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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 in Vitro Activity of Tigecycline Against the Multidrug Resistant Acinetobacter Spp. at a Tertiary Care Hospital
Correspondence Address :
Dr. Dipender Kaur Najotra,
Senior Resident, Department of Microbiology,
207-D uttam nagar Kunjwani Bye- pass, jammu,
Jammu and Kashmir, Pin code- 180010, India.
Phone: 09419135664
E-mail: chahalovely@yahoo.co.in
Background: The Acinetobacter spp., particularly A.baumanii, has emerged as one of the most troublesome pathogens in health care institutions globally, because they are often Multi Drug Resistant (MDR), which means that the therapy and the infection control are complicated. With the emergence of the carbapenemase-producing isolates which show resistance to all the available agents except the polymyxins, this genus deserves close attention. In this scenario, tigecycline, a glycylcycline which has a spectrum of activity which is unparalleled by any other broad spectrum agent, and is not affected by most of the known mechanisms of resistance to tetracycline which have been encountered in bacteria, is a useful alternative for the treatment of the infections which are caused by the Acinetobacter spp.
Aim: This study was conducted to investigate the in vitro activity of tigecycline against a collection of MDR isolates of Acinetobacter spp. from our hospital.
Material and Methods: A prospective, hospital based study was conducted from October 2010 to April 2012 in which all the Acinetobacter spp. isolates which were obtained from clinical samples, were subjected to the testing of their antimicrobial susceptibilities to different groups of drugs, which included tigecycline. Based on the susceptibility profile, the isolates which were labeled as MDR were further subjected to the Epsilometer test (E-test) to determine the minimum inhibitory concentrations (MIC) of tigecycline.
Results: A total of 85 Acinetobacter spp. isolates were obtained, out of which 38 (44.7%) were labeled as MDR. 91.8% of the total and 81.5% of the MDR isolates were sensitive to tigecycline and the MICs of tigecycline for these MDR isolates ranged from 0.25 to 32 μg/ml.
Conclusion: This study proved that tigecycline exhibited a good in vitro activity against the clinical isolates of the MDR Acinetobacter spp., and that it may be considered as a promising therapeutic option for the treatment of the nosocomial infections which were caused by these pathogens. But the tigecycline resistance among the isolates that had not previously been exposed to the drug is worrisome. So before starting the treatment, the in vitro susceptibility of the isolates to tigecycline and its MIC should be assessed.
Acinetobacter spp., Tigecycline, MDR, MIC, E-test
Introduction
The Acinetobacter spp., particularly A.baumanii, has emerged as one of the most troublesome pathogens for the health care institutions globally. Hospital acquired pneumonia is still the most common infection which is caused by this organism. However, in the more recent times, the infections which involve the central nervous system, skin and soft tissue, and the bone have emerged as highly problematic for certain institutions (1),(2). The mortality which is due to the nosocomial infections which are caused by A. baumannii is high, reaching from 25 to 34% for bacteraemia and from 40 to 80% for nosocomial pneumonia (3),(4). This genus deserves close attention as it displays mechanisms of resistance to all the existing antibiotic classes, as well as a prodigious capacity to acquire new determinants of resistance (5). Many carbapenemase-producing A. baumannii isolates are resistant to all the available therapeutic agents except the polymyxins and to the drugs with significant toxicity and poor penetration to respiratory secretions (6).
Acting in synergy with this emerging resistance profile is the unO riginal Article M icrobiology Sectioncanny ability of Acinetobacter spp. to survive for prolonged periods throughout the hospital environment, thus potentiating its ability for nosocomial spreads (2). In this scenario, tigecycline, a 9-t-butylglyclamide derivative of minocycline, which has a spectrum of activity which is unparalleled by any other broad spectrum agent, and is not affected by most of the known mechanisms of resistance to tetracycline (ribosomal protection and active drug efflux) which have been encountered in bacteria, is a useful alternative to the polymyxins (6). Tigecycline acts by the inhibition of the protein translation in bacteria, by binding to the 30S ribosomal subunit, and by blocking the entry of the amino-acyl tRNA molecules into the A site of the ribosome (7). But in view of the increasing number of reports of the variable susceptibility of tigecycline against the Multiple Drug Resistant (MDR) Acinetobacter spp. isolates around the world and the few therapeutic options which are available for the treatment of the infections which are caused by this organism, this study was conducted to investigate the in vitro activity of tigecycline against a collection of MDR isolates of Acinetobacter spp. at our hospital.
A prospective study was conducted at the Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, India, from October 2010 to April 2012. All the MDR Acinetobacter spp. isolates which were obtained from the clinical samples which were received in the microbiology laboratory of our hospital were included in this study. None of the patients had undergone any previous treatment with tigecycline and only one isolate per patient was included in the study. The isolates were identified by the standard laboratory methods (8). The testing of the antimicrobial susceptibility of the isolated strains to the different groups of drugs was carried out on Mueller-Hinton agar by the Kirby Bauer disc diffusion method, and the results were interpreted as was recommended by the CLSI (Clinical Laboratory Standards Institute) guidelines (9). The interpretation of the zone diameters of tigecycline was done by using the US FDA susceptible breakpoints (10). Pseudomonas aeruginosa ATCC 27853 was used as a quality control. The following antimicrobial agents (μg) were used - cefotaxime (30), cefepime(30), ceftazidime (30) gentamicin (10), amikacin (30), ciprofloxacin (5), levofloxacin (10), co-trimoxazole (1.2/23.8), imipenem (10), piperacillin and tazobactam (75+10), cefoperazone and sulbactam (75+30), tigecycline (15), colistin (10) and nitrofurantoin (30), which was tested only for the urinary isolates.
