Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 642 - 644

The Antibiotic Resistance Pattern in Citrobacter Species: An Emerging Nosocomial Pathogen in a Tertiary Care Hospital

Ashish Khanna, Nachatar Singh, Aruna Aggarwa l, Menka Khanna

1. Assistant Professor, Microbiology, SGRDIMSR. 2. Phd Student, Deptt of Microbiology, SGRDIMSR. 3. Professor and Head Microbiology Deptt., SGRDIMSR. 4. Associate Professor, Pathology, SGRDIMSR.

Correspondence Address :
Dr. Ashish Khanna
538, Basant Avenue
Amritsar, India - 143001.
Phone: 9465128936 , 0183-2562919
E-mail: ashish_538@yahoo.co.in

Abstract

Members of the genus, Citrobacter, a gram negative, nonsporing rod which belongs to the family, Enterobacteriaceae are emerging as important nosocomial pathogens. The study was carried out to determine the frequency and the anti-microbial sensitivity pattern of the Citrobacter species among the various gram negative isolates which were obtained from different clinical samples. Out of the total 1830 gram negative bacilli which were isolated over a period of one and half year, from February 2010 to August 2011, from various clinical samples which were submitted to the microbiology laboratory of the Sri Guru Ram Das Hospital, eighty six (4.70%) isolates belonged to the Citrobacter species, of which 58 were Citrobacter freundii and 28 were Citrobacter koseri. Sixty three (73.26%) out of 86 Citrobacter isolates were multi-drug resistant. There was a highly significant difference in the resistance of the Citrobacter isolates to all the antimicrobials including beta lactams, quinolones and aminoglycosides, among the hospital and outdoor isolates. ESBL production was seen in 61.64% of the hospital and in 30.70% of the outdoor isolates.

Keywords

Citrobacter freundii, Citrobacter koseri, Antimicrobial resistance, ESBL, MBL

How to cite this article :

Ashish Khanna, Nachatar Singh, Aruna Aggarwa l, Menka Khanna. THE ANTIBIOTIC RESISTANCE PATTERN IN CITROBACTER SPECIES: AN EMERGING NOSOCOMIAL PATHOGEN IN A TERTIARY CARE HOSPITAL. Journal of Clinical and Diagnostic Research [serial online] 2012 May [cited: 2018 Dec 16 ]; 6:642-644. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=May&volume=6&issue=4&page=642-644&id=2153

Introduction
Antibiotic resistance is emerging in the isolates of Enterobacteriaceae and in other gram negative bacilli in many parts of the world and this is a major threat to the successful treatment of infections in hospitals (1). Nosocomial infections are major public health concerns because of the substantial morbidity and the mortality which are associated with them. Although Citrobacter spp. are infrequent nosocomial pathogens, a local or systemic breach in the host defenses can allow them to cause a range of infections. These include urinary tract infections, neonatal sepsis, pulmonary infections, brain abscess, meningitis and blood stream infections. The Citrobacter species are emerging as important nosocomial pathogens. The Citrobacter infections are associated with a high mortality rate. They are often resistant to the routinely used antibiotics, especially the extended spectrum cephalosporins, due to the overexpression of chromosomal beta lactamases (2). Keeping these facts in mind, this study was conducted to know the prevalence of the Citrobacter spp. amongst gram negative bacilli, its antibiotic resistance pattern and ESBL/MBL production in this part of the country.

Material and Methods

A total of 1830 consecutive gram negative bacilli which were recovered from clinical specimens during the study period from 1-2-2010 to 30-8-2011 were included in this study. These were isolated from various clinical samples like urine, blood, pus (pus aspirate, chest tubes, I/V cannula and catheter tips). The isolates of the Citrobacter spp. were further identified by their colony characteristics; Gram’s staining, and biochemical reactions by standard methods (3). The anti-microbial sensitivity testing of the isolates of Citrobacter spp. was performed on Mueller Hinton agar by the Kirby Bauer method by using the disc diffusion technique and the results were interpreted as per the Clinical Laboratory Standard Institute (CLSI) guidelines (4). The isolates which were resistant or intermediately susceptible to any of the third generation cephalosporins were further processed for ESBL detection by the double disc potentiation method (4) by using a disc of cefotaxime (30μg)/ ceftazidime (30μg), and combination discs of cefotaxime 30μg and clavulanic acid 10μg and of ceftazidime 30μg plus clavulanic acid 10μg. Klebsiella pneumoniae ATCC 700603 was used as the ESBL positive control. ESBL production was inferred if the inhibition zone increased by 5 mm towards the cefotaxime plus clavulanic acid disc or towards the ceftazidime plus clavulanic acid disc in comparison to the third generation cephalosporin disc alone. MBL detection was done by using imipenem and imipenem- EDTA discs (5) (Table/Fig 2).

