Browsing by Author "Dassanayake, K.M.M.P."

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Antimicrobial susceptibility and empirical prescribing practices in treating urinary tract infections
(Sri Lanka Medical Association, 2012) Wijekoon, C.N.; Dassanayake, K.M.M.P.; Pathmeswaran, A.
INTRODUCTION: Empiric antimicrobials are recommended for urinary tract infection (UTI). Knowledge of local antimicrobial susceptibility is essential for prudent empiric therapy. Aims: To describe antimicrobial susceptibility patterns and empirical prescribing practices in adult in¬ward patients with UTI. METHODS: Data for this descriptive study was collected prospectively from consecutive adult patients with positive urine culture admitted to Colombo North Teaching Hospital. Sensitivity testing was done using Joan Stokes method. RESULTS: Among 745 patients, 441 (59.2%] were females. Mean (SD) age of the study population was 48.2 (19) years. Coliforms were the commonest (85.6%) isolates followed by Streptococcus spp., Candida spp., Staphylococcus spp., and Pseudomonas spp.. Susceptibility of bacteria to antimicrobials was as follows; nitrofurantoin- 76.8%, gentamicin- 62.7%, cefuroxime- 46.3%, co-trimoxazole- 44.1%, norfloxacin-43.6%, cefalexin- 37.6%, ciprofloxacin- 37.3%, co-amoxiclav- 20.7%, ampiciUin- 17.6%. 381(51.1%) received empirical antimicrobial therapy. 75 received more than one antimicrobial. Ciprofloxacin was the most frequently prescribed empirical antimicrobial (208/381; 54.6%). Nitrofurantoin was prescribed in only 9.2%. Concordance between the empirical antimicrobial prescribed and the sensitivity of the isolated organism was seen only in 25.7%. In 29.6%, urinary isolate was resistant to the empirical antimicrobial and in 44.7% the prescribed empirical antimicrobial was not included in sensitivity testing. CONCLUSIONS: Susceptibility was low (<50%) to the first line antimicrobials other than nitrofurantoin and gentamicin. Ciprofloxacin was the most frequently prescribed empiric therapy even though susceptibility to it was low. Despite high susceptibility nitrofurantoin was underutilized. There was obvious discrepancy between empirical prescribing practices and susceptibility pattern of isolates.
Antimicrobial susceptibility of urinary isolates and prescribing practices of empirical antimicrobials in patients with urinary tract infection in a tertiary care hospital
(Sri Lanka College of Microbiologists, 2009) Wijekoon, C.N.; Dassanayake, K.M.M.P.; Perera, W.P.M.H.; Pathmeswaran, A.
OBJECTIVE: Knowledge of local antimicrobial susceptibility is essential for prudent empiric therapy of urinary tract infection (DTI). We sought to describe antimicrobial susceptibility patterns in in-ward patients with UTI and compare it with prescribing practices. METHODS: A descriptive study was conducted at the Colombo North Teaching Hospital in consecutive patients with a positive urine culture between January 2007 and July 2008. Sensitivity testing was done using Joan Stokes method. RESULTS: Coliforms were the commonest (89.6%) isolates in 1206 specimens. The susceptibility was as follows; nitrofurantoin - 83.9% jgentamicin - 74.3%, coamoxiclav - 69.7%, cefalexin - 57.8%, norfloxacin - 57.7%, ciprofloxacin - 50%, cotrimoxazole-37.5%, ampicillin -23.3%. Clinical data analysed for 259 (females -67,95%,^12 years - 95.2%). 25.1% didn't receive empirical antimicrobials. Among the 194 who received an antimicrobial 52.1% received ciprofloxacin and 11.3% received nitrofurantoin. Concordance between the empirical antibiotic prescribed and the sensitivity of the isolated organism was seen only in 21.7%. In 16.5% urinary isolate was resistant to the empirical antibiotic and in 61.8% empirical antibiotic was not included in sensitivity testing. Overall, sensitivity of ciprofloxacin and nitrofurantoin was tested in 6.7% (susceptibility rate - 50%) and 94.3% (susceptibility rate - 83.9%), respectively. CONCLUSIONS: Coliforms were the commonest isolate irrespective of the origin, site and type of DTI. Resistance was high (£50%) to ampicillin, cotrimoxazole and ciprofloxacin. Ciprofloxacin was the most frequently prescribed empiric therapy but its sensitivity was tested in less than 10%. Despite high susceptibility rate nitrofurantoin was underutilised. There was obvious discrepancy between empirical prescribing practices and both the susceptibility pattern of isolates and sensitivity testing practices.
Antimicrobial susceptibility patterns and empirical prescribing practices in adult in patients with urinary tract infection: is there a need for changing clinical practices?
(Sri Lankan Society for Microbiology, 2014) Wijekoon, C.N.; Dassanayake, K.M.M.P.; Pathmeswaran, A.
