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 : September | Volume : 6 | Issue : 7 | Page : 1184 - 1187

The in Vitro Activity of Tigecycline Against the Multidrug Resistant Acinetobacter Spp. at a Tertiary Care Hospital

Dipender Kaur Najotra, Poonam Slathia, Niraj Kumar, Sanjeev Kumar Digra

1. Senior Resident, Department of Microbiology, 2. Assistant Professor, Department of Microbiology, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, J&K, India. 3. Senior Resident, Department of Paediatrics, 4. Assistant Professor, Department of Paediatrics, Govt. Medical College, Jammu, J&K, India.

Correspondence Address :
Dr. Dipender Kaur Najotra,
Senior Resident, Department of Microbiology,
207-D uttam nagar Kunjwani Bye- pass, jammu,
Jammu and Kashmir, Pin code- 180010, India.
Phone: 09419135664
E-mail: chahalovely@yahoo.co.in

Abstract

Background: The Acinetobacter spp., particularly A.baumanii, has emerged as one of the most troublesome pathogens in health care institutions globally, because they are often Multi Drug Resistant (MDR), which means that the therapy and the infection control are complicated. With the emergence of the carbapenemase-producing isolates which show resistance to all the available agents except the polymyxins, this genus deserves close attention. In this scenario, tigecycline, a glycylcycline which has a spectrum of activity which is unparalleled by any other broad spectrum agent, and is not affected by most of the known mechanisms of resistance to tetracycline which have been encountered in bacteria, is a useful alternative for the treatment of the infections which are caused by the Acinetobacter spp.

Aim: This study was conducted to investigate the in vitro activity of tigecycline against a collection of MDR isolates of Acinetobacter spp. from our hospital.

Material and Methods: A prospective, hospital based study was conducted from October 2010 to April 2012 in which all the Acinetobacter spp. isolates which were obtained from clinical samples, were subjected to the testing of their antimicrobial susceptibilities to different groups of drugs, which included tigecycline. Based on the susceptibility profile, the isolates which were labeled as MDR were further subjected to the Epsilometer test (E-test) to determine the minimum inhibitory concentrations (MIC) of tigecycline.

Results: A total of 85 Acinetobacter spp. isolates were obtained, out of which 38 (44.7%) were labeled as MDR. 91.8% of the total and 81.5% of the MDR isolates were sensitive to tigecycline and the MICs of tigecycline for these MDR isolates ranged from 0.25 to 32 μg/ml.

Conclusion: This study proved that tigecycline exhibited a good in vitro activity against the clinical isolates of the MDR Acinetobacter spp., and that it may be considered as a promising therapeutic option for the treatment of the nosocomial infections which were caused by these pathogens. But the tigecycline resistance among the isolates that had not previously been exposed to the drug is worrisome. So before starting the treatment, the in vitro susceptibility of the isolates to tigecycline and its MIC should be assessed.

Keywords

Acinetobacter spp., Tigecycline, MDR, MIC, E-test

How to cite this article :

Dipender Kaur Najotra, Poonam Slathia, Niraj Kumar, Sanjeev Kumar Digra. THE IN VITRO ACTIVITY OF TIGECYCLINE AGAINST THE MULTIDRUG RESISTANT ACINETOBACTER SPP. AT A TERTIARY CARE HOSPITAL. Journal of Clinical and Diagnostic Research [serial online] 2012 September [cited: 2019 Aug 23 ]; 6:1184-1187. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=September&volume=6&issue=7&page=1184-1187&id=2468

Introduction
The Acinetobacter spp., particularly A.baumanii, has emerged as one of the most troublesome pathogens for the health care institutions globally. Hospital acquired pneumonia is still the most common infection which is caused by this organism. However, in the more recent times, the infections which involve the central nervous system, skin and soft tissue, and the bone have emerged as highly problematic for certain institutions (1),(2). The mortality which is due to the nosocomial infections which are caused by A. baumannii is high, reaching from 25 to 34% for bacteraemia and from 40 to 80% for nosocomial pneumonia (3),(4). This genus deserves close attention as it displays mechanisms of resistance to all the existing antibiotic classes, as well as a prodigious capacity to acquire new determinants of resistance (5). Many carbapenemase-producing A. baumannii isolates are resistant to all the available therapeutic agents except the polymyxins and to the drugs with significant toxicity and poor penetration to respiratory secretions (6).

