thoroughly
MOLECULAR TOOLS IN DIAGNOSIS AND CHARACTERIZATION OF INFECTIOUS DISEASES tawheedshafi
The future of the molecular diagnostics of infectious diseases will undoubtedly be focused on a marked increase in the amount of information detected with remarkably simplified, rapid platforms that will need complex software analysis to resolve the data for use in clinical decision-making.
Methicillin-resistant Staphylococcus aureus (MRSA) infections have been recognized for decades as hospital acquired MRSA (HA-MRSA). Nowadays, MRSA is also recognized as a worldwide emerging community-associated pathogen. Community associated- MRSA (CA-MRSA) has been shown to be more virulent with a high degree of severity of disease when compared to HA-MRSA.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. Enterococcus
• Gram positive cocci, non motile, non sporing
• Catalase Negative
• Previously classified as group D streptococci
• Natural inhabitants of GIT
• Distinct features
– Ability to grow at 10°C and 45°C
– Ability to grow in 6.5%NaCl
– Ability to grow at 9.6pH
– Ability to hydrolyze esculin in 40% bile
– Ability to process pyrrolidonyl arylamidase (PYR)
3. Presumptive identification of
Streptococci & Enterococcci
Hemolysis
Hippurate
Bacitracin
Organism
6.5%NaCl
Optochin
solubility
esculin
Camp
PYR
Bile
Bile
SXT
Lap
Group A ß S R - - + + - - R -
streptococci
Group B ß, none R R + + + - - V R -
streptococci
Group C,G & F ß V S - - + - - - R -
streptococci
Group D α, ß, R R - V + + + + R -
Enterococcci none
Other Group D α, R S - - + - + - R -
streptococci none
Viridans α, none V S - V + - V - R -
streptococci
Pneumococci α V S - - + - - - S +
4. Classification (based on phenotypic characters in
clinical isolates)
Group 1 Group 3 Group 5
E.avium E.dispar E.columbae
E.gilvus E.durans E.canis
E.malodartus E.hirae E.moraviensis
E.pallens E.ratti
E. pseudoavium E.villorum
E.raffinosus
E.sacchrolyticus
Group 2 Group 4
E.fecalis E.asini
E.fecium E.cecorum
E.casseliflavus E.sulfures
E.gallinarum E.phoeniculicola
E.mundtii Enterococcus sp
E.hemoperoxidus
Enterococcus sp
Koneman textbook of diagnostic microbiology
5. MANNITOL
Species
PYRUVATE
RAFFINOSE
SORBOSE
ARABINOS
GLUCOSE
SUCROSE
6.5%Nacl
SORBITOL
MGP
10°C
45°C
ADH
PYR
LAP
HIP
E
E.fecalis + + + + + + + + + - - + - + + -
E.fecium + + + + + + - + + - + V V + - -
E.casselifl + NA + + + + - + + - + V + + V +
avus
E.gallinar + + + + + + + + + - + - + + - +
um
E.durans + NA + + + + V + - - - - - - - -
E.hirae + + + + + + - + - - - - + + - -
E.avium + NA + + + - V + + + + + - + + V
LAP-leucine aminopeptidase, PYR- pyrrolidonyl arylamidase, ADH- arginine dihydrolase, HIP – hippurate, MGP-
methyl α-D-glucopyranoside
9. Intrinsic resistance
• Resistance to ß-lactams Low affinity of
penicillin binding protein
• Low level resistance to aminoglycosides
Low uptake of these agents
11. Acquired resistance (Cont’d)
• Chloramphenicol mediated by chloramphenicol acetyl
transferase, prevents binding to 50S ribosome
• Erythromycin resistance occurs as a part of Macrolide-
Lincosamide-streptogramin B resistance phenotype.
– Transferred by resistance deretminant ermB carried on Tn917.
– Leads to methylation of adenosine residue in 23S rRNA.
– Also confers high level resistance to clindamycin
• Tetracycline resistance transferred by plasmid pAMα1
– Promotes active efflux of tetracycline from cells
– Protects ribosomes from inhibition by tetracycline
• Aminoglycosides
– Cell membrane bound inactivating enzymes
– Decreased affinity of ribosomal proteins to aminoglycoside (mutation)
– Decreased uptake of drug
12. Vancomycin resistance
• Resistance to glycopeptides is due to alteration of peptidoglycan precursor
D-Ala –D- Ala to D-Ala – D-Lactate / D-Ala-D-Ser
• Genes involved are VanS/VanR
• VanS gene activates D-Lac/D-Ser peptidoglycan precursor
• D-Lac has 1000 times less affinity to vancomycin
• D-Ser exhibits 7fold less affinity to vancomycin
• Six gene clusters have been identified
– VanA, VanB, VanC, VanD, VanE & VanG
• VanA is acquired by Transposon Tn1546
• vanB is acquired by Transposon Tn1547/Tn5382
• Genetic material transferred via conjugation involving a pheromone
induced system.