Results

Out of the 1830 gram negative isolates, 86 belonged to the Citrobacter species (Citrobacter freundii-58, Citrobacter koseri-28). Among the 86 Citrobacter isolates, 73 (84.88%) were obtained from nosocomial samples, whereas 13 (15.12%) were obtained from outdoor specimens. A majority of these isolates were recovered from pus samples (44.19 %), followed by urine (36.05%) and blood (8.14%). [Table/Fig-3] Further statistical analysis showed a highly significant difference (p < 0.001) in the resistance of the Citrobacter species to all the antimicrobials including beta lactams, aminoglycosides and flouroquinolones among the hospital and the outdoor isolates [Table/Fig-4]. ESBL production was seen in 45 (61.64%) of the hospital and in 4(30.70%) of the outdoor isolates. The ESBL producing Citrobacter freundi and Citrobacter koseri among the hospital isolates and the outdoor isolates is shown in the graph. (Table/Fig 1).MBL production was seen in only 2(4.08) isolates.

Discussion

The present study indicates that the Citrobacter spp. are mostly associated with nosocomially acquired infections. Of the total gram negative bacilli, 4.70% were of Citrobacter spp. and this rate of isolation was much higher than that which was reported by Ali et al (6) i.e. 1.35% of the Citrobacter freundii out of a total of 812 gram negative bacilli. This might be because of a lack of preventive measures during the handling of the patients in our institution, thus leading to the spread of this organism among the patients, especially the old, debilitated patients who were on IV catheters, CVP lines, urinary catheters, etc. A majority of the isolates were recovered from pus samples (44.19%), which was higher than that which was reported by Patil et al (7) (21.1%) and Shah et al (8) (22.85%). In our study, about 36.05% isolates were recovered from urinary samples, whereas other authors had reported the isolation of about 65.71% Citrobacter species from urinary samples (8). The antibiotic resistance pattern showed a significantly higher level of resistance among the hospital isolates as compared to that among the outdoor isolates. Similar results have been reported in other studies also (7),(9). The high level of antibiotic resistance among the hospital isolates in the present study may be due to the fact, that ours was a tertiary care hospital with a widespread use of broad spectrum antibiotics, which might have led to the selective survival advantage of these pathogens. In our study, Citobacter freundi was the commonest species which was isolated, followed by Citrobacter koseri, as was the case in other studies also (10). ESBL production was found in 45 (61.64%) of the hospital and in 4 (30.70%) of the outdoor isolates by the double disc potentiation method by using a disc of cefotaxime (30μg)/ ceftazidime(30μg) and combination discs of cefotaxime 30μg and clavulanic acid 10μg and of ceftazidime 30μg plus clavulanic acid 10μg (4). The rate of the ESBL production among the Citrobacter species in our study was higher than that which was reported by other authors (6),(11), which was 36.36% and 19.3% respectively. However, it was comparable with the finding of Rizvi et al (12) (62%) and lower than that which was reported by Uma A et al (13) who had reported it to be 86.50% amongst the hospital isolates. Excessive antibiotic exposure (especially the extended spectrum cepholosporins), extended hospital stay, recent surgery, admission to the ICU and instrumentation have been identified as the risk factors for the selection of the ESBL producing strains. The rate of the ESBL production was also much higher in the outdoor patients, which could have been due to the fact, that in our setup, extended spectrum cephalosprins were being prescribed injudiciously to the outpatients.