Acting in synergy with this emerging resistance profile is the unO riginal Article M icrobiology Sectioncanny ability of Acinetobacter spp. to survive for prolonged periods throughout the hospital environment, thus potentiating its ability for nosocomial spreads (2). In this scenario, tigecycline, a 9-t-butylglyclamide derivative of minocycline, which has a spectrum of activity which is unparalleled by any other broad spectrum agent, and is not affected by most of the known mechanisms of resistance to tetracycline (ribosomal protection and active drug efflux) which have been encountered in bacteria, is a useful alternative to the polymyxins (6). Tigecycline acts by the inhibition of the protein translation in bacteria, by binding to the 30S ribosomal subunit, and by blocking the entry of the amino-acyl tRNA molecules into the A site of the ribosome (7). But in view of the increasing number of reports of the variable susceptibility of tigecycline against the Multiple Drug Resistant (MDR) Acinetobacter spp. isolates around the world and the few therapeutic options which are available for the treatment of the infections which are caused by this organism, this study was conducted to investigate the in vitro activity of tigecycline against a collection of MDR isolates of Acinetobacter spp. at our hospital.

Material and Methods

A prospective study was conducted at the Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, India, from October 2010 to April 2012. All the MDR Acinetobacter spp. isolates which were obtained from the clinical samples which were received in the microbiology laboratory of our hospital were included in this study. None of the patients had undergone any previous treatment with tigecycline and only one isolate per patient was included in the study. The isolates were identified by the standard laboratory methods (8). The testing of the antimicrobial susceptibility of the isolated strains to the different groups of drugs was carried out on Mueller-Hinton agar by the Kirby Bauer disc diffusion method, and the results were interpreted as was recommended by the CLSI (Clinical Laboratory Standards Institute) guidelines (9). The interpretation of the zone diameters of tigecycline was done by using the US FDA susceptible breakpoints (10). Pseudomonas aeruginosa ATCC 27853 was used as a quality control. The following antimicrobial agents (μg) were used - cefotaxime (30), cefepime(30), ceftazidime (30) gentamicin (10), amikacin (30), ciprofloxacin (5), levofloxacin (10), co-trimoxazole (1.2/23.8), imipenem (10), piperacillin and tazobactam (75+10), cefoperazone and sulbactam (75+30), tigecycline (15), colistin (10) and nitrofurantoin (30), which was tested only for the urinary isolates.

The MDR phenotype was defined as the resistance to more than two of the following five drug classes: antipseudomonal cephalosporins, antipseudomonal carbapenems, β-lactam/β-lactamase inhibitor combinations, fluoroquinolones and aminoglycosides. The isolates which were resistant to all the drug classes which included the glycylcyclines and the polymixins were further labelled as pan drug resistant (PDR) (2).

Minimum inhibitory concentration testing (MIC): The MIC of tigecycline was determined for all the MDR Acinetobacter spp. isolates by using the E-test strips according to the manufacturer’s instructions. The MIC breakpoints which were used were ≤2, 4 and ≥8 mg/L for the susceptible, intermediate and the resistant strains, respectively (11).

Results

A total of 85 Acinetobacter spp. isolates were obtained during the study period, out of which 38 (44.7%) were labeled as MDR, based on the antibiotic susceptibility pattern of these isolates to various antibiotics, while 15(17.6%) showed resistance to imipenem (Table/Fig 1). The origins of the Acinetobacter spp. isolates were (n/%): the respiratory tract (30/35.3), blood (25/29.4), skin and soft tissue (13/15.3), urine (9/10.6) and catheters (8/9.4). The ages of the patients ranged from 1-75 yrs, with the highest percentage of patients in the age group of 40-60 years (Table/Fig 2).The male to female ratio was 1.6:1 (52 males and 33 females). The most significant finding was the reporting of two (2.4% of the total) PDR Acinetobacter spp. isolates which were resistant to both tigecycline and colistin. These PDR isolates were also resistant to imipenem. On being considered alone, 91.8% of the total isolates and 81.5% of the MDR isolates were found to be sensitive to tigecycline.

