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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
Species Prevalence And Antimicrobial Resistance Pattern Of Enterococcal Isolates In A Tertiary Health Care Centre
Correspondence Address :
Dr.Baragundi.Mahesh.C. M.D.
Assistant professor,
Dept. of microbiology,
S.N.Medical college,
Bagalkot- 587101
Karnataka.
Ph:9945471374
Mail-baragundimc@rediffmail.com
Context: Enterococci are one of leading causes of nosocomial and community acquired infections and in recent years, they have become increasingly resistant to a wide range of antimicrobial agents. Aim: The present study was done to determine the species distribution and antimicrobial resistance pattern of enterococcal isolates. Material and Methods: 120 enterococcal isolates from different clinical samples were included in the study. They were identified by the standard microbiological methods and their antimicrobial susceptility was done by the Kirby-Bauer disc diffusion method. Vancomycin resistance was detected by the disc diffusion method and the agar dilution method and MIC testing was done by the macrobroth dilution method. High level aminoglycoside resistance (HLAR) was detected as per the CLSI guidelines. Results: E. faecium was the predominant species (47.50%) which was detected, followed by E.faecalis (44.16%) and others. E. faecium strains displayed a higher degree of drug resistance. The E.gallinarum species expressed low level vancomycin resistance, which was not detected by the disc diffusion method. More than 70% resistance was seen for ampicillin, erythromycin and tetracycline. 9(7.5%) isolates were found to be resistant to vancomycin. 5(4.16%) isolates were resistant to teicoplanin. All the isolates were susceptible to linezolid. HLAR was seen in 73(47.18%) isolates. Conclusion: E.faecium is now emerging as the predominant enterococcal species which causes infections and most of the enterococcal isolates (>77%) are multidrug resistant. Vancomycin resistance and HLAR in enterococci are rising rapidly. This study emphasizes the need for routinely carrying out a detailed speciation and antibiotic susceptibility testing of the enterococcal isolates in the bacteriology laboratory.
Enterococcus, VRE, High level aminoglycoside resistance, Enterococcus faecium.
INTRODUCTION
Once regarded as a bacterial genus of little consequence, entrococci in the past several years, have rapidly emerged as important nosocomial and community acquired pathogens. These organisms can cause serious invasive infections including endocarditis, bacteraemia, meningitis and urinary tract infections, with high mortality.(1) Traditionally, of the 19 species of enterococcus which have been recognized so for, E.faecalis has accounted for approximately 80-90% of the clinical isolates, while E.faecium was isolated in the remaining 5-15% of the cases.(2) Other species are also being isolated. E. faecium strains display a higher degree of drug resistance(3),(4). E.casseliflavus, E.flavascence and E.gallinarum are intrinsically resistant to vancomycin. So, the speciation of the enterococcal isolates has now become important. Enterococci are resistant to a wide range of antimicrobial agents including B-lactams and aminoglycosides, which are frequently used to treat infections caused by gram-positive cocci. Enterococci have the ability to acquire resistance through the transfer of plasmids or transposons, or by mutations.(5) Further, the acquisition of vancomycin resistance leaves limited options for therapeutic management.(6) The present prospective study was carried out to know the species prevalence and antimicrobial resistance pattern of the enterococcal isolates in our hospital.
The present study was conducted on 120 enterococcal isolates which were retrieved from clinical samples. The ethical standards laid down by the institutional committee on human experimentation were followed during the study.
Of the 120 enterococcal isolates, 50 were from urine, 35 were from blood, 20 were from pus and 15 were from body fluids. The isolates were identified up to the species level by gram staining, by studying their cultural characteristics and by biochemical tests and motility testing by using the standard microbiological techniques.(6)
Antimicrobial susceptibility testing was done according to the CLSI guidelines(7) by the disc diffusion method of Kirby-Bauer by using MH (Mueller-Hinton) agar. The various antibiotics which were tested were Ampicillin (10µg), Vancomycin (30µg), Teicoplanin (30µg), Erythromycin (15µg), Tetracycline (30 µg), Ciprofloxacin (5µg), Nitrofurantoin (300µg) and Linezolid (30µg). Vancomycin resistance was tested by the disc diffusion method and the agar screen method and MIC testing was done by the macrobroth dilution method.
For vancomycin susceptibility testing by the disc diffusion method, a zone diameter of less than or equal to 14mm was taken as resistant, 15-16mm was taken as intermediate and more than or equal to 17mm was taken as sensitive, after 24hrs of incubation.
For agar screening, BHI agar with 6µg/ml of vancomycin was used. 10 µl of 0.5 Mc Farland’s suspension organism was spot inoculated and incubated at 350C for 24hrs. The growth of more than one colony was taken as presumptive resistance.
MIC was done by the macrobroth dilution method in cat ion- adjusted Mueller-Hinton broth. An MIC of less than or equal to 4µg /ml was taken as susceptible, 8-16µg /ml was taken as intermediate and that which was more than or equal to 32µg /ml was taken as resistant, after 24hrs of incubation.
The detection of high-level aminoglycoside resistance (HLAR) was performed by the agar dilution method for gentamycin and streptomycin by supplementing the BHI agar with 500µg/ml and 2000 µg /ml of antibiotics respectively. 10µg of 0.5Mc Farland’s suspension was spot inoculated on the agar surface and incubated at 35oC for 24hrs for gentamycin and 48hrs for streptomycin. The growth of more than one colony was taken as resistant.
