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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
The Antibiotic Resistance Pattern in Citrobacter Species: An Emerging Nosocomial Pathogen in a Tertiary Care Hospital
Correspondence Address :
Dr. Ashish Khanna
538, Basant Avenue
Amritsar, India - 143001.
Phone: 9465128936 , 0183-2562919
E-mail: ashish_538@yahoo.co.in
Members of the genus, Citrobacter, a gram negative, nonsporing rod which belongs to the family, Enterobacteriaceae are emerging as important nosocomial pathogens. The study was carried out to determine the frequency and the anti-microbial sensitivity pattern of the Citrobacter species among the various gram negative isolates which were obtained from different clinical samples. Out of the total 1830 gram negative bacilli which were isolated over a period of one and half year, from February 2010 to August 2011, from various clinical samples which were submitted to the microbiology laboratory of the Sri Guru Ram Das Hospital, eighty six (4.70%) isolates belonged to the Citrobacter species, of which 58 were Citrobacter freundii and 28 were Citrobacter koseri. Sixty three (73.26%) out of 86 Citrobacter isolates were multi-drug resistant. There was a highly significant difference in the resistance of the Citrobacter isolates to all the antimicrobials including beta lactams, quinolones and aminoglycosides, among the hospital and outdoor isolates. ESBL production was seen in 61.64% of the hospital and in 30.70% of the outdoor isolates.
Citrobacter freundii, Citrobacter koseri, Antimicrobial resistance, ESBL, MBL
Introduction
Antibiotic resistance is emerging in the isolates of Enterobacteriaceae and in other gram negative bacilli in many parts of the world and this is a major threat to the successful treatment of infections in hospitals (1). Nosocomial infections are major public health concerns because of the substantial morbidity and the mortality which are associated with them. Although Citrobacter spp. are infrequent nosocomial pathogens, a local or systemic breach in the host defenses can allow them to cause a range of infections. These include urinary tract infections, neonatal sepsis, pulmonary infections, brain abscess, meningitis and blood stream infections. The Citrobacter species are emerging as important nosocomial pathogens. The Citrobacter infections are associated with a high mortality rate. They are often resistant to the routinely used antibiotics, especially the extended spectrum cephalosporins, due to the overexpression of chromosomal beta lactamases (2). Keeping these facts in mind, this study was conducted to know the prevalence of the Citrobacter spp. amongst gram negative bacilli, its antibiotic resistance pattern and ESBL/MBL production in this part of the country.
A total of 1830 consecutive gram negative bacilli which were recovered from clinical specimens during the study period from 1-2-2010 to 30-8-2011 were included in this study. These were isolated from various clinical samples like urine, blood, pus (pus aspirate, chest tubes, I/V cannula and catheter tips). The isolates of the Citrobacter spp. were further identified by their colony characteristics; Gram’s staining, and biochemical reactions by standard methods (3). The anti-microbial sensitivity testing of the isolates of Citrobacter spp. was performed on Mueller Hinton agar by the Kirby Bauer method by using the disc diffusion technique and the results were interpreted as per the Clinical Laboratory Standard Institute (CLSI) guidelines (4). The isolates which were resistant or intermediately susceptible to any of the third generation cephalosporins were further processed for ESBL detection by the double disc potentiation method (4) by using a disc of cefotaxime (30μg)/ ceftazidime (30μg), and combination discs of cefotaxime 30μg and clavulanic acid 10μg and of ceftazidime 30μg plus clavulanic acid 10μg. Klebsiella pneumoniae ATCC 700603 was used as the ESBL positive control. ESBL production was inferred if the inhibition zone increased by 5 mm towards the cefotaxime plus clavulanic acid disc or towards the ceftazidime plus clavulanic acid disc in comparison to the third generation cephalosporin disc alone. MBL detection was done by using imipenem and imipenem- EDTA discs (5) (Table/Fig 2).
