Date: 11/10/2013
Place: Bellary.
From:
DR.SHILPA H S
Post Graduate Student in Microbiology (M.D)
Dept. of Microbiology,
VIMS, Bellary.
To:
The Principal,
Vijayanagar Institute of Medical sciences,
Bellary.
THROUGH PROPER CHANNEL
Respected Sir,
SUBJECT: SUBMISSION OF SYNOPSIS FOR REGISTRATION
OF SUBJECT FOR DISSERTATION
In accordance with fulfillment of the MD Microbiology course, I, the undersigned studying PG course in M.D. Microbiology have been allotted the dissertation topic “BACTERILOGICAL PROFILE OF URINARY TRACTINFECTIONS FOLLOWING INSTRUMENTATION WITH SPECIAL REFERENCE TO ESBL DETECTIONUNDER THE GUIDANCE OF DR. SUREKHA Y A Professor, Department of Microbiology, Vijayanagar Institute of Medical Sciences, Bellary.
I request you to kindly forward the synopsis in the prescribed form to the University for approval.
Thanking you,
Yours faithfully,
Dr. SHILPA H S
Signature of the guide
Dr. SUREKHA Y A
Professor,
Dept. of Microbiology,
VIMS, Bellary.
Date: 11/10/2013
Place: Bellary.
From:
The Professor and Head,
Dept. of Microbiology,
Vijayanagar Institute of Medical Sciences,
Bellary-583104.
To:
The Registrar,
Rajiv Gandhi University of Health sciences,
Bangalore-560041.
THROUGH PROPER CHANNEL
Respected Sir,
SUBJECT: SUBMISSION OF SYNOPSIS FOR REGISTRATION
OF SUBJECT FOR DISSERTATION
As per the regulations of the University for Dissertation topic, the following post graduate student in M.D Microbiology has been allotted the dissertation topic as follows:-
NAME / TOPIC / GUIDEDr. SHILPA H S
Post Graduate Student in M.D. Microbiology,
Dept of Microbiology,
VIMS, Bellary. / BACTERIOLOGICAL PROFILE OF URINARY TRACT INFECTIONS IN PATIENTS FOLLOWING INSTRUMENTATION WITH SPECIAL REFERENCE TO ESBL DETECTION. / Dr.SUREKHA .Y.A
Professor
Dept. of Microbiology
V.I.M.S, Bellary.
Therefore, I kindly request you to communicate after the acceptance of the dissertation topic allotted to the PG student at an early date.
Thanking you,
Yours faithfully,
DR. S. KRISHNA
Professor and Head,
Dept. of Microbiology,
VIMS, Bellary.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA BANGALORE
ANNEXURE-II
SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. /Name of the candidate AND ADDRESS
/ dr. sHILPA H SPOST GRADUATE STUDENT IN
M.D. MICROBIOLOGY,
DEPARTMENT OF
MICROBIOLOGY,
VIMS, BELLARY.
2. / NAME OF THE INSTITUTION / Vijayanagar Institute of Medical Sciences, Bellary.
3. / Course of Study and Subject / MEDICAL
M.D. MICROBIOLOGY
4. / DATE OF ADMISSION TO THE COURSE / 31ST AUGUST,2013
5. / TITLE OF THE TOPIC
“BACTERIOLOGICAL PROFILE OF URINARY TRACT INFECTIONS IN PATIENTS FOLLOWING INSTRUMENTATION WITH SPECIAL REFERENCE TO ESBL DETECTION.
6. / BRIEF RESUME OF THE INTENDED WORK:
Urinary tract infections(UTI) are among the most common bacterial infection both in community and hospital setting. UTI has become the most common hospital acquired infection accounting for as many as 35% of nosocomial infection.1
UTI accounts for approximately one million hospitalisations annualy worldwide.It presents a spectrum of clinical entities upon severity ranging from asymptomatic infection to acute pyelonephritis with sepsis.1
What adds to the problem is emergence of drug resistance frequently complicated by structural or functional alterations in urinary tract,impaired renal function or disease which impair the immunity in contrast to community acquired UTI’s2.
