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to large scale laboratories. The greatest advantage of the technique is that the unavoidable toxic O2 exposure time during handling, can be reduced substantially due to scope of anaerobic inoculation at collection point. Thus it will meet-up a long-pending need of most laboratories. References 1. Maiti PK, Haldar J, Mukherjee P, Dey R. Anaerobic culture on growth efficient bi-layered culture plate in a modified candle jar using a rapid and slow combustion system. Indian J Med Microbiol 2013;31:173-6. 2. Rosenblatt JE, Stewart PR. Anaerobic bag culture method. J Clin Microbiol 1975;1:527-30. 3. Nicol H. Note on anaerobiosis and the use of alkaline solutions of pyrogallol. Biochem J 1929;23:324-6.

vol. 32, No. 3

Microbiology (TG), Radha Gobinda Kar Medical College, Kshudiram Basu Sarani, Kolkata, Microbiology (SKP), Sagar Dutta Medical College, Kamarhati, Kolkata, Microbiology (AM), Malda Medical College, Malda, West Bengal, India *Corresponding author (email: ) Received: 16-09-2013 Accepted: 20-12-2013 Access this article online Quick Response Code:

Website: www.ijmm.org PMID: ***

A Roy, T Ghosh, SK Patra, *A Manna

DOI: 10.4103/0255-0857.136614

Departments of Microbiology (AR), Mata Gujri Memorial Medical College, Kishanganj, Bihar,

First detection of a metallo‑β‑lactamase producing Serratia marcescens in a European university hospital Dear Editor, Serratia marcescens produces an AmpC‑β‑lactamase conferring resistance to many β‑lactams and also a chromosomal AAC  (6′)‑Ic enzyme that affects the activity of all major aminoglycosides except gentamicin. Moreover, all S. marcescens isolates are resistant to colistin. Hence, acquisition of any additional major resistance mechanism will render Serratia to one of the most problematic microorganisms. Metallo‑β‑lactamases (MBLs) can hydrolyse all β‑lactams except aztreonam. Although MBL‑producing S. marcescens has sporadically been detected in different parts of the world,[1‑3] to our knowledge this is the first report of its detection in a European hospital. A 62‑year‑old patient presented at the emergency department of our institution with acute peritonitis. He underwent emergency surgery and he was transferred to the ICU. Two months later  (January 2013) and over a 10‑day‑period S. marcescens (SM1113) was isolated from four different clinical samples of the 62‑year‑old patient  (peritoneal fluid, catheter and two bronchoalveolar lavage samples). Identification and susceptibility testing was performed with Vitek‑2 (BioMérieux, France) and MICs to certain antimicrobials were determined with E‑test (BioMérieux). All four isolates were resistant to the

majority of antimicrobials with the exception of (MICs in parentheses): Aztreonam (32 µg/ml), and intermediately resistant to meropenem (6 µg/ml). Detection for Extented‑Spectrum‑β‑lactamases or AmpC hyperproduction with the relevant E‑test strips was negative. Modified Hodge Test was positive verifying the presence of a carbapenamase. The applied meropenem (10 µg)-EDTA and meropenem3‑aminophenylboronic acid (300 µg) synergy tests ruled out the presence of a KPC‑type carbapenamase and clenched the production of an MBL. Regimens including moxifloxacin and tigecycline were administered with favourable outcome. Our region was one of the first worldwide to detect production of an MBL by Enterobacteriaceae.[4] Now, a difficult‑to‑handle Enterobacteriaceae such as S. marcescens has acquired an additional major resistance mechanism. As shown in a recent 5‑year study conducted in our setting 65 infections were attributed to S. marcescens, with the majority of them being respiratory tract infections.[5] Among these 65 patients, three (4.6%) eventually died due to the Serratia infection. It is anticipated that a possible spread and prevalence of the MBL‑producing S. marcescens will dramatically increase the number of infections and deaths in our institution.