Introduction: Knowledge of local antimicrobial susceptibility is essential for prudent empiric therapy for urinary tract infection (UTI).The aim of this study was to describe antimicrobial susceptibility patterns and empirical prescribing practices in adult in patients with UTI. Methods: The study was carried out at a tertiary care hospital in Sri Lanka. Data was collected prospectively from consecutive adult in patients with positive urine culture and clinical features compatible with UTI. Sensitivity testing was done using Joan Stokes method. The etiological uropathogens, antibiotic susceptibility rates, association between antimicrobial susceptibility rates and background variables and empirical prescribing practices were analyzed. Results: 745 subjects were studied. Mean (SD) age was 48.2 (19) years and 441(59.2%) were females. Coliforms were the commonest isolates (85.6%). Overall, 76.8% of the isolates were susceptible to nitrofurantoin. (coliforms-74.9%; Streptococcus spp.-100%; Staphylococcus spp.-95.6%). Overall susceptibility was < 50%, to many antimicrobials. Among coliforms and pseudomonas isolates susceptibility to ciprofloxacin was 37.7% and 29.4% respectively. The susceptibility rates of coliforms varied according to age, gender, origin of UTI and presence of co-morbidities. 381(51.1%) subjects received empirical antimicrobials. Ciprofloxacin was the most frequently prescribed empirical antimicrobial (208/381; 54.6%). Despite high susceptibility nitrofurantoin was prescribed in 9.2% only. Conclusions: Susceptibility was low to many first line and second line antimicrobials used to treat UTI in adults. There was obvious discrepancy between empirical prescribing practices and the susceptibility pattern of isolates. Incorporation of local surveillance data in to clinical practice will be useful to optimize the use of empirical antimicrobial therapy. DOI: http://dx.doi.org/10.4038/sljid.v4i1.6229 Keywords: Urinary tract infection, Antimicrobial susceptibility, Resistance, Empirical DOI: 10.4038/sljid.v4i1.6229
Central nervous system infections in a tertiary care hospital: disease patterns and difficulties in diagnosis
(Sri Lanka Medical Association, 2011) Ranawaka, U.K.; Harshani, M.L.; Fonseka, V.N.R.M.; Hathagoda, K.L.W.; Nawaratne, A.N.H.M.U.K.G.D.B.; Weerasooriya, W.A.L.K.; Samarakoon, S.M.S.B.; Thirumawalawan, K.; Premawansa, G.; Fernando, M.A.M.; de Silva, L.; Perera, K.V.H.K.K.; Dassanayake, K.M.M.P.; Wijesooriya, T.; Rajindrajith, E.G.D.S.
INTRODUCTION AND OBJECTIVES: Central nervous system (CNS) infections produce high morbidity and mortality, and effective treatment and outcome depend on precise microbiological diagnosis. We aimed to describe the pattern of CNS infections and accuracy of diagnosis in patients presenting to a tertiary care hospital. METHODS: We prospectively studied patients with suspected CNS infection admitted to medical and paediatric units of Colombo North Teaching Hospital over three years. Data related to demographic and clinical features, laboratory findings, treatment and immediate outcome. Diagnosis of CNS infection was categorised as definite, probable, possible, and uncertain. RESULTS: 426 patients (293 adults, 133 children) were studied [57.2% males, mean age (SD) years-adults 44(20), children 4(3.15)]. Of them, 27.5% had received antibiotics before admission. Blood cultures were done in 149 (35%) and only 14 were positive. Lumbar puncture was done in 347 (81.4%). CSF culture was positive only in two patients. CSF Gram stains and TB-PCR were all negative. The likely diagnosis was meningitis in 35.4%, encephalitis in 10.6% and a non-specific 'meningo-encephalitis' in 16.7%. A 'definite' microbiological diagnosis was made only in five patients. Diagnosis was considered 'probable' in, 53.7%, 'possible' in 8.7%, and 'uncertain' in 14.8%. An alternative diagnosis was found in 22% (13.6% adults, 40.6% children). Intravenous antibiotics (86.8%) and acyclovir (42.5%) were widely used on empiric grounds. CONCLUSIONS: Diagnosis of CNS infections is highly unsatisfactory with available facilities, even in a tertiary care setting. Better facilities are needed to improve aetiological diagnosis, and are likely to improve care and minimise treatment costs.
Clinical profile and difficulties in diagnosis of central nervous system infections in adult patients in a tertiary care hospital
(Sri Lanka Medical Association, 2013) Ranawaka, U.K.; Rajindrajith, E.G.D.S.; Perera, K.V.H.K.K.; Dassanayake, K.M.M.P.; Premaratna, B.A.H.R.; de Silva, H.J.