Out of the 1830 gram negative isolates, 86 belonged to the Citrobacter species (Citrobacter freundii-58, Citrobacter koseri-28). Among the 86 Citrobacter isolates, 73 (84.88%) were obtained from nosocomial samples, whereas 13 (15.12%) were obtained from outdoor specimens. A majority of these isolates were recovered from pus samples (44.19 %), followed by urine (36.05%) and blood (8.14%). [Table/Fig-3] Further statistical analysis showed a highly significant difference (p < 0.001) in the resistance of the Citrobacter species to all the antimicrobials including beta lactams, aminoglycosides and flouroquinolones among the hospital and the outdoor isolates [Table/Fig-4]. ESBL production was seen in 45 (61.64%) of the hospital and in 4(30.70%) of the outdoor isolates. The ESBL producing Citrobacter freundi and Citrobacter koseri among the hospital isolates and the outdoor isolates is shown in the graph. (Table/Fig 1).MBL production was seen in only 2(4.08) isolates.
The present study indicates that the Citrobacter spp. are mostly associated with nosocomially acquired infections. Of the total gram negative bacilli, 4.70% were of Citrobacter spp. and this rate of isolation was much higher than that which was reported by Ali et al (6) i.e. 1.35% of the Citrobacter freundii out of a total of 812 gram negative bacilli. This might be because of a lack of preventive measures during the handling of the patients in our institution, thus leading to the spread of this organism among the patients, especially the old, debilitated patients who were on IV catheters, CVP lines, urinary catheters, etc. A majority of the isolates were recovered from pus samples (44.19%), which was higher than that which was reported by Patil et al (7) (21.1%) and Shah et al (8) (22.85%). In our study, about 36.05% isolates were recovered from urinary samples, whereas other authors had reported the isolation of about 65.71% Citrobacter species from urinary samples (8). The antibiotic resistance pattern showed a significantly higher level of resistance among the hospital isolates as compared to that among the outdoor isolates. Similar results have been reported in other studies also (7),(9). The high level of antibiotic resistance among the hospital isolates in the present study may be due to the fact, that ours was a tertiary care hospital with a widespread use of broad spectrum antibiotics, which might have led to the selective survival advantage of these pathogens. In our study, Citobacter freundi was the commonest species which was isolated, followed by Citrobacter koseri, as was the case in other studies also (10). ESBL production was found in 45 (61.64%) of the hospital and in 4 (30.70%) of the outdoor isolates by the double disc potentiation method by using a disc of cefotaxime (30μg)/ ceftazidime(30μg) and combination discs of cefotaxime 30μg and clavulanic acid 10μg and of ceftazidime 30μg plus clavulanic acid 10μg (4). The rate of the ESBL production among the Citrobacter species in our study was higher than that which was reported by other authors (6),(11), which was 36.36% and 19.3% respectively. However, it was comparable with the finding of Rizvi et al (12) (62%) and lower than that which was reported by Uma A et al (13) who had reported it to be 86.50% amongst the hospital isolates. Excessive antibiotic exposure (especially the extended spectrum cepholosporins), extended hospital stay, recent surgery, admission to the ICU and instrumentation have been identified as the risk factors for the selection of the ESBL producing strains. The rate of the ESBL production was also much higher in the outdoor patients, which could have been due to the fact, that in our setup, extended spectrum cephalosprins were being prescribed injudiciously to the outpatients.
Citrobacter species are emerging as important nosocomial pathogens. Citrobacter. freundii was the commonest species which was isolated at our hospital. Multi-drug resistance and ESBL production are quite high amongst the Citrobacter species. The multidrug resistant Citrobacter species that were isolated in our study were mostly sensitive to a combination of piperacillin/tazobactum and sulbactum/ cefoperazone. So, greater caution is required in the selection of the antibiotics which have to be used, to avoid treatment failure. Carbapenems like imipenem and meropenem should be kept as reserve drugs, in case the organism becomes resistant to these combinations. This bacterium can become resistant to these drugs at any time and so, the indiscriminate, inadequate and the prophylactic use of these antibiotics should be avoided. Infection control measures like disinfection of the wards and equipments, barrier precautions against colonized patients and proper hand hygiene measures should be strictly adhered to, to prevent the spread of this pathogen. The antibiogram is a cost effective, easy and rapid typing tool in a low resource country like ours, where molecular typing tools are not easily accessible. Only in case of emergency, empirical therapy which is based on the antibiotic sensitivity pattern of that institute should be given to the patients.
ID: JCDR/2012/4032:0024
Date of Submission: Jan 22, 2012
Date of peer review: Mar 03, 2012
Date of acceptance: Mar 29, 2012
Date of Publishing: May 31, 2012
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