The study of drug resistance in UTI causing pathogens is gaining more importance because the resistance mechanism of ESBL- producers differs from one species to another.Moreover the vast number of species included in Enterbactericeae further adds to diagnostic and clinical complications associated with UTI’s.ESBL producing genes are normally harboured on plasmids 80 kb in size or larger most often carry resistance determinants for aminoglycosides, flouroquinolones, tetracyclines, chloramphenicol and even cotrimoxazole making the microorganisms resist a wide variety of drugs2.
6.2 / REVIEW OF LITERATURE :
Extended spectrum beta lactmases isolates were first detected in western Europe in the mid 1980’s .Since then, their incidence has been increasing steadily.A large number of outbreaks of infections due to ESBL producing organisms have been described on every continent of the globe In some hospitals,initial out breaks of infections have been supplanted by endemicity of the ESBL producing organisms .This may lead to increased patient mortality when antibiotics inactive against ESBL producers3.
In a study conducted by Abdul Rahaman Sharife V A et al showed out of 8833 samples 2674 were culture positive (30%)E.coli48.3%(1292) being most common followed by Klebsiella,citrobacter,proteus,psuedomonas, enterococcous, staphylococcus, candida. The isolates showed high degree resistance to penicillin, cephalosporins, fluoroquinalones with 59% of isolates being ESBL producers.TheESBL were also studied for the co-resistance to ciprofloxacin disk resistant strains were also ESBL producers 4.
In a study conducted by Aruna et al most common isolate was E.coli
followed by Klebsiella pneumoniae, proteus, pseudomonas and study showed 72.05% of ESBL producers among isolates.Antibiotic sensitivity test was carried out using Kirby Bauer metod around 88.2% (172/195) isolates were found to be resistant to more than 3 antibiotics .Among these cultures,43.07%(84/195) isolates were resistant to over 70% antibiotics used in the study including 3rd generation cephalosporins. Connfirmatory test for detection of ESBL producers using EZy-MICTM strips showed 34.87% of the isolates to ESBL producers2.
In a study conducted by Samuel Kariuki et al 12 were resistant to multiple drugs including ampicillin, co-amoxiclav, cefotaxime, ceftriaxone, ceftazidime & gentamicin & nalidixic acid and produced plasmid-mediated CTX-M-15 type ESBL’s and CMY-2AmpC type enzymes. The other 5 E coli were non ESBL producing were multiple resistant to ampicillin, nitrofurantoin, cefoxitin, nalidixic acid5.
In a study conducted by DMBT Dissanayake et al of 2303 samples 626 were culture positive. E.coli & klebsiella species accounted for 46% (n=286) of the total isolates with the majority (n=228,80%) being E coli. 33% (n=94%) of these isolates produced ESBL’s. Half (50%) of the klebsiella isolates were ESBL producers while 29% of E coli produced ESBL’s. The ESBL rate in general, medical & surgical wards & OPD were 33% & 14% respectively6.
6.3 / OBJECTIVES OF THE STUDY :
1.To identify the causative organisms from patients with UTI after instrumentation.
2.To know the antimicrobial susceptibility pattern of isolated bacteria.
3.To detect the ESBL production among the bacterial isolates.
7. / MATERIALS AND METHODS :
7.1 / SOURCE OF DATA: The study will include all the urine samples after instrumentation of the hospitalised patients ,admitted in VIMS,Bellary.
STUDY PERIOD:1stJanuary 2014-31st December 2014
STUDY DESIGN:Prospective study.
INCLUSION CRITERIA:
1. All the urine samples collected post –instrumentation, from the hospitalized patients presenting with UTI symptoms.
EXCLUSION CRITERIA:
- Patients having UTI symptoms before instrumentation
- Samples yielding polymicrobial flora.