The MDR phenotype was defined as the resistance to more than two of the following five drug classes: antipseudomonal cephalosporins, antipseudomonal carbapenems, β-lactam/β-lactamase inhibitor combinations, fluoroquinolones and aminoglycosides. The isolates which were resistant to all the drug classes which included the glycylcyclines and the polymixins were further labelled as pan drug resistant (PDR) (2).
Minimum inhibitory concentration testing (MIC): The MIC of tigecycline was determined for all the MDR Acinetobacter spp. isolates by using the E-test strips according to the manufacturer’s instructions. The MIC breakpoints which were used were ≤2, 4 and ≥8 mg/L for the susceptible, intermediate and the resistant strains, respectively (11).
A total of 85 Acinetobacter spp. isolates were obtained during the study period, out of which 38 (44.7%) were labeled as MDR, based on the antibiotic susceptibility pattern of these isolates to various antibiotics, while 15(17.6%) showed resistance to imipenem (Table/Fig 1). The origins of the Acinetobacter spp. isolates were (n/%): the respiratory tract (30/35.3), blood (25/29.4), skin and soft tissue (13/15.3), urine (9/10.6) and catheters (8/9.4). The ages of the patients ranged from 1-75 yrs, with the highest percentage of patients in the age group of 40-60 years (Table/Fig 2).The male to female ratio was 1.6:1 (52 males and 33 females). The most significant finding was the reporting of two (2.4% of the total) PDR Acinetobacter spp. isolates which were resistant to both tigecycline and colistin. These PDR isolates were also resistant to imipenem. On being considered alone, 91.8% of the total isolates and 81.5% of the MDR isolates were found to be sensitive to tigecycline.
The MICs of tigecycline for the MDR Acinetobacter spp. isolates ranged from 0.25 to 32 μg/ml (Table/Fig 3). All the isolates which had an MIC of ≤ 2 μg/ml also had a zone diameter of ≥ 19mm (the cut-off for the susceptibility). Similarly, the three isolates which hadan MIC of 4 μg/ml were found to be intermediate (15-18mm) and the isolates with an MIC of ≥8 μg/ml were found to be resistant (≤ 14mm) by the disc diffusion method.
In the present study, the predominant source of the Acinetobacter spp. isolates was the respiratory tract, which is consistent with the findings of various other studies which were done in different parts of the world (12),(13),(14). The prevalence rate of the multi drug resistance in the Acinetobacter spp. isolates was 44.7%, which is comparable to that which was reported by Taneja et al., (15), but it was quiet high as compared to that in a study which was done by Kuo et al., (16) , who reported MDR rates of 21.4 and 8.9 per cent in catheterized patients and in respiratory samples respectively. Further, various authors have reported the resistance rate to tigecycline to vary from being nonexistent to 66 % (13),(14),(15), (17),(18),(19). But in the present study, tigecycline was shown to have a good sensitivity (81.5%) against the MDR Acinetobacter spp., which was almost comparable to that which was reported by Insa et al., (12).
In our study, the E test correlated 100 percent with the inhibition zone diameters, which was in contrast to the findings of a study which was done by Behera et al., (19) but it was similar to the findings of a study which was done by Venezia et al., (18). Inspite of the high sensitivity rate, the finding of the increased tigecycline MIC values (8-32μg/ml) for four Acinetobacter spp. isolates in our study was a cause of concern, since this organism was not only totally unexposed to tigecycline but also to the tetracycline group of antibiotics in our hospital. It has been described that mutations of tet(A) selected in vitro could enable the efflux of glycylcyclines and that the up-regulation of the chromosomally-mediated efflux pumps could lead to the resistance of the Acinetobacter spp. to tigecycline (6),(20).
In the present study, we reported 2.3% of the Acinetobacter spp. to be pan drug resistant, which although was lower as compared to the 3.5% which was reported by Taneja et al., (15) , was significant, as it signified the beginning of the era where only a few therapeutic options would be available for their treatment.
The treatment options for the infections which are caused by multidrug resistant organisms are very limited, and tigecycline is rapidly finding a role in the treatment of severe infections, as this antimicrobial has a favourable in vitro activity against a wide variety of organisms, which include the MDR Acinetobacter spp. But the tigecycline resistance among the MDR isolates that had not previously been exposed to this drug and also the emergence of PDR isolates is worrisome. So before starting the treatment, the in vitro susceptibility to tigecycline should be assessed, to prevent the development and the dissemination of resistance against this one of the last available promising and safe therapeutic options which is available to the clinicians for combating these bacteria.
ID: JCDR/2012/4784:2468
Date of Submission: Jun 30, 2012
Date of Peer Review: Jul 24, 2012
Date of Acceptance: Sep 11, 2012
Date of Publishing: Sep 30, 2012
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