Purpose: Needle-stick injury (NSI) is one of the most potential occupational hazards for healthcare workers because of the transmission of blood-borne pathogens. As per recent data, around 30 lakh healthcare workers s...Purpose: Needle-stick injury (NSI) is one of the most potential occupational hazards for healthcare workers because of the transmission of blood-borne pathogens. As per recent data, around 30 lakh healthcare workers sustain Needle stick injuries each year. This study was conducted to assess healthcare workers’ knowledge, attitude and practices regarding needle stick injury. Materials & Methods: A cross-sectional study was conducted in a Tertiary Care Hospital over the period of 3 months. The study population consisted of Intern Doctors, Post Graduate resident Doctors, Staff Nurses, laboratory technicians of Government Medical College and New Civil Hospital, Surat (n = 300). The data were collected using a self-administered questionnaire via the means of Google Forms. Questionnaire was made with prior review literature. The data obtained were entered and analysed in Microsoft Excel. Results: The prevalence of NSI in our study was 46%, with a higher prevalence among the PG residents (72%). Overall scores regarding knowledge and attitude were better in PG residents (knowledge score > 7 in 71% and Attitude Score > 7 in 68% of PG Residents). Even though the PG residents scored highest in the knowledge category, the majority of them suffered needle stick injuries as a result of poor practice scores. Among those who had NSI (n = 139/300), 70% of study participants had superficial injuries, only 9% reported the incident, 18% got medical attention within 2 hours of the incident, and 7% followed up to recheck their viral markers status. Most incidents of NSI were due to hypodermic needles while recapping needles. Conclusion: Exposure to needle stick injuries and their underreporting remains a common problem. It is imperative that healthcare workers receive regular training on the proper handling of sharp objects. We can also draw the conclusion that preventing NSIs requires putting knowledge into practice.展开更多
Tuberculosis is one of the most important infectious diseases in our country. Also nosocomial infection by tuberculosis can occur, which can be prevented by implementing simple, effective and affordable tuberculosis i...Tuberculosis is one of the most important infectious diseases in our country. Also nosocomial infection by tuberculosis can occur, which can be prevented by implementing simple, effective and affordable tuberculosis infection control measures in health care facilities. To evaluate the effectiveness of infection control measures, such study was planned. Questionnaires were administered to all doctors, healthcare workers and servants working in outdoor and indoor department of tuberculosis at tertiary care hospital to assess the knowledge, attitudes and practices on prevention and control of Tuberculosis infection. A scoring system was devised to grade them. One-time audit was also done in outpatient and inpatient department. The analysis showed scoring of poor for doctors, good for nurses and poor forward aids. There is a need to develop strategies for training of health care workers on regular basis in order to reduce the incidence of nosocomial infections. Audit result shows a good level of environmental control measures. Better knowledge, attitude and practices are helpful for the prevention and control of tuberculosis. Also environmental control measures are helpful to prevent infection.展开更多
Introduction: Multi-drug resistant tuberculosis (MDR-TB) that is the tuberculosis that is resistant to at least 2 of the first line anti-tuberculosis drugs is fatal infectious disease. Cases of MDR-TB are now increasi...Introduction: Multi-drug resistant tuberculosis (MDR-TB) that is the tuberculosis that is resistant to at least 2 of the first line anti-tuberculosis drugs is fatal infectious disease. Cases of MDR-TB are now increasing with 30,000 cases of MDR-TB reported in 2013 by national TB programme. Rapid diagnosis of MDR-TB is extremely important for rapid treatment of patient and to prevent spread of MDR-TB to other. BACTEC 960 system helps in rapid diagnosis but purchase of expensive instrument for the same is the limitation. However, the same purpose can be solved by use of semi-automated MGIT system. Aims and Objectives: Aim of this study is to do drug sensitivity testing of the first line anti-tuberculosis drugs with the use of semi-automated MGIT systems. 350 newly registered and suspected cases of tuberculosis in tertiary care hospital were included. Samples were processed for digestion and decontamination and inoculated in MGIT tubes and also on LJ medium. Reading was taken using semi-automated MGIT system. Positive tubes were confirmed by rapid test for M. tuberculosis and then drug sensitivity was performed. Result: Out of 350 samples, 62% were sputum;33% were pleural fluid and rest 5% were lymph node, Ascetic fluid, CSF, pus. Average day of positivity by MGIT was 13 - 20 days as compared to 25 - 37 days by solid medium, which was statistically significant with p value Conclusion: Manual MGIT System is a simple, efficient, safe to use diagnostic system. It does not require any expensive/special instrumentation other than the UV lamp for detection of fluorescence. The rapidity by which mycobacteria are detected is the most important advantage of the Manual MGIT. In areas with limited resources where purchase of expensive instruments such as the MGIT960 is out of scope, the use of manual MGIT for rapid susceptibility testing for MDR-TB could be a possibility.展开更多