The MICs of tigecycline for the MDR Acinetobacter spp. isolates ranged from 0.25 to 32 μg/ml (Table/Fig 3). All the isolates which had an MIC of ≤ 2 μg/ml also had a zone diameter of ≥ 19mm (the cut-off for the susceptibility). Similarly, the three isolates which hadan MIC of 4 μg/ml were found to be intermediate (15-18mm) and the isolates with an MIC of ≥8 μg/ml were found to be resistant (≤ 14mm) by the disc diffusion method.

Discussion

In the present study, the predominant source of the Acinetobacter spp. isolates was the respiratory tract, which is consistent with the findings of various other studies which were done in different parts of the world (12),(13),(14). The prevalence rate of the multi drug resistance in the Acinetobacter spp. isolates was 44.7%, which is comparable to that which was reported by Taneja et al., (15), but it was quiet high as compared to that in a study which was done by Kuo et al., (16) , who reported MDR rates of 21.4 and 8.9 per cent in catheterized patients and in respiratory samples respectively. Further, various authors have reported the resistance rate to tigecycline to vary from being nonexistent to 66 % (13),(14),(15), (17),(18),(19). But in the present study, tigecycline was shown to have a good sensitivity (81.5%) against the MDR Acinetobacter spp., which was almost comparable to that which was reported by Insa et al., (12).

In our study, the E test correlated 100 percent with the inhibition zone diameters, which was in contrast to the findings of a study which was done by Behera et al., (19) but it was similar to the findings of a study which was done by Venezia et al., (18). Inspite of the high sensitivity rate, the finding of the increased tigecycline MIC values (8-32μg/ml) for four Acinetobacter spp. isolates in our study was a cause of concern, since this organism was not only totally unexposed to tigecycline but also to the tetracycline group of antibiotics in our hospital. It has been described that mutations of tet(A) selected in vitro could enable the efflux of glycylcyclines and that the up-regulation of the chromosomally-mediated efflux pumps could lead to the resistance of the Acinetobacter spp. to tigecycline (6),(20).

In the present study, we reported 2.3% of the Acinetobacter spp. to be pan drug resistant, which although was lower as compared to the 3.5% which was reported by Taneja et al., (15) , was significant, as it signified the beginning of the era where only a few therapeutic options would be available for their treatment.

Conclusion

The treatment options for the infections which are caused by multidrug resistant organisms are very limited, and tigecycline is rapidly finding a role in the treatment of severe infections, as this antimicrobial has a favourable in vitro activity against a wide variety of organisms, which include the MDR Acinetobacter spp. But the tigecycline resistance among the MDR isolates that had not previously been exposed to this drug and also the emergence of PDR isolates is worrisome. So before starting the treatment, the in vitro susceptibility to tigecycline should be assessed, to prevent the development and the dissemination of resistance against this one of the last available promising and safe therapeutic options which is available to the clinicians for combating these bacteria.