Conclusion

Citrobacter species are emerging as important nosocomial pathogens. Citrobacter. freundii was the commonest species which was isolated at our hospital. Multi-drug resistance and ESBL production are quite high amongst the Citrobacter species. The multidrug resistant Citrobacter species that were isolated in our study were mostly sensitive to a combination of piperacillin/tazobactum and sulbactum/ cefoperazone. So, greater caution is required in the selection of the antibiotics which have to be used, to avoid treatment failure. Carbapenems like imipenem and meropenem should be kept as reserve drugs, in case the organism becomes resistant to these combinations. This bacterium can become resistant to these drugs at any time and so, the indiscriminate, inadequate and the prophylactic use of these antibiotics should be avoided. Infection control measures like disinfection of the wards and equipments, barrier precautions against colonized patients and proper hand hygiene measures should be strictly adhered to, to prevent the spread of this pathogen. The antibiogram is a cost effective, easy and rapid typing tool in a low resource country like ours, where molecular typing tools are not easily accessible. Only in case of emergency, empirical therapy which is based on the antibiotic sensitivity pattern of that institute should be given to the patients.

References

1.
Nada T, Baba H, Kawamura K, OhkuraT, Toni K, Ohta M. A small outbreak of third generation, cephem-resistant Citrobacter freundi infections in a surgical ward. Japan Infect Dis 2004;57: 181-2.
2.
Pepperell C, Kus JV, Gardan MA, Humar A, Burrows LL. Low virulence Citrobacter species encode resistance to multiple anti-microbials. Anti-microbial Agents and Chemotherapy. 2002; 46(11): 3555-60.
3.
Collee JG, Miles RS, Watt B. Tests for the identification of bacteria. In : Coller JG, Fraser AG, Marimion BP, Simmons A. Mackie and McCArtney Practical Medical Microbiology. Ed 14 Vol. II, Churchill Livingstone, London 1996; 131-49.
4.
Clinical Laboratory Standards Institute (2010) Performance standards for antimicrobial susceptibility testing. Twentieth informational supplement ed. In: CLSI document M100-S20. CLSI: Wayne, PA.
5.
Lee K, Chong Y, Shin HB, Kim YA, Yong D, Yum JH. The modified Hodge and the EDTA disc synergy tests for the screening of the metallo- β-lactamase producing strains of Pseudomonas and Acinetobacter species. Clin Microbiol Infect 2001; 7:88-91.
6.
Ali AM, Rafi S, Qureshi AM. Frequency of ESBL producing gram negative bacilli among the clinical isolates at the clinical laboratories of the Army Medical College, Rawalpindi. Journal of Ayub Medical College, 2004; 16(1): 1-3.
7.
Patil MA, Lakshmi V. Antibiotic resistance among the Citrobacter species from different clinical specimens. Indian Journal of Medical Microbiology 2000; 18(1): 25-9.
8.
Shah A, Hasan AF, Hameed A. A study on the prevalence of enterobacteriaceae in hospital acquired and community acquired inflections. Pakistan J Med Res. 2002; 41(1): 1-7.
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Mohanty S, Kapil A, Dhawan B, Das BK. The bacteriological and the anti-microbial susceptibility profile of soft tissue infections from northern India. Indian Journal of Medical Sciences 2004; 58(1): 10-15.
10.
Samonis G, Karageorgopoulous DE, Kofteridis DP, Matthaion DK, Sidiropoulou V, Maraki S, et al. Citrobacter infection in a general hospital: characteristics and outcomes. Eur J Infect Dis 2009; 28:61-8.
11.
Kanamori H, Yano H, Hirakata Y, Endo S, Arai K, Ogawa M, et al. High prevalence of the extended spectrum β lactamases and the QNR determinants in the Citrobacter species from Japan: the dissemination of CTX- M-2. J Antimicrob Chemother 2011 ; 66(10): 2255-62.
12.
Rizvi M, Fatima N, Shukla I, Malik A. Epidemiology of the extended spectrum β lactamases in the Serratia and Citrobacter species in north India. Indian J Pathol Microbiol 2010; 53: 193-4.
13.
Uma A, Mehta A, Ayagari A, Kapil A, Shahani A, Rodrigues C, Chitins DS, et al. Prevalence of beta lactamase producing strains among the clinical isolates which were obtained from hospital in-patients across India and comparison of the anti-bacterial susceptibility testing by using the disc diffusion method. Hospital Today 2004; 9 (1): 1-12.

DOI and Others

ID: JCDR/2012/4032:0024

Date of Submission: Jan 22, 2012
Date of peer review: Mar 03, 2012
Date of acceptance: Mar 29, 2012
Date of Publishing: May 31, 2012

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  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com