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References 1. Osano  E, Arakawa Y, Wacharotayankun  R, Ohta  M, Horii T, Ito H, et al. Molecular characterization of an enterobacterial metallo beta‑lactamase found in a clinical isolate of Serratia marcescens that shows imipenem resistance. Antimicrob Agents Chemother 1994;38:71‑8. 2. Nastro  M, Monge  R, Zintgraff  J, Vaulet  LG, Boutureira  M, Famiglietti A, et al. First nosocomial outbreak of VIM‑16‑producing Serratia marcescens in Argentina. Clin Microbiol Infect 2013;19:617‑9. 3. Yum JH, Yong D, Lee K, Kim HS, Chong Y. A new integron carrying VIM‑2 metallo‑beta‑lactamase gene cassette in a Serratia marcescens isolate. Diagn Microbiol Infect Dis 2002;42:217‑9. 4. Scoulica  EV, Neonakis  IK, Gikas  AI, Tselentis  YJ. Spread of bla (VIM‑1)‑producing E. coli in a university hospital in Greece. Genetic analysis of the integron carrying the bla (VIM‑1) metallo‑beta‑lactamase gene. Diagn Microbiol Infect Dis 2004;48:167‑72. 5. Samonis G, Vouloumanou EK, Christofaki M, Dimopoulou D, Maraki S, Triantafyllou E, et al. Serratia infections in a

general hospital: Characteristics and outcomes. Eur J Clin Microbiol Infect Dis 2011;30:653‑60.

I Neonakis, H Messaritakis, D Stafylaki, *S Maraki Department of Bacteriology‑Parasitology‑Zoonoses and Geographical Medicine, Heraklion, Crete, Greece *Corresponding author (email: ) Received: 25-07-2013 Accepted: 18‑11‑2013 Access this article online Quick Response Code:

Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.136615

Daptomycin as a promising antimicrobial agent for the treatment of serious infections caused by resistant gram‑positive organisms Dear Editor, Multidrug‑resistant (MDR) Gram‑positive bacteria have posed a major therapeutic challenge in the past few years. We aimed to evaluate the in vitro antimicrobial efficacy of daptomycin  (DAP), teicoplanin (TEIC), linezolid (LNZ) and vancomycin (VAN) against 183 clinical isolates of methicillin‑resistant Staphylococcus aureus (MRSA) (n = 80), methicillin‑resistant coagulase‑negative Staphylococcus species  (MR‑CoNS) (n = 80) and vancomycin‑resistant Enterococci (VRE) (n = 23) at a super‑specialty hospital in north India in February 2013. Identification and antimicrobial susceptibility testing was done by Vitek 2 system (bioMérieux, Marcy i etoile, France) according to manufacturer’s instructions using CLSI breakpoints.[1] For DAP, MIC testing by Etest was also done (bioMérieux) for further confirmation. S. aureus ATCC 29213 and E. faecalis ATCC 29212 strains were used for internal quality control. All MRSA isolates were susceptible to DAP, LNZ, VAN and TEIC. MICs were found to be high for VAN, i.e., MIC50 (VAN 1 μg/mL vs. DAP 0.25 μg/mL) and MIC90 (VAN 1.5 μg/mL vs. DAP 0.75 μg/mL) [Table 1]. All MR-CoNS isolates were susceptible to DAP and VAN, 95.5% to LNZ, and 91.1% to TEIC [Table 1]. Among VRE also, DAP showed 100% susceptibility (MIC50  =  1.5  µg/ mL, MIC90  =  3.0  µg/mL), 87% isolates were susceptible to

Table 1: Antimicrobial activity of antibiotics tested against MRSA, MR-CoNS and VRE Breakpoints Susceptible Intermediate Resistant (µg/L) n (%) n (%) n (%) S- susceptible, I-Intermediate R-Resistant MRSA (n=80) Daptomycin ≤1-S 80 (100) 80 (100) Vancomycin ≤2-S 4-8-I ≥16-R Teicoplanin ≤8-S 80 (100) 16-I ≥32-R Linezolid ≤4-S 80 (100) ≥8-R MR-CoNS (n=80) Breakpoints Susceptible Intermediate Resistant (µg/L) n (%) n (%) n (%) S- susceptible, I-Intermediate R-Resistant Daptomycin ≤1-S 80 (100) Contd...

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First detection of a metallo-β-lactamase producing Serratia marcescens in a European university hospital.

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