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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
Prevalence of Methicillin, Vancomycin and Multidrug Resistance among Staphylococcus aureus
Correspondence Address :
Dr. Dhanalakshmi T. A.
Assistant Professor
Department of Microbiology
Adichunchanagiri Institute of Medical Sciences
B.G.Nagara, Mandya district
Karnataka state, India - 571448.
Phone: 9844967412
E-mail: dhans07_adi@yahoo.co.in
Background and Objectives:
The treatment of Staphylococcus aureus infections is becoming increasingly more complicated due to the emergence of various types of antibiotic resistance. The present study was undertaken to know the prevalence of methicillin resistant Staphylococcus aureus (MRSA), vancomycin intermediate and vancomycin resistant Staphylococcus aureus (VISA and VRSA respectively) and multidrug resistant MRSA and to evaluate the phenotypic detection methods.
Materials and Methods:
A total of 250 non-duplicate isolates of Staphylococcus aureus which were isolated from various clinical samples were tested for methicillin resistance by using the oxacillin disc diffusion test (1μg), the cefoxitin disc diffusion test (30 μg) and the oxacillin agar screen method (Muller Hinton agar (MHA) with 4% NaCl+6 μg/ml oxacillin). Vancomycin screen agar (MHA containing 5 μg/ml vancomycin) was used for screening the VISA/VRSA isolates. The MIC of vancomycin was determined by using the agar dilution method and the E-test. The antibiogram of the isolates to other antibiotics was studied by the Kirby-Bauer disc diffusion method.
Results:
80 (32%) isolates were found to be methicillin resistant by the cefoxitin disc diffusion method, 78 (31.2%) were found to be methicillin resistant by the oxacillin agar screen test and 77 (30.8%) were found to be methicillin resistant by the oxacillin disc diffusion method. No VISA and VRSA isolate was detected by using the vancomycin screen agar test, agar dilution and the E-test. The vancomycin screen agar showed 100% specificity and 100% negative predictive value. Sixty seven (83.8%) of the 80 MRSA isolates and 26.8 % of the total 250 Staphylococcus aureus isolates tested were found to be multidrug resistant MRSA.
Conclusions:
Where the facilities are limited, the cefoxitin disc diffusion test and the vancomycin screen agar test can be used for screening the MRSA and the VRSA isolates respectively. With the revised CLSI guidelines, the screening method for VISA with an MIC of 4μg/ml needs to be evaluated with further more studies.
Agar dilution, Cefoxitin disc diffusion, E-test, Methicillin resistant Staphylococcus aureus, Multidrug resistance, Vancomycin intermediate/resistant Staphylococcus aureus, Vancomycin screen agar
Introduction
Staphylococcus aureus (S.aureus) is one of the major causes of community and hospital acquired infections, leading to high morbidity and mortality (1). The treatment of the S.aureus infections has become problematic because of the emergence of resistance to methicillin, vancomycin and other antibiotics (2),(3). The determination of the anti-microbial susceptibility is crucial for an optimal therapy, for epidemiological purposes and for infection control measures (3),(4). The routinely used methods cannot accurately detect the methicillin and the vancomycin resistance (5). The present study was done to know the prevalence of methicillin and vancomycin resistance among S.aureus, to evaluate the phenotypic screening methods and to know the antibiogram of the isolates to the commonly used antibiotics.
This study included a total of 250 non-duplicate S.aureus which were isolated from various clinical specimens from January 2010 to October 2010. All the clinical specimens were first inoculated onto blood agar and MacConkey agar plates (Hi Media Mumbai India) and these were incubated at 370C for 24-48 hours (6). The identification of S.aureus was done by standard methods (5). The screening for methicillin resistance was done by the oxacillin disc diffusion method (1μg) and by the cefoxitin disc diffusion method (30μg) and by inoculating the S.aureus onto oxacillin screen agar (Muller Hinton agar (MHA) with 4% NaCl + 6μg/ml oxacillin), (Hi Media Mumbai India) (2),(7),(8). S.aureus ATCC 25923 was used as the control stain (9). Screening for the vancomycin intermediate and the vancomycin resistant S.aureus ( VISA and VRSA respectively) was carried out by using vancomycin screen agar ( MHA with 5μg/ml vancomycin, Hi Media Mumbai India), its MIC was determined by the agar dilution method and it was rechecked by the E-test (Hi Media Mumbai India) (7). All the plates were incubated at 350 for 24-48 hours (1),(6). S.aureus ATCC strains 29213 and 43300 and E.faecalis ATCC 51299 were used as the control strains (10). The antibiotic susceptibility tests for the following antibiotics was carried out by the Kirby-Bauer disc diffusion method (7); Penicillin (10U), erythromycin (15μg), tetracycline (30μg ), gentamicin (10μg), amoxicillin-clavulanic acid (30 μg), clindamycin (2 μg), ciprofloxacin (15 μg), cotrimoxazole (1.25/23.75 μg), linezolid (30 μg ), rifampicin (5 μg ) amikacin (30 μg) and azithromycin (30 μg). This study was approved by the ethical committee of the institution.