7.2 / METHODS OF COLLECTION OF DATA :
Urine samples will be collected from the patients having UTI symptoms after instrumentation under aseptic precautions .Sample processing will be acccording to standard microbiological culture methods(using MacConkey ,chacolate and CLED-cystine lactose electrolyte deficient agar) to study their cultural characteristics7.
A single isolated colony will be considered for further studies,followed by identification using standard conventional ,morphological and biochemical test 8.
Antimicrobial susceptibility will be tested by :-
Kirby-Bauer disc diffusion method9.
ESBL SCREENING will be done by:-
1.Double disc synergy test.
2.Phenotypic confirmation method by disc diffusion method10.
Statistical analysis:
Statistical analysis done using appropriate formulae and P value is calculated.
7.3 / DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?
IF SO, PLEASE DESCRIBE BRIEFLY.
YES. Routine investigations will be done in each patient participating in our study. Written or informed consent will be obtained from each patient before subjecting them for investigations. All the investigations will be done under the direct guidance and supervision of guide.
7.4 / HAS THE ETHICAL CLEARANCE OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
Ethical clearance has been obtained from institutional ethics committee,
VIMS, Bellary.
8. / LIST OF REFERENCES :
1.Sasirekha .B.Prevalence of ESBL,AMPC B-Lactamases and MRSA among Uropathogens and its Antibiogram.EXCL journal 2013;12:81-88.
2.Aruna .K,Mobashshera .T. Prevalence of Extentended spectrum Beta –Lactamases production among uropathogens in south Mumbai and its Antibiogram pattern .EXCLI Journal 2012;11:363-372.
3.Ritu Aggarwal ,Uma chaudary and Rama Sikka .Detection of Extended Spectrum Beta –Lactamases production among Uropathogens .JlabPhysicians .2009 Jan-June;1(1):7-10.
4.Abdul Rahaman Shariff V A,Suchithra Shenoy M, Taruna Yadav et al.The antibiotic susceptibility patterns of Uropathogenic Esherichia coli with special reference to the Fluoroquinolones.Journal of clinical and diagnostic research .2013 June volume-7(6):1027-1030.
5.Samuel Kariuki,Gunturu Revathi ,John corkill et al .Eschreichia coli from community acquired urinary tract infections resistant to the fluoroquinolones and Extened spectrum Beta–Lactmases.J Infect developing countries 2007:1(3):257-262.
6.DMBT Dissanayake ,SSN Fernando ,NS Chandrasiri.The distribution and charecteristics of Extended spectrum Beta –Lactamases (ESBL) producing Escherichiacoli and Klebshiella species among urinary isolates in tertiary care hospital .Srilanka Journal of infectious disease 2012 vol 2(2): 30-36.
7.G .Willee, A .G Fraser, B.P Marion et al Editors Mackie & Mc Cartey Practical Medical Microbiolgy1996 14th ed P 132
8.Ananthnarayan & Paniker’s Text book of microbiology2009 8th ed P 49 – 50.
9.Bailey & Scott’s Diagnostic Microboilogy 12th ed P 194
10.Washington Winn J R , Stephen Allen , William Jonda et al Koneman’s color Atlas &Textbook of Diagnostic Microbiology. .6th edition .2006 p1170.
9. / SIGNATURE OF THE CANDIDATE
10 / REMARKS OF THE GUIDE :
11 / NAME AND DESIGNATION OF (IN BLOCK LETTERS) :
11.1 / GUIDE: / DR SUREKHA Y.A
PROFESSOR,
DEPT. OF MICROBIOLOGY,
VIMS, BELLARY.
11.2 / SIGNATURE :
11.3 / CO-GUIDE (IF ANY) :
11.4 / SIGNATURE :
11.5 / HEAD OF THE
DEPARTMENT : / DR. S. KRISHNA
PROFESSOR AND HEAD,
DEPT. OF MICROBIOLOGY,
VIMS, BELLARY
11.6 / SIGNATURE :
12 / 12.1 / REMARKS OF THE
CHAIRMAN AND
PRINCIPAL :
12.2 / SIGNATURE :