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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
Detection Of Extended Spectrum Beta-Lactamase Production And Multidrug Resistance In Clinical Isolates Of E.Coli And K.Pneumoniae In Mangalore.
Correspondence Address :
R Yashavanth, Dept. of Microbiology, A.J.I.M.S, Kuntikana,Mangalore-575004Ph: 09986297656.E-mail: dryashwanthrai@gmail.com
Purpose:The incidence of Extended Spectrum β –Lactamase (ESBL) producing strains among clinical Klebsiella species and Escherichia coli isolates has been steadily increasing over the past years. ESBL producing organisms pose a major problem for clinical therapeutics. Identifying organisms that are ESBL producers are a major challenge for the clinical microbiology laboratory. An attempt was therefore made to study ESBL production and multidrug resistance in clinical isolates of K.pneumoniae and E.coli at a hospital in Mangalore.
MethodESBL production and multidrug resistance was studied in a total of 228 isolates of K.pneumoniae and E.coli which were obtained from various clinical samples during one year period from January to December 2008.
Identification of the isolates was done based on cultural characteristics and reactions in standard biochemical tests. All the isolates were tested for antimicrobial susceptibility by the disk diffusion technique according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The screening for ESBL production was done by the phenotypic confirmatory test using ceftazidime discs in the presence and absence of clavulanic acid.
Result:All the isolates showed resistance or decreased susceptibility to at least one of the third generation cephalosporins (ceftazidime, cefotaxime, ceftriaxone) which were used for the study. ESBL production was noted in 59.65% of the isolates tested. ESBL production was detected in 51.47% strains of E.coli and 48.53% strains of K.pneumoniae (70% of E.coli isolated from urine samples and 75% of K.pneumoniae isolated from exudates samples were ESBL producers). All the isolates were found to be sensitive to the antibiotic, imipenem. Sensitivity of E.coli to piperacillin-tazobactum (Pt) and cefaperazone-sulbactum (Cfs) was 100%, whereas K.pneumoniae showed 98% sensitive to Pt and 88% sensitive to Cfs.
Conclusion:The study has shown an increase in the incidence of ESBL producing E.coli and K.pneumoniae strains in Mangalore. The prevalence of ESBL and multidrug resistant strains constitute a serious threat to the current β -lactam therapy. Tests for the detection of ESBL producing bacteria should be carried out at all diagnostic centers routinely and the use of third generation cephalosporins should be restricted. This can reduce the prevalence of ESBL producing organisms.
ESBL, multidrug resisitance, Escherichia coli, Klebsiella pneumoniae, double-disk synergy test.
Introduction
The Extended Spectrum β-Lactamases (ESBL) are plasmid-mediated enzymes which are capable of hydrolyzing and inactivating a wide variety of β -lactams including third generation cephalosporins (3GC), penicillins and aztreonam (1). Most of these plasmids not only contain DNA encoding ESBL enzymes, but also carry genes which confer resistance to several non β-lactam antibiotics. The most frequent coresistances found in ESBL producing organisms are aminoglycosides, fluoroquinolones, tetracyclines, chloramphenicol and sulfamethoxazole-trimethoprim (2).
ESBL isolates were first discovered in Western Europe in the mid-1980s. ESBLs occur predominantly in Klebsiella species and E.coli. It is also been increasingly reported in other genera of the family Enterobacteriaceae (3), (4). The incidence of ESBL producing strains among clinical Klebsiella species and E.coli isolates has been steadily increasing over the past years. ESBL producing strains are probably more prevalent than the currently recognized ones because they are often undetected by the routine susceptibility testing methods. Occurrence of ESBL producing members of the family Enterobacteriaceae have also been reported from South India (5) and Central India (6).
The present study was conducted with an objective to examine the incidence of ESBL producing strains and the multidrug resistant
strains of E.coli and K.pneumoniae, which were recovered from patients attending a tertiary care hospital in Mangalore.
A total number of 228 isolates obtained from the cultures of various specimens such as urine (132), pus (70), sputum (10), bronchial lavage (12) and pleural fluid (4) were studied for ESBL production.
The samples were collected with universal safety precautions and were transported to the laboratory without delay. Samples were obtained from both outpatients and from those admitted to the hospital attached to our medical college between January and December 2008. The samples were cultured on brain heart infusion agar (BHIA) and MacConkey’s agar. The specimens were processed for isolation and identification based on standard laboratory techniques (7).