Out of the 250 S.aureus isolates, 80 (32%) were found to be methicillin resistant by the cefoxitin disc diffusion method, 78(31.2%) were found to be methicillin resistant by the oxacillin screen agar test and 77(30.8%) were found to be methicillin resistant by the oxacillin disc diffusion method (Table/Fig 1). No VISA and VRSA were found among the 250 S.aureus isolates by all three methods i.e., the vancomycin screen agar test, the vancomycin agar dilution method and by the E-test (Table/Fig 2), (Table/Fig 3) and (Table/Fig 4). The vancomycin screen agar showed 100% specificity and 100% negative predictive value. The antibiotic resistance profile of the isolates to other antibiotics is represented in (Table/Fig 5).
Staphylococci are the commonest of all the clinical isolates which are responsible for several suppurative types of infections and they are capable of acquiring and using one or more of the resistance mechanisms (2),(11). Due to the widespread occurrence of MRSA, the empiric therapy for MRSA was changed to vancomycin. This has lead to the emergence of vancomycin intermediate and vancomycin resistant S.aureus (3). Because only limited therapeutic alternatives are available presently to treat the MRSA and the VRSA isolates, the detection of methicillin and vancomycin resistance should be done in the clinical microbiology laboratory with meticulous care, keeping in mind the sensitivity and the specificity of the methods which are used (3). In the present study, 80 (32%) isolates were found to be MRSA (Table/Fig 1). The prevalence of the S.aureus infections vary from place to place and so also the resistance pattern which depends on the local antibiotic policy, the infection control activities, the time of the study, the number of cases which are studied and the biological characteristics of the S.aureus strains (12),(13). One of the limitations of the present study was that, the detection of mecA or PBP 2a which is considered as the gold standard for detecting the MRSA strains, was not done because of technical and economic constrains (14). Among the screening methods which were used for MRSA, cefoxitin disc diffusion was preferred over oxacillin disc diffusion and the oxacillin screen agar test because cefoxitin was a potent inducer of the mecA gene, it gave clearer end points, it was less affected by the hyper production of penicillinases, it required no special medium or incubation temperature as was required when the testing was done with oxacillin and it could be done routinely in the same antibiotic sensitivity plate (2),(12),(14),(15). Even with a 32% MRSA prevalence rate, no isolate with a reduced susceptibility to vancomycin was found in the present study (Table/Fig 2). This may be due to the fact that the community acquired MRSA (CA-MRSA) unlike the hospital acquired MRSA (HA-MRSA) are known to be sensitive to drugs other than vancomycin (16). Because of its high cost, vancomycin may not be in use in the peripheral rural setups, thus decreasing the selection pressure for vancomycin resistance. As per the new guidelines, CLSI has suggested further studies to define the level of sensitivity of the methods for VISA, for which the MICs are 4 μg/ ml (10). In the present study, the vancomycin screen agar test (MHA with 5μg /ml of vancomycin) was evaluated. No VISA or VRSA isolate was found in the present study and this was confirmed by the vancomycin agar dilution method (Table/Fig 3) and the E-test (Table/Fig 4). The vancomycin screen agar test showed cent percent specificity and cent percent negative predictive value. With the revised CLSI guide lines for VISA, if only BHIA with 6 μg /ml of vancomycin is used, a fraction of the VISA isolates with an MIC of 4 μg/ml may be missed. MHA was used in the present study because MHA was widely available and it was well standardized, it readily supported the growth of Staphylococci, it was commercially available and it could be easily prepared in house (17). The burden of multidrug resistant MRSA is increasing over time (18). The reports of recent studies are implicating the gut as an important reservoir of multidrug resistant S.aureus (19). In the present study, 67(83.8%) of the MRSA isolates were found to be multidrug resistant. (Table/Fig 5) The increased prevalence of MDR-MRSA is due to a lack of sufficient knowledge on the danger of the wrong use of antibiotics, high proximity to a large number of unlicensed drug vendors, high poverty among the people which hinders them from completing the dosage regimen of the antibiotics, widespread and sometimes, the inappropriate use of broad spectrum antibiotics in the medical and the veterinary practice, antibiotic prophylaxis, high number of immune compromised patients, the increased use of invasive procedures and devices and inadequate infection control measures (19),(20).
Vancomycin resistance has been perceived as a fearsome threat to the already challenging therapy of MRSA and MDR-MRSA (6),(18). The clinical microbiology laboratories must ensure that they are using detection methods with good sensitivity and specificity. In the rural hospitals, where the facilities are limited, the cefoxitin disc diffusion test and the vancomycin screen agar test can be used as reliable screening methods for the MRSA and the VRSA strains respectively. More studies should be done for finding the accurate screening method for VISA. The emergence and the dissemination of resistance can be controlled by a heightened awareness of the issues, by encouraging proper personal hygiene, provision of adequate effective sewage disposal systems to prevent dissemination of the multidrug resistant bacteria from the gut, surveillance of the local bacterial population, early intervention, rigorous cross infection control measures and by the judicious use of current antimicrobial agents based on the susceptibility data (19),(20),(21).
We are thankful to all our colleagues and technicians for their support.
Financial OR OTHER COMPETING INTERESTS:
None.
Date of Submission: Mar 30, 2012
Date of Peer Review: Apr 26, 2012
Date of Acceptance: Jun 02, 2012
Date of Online Ahead of Print: Jun 20, 2012
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