Browsing by Author "Aggarwal, Pushpa"
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Item In vitro evaluation of a new cefixime-clavulanic acid combination for gram-negative bacteria.(2009-01-28) Rawat, Deepti; Hasan, Azra S; Capoor, Malini R; Sarma, Smita; Nair, Deepthi; Deb, Monorama; Pillai, Parukutty; Aggarwal, PushpaThe study was conducted to evaluate a new cefixime-clavulanic acid combination for in vitro susceptibility towards gram-negative bacteria. A total of 220 isolates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeroginosa, Acinetobacter spp, Salmonella enterica serovar Typhi and Salmonella enterica serovar Typhimurium were included in the study. The isolates were tested for susceptibility towards the new combination antimicrobial molecule cefixime with clavulanic acid by disk diffusion and Epsilometer strip (E-strip) Minimum Inhibitary Concentration (MIC) method. Of the 101 E. coli and K. pneumoniae isolates, 62.4% were found to be extended spectrum beta-lactamase (ESBL) producers. Almost half of these were from the community and 55.6% were hospital isolates. Of the ESBL isolates, 19% were AmpC (cephalosporinases that are poorly inhibited by beta lactamase inhibitor) producers while the remaining 81% were non AmpC ESBL producers. The AmpC producers were resistant to both cefixime and the combination, while the non-AmpC producers were sensitive to the combination. The addition of clavulanate to cefixime did not improve the sensitivities of P. aeruginosa and Acinetobacter isolates. There were no ESBL isolates among the S. Typhi isolates, all of which were sensitive to cefixime. Of the S. Typhimurium, 88.9% were ESBL producers and all of these were resistant to cefixime but sensitive to the combination. The combination of cefixime with clavulanic acid offers the advantage of oral administration and appears to be a viable option for the treatment of uncomplicated community acquired infections caused by non-AmpC ESBL producing gram-negative bacteria.Item Typhoid fever: narrowing therapeutic options in India.(2006-11-06) Capoor, Malini R; Nair, Deepthi; Hasan, Azra S; Aggarwal, Pushpa; Gupta, BTyphoid fever remains an important public health problem in India. One thousand four hundred fifty-eight blood cultures were screened, 178 grew out Salmonella enterica serovar Typhi. On agar dilution minimum inhibitory concentration (MIC) testing, 0.6% of the isolates were resistant to ciprofloxacin, 2% to cefotaxime and 1% to cefepime. Nalidixic acid resistance was observed in 51% isolates, of which 98.9% had decreased susceptibility (MIC > or = 0.125-4 microg/ml) to ciprofloxacin. One strain of nalidixic acid sensitive S. Typhi (NASST) also had a decreased MIC (0.125 microg/ml) to ciprofloxacin. Resistance to third and fourth generation cephalosporins is emerging in India and will gain significance in the coming decade. The molecular basis of resistance to cephalosporinsand ciprofloxacin resistance in NASST strains need to be further evaluated for S. Typhi.