The source of antimicrobials was Hi-Media Ltd (Mumbai) India. The standard strains, E. faecalis ATCC 29212 and E. faecalis ATCC 51299 were used as the susceptible and resistant quality control strains.
A total of 120 Enterococcal stains were isolated from various clinical samples. These included 57(47.50%) E.faecium, 53(44.16%) E.faecalis, 5(4.16%) E.mundti, 2(1.66%) E.durans, 2(1.66%) E. dispar 1(0.83%) and
The antimicrobial resistance profile of the isolates is shown in (Table/Fig 1). Most of the isolates were resistant to the tested antibiotics. More then 70% resistance was seen for ampicillin, erythromycin and tetracycline. 5(4.16%) isolates were resistant to teicoplanin and all isolates were susceptible to linezolid.
(Table/Fig 1): Antimicrobial resistance profile among enterococcal isolates.
8 (6.66%) isolates were vancomycin resistant enterococci (VRE) which were detected by the disc diffusion method, but 9(7.50%) isolates were found to be vancomycin resistant by the agar screening method and the MIC method. Disc diffusion showed one E.gallinarum isolate which was susceptible (18mm) to vancomycin, but it was found to be intermediately resistant by the MIC method (8µg/ml). This was a major error of the disc diffusion method (Table/Fig 2).
(Table/Fig 2): Comparison of disc diffusion and agar dilution test for detection of vancomycin resistant enterococcus (VRE).
(Table/Fig 3) shows High level aminoglycoside resistance. High level gentamycin resistance (HLGR) was seen in 93 (77.69%) isolates and High level streptomycin resistance (HLSR) was seen in 94(61.63%) isolates . Overall, HLAR (HLGR+HLSR) was seen in 73(47.18%) isolates.
(Table/Fig 3): HLAR among Enterococcal isolates
HLGR – High level gentamycin resistance
HLSR - High level streptomycin resistance
In the present study, we determined the species prevalence and the antimicrobial resistance pattern of enterococcal isolates from different clinical samples in our tertiary care teaching hospital.
Earlier studies from various parts of India (8),(9),(10),(11) have shown E.faecalis as the predominant species isolated from humans. In our study, we isolated E.faecium(47.50%) as the predominant isolate, followed by E. faecalis (44.16%), E.mundti (4.16%), E.durans (1.66%), E. dispar (1.66%) and E.gallinarum (0.83%). Changes in the hospital’s patient population and the antimicrobial use pattern, coupled with the greater antibiotic resistant nature of E.faecium probably conferred a greater selective survival advantage to E.faecium as compared to E.faecalis. This explains the emergence of E. faecium as the predominant isolate.(2)
Multidrug resistant enterococci are being increasingly reported from all over the world. Our study also revealed multidrug resistance in most of the enterococcal isolates. Drug resistance is rapidly acquired by enterococci by plasmids(12), conjugative transposition(13) or by mutations.(5)
Our study revealed E.faecium to be more resistant to antimicrobials than E.faecalis. Similar findings have been reported by other studies also.(10),(14)
Till recently, many Indian studies have shown vancomycin resistance of 0-5% in the enterococcal isolates. (8),(9),(10),(11) In the present study, vancomycin resistance was seen in 9 (7.50%) isolates. Our study showed increasing vancomycin resistance in the enterococcal isolates. The agar screen method and MIC by the macrobroth dilution method detected vancomycin resistance in all the 9 isolates, but the disc diffusion method failed to detect vancomycin resistance in one E.gallinarum isolate. Studies done at CDC, Atlanta (15) and Minnesota USA (16) have also shown this error. This type of an error occurs because motile enterococci have the VAN C genes ( E.casseliflavus, E.flavascence, E.gallinarum ) which encode low level vancomycin resistance (MIC less than or equal to 8 µg/ml) and they are intrinsically resistant to vancomycin. Modification of the CLSI break points, especially for the motile enterococcal species, may resolve the problem, or otherwise, MIC should be done for all motile enterococci. The agar screening method which contains 6µg/ml of vancomycin, should be further evaluated for the detection of such low level resistance, as in our study, we encountered only one motile enterococcus.
HLAR was seen in >75% isolates for gentamycin and in >60% isolates for streptomycin. Overall, HLAR (HLGR+HLSR) was seen in 47.18% isolates. Such high level resistance has been shown by other studies also. (2),(17) This is of great concern, since it eliminates the synergy of the aminoglycosides with the B-lactam antibiotics which is the therapy of choice for enterococcal infections, thus limiting the therapeutic options.
Linezolid has demonstrated good antienterococcal activity and may be kept as a second line drug for VRE.
It can be concluded that this study illustrated the changing epidemiology of enterococcal infections and the high rate of resistance to most of the antibiotics, with an increasing rate of vancomycin and high level aminoglycoside resistance. Measures should be taken to routinely identify the enterococcal species, test their antimicrobial susceptibilities properly and to implement a sound antibiotic policy in every hospital to prevent further increases in resistance and the spread of enterococcal infections.
• E.faecium is now emerging as the predominant enterococcal isolate from human infections.
• The disc diffusion method fails to detect low level vancomycin resistance of motile enterococci.
• Speciation and antibiotic susceptibility testing should be done on all enterococcal isolates.
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