13. Prevalence and antimicrobial resistance
pattern of multidrug –resistant
enterococci isolated from clinical
specimens
MM Salem-Bekhit et al
Indian Journal Of Medical Microbiology
(2012) 30(1): 44-51
14. Introduction
• Evolved from intestinal commensal to 2nd most
common nosocomial pathogen.
• Common species
– Entrococcus fecalis
– Enterococcus fecium
– E gallinarum
– E casseliflavus
– E durans
– E avium
– E hirae
15. • Rapid increase in colonization and infection with
Vancomycin Resistant Enterococci(VRE)
• Resistance intrinsic/ plasmid mediated.
• Resistance likely due to widespread use of
Vancomycin and Cephalosporins
• Vancomycin resistance
– Van A High level resistance
– Van B
– Van B2
– Van D
– Van C Intrinsic low level resistance
• VRE most common in E.fecium
• Transfer resistance via plasmids to MRSA
16. Materials & Methods
Distribution of samples
• Period of study January 2009 – March 2010
• Place of study
• King Khaled University Hospital (140samples)
Urine 32
• King Saud Medical City Hospital (100 Samples)
Blood 30
• Ethical Burns
committee approval 17
• Approval from both hospital ethical committee & from Saudi ministry
Throat swabs
of Health 12
• Isolation
Bed sore 11
– Urine, sterile body fluids & wounds
Devices 14
• Trypticase soy agar with 5% sheep blood
– Stool samples
Stool samples 47
• Inoculated into enterococcal37
Pus broth , incubated overnight at 35°C
• Subcultured to BHIA with 6µg vancomycin/ml & BHIA without
Body fluids
Vancomycin 16
Wound discharge 24
17. • Presumptive identification
– Growth characteristics on blood agar
– Gram staining morphology,
– Catalase reaction,
– Ability to grow in 6.5%Nacl,
– Bile esculin hydrolysis &
– Biochemicals using API Strep system.
• Enterococcal samples stored in 16%glycerol at
-70°C
19. MIC
• E-test Vancomycin , Teicoplanin
• Agar dilution method Gentamycin,
Kanamycin, Streptomycin, Amikacin &
Linezolid.
• Vancomycin resistance any enterococcal
isolate with MIC to vancomycin if atleast
16µg/ml
20. ß-Lactamase production &inhibition
tests
• Nitrocefin 5µl
• Amoxicillin-clavulanic acid, Ampicillin-
sulbactum on disc-agar diffusion method.
21. Further analysis
• DNA isolation
• Detection of vancomycin determinants
– Denaturation at 94°C for 3 min
– Anneling at 60°C for 45seconds
– Extension at 72°C for 1min
– Final extension at 72°C for 2min
– Amplicons analysed by electrophoresis on 1% agarose
gel containing ethidium bromide
• Restriction fragment length analysis by pulse field
gel electrophoresis
26. VRE
• Van A
– 8 isolates
– 5 E.faecium and 3 E.fecalis
– Resistant to vancomycin & Teicoplanin
• Van B
– 1 isolate
– Intermediate resistance to Vancomycin and sensitive to
Teicoplanin
• Van C
– 4 isolates
– 3 E.gallinarum and 1 E.casseliflavus
– Intermediate resistance to Vancomycin and sensitive to
Teicoplanin
27. PGFE of VRE
• 8 isolates tested
• 5 isolates had identical profile
• Isolates obtained from patients admitted in
different wards in same hospital
28. Discussion
• E.fecalis was the predominant pathogen
• Many isolates were resistant to Tetracycline, Ciprofloxacin &
Chloramphenicol
• Resistance to Erythromycin was lower compared to other countries
• Nosocomial VRE reported is 3.9% (0.3% in 1989 – 11% in 1996)
• Isolates of VRE in this study were from immunocompromised
patients or with h/o Nosocomial infection
• Vancomycin resistant phenotype Van A was predominant and
resulted in high level resistance
• Van B phenotype showed moderate vancomycin resistance
• Being the mainstay of treatment, ampicillin resistance causes
concern
29. • E.gallinarum , a rare enterococcal species in human
infection was isolated
• The clone of E.fecalis obtained from two hospital were
identical. This may be due to intra hospital
dissemination.
• Aminoglycoside resistance along with vancomycin
resistance indicates a need for regular surveillance
studies, infection control measures and antibiotic
policy
• As vancomycin resistance can spread via plasmids to
other species like S.aureus there is an increased chance
of seeing more vancomycin resistant cases in future.
30. REFERENCES
• Koneman Textbook Of Diagnostic Microbiology
• Kater fisher et al . The ecology, epidemiology and
virulence of enterococcus Microbiology(2009),
155,1749-1757
• PM Giridhara upadhyaya et al. Review of
virulence factors of enterococcus: an emerging
nosocomial pathogen IJMM (2009) 27(4): 301-5
• Barbara E.Murray. The life and times of
enterococcus Clinical microbiology reviews jan
1990. p 46-65