Comparison of clinical criteria and laboratory criteria used for the diagnosis of bacterial vaginosis
(Sri Lanka College of Microbiologists, 2013) Mendis, K.H.C.; Dassanayake, K.M.M.P.; Kasturiratne, A.; Ginige, S.
OBJECTIVES: To determine the prevalence of BV among women who present with vaginal discharge.To determine the usefulness of Amsel's clinics' criteria to diagnose BV by comparing it with the Nugent criteria, which is the gold standard. METHODOLOGY: 300 patients who presented with vaginal discharge to the sexually transmitted diseases (STD) clinic, gynecology clinics and gynecology wards at North Colombo Teaching Hospital,Ragama and STD clinic -Colombo, between 1 st January 2011 to 30th April 2011 were included in the study Four high vaginal swabs were collected during the speculum examination and examined according to the Amsel's and Nugent's criteria. Appearance of the vaginal discharge was observed. RESULTS: The prevalence of BV among women who presented with vaginal discharge was 25.3% (76/300) by the Nugent's method. Among the women with vaginal discharge BV was diagnosed more in STD group which is 33.8% (52/ 154) compared to the non STD group which is 16.4% (24/146). The sensitivity, specificity, positive and negative predictive values were calculated to assess the validity of the Amsel's method considering the Nugent's criteria as the goid standard. Diagnosis of BV by performing Amsel's method exhibit a low sensitivity (55.3%) and high proportion of false positives (positive predictive value-59.2%) when compared against Nugent's method. CONCLUSIONS: The Amsel's method is not a satisfactory method to be used as a diagnostic tesffor BV. At present BV is diagnosed by examining the nature of vaginal discharge or by using some of the Amsel's criteria. As we have found that Amsel's criteria cannot diagnose BV satisfactorily, we have to establish Nugent's method to diagnose BV in Sri Lanka.
Dengue viral myositis complicated with Rhabdomyolysis and superinfection of Methicillin-resistant Staphylococcus aureus
(Hindawi Pub. Corp, 2013) Sunderalingam, V.; Kanapathipillai, T.; Edirisinghe, P.A.S.; Dassanayake, K.M.M.P.; Premawansa, I.H.G.S.
Dengue is endemic in Sri Lanka and the physician should be aware of different and unusual presentation of the illness. Rhabdomyolysis is a well-known complication following many viral and bacterial infections; however, only a few cases have been reported with dengue viral infections. Further occurrence of coinfection by dengue and bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) has been underestimated, and few reports have been published so far. This case describes a 17-year-old boy who presented with prolonged severe myalgia, dark red urine, and a febrile illness that was diagnosed as having dengue viral myositis, dark red urine, and a febrile illness that was diagnosed as having dengue viral myositis complicated with rhabdomyolysis and super infection of MRSA. Despite intensive care management, he died due to multiorgan failure. Autopsy and serological studies confirmed the diagnosis. This case stresses that red-coloured urine in dengue patients is not always due to haematuria, and if a patient's vital signs do not respond to appropriate fluid management in DHF, sepsis from a secondary pathogen including MRSA should be suspected.
The Utility of the ALT: AST ratio as an early screening test for dengue fever
(Sri Lanka Medical Association, 2010) de Silva, A.P.; Keragala, B.S.D.P.; Kasturiratne, A.; Kumarasena, R.S.; Dassanayake, A.S.; Premaratna, R.; Dassanayake, K.M.M.P.; de Silva, H.J.
OBJECTIVES: Early diagnosis of dengue infection is important to reduce morbidity and mortality. The widely used antibody test becomes positive only after the fifth day of fever, and viral diagnosis by PCR is expensive and not widely available. Liver transaminases are commonly elevated in dengue, and the aspartate aminotransferase: alanine aminotransferase (AST: ALT) ratio is >1. This study was done to determine the utility of the AST/ALT ratio >1 as a test to detect dengue infection early. Methods: We recruited all patients aged 18 to 65 years who were not pregnant, with fever less than three days admitted to hospital from September 2009 to January 2010 during the current dengue epidemic. In addition to routine invetigations and management, all patients had liver transaminases (AST and ALT) measured on day 3, and dengue IgM antibody on day five of the illness. Statistical analysis was performed using SPSS 16. RESULTS: 117 patients [65 males; mean age 32 years (SD =14.7)] were recruited. 83/117 (70.9%) were confirmed as dengue infection. AST: ALT >1 was significantly more common in dengue compared to other short duration fevers (75/83 vs 13/34, pO.OOl; Chi squared test). AST: ALT ratio >1 on day 3 had a sensitivity of 90.4% and specificity of 61.8% to detect dengue. The positive predictive value and negative predictive value of the ratio were 85.2% and 72.4% respectively. CONCLUSIONS: AST/ALT ratio seems a useful test to differentiate dengue fever from other short duration febrile illnesses in an epidemic setting.