Antibiotic susceptibility of the isolates was determined against 14 antibacterial agents by the Kirby Bauer disk diffusion method. They include ceftriaxone (Ci-30µg), cefotaxime (Ce-30µg), ceftazidime (Ca-30µg), gentamicin (G-10µg), tobramycin (Tb-10µg), amikacin (Ak-30µg), netilmicin (Nt-30µg), nalidixic acid (Na-30µg), ciprofloxacin (Cf-5µg), imipenem (I-10µg), cefaperazone-sulbactum (Cfs-75/15µg), co-trimoxazole (Co-25µg), piperacillin-tazobactum (Pt-100µg) and chloramphenicol (C-30µg); (Hi-Media, Mumbai). The results were recorded and interpreted as per CLSI recommendations (8).
The isolate that showed resistance to at least one of the third generation cephalosporins (ceftazidime, cefotaxime, ceftriaxone) was tested for ESBL production by both the double-disk synergy test (DDST method) (9) and the phenotypic confirmation test which were recommended by CLSI.(8) The E.coli ATCC 25922 and K.pneumoniae ATCC 700603 strains were used as controls.
Among the 228 isolates, 64(56.14%) were E.coli and 50(43.86%) were K.pneumoniae. Of these, 228 strains tested, 136(59.65%) were found to be ESBL producers, of which, 70(51.47%) were E.coli and 66(48.53%) were K.pneumoniae. 70% of E.coli isolated from urine samples and 75% of K.pneumoniae isolated from other samples were detected as ESBL producers. Among these, 96% of the isolates showed resistance to at least one of the three third generation cephalosporins (ceftazidime, cefotaxime, ceftriaxone), 89% of the isolates showed resistance to all the three 3GC and their resistance was found to co-exist with the resistance to other antibiotics. All the isolates were found to be sensitive to the antibiotic, imipenem. The sensitivity of E.coli to Pt and Cfs was found to be 100%, whereas K.pneumoniae showed 98% sensitivity to Pt and 88% sensitivity to Cfs. The resistance pattern of each isolate to various antibiotics used in our study was different (Table/Fig 1).
ESBL producing organisms pose a major problem in clinical therapeutics. The incidence of ESBL producing strains among clinical isolates has been steadily increasing over the past few years, resulting in limitations of therapeutic options (10). Previous studies from India have reported the presence of ESBL producers to be 6.6 to 68 % (11). The frequency of ESBL producers (59.65%) in our study is comparable to previous Indian studies (12),(13),(14).Among this, 51.47% were E.coli and 48.53% were K.pneumoniae. It is an established fact that ESBL producers show cross resistance to other antibiotics also, thus limiting therapeutic choices. We have noted this in our study as well. The sensitivity to carbapenem (imipenem) was 100%, ESBL positive E.coli strains were 100% sensitve to cefoperozone sulbactum and piperacillin-tazobactum. ESBL positive K.pneumoniae strains showed 88% and 98% sensitivity to cefaperazone sulbactum and piperacillin-tazobactum, respectively. The sensitivity to gentamicin, ciprofloxacin, co-trimoxazole, nalidixic acid and netilmicin was poor and not suitable for empirical selection. Major outbreaks involving ESBL strains have been reported from all over the world, thus making them emerging pathogens (15). A number of nosocomial outbreaks caused by ESBL producing organisms have been reported in the U.S. (16).
The routine susceptibility test done by clinical laboratories can fail to detect ESBL positive strains and can sometimes erroneously detect isolates to be sensitive to any of the broad spectrum cephalosporins like cefotaxime, ceftazidime, ceftriaxone (17). With the spread of ESBL positive strains in hospitals, there is a need to formulate a policy of empirical therapy in a high risk unit where infection due to resistant organisms is much higher (17). As indicated in many previous studies, the 100% carbapenem sensitivity in our study advocates the usage of the carbapenem antibiotic as the therapeutic alternative in the wake of the increasing resistance rates observed with conventional β-lactam and non-β-lactam antibiotics (18). Equally important is the information on an isolate from a patient to avoid the misuse of extended spectrum cephalosporins, which still remain as an important component of antimicrobial therapy in high risk wards (18).
Knowledge of the resistance patterns of bacterial strains in a geographical area will help to guide appropriate and judicious antibiotic use (18). There is a possibility that restricted use can lead to the withdrawal of selective pressure and resistant bacteria will no longer have the advantage of survival in such settings.
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