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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 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Effectiveness of Minocycline in Multidrug Resistance Gram Negative Bacilli: A Cross-sectional Study
Correspondence Address :
Dr. Palraj Kennedy Kumar,
Plot No. 35, West Patel Street, Kamaraj Nagar, Avadi, Chennai-600071, Tamil Nadu, India.
E-mail: kennychennai1973@gmail.com
Introduction: Antibiotic resistance is a global public health threat and remains a challenge for the physicians. Due to increased incidence of resistance to the commonly prescribed antibiotics, a newer drug or a re-emerge of an older class of antibiotic will be a choice of treatment of the Multidrug Resistant (MDR) organisms.
Aim: To determine the effectiveness of minocycline in MDR gram negative bacterial isolates by determining its Minimum Inhibitory Concentration (MIC) and to compare its effectiveness with imipenem and meropenem.
Materials and Methods: A cross-sectional periodical study was conducted during May 2016 to May 2017 using 150 non repetitive MDR gram negative bacterial isolates recovered from various clinical specimens sent to Central Laboratory, Department of Microbiology, Sri Ramachandra Medical College and Research Institute, SRIHER, Porur, Chennai, India. All the isolates were subjected for antibiotic susceptibility testing by disc diffusion method for the routine antibiotics and MIC determination by Epsilometry test (E-strip) for minocycline and meropenem and interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines 2016. Statistical analysis was calculated with Open Epi using two by two table version 3.01.
Results: Out of the 150 study isolates minocycline was susceptible in 105 (70%) followed by imipenem and meropenem both susceptible for isolates 94 (62.7%). Minocycline was also susceptible among the 79 (84%) out of 94 of meropenem susceptible strains with a statistically significant p-value of <0.05. Similarly 26 (46.4%) out of 56 of meropenem resistant strains were susceptible for minocycline which was also statistically significant with a p-value <0.05.
Conclusion: Considering the cost of treatment with colistin which is the choice of treatment for carbapenemase producing gram negative bacteria’s, minocycline can be considered as it is cheaper and less toxic. The possibility to switch from injectable to oral formulation is also possible with minocycline and so can also be considered as an alternative for colistin in such conditions.
Colistin, E-strip, Meropenem, Minimum inhibitory concentration
Antibiotic resistance is a global public health threat. Infections caused by Multidrug Resistant (MDR) bacteria continue to be a challenge for the physicians in treating their patients. The morbidity and mortality are on the rise of the hospitalised patients because of Hospital Acquired Infections (HAI), which are many times are due to Multi or Pan Drug Resistance (PDR) organisms which are very difficult to treat as there is no new antibiotics are available in the recent past (1). World Health Organisation (WHO) estimates these infections to occur among hospitalised patients at a rate of 7-12% globally (2).
In India HAI is on the rise, so also the drug resistance. Many centres have reported on an average resistance to aminoglycosides ranging from 32.6-83.6%, resistance to β-Lactams (BL) and β-lactamase Inhibitors (BL-BLI) ranged from 41-80% (3). The carbapenem resistance rate among Gram Negative Bacilli (GNB) is 36.4%, whereas resistance to quinolones is approximately 30% [4,5]. Percentage of Extended Spectrum Beta Lactamases (ESBL) producers range from 66.8-71.5% (6). Colistin resistance rate is approximately 20% (7).
Minocycline is a second-generation tetracycline derivative, was first introduced in 1967 (8). Minocycline acts by inhibiting the bacterial protein synthesis by binding to the 30s ribosomal subunit and specifically preventing the enzyme binding of aminoacyl-tRNA (transfer RNA) to its acceptor site, and are considered bacteriostatic agents (9). Minocycline is a broad-spectrum antibiotic with a wide range of activity against aerobic and anaerobic gram positive cocci and gram negative organisms. In addition, they also have activity against Mycoplasma, Chlamydia, Rickettsia, Spirochetes, Nocardia and Legionella (10). As there is increase in the incidence of resistance to all of the commonly prescribed antibiotics a newer drug or a re-emerge of an older class of antibiotic will be a choice in the treatment of these MDR organisms. In this pursue, the current study was undertaken to evaluate minocycline susceptibility in MDR GNB.
