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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
Choice of Antibiotics in Community Acquired UTI due to Escherichia Coli in Adult Age group
Correspondence Address :
Prof. Varsha Gupta, Department of Microbiology
Government Medical College Hospital
Sector-32, Chandigarh-160 030
E-mail: varshagupta_99@yahoo.com
Telephone no.: 09646121571
Background: Urinary tract infections (UTI), being the most common infections diagnosed in community and hospital, are to be treated scrupulously considering the type of infecting organism and its antibiotic resistance pattern. The study of changing antibiotic resistance pattern is pertinent for appropriate treatment.
Aim: The aim of this study was to find out the drug options for treatment of community acquired urinary tract infection (UTI) due to Escherichia coli in adult age group in our geographical area in the current scenario of increasing antimicrobial resistance.
Setting and Design: A total of 208 Escherichia coli isolates from urine of adult patients presenting in various out patient department of Government Medical College & Hospital, Chandigarh were studied between January 2009 to June 2009. Antimicrobial susceptibility of various drugs was carried out by disc diffusion method following CLSI guidelines.
Results: Amongst the orally administered drugs ampicillin, amoxycillin/clavulanic acid, norfloxacin, ciprofloxacin, tetracycline and co-trimoxazole showed 100%, 83.6%, 78.1%, 72.5%, 69.1% and 69% resistance respectively. Amongst parenterally administered antibiotics, the antimicrobial resistance for cefotaxime, ceftazidime, gentamicin, netilmicin and amikacin was found to be 58.8%, 67.2%, 18.7%, 4.8% and 4.6% respectively. Nitrofurantoin showed only 3.8% resistance. No drug resistance was seen with imipenem.
Conclusion: Amongst oral drugs, nitrofurantoin was shown to be suitable for the treatment of UTI due to Escherichia coli. Ampicillin, amoxycillin/clavulanic acid, norfloxacin, ciprofloxacin, tetracycline, co-trimoxazole should no longer be considered first line drugs for empirical treatment of clinically evident UTI because of very high resistance rates. Aminoglycosides though parentral drugs can be the alternative choice for community acquired UTI.
UTI, Escherichia Coli, Outpatient, Antibiotic
Urinary tract infections (UTI) are one of the most common infections diagnosed in outpatients as well as in hospital. The choice of antibiotic for treatment depends upon the type of infecting organism and its antibiotic resistance pattern. The most common organism responsible for both community acquired and hospital acquired UTI is Escherichia coli and these days we have seen the upsurge of highly drug resistant strains even in the community. Antibiotic resistance has become one of the world’s most pressing public health problems. With the increase in over-the counter availability of drugs in developing countries like India, antibiotic resistance is onthe rise. Antibiotic resistance varies according to the geographical and regional locations. The knowledge about the antibiotic resistance pattern is important not only for appropriate therapy but also for the prevention of resistance amongst microbes as the treatment given without considering the prevalent microbe and its antibiotic resistance pattern results in the selection of more resistant strain (1). We have conducted this study to know the antimicrobial resistance pattern of Escherichia coli isolates from urine samples of adult patients (defined as patients >18 years of age) attending outpatient clinics and to find out the drug options for the empiric treatment of community acquired UTI in our geographical region.
This study was conducted on 208 Escherichia coli isolates from urine of adult patients attending various outpatient clinics at Government Medical College Hospital, Chandigarh over a time period of six months (1st January 2009-30th June 2009). These isolates were obtained as pure growth of ≥105 colony forming unit (CFU)/ml from patients with symptoms of UTI but without history of hospitalization and catheterization. The samples were inoculated on CLED (Cysteine Lactose Electrolyte Deficient) agar by standard loop method using 0.001ml loop and incubated at 37°C overnight. Identification of the organisms was done by standard biochemical methods and antimicrobial susceptibility was done by disc diffusion method using Kirby-Bauer method following CLSI guidelines (2),(3). The drugs along with their content which were tested include ampicillin (10μg), amoxycillin/clavulanic acid (20/10μg), cefotaxime (30 μg), ceftazidime (30μg), cefoperazone+sulbactam (75/10 μg), pipeacillin+tazobactam (100/10 μg), cefepime+tazobactam (30/10 μg), imipenem (10 μg), norfloxacin (10 μg), ciprofloxacin (5 μg), gentamicin (10 μg), netilmicin (30 μg), amikacin (30 μg), tobramycin (10 μg), tetracycline (30 μg), nitrofurantoin (300 μg), trimethoprim/ sulfamethoxazole (1.25/23.75 μg) (HiMedia, Mumbai, India). Escherichia coli ATCC 25922 strain was used as a quality control strain for antimicrobial susceptibility testing.
