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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
Change in the Prevalence and the Antibiotic Resistance of the Enterococcal Species Isolated from Blood Cultures
Correspondence Address :
Anjana Telkar,
Assistant Professor, Dept. of microbiology,
J.J.M. Medical College, Davanagere
Karnataka – Pin 577004, India.
Phone: 9844759777 / 9844759777
E-mail: dranjanarpisale@yahoo.com
Context: Blood stream infections are an important cause of mortality and morbidity. Enterococci have become increasingly resistant to a wide range of antimicrobial agents and enterococcal bacteraemia results in a high mortality of about 54%.
Aim: The present study was done to determine the prevalence of different enterococcal species in blood stream infections and their anti-microbial resistance, with a special reference to vancomycin and high level aminoglycoside resistance.
Material and methods: The study was conducted on 50 enterococcal blood isolates. The isolates were identified by using standard microbiological techniques and antimicrobial susceptibility testing was done by the Kirby Bauer disc diffusion method according to the CLSI guidelines.
Results: The maximum numbers of enterococci were isolated from male patients of the age group of 0-20 years. Most of the enterococcal isolates (78%) were non-haemolytic and multidrug resistant. E.faecium (70%) was the predominant species which was isolated. Linezolid showed good antienterococcal activity. Vancomycin resistance was seen in 6 (12%) isolates and high level aminoglycoside resistance was seen in 20 (40%) isolates. The E.faecium isolates were more drug resistant than the E.faecalis isolates.
Conclusion: Steps should be taken to regularly screen the enterococcal isolates for vancomycin and high level aminoglycoside resistance and to treat the enterococcal infections effectively to limit the spread of multidrug resistant enterococcal infections.
Enterococcus, VRE, E.faecium, High level aminoglycoside resistance, Enterococcal bacteremia.
Introduction
Blood stream infections are an important cause of mortality and morbidity and they are among the most common health care associated infections (1). The illnesses which are associated with blood stream infections range from self-limiting infections to life threatening sepsis, which require a rapid and aggressive antimicrobial treatment (2). The enterococci have become major nosocomial pathogens (3). The enterococci come well equipped with a variety of intrinsic (i.e. naturally occurring) antibiotic resistance. They are also capable of acquiring new resistance genes by gene transfer and/or mutations. The combination of high level resistance to ampicillin, vancomycin and aminoglycosides is now fairly common (4). Enterococcal bacteraemia results in a high mortality of about 54% (5). Although 12 species in the genus, Enterococcus have been recognized, the most common species which is implicated in human infections is E.faecalis, followed by E.faecium (6). Hence, the present study was undertaken to know the prevalence of different enterococcal species in blood stream infections and their antimicrobial resistance, with a special reference to the vancomycin and high level aminoglycoside resistance which was seen at our teaching hospital.
A total of 50 enterococci which were isolated from blood cultures were included in the study. The ethical standards which were laid Original Article Microbiology Sectiondown by the institutional committee on human experimentation were followed during the study. The isolates were identified by their colony morphologies, Gram’s staining patterns, catalase reactions, growth on bile esculin agar and tolerance to 6.5% NaCl. The species identification was done by using the standard microbiological techniques. Anti-microbial sensitivity testing was done according to the CLSI guidelines (7) by the disc diffusion method of Kirby-Bauer by using Mueller Hinton (MH) agar. The various antibiotics which were tested were Ampicillin (10μg), Tetracycline (30μg), Erythromycin (15μg), Ciprofloxacin (5μg), Gentamicin (10μg), Vancomycin (30μg) and Linezolid (30μg). For high level aminoglycoside resistance detection, Gentamicin (120μg) and Streptomycin (300μg) discs were used. The source of the anti-microbials 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 50 enterococcal isolates were recovered from blood cultures. (Table/Fig 1) shows the age and sex distribution of the isolates. The maximum number of isolates (54%) were seen in the 0-20 years age group, followed by those in the 21-40 years age group. More number of enterococci were isolated from males (64%) than fromfemales (36%). (Table/Fig 2) shows the haemolytic activity of the enterococcal isolates. Most of isolates were non haemolytic and no isolate was ß-haemolytic.