A cross-sectional periodical study was conducted between May 2016 to May 2017 in the Department of Microbiology, South India a tertiary care centre after obtaining Institutional Ethics Committee (IEC) approval, REF: CSP-MED/16/JUN29/72.
Inclusion criteria: All the culture specimens sent to the laboratory during the study period growing non repetitive MDR GNB isolates were included in the study.
Exclusion criteria: Repetitive samples and highly susceptible (Non MDR) gram negative bacterial isolates were excluded from the study.
Study Procedure
A total of 150 non repetitive MDR gram negative bacterial isolates from clinical specimens of exudates, Broncho-Alveolar Lavage (BAL), urine and blood were included (Table/Fig 1). Study isolates were identified upto species level by conventional methods (Biochemical reactions like indole test, urease enzyme production, citrate utilisation. Triple sugar iron, manitol fermentation and motility test, phenyl alanine deaminase test, oxidase test, catalase test etc.,) and/automated methods (VITEK-2 system (Vitek2 GN-card; BioMerieux, Brussels, Belgium) (11). Antibiotic susceptibility testing of the isolates for ampicillin (10 μg), cephelexin (30 μg), cefotaxime (30 μg), cephalexin (30 μg), trimethoprim- sulfamethoxazole (1.25 μg and 23.75 μg), cefepime (30 μg), amikacin (30 μg), cefaperazone sulbactum (15/10 μg), piperacillin tazobactum (100 μg and 10 μg), nitrofurantoin (300 μg), ciprofloxacin (5 μg), levofloxacin (5 μg), imipenem (10 μg), meropenem (10 μg), ertapenem (10 μg) and tobramycin (10 μg) was done by disc diffusion method and interpreted as per Clinical and Laboratory Standards Institute (CLSI) guidelines 2016 (12). MIC of the study isolates to minocycline, colistin and meropenem was done by Epsilometery strip (E-strip) obtained from HiMedia, Mumbai and interpreted as per CLSI guide lines 2016 (Table/Fig 2),(Table/Fig 3),(Table/Fig 4) (12). Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853 (Procured from HiMedia) were used as controls and the controls were satisfactory.
Statistical Analysis
Statistical analysis was calculated with Open Epi using two by two table version 3.01. The p-value was calculated by Chi-square test and p-value <0.05 was considered to be statistically significant.
A total of 150 gram negative bacterial isolates screened by disc diffusion as MDR from various clinical specimens, urine 84 (56%), pus 45 (30%), blood 13 (8.7%) and BAL 8 (5.3%), were included in this study. Out of these 150 samples, 87 were isolated from males and 63 from females (M:F ratio=1.4:1). The age of the study population ranged from one day to 94 years. (Mean age: 46.4 years). Bacterial isolates break up from the various clinical samples is shown in the (Table/Fig 5) and antibiotic susceptibility percentage of the study isolates for the routine antibiotics by disc diffusion method is shown in the (Table/Fig 6).
All the test isolates were subjected for MIC determination by Epsilometry test (E-strip) for minocycline, colistin and meropenem (Table/Fig 7),(Table/Fig 8),(Table/Fig 9). Susceptible percentage of test isolates were as follows: A total of 129 (95.5%; n=135, Protea group, Burkholderia spp., were excluded) were susceptible for colistin followed by 105 (70%) isolates for minocycline and 94 (62.7%) of the test isolates had shown susceptibility to meropenem.
Comparison of meropenem susceptibility by disc diffusion and E-strip method: A total of 100 (66.7%) isolates were susceptible by disc diffusion method. Whereas by E-strip method 94 (62.7%) of them were susceptible. All the test isolates (50) which were resistant by disc diffusion was also found to be resistant by E-strip method. Among the six which were susceptible by disc diffusion, the MIC ranged between 4-12 μg.
Minocycline susceptibility and its statistical significance: The comparison of susceptibility of minocycline and meropenem is shown in (Table/Fig 10). Among the 94 meropenem susceptible strains, 79 (84%) showed susceptible to minocycline with statistical significant p-value <0.05. A total of 26 (46.4%) out of 56 the meropenem resistant strains susceptible to minocycline with statistical significant p-value of < 0.05.