Out of 208 isolates, 127 were obtained from females and 81 were obtained from males. The number of these isolates amongst male and female patients in different age groups is given in (Table/Fig 1). We found that maximum isolates in males were obtained from patients of >60 years of age while in females the maximum isolates were from patients in between 18-25 years of age. The overall resistance to various antibiotics in male and female patients is given in (Table/Fig 2).
IDSA (Infectious disease Society of America) recommends the use of a 3 day course of co-trimoxazole as a first line treatment except in communities with high rate of resistance (>10-20%) to co-trimoxazole among uropathogens (4). In our study, we have found a very high i.e. 69% resistance to co-trimoxazole. Therefore, in our geographical area, we do not have any option of using this drug empirically even though it is an oral drug, cost effective and safe. In a previous study between 1997-1999 from our institute, we found similar resistance for co-trimoxazole (5). Norfloxacin, being an oral drug with easy dosage schedule, is commonly prescribed by the clinicians for the treatment of UTI in outpatients not only in India but in other countries also (6). This may be the reason of increasing quinolones resistance in our area and is also revealed by other studies (7),(8). Amongst other oral antibiotics, nitrofurantoin was found to be the most effective in both males and females. This finding has been corroborated by other studies also (1),(9),(10). However, in a study conducted by Akram M et al in Aligarh on community acquired UTI, the resistance to nitrofurantoin was found to be very high (80%) (8). This reflects the importance of generation of data from respective geographical region for preparing antibiotic guidelines.
A high resistance was seen for beta lactam antibiotics. A very high resistance was seen not only for ampicillin (aminopenicillin) but also for amoxycillin+clavulanic acid which is the combination of aminopenicillin with beta lactamase inhibitor and also a costlier drug. Resistance rate for third generation cephalosporins was significantlyhigh which is indicative of production of extended spectrum beta lactamase (ESBLs) enzyme by the isolates from community. A study conducted in our institute by Gupta et al between January and October 2004 also revealed the infiltration of ESBLs in community isolates. They found 23.91% of Escherichia coli isolated from various clinical samples to be ESBLs positive (11).
Amongst β-lactam+ β-lactamase inhibitor combinations, cefepime+ tazobactam showed good susceptibility in-vitro. We found that resistance to imipenem has not entered in our community till now. In addition to this, aminoglycosides were found to be the preferred alternative drugs in case of resistance towards oral drugs. Amongst them, netilmicin and amikacin were found to be the most effective. In the last (10) years, the resistance rates of gentamicin and amikacin have shown a downward trend in our area (26% to 18.68% for gentamicin and 6% to 4.6% for amikacin) (4). Based on current antibiotic resistance pattern amikacin can be used. Seeing the see-saw pattern of antibiotic resistance over the years, we emphasize on the generation of own data for empirical treatment. This fact is also corroborated by Dyer IE et al who in their study between 1991-1997 found that in the first 3 years the resistance to ampicillin, carbenicillin, tetracycline and co-trimoxazole wasincreased but in the next three years it showed the downward trend and almost returned to 1991 levels (12).
In females, UTI was maximally seen in 18-25 yrs age group while the males of >61 years were most commonly affected amongst all age groups. A higher level of resistance was seen in elderly males as compared to females which can be due to prostatic enlargement predisposing to recurrent UTI and chronic use of antibiotics.
In the last, we may say that, amongst oral drugs nitrofurantoin is suitable for the treatment of community acquired Escherichia coli UTI in our geographical region. Ampicillin, amoxycillin/clavulanic acid, norfloxacin, ciprofloxacin, tetracycline, co-trimoxazole should no longer be considered first line drugs for empirical treatment of clinically evident UTI. In cases of resistance to oral drugs or where combination treatment is desirable, parentrally administered aminoglycosides could be a good choice for community acquired UTI. Continuous analysis of antibiotic resistance patterns act as a guide to initiate the empirical treatment but for institution of appropriate therapy urine culture and sensitivity is the gold standard even in community.
Continuous surveillance of antibiotic resistance pattern is important in the scenario of increasing antibiotic resistance even in community. Nitrofurantoin is suitable as an oral drug for the treatment of community acquired UTI due to Escherichia coli in our geographical region. Quinolones (Norfloxacin and Ciprofloxacin), commonly prescribed by the physicians in our region can no longer be used empirically i.e. before the availability of urine culture and sensitivity report. Aminoglycosides can be instituted as a parenteral drug in community. For institution of appropriate therapy urine culture and sensitivity is the gold standard test.
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