(Table/Fig 3) shows the resistance pattern of the enterococcal isolates. Only three species of enteococci, E.faecium (35), E.faecalis (14), E.durans (1) were isolated from blood cultures. All these three species were multidrug resistant and more than 50% resistance was seen to most of the drugs which were tested, except for Linezolid. Only one E.faecium isolate (2.8%) showed resistance to Linezolid. (Table/Fig 4) shows the vancomycin and the high level aminoglycoside resistance among the enterococcal isolates. Vancomycin resistance was seen in 6(12%) of the enterococcal isolates. 34 (68%) isolates were high level gentamicin resistant and 28 (56%) were high level streptomycin resistant. Both high level gentamicin and streptomycin resistance was seen in 20 (40%) isolates. The E.faecium isolates were more resistant to all the drugs as compared to the E.faecalis isolates.
In the present study, we determined the species prevalence and the antimicrobial resistance pattern of the enterococcal isolates from blood cultures. This study showed the highest number of enterococcal isolates in the 0-20 years age group and males were more effected than females. This could be due to the exposure of these groups to environmental conditions more than others or it may be due to some unexplained cause. 78% of the enterococcal isolates were non-haemolytic and a-haemolysis was seen in 22% of the isolates.
In the present study, 35 (70%) isolates were E.faecium, 14 (28%) were E.faecalis and 1 (2%) was E.durans. Earlier studies from various parts of India (8),(9),(10),(11) had shown E.faecalis as the predominant species which was isolated from humans. A study on hospitalized patients from the United States reported E.faecalis to be two times more common than E.faecium among the blood culture isolates (12). But recently, few studies have reported an increase in the number of the E.faecium isolates (11),(13). In the present study also, E.faecium was the major species which was isolated from the blood cultures. This could be attributed to the geographical variation in the distribution of the enterococcal species in different areas and the increasing drug resistance among the E.faecium isolates. The present study revealed the presence of multidrug resistant enterococcal species. Similar results were obtained in various studies from different parts of world. (6),(8),(14),(15),(16), Drug resistance is rapidly acquired by enterococci by plasmids (17), conjugative transposition (18) or by mutations (19), leading to the rapid spread of multidrug resistant enterococcal infections.
The present study also revealed E.faecium to be more drug resistant than E.faeclais. Similar findings have been reported by other workers. Linezolid showed a good antienterococcal activity,(4),(10) and this can be used as a second alternative for the vancomycin resistant enterococci. Studies (20),(21) have shown daptomycin to have a good activity against the enterococcal isolates, but in the present study, we did not test the sensitivity of daptomycin as it was not included in CLSI document. In the present study, vancomycin resistance was seen in 6(12%) isolates. 7.14% of the vancomycin resistance was seen in E.faecalis, whereas 14.28% of the E.faecium isolates were found to be vancomycin resistant. Overall, vancomycin resistance was seen in 12% isolates. This was more in comparison with the findings of other Indian studies (8),(9),(10),(18). which showed between 0-5% vancomyin resistance in the enterococcal isolates. Thus, the present study indicated an increase in the vancomycin resistance of the enterococcal isolates. The vancomycin resistance in enterococci not only leaves fewer options for the disease management, but it is also important due to the potential risk of the vancomycin resistance gene transfer from the enterococci to Staphylococcus aureus (6).
A high level of aminoglycoside resistance (HLGR+HLSR) was seen in 20 (40%) isolates and again, this was more in the E.faeciumisolates (40%) as compared to that in the E.faecalis isolates (35.71%). Our results were comparable to the results of other studies (8),(14),(15). The resistance to aminoglycosides is of great concern, since it eliminates the synergy of the aminoglycosides with the b-lactam antibiotics, which is the therapy of choice for the enterococcal infections, thus limiting the therapeutic options. In conclusion, E.faecium was found to be the predominant isolate in enterococcal bacteraemia. Most of the enterococcal isolates were multidrug resistant. Vancomycin and high level aminoglycoside resistance is on the rise in enterococcal isolates. Linezolid has a good antienterococcal activity. Steps should be taken to regularly screen the enterococcal isolates for vancomycin and high level aminoglycoside resistance and to treat the enterococcal infections effectively, to limit the spread of multidrug resistant enterococcal infections.
DOI: JCDR/2012/4263:2090
Financial OR OTHER COMPETING INTERESTS:
None.
Date of Submission: Mar 10, 2012
Date of Peer Review: Apr 02, 2012
Date of Acceptance: Apr 09, 2012
Date of Publishing: May 01, 2012
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