In this era of MDR infections, especially in the hospitalised patients and also with limited antimicrobials available for managing such patients, minocycline is thought to be an effective alternate at present. Akers KS et al., in his study at military centre against MDR Acinetobacter spp showed a favourable clinical outcome with minocycline (13). A study done by Shankar C et al., against with Klebsiella pneumoniae reported 71.4% susceptibility to minocycline (14).
Colton B et al., reported 50% of colistin resistant strains were susceptible to minocycline but in this study, colistin was found to be highly efficacious against MDR strains rather than minocycline in-vitro (15). A comparative study done by Flamm RK et al., with tetracycline, doxycycline and minocycline reported that minocycline was found to be increasingly effective against MDR organisms (16). In current study, 70% of MDR organisms were susceptible to minocycline (16). Similarly study done by Vento TJ et al., with MDR E. coli reported as minocycline was effective against 85% of study isolates (17). In this study, 88.1% isolates showed susceptibility to minocycline. Ritchie DJ and Garavaglia-Wilson A, in their study with MDR Acinetobacter spp in 2014 has reported 80% susceptibility to minocycline, whereas, in this study, 75% of MDR Acinetobacter spp. were susceptible to minocycline (18). Castanheira M et al., again with MDR Acinetobacter has given susceptibility to colistin as 98.8% and minocycline 79.1% (19). In present study also, similar findings were observed. They also compared the efficacy of minocycline for various MDR GNB had shown the following: 81.4% susceptibility for Citrobacter followed by 81.4% for Enterobacter, 79.1% for Acinetobacter, 78.8% for Escherichia coli and 75.7% for Klebsiella spp. (19). In this study, 80% of the MDR Enterobacter was susceptible to minocycline followed by Acinetobacter spp. (75%), E. coli (88.1%) and Klebsiella spp. 57.9%. Adibhesami H et al., had reported only 56% of MDR Acinetobacter susceptible to minocycline (20). In contrast, this study had about 75% susceptibility. Vento TJ et al., had found 85% of MDR E. coli were susceptible to minocycline (17), whereas present study had only 88.1% susceptibility. Yang Y et al., has stated in their study that 82.4% of their study isolates i.e., Acinetobacter spp. were susceptible to minocycline (21). In another study by Parveen A and Bhat P, reported 40.5% of their Acinetobacter spp. isolates susceptible to minocycline (22); whereas in this study, 75% of Acinetobacter was susceptible to minocycline. Most of the findings done by various authors in different studies periods in different parts of the world have reported the efficacy of minocycline almost equal to the present study done in 2016 (22). A systematic review done by Fragkou PC et al., for MDR Acinetobacter baumannii showed a significant clinical and microbiological success rates following minocycline treatment as 72.6% and 60.2%, respectively (23). As the treatment of choice in MDR GNB usage of carbapenem like meropenem, imipenem and ertapenem are often practiced. In present study, among the 94 meropenem susceptible bacterial isolates, 84% were also susceptible for minocycline also and so it is very important to also consider minocycline as an alternative for meropenem where minocycline is cost-effective and least toxic comparatively. Similarly 26 (46.4%) of meropenem resistant strains were susceptible to minocycline, hence can also be used in conditions where organisms are producing carbapenemase and can replace colistin in these conditions.
Limitation(s)
Being a periodic study, only 150 MDR gram negative organisms were tested and colistin susceptibility would have been compared by performing microbroth dilution method.
Selection of appropriate and ideal antibiotics remains a main key f orthe treatment of MDR organisms. As minocycline is showing efficacy in carbapenemase producing GNB, minocycline can be used as an alternative for colistin in these conditions especially in patient admitted in Intensive Care Units as minocycline is cost-effective and less toxic. Minocycline can also replace the carbapenems in the treatment except for its bacteriostatic action.
DOI: 10.7860/JCDR/2023/60596.17644
Date of Submission: Oct 06, 2022
Date of Peer Review: Nov 12, 2022
Date of Acceptance: Dec 07, 2022
Date of Publishing: Mar 01, 2023
Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
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