References

1.
Humphreys H, Towner KJ. The impact of the Acinetobacter spp. in the intensive care units in Great Britain and Ireland. J Hosp Infect 1997; 37:281-86.
2.
Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: the emergence of a successful pathogen. Clin Microbiol Rev 2008; 21(3):538-82.
3.
Fagon JY, Chastre J, Hance AJ. Nosocomial pneumonia in ventilated patients: a cohort study which evaluated the attributable mortality and the hospital stay. Am. J. Med 1993; 94:281–88.
4.
Garnacho-Montero J, Ortiz-Leyba C, Jime´nez-Jime´nez FJ, Barrero-Almodo´var AE, García-Garmendia JL, Bernabeu-Wittel M et al. The treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP) with intravenous colistin: a comparison with imipenem-susceptible VAP. Clin Infect.Dis 2003; 36:1111–18.
5.
Bergogne BE, Towner KJ. The Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996; 9:148–65.
6.
Livermore DM. Tigecycline: what is it, and where should it be used? J Antimicrob Chemother 2005; 56: 611-14.
7.
Bauer G, Berens C, Projan SJ, Hillen W. The comparison of the tetracycline and the tigecycline binding to the ribosomes which were mapped by dimethylsulphate and the drug-directed Fe2+ cleavage of the 16S rRNA. J Antimicrob Chemother 2004; 53: 592–99.
8.
Schreckenberger PC, Daneshvar MI, Weyant RS, Hollis DG. Acinetobacter, Achromobacter, Chryseobacterium, Moraxella and other nonfermentative gram-negative rods. In: Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA, editors. Manual of Clinical Microbiology, 9th ed. Washington, DC: ASM Press; 2007; 770-802.
9.
CLSI. Performance standards for antimicrobial susceptibility testing. 20th Informational Supplement. M100-S20. Wayne, PA: Clinical and Laboratory Standards Institute; 2010.
10.
Wyeth Pharmaceuticals. Tygacil (tigecycline) for injection [Package insert]. 2005. Wyeth Pharmaceuticals Inc., Philadelphia, PA.
11.
Pachon-Ibanez ME, Jimenez-Mejias ME, Pichardo C, Llanos AC, Pachon J. The activity of tigecycline (GAR-936) against the Acinetobacter baumannii strains, which included those which were resistant to imipenem. Antimicrob Agents Chemother 2004; 48: 4479–81.
12.
Insa R, Cercenado E, Goyanes MJ, Morente A, Bouza E. The in vitro activity of tigecycline against the clinical isolates of Acinetobacter baumannii and Stenotrophomonas maltophilia. J Antimicrob Chemother 2007; 59: 583-85.
13.
Hassan A, Usman J, Kaleem F, Khan A, Hussain Z. The in vitro activities of the aminoglycosides, the β-lactam-β lactamases inhibitor combinations and the tetracyclines against the multi-drug resistant Acinetobacter baumannii which were isolated from a tertiary care hospital. J Microbiol Antimicrob 2010; 2(4): 47-50.
14.
Shanthi M, Uma Sekar. The invitro activity of tigecycline against the gram positive and the gram negative isolates in a tertiary care Hospital. JCDR 2011; 5(8): 1559-63.
15.
Taneja N, Singh G, Singh M, Sharma M. The emergence of tigecycline and colistin resistant Acinetobacter baumanii in patients with complicated urinary tract infections in north India. Indian J Med Res 2011; 133: 681-84.
16.
Kuo LC, Lai CC, Liao CH, Hsu CK, Chang YL, Chang CY, et al. Multidrug-resistant Acinetobacter baumannii bacteraemia: the clinical features, the antimicrobial therapy and the outcome. Clin Microbiol Infect 2007; 13 : 196-98.
17.
Mezzatesta ML, Trovato G, Gona F, Nicolosi VM, Nicolosi D, Carattoli A, et al. The in vitro activity of tigecycline and the comparators against the carbapenem-susceptible and the resistant Acinetobacter baumannii clinical isolates in Italy. Ann Clin Microbiol Antimicrob 2008; 7: 4.
18.
Navon-Venezia S, Leavitt A, Carmeli Y. The high tigecycline resistance in the multidrug-resistant Acinetobacter baumannii. J Antimicrob Chemother 2007; 59: 772-74.
19.
Behera B, Das A, Mathur P, Kapil A, Gadepalli R, Dhawan B. The tigecycline susceptibility report from an Indian tertiary care hospital. Indian J Med Res 2009; 129: 446-50.
20.
Tuckman M, Petersen PJ, Projan SJ. The mutations in the interdomain loop region of the tetA (A) tetracycline resistance gene increase the efflux of minocycline and the glycylcyclines. Microb Drug Resist 2000; 6:277–82.

DOI and Others

ID: JCDR/2012/4784:2468

Date of Submission: Jun 30, 2012
Date of Peer Review: Jul 24, 2012
Date of Acceptance: Sep 11, 2012
Date of Publishing: Sep 30, 2012

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