Background: Tuberculosis is a highly infectious disease and India has the highest burden with it. Diagnosis of tuberculosis in many countries is still dependent on microscopy. Although its sensitivity is low in compar...Background: Tuberculosis is a highly infectious disease and India has the highest burden with it. Diagnosis of tuberculosis in many countries is still dependent on microscopy. Although its sensitivity is low in comparison to culture and molecular methods, its sensitivity can still be improved by using fluorescence staining method and processing of samples by homogenization and concentration method. Material and methods: Samples were collected from all newly registered suspected cases of tuberculosis in tertiary care hospital from outward and indoor department during a period of one year. Smears were prepared for Ziehl Neelsen stain and fluorescence stain both before and after homogenization and concentration procedure by 4% NAOH-2.9% sodium citrate method and results of them were interpreted according to RNTCP criteria for grading of sputum samples. All the samples were cultured in liquid culture MGIT system (Mycobacterial Growth Indicator Tube) and results of microscopy were compared with liquid culture taken as gold standard. Data were analyzed by using SPSS software version 16. Result: 350 samples were collected during study period. Out of 350 samples, 48 samples were positive for M. tuberculosis by MGIT system. In comparison with MGIT system, sensitivity of Z N stain for detection of acid fast bacilli was 77% before decontamination procedure, which was increased up to 85.42% after decontamination and concentration process. Sensitivity of fluroscence stain was 85.42% before processing, which was increased up to 91.67% after processing of samples. Conclusion: Sensitivity of smear microscopy can be enhanced by use of fluroscence microscopy and concentration method.展开更多
Haemophilus species are Gram-negative coccobacilli that require factor X and factor V for growth. Beyond this, it is a finicky bacterium to culture, and any modification of culture procedures greatly reduces isolation...Haemophilus species are Gram-negative coccobacilli that require factor X and factor V for growth. Beyond this, it is a finicky bacterium to culture, and any modification of culture procedures greatly reduces isolation rates. Poor quality of laboratories in developing countries results in its poor isolation rates. This study was done with the objective of finding out the optimal cultural environment and media so that it could be maintained for a longer period in economical settings like ours which was done using H. influenzae ATCC 49,766. In this study, several culture media were tested as a means to preserve H. influenzae ATCC like TSB + glycerol + sheep blood, BHI broth, BHI broth + glycerol, BHI broth+ glycerol + sheep blood, Chocolate agar slant and satellitism plate. Three sets of respective media were inoculated with 18 - 24 hours growth of H. influenzae. They were incubated at 37?oC 48 hours in a candle extinction jar. The media were checked for growth by subculturing them on chocolate agar plates and identified by biochemical reactions. Each set was maintained at 2 oC - 8?oC, -20?oC and at room temperature and checked for the viability 24 hourly by subculturing them on chocolate agar. Results showed best growth of H. influenza on chocolate agar slants for 15 - 20 days, followed by BHI + glycerol + sheep blood broth and satellitism plate for 4 - 6 days followed by BHI broth for 2 - 4 days. There was no growth in TSB + glycerol + sheep blood broth and BHI + glycerol broth media. Present study showed similar results as done by NS Srikanth et al. 2003 with growth on chocolate agar & satellitism plate for 3 - 5 days but no growth in TSB + Glycerol + Sheep blood broth media. Chocolate agar slant is by far the most long term preserving media for H. influenzae. However, growth on BHI broth with various modifications is also showed a good preservation for 3 - 5 days, so with further experiments we can hope to maintain the organism in these media also.展开更多
Context: MIC results can be misleading for treatment of biofilm associated. The Minimum Biofilm Eradication Concentration (MBEC) measures the determination to be made for a biofilm susceptibility to antibiotics. Aims:...Context: MIC results can be misleading for treatment of biofilm associated. The Minimum Biofilm Eradication Concentration (MBEC) measures the determination to be made for a biofilm susceptibility to antibiotics. Aims: Assessment of biofilm production and comparison of the MIC and MBEC assays evaluate differences in the antibiotic sensitivity patterns of different clinical bacterial isolates from patients implanted with medical devices. Settings and Design: Random sampling with experimental study at tertiary care institute. Methods and Material: The study was carried out during January 2014 to March 2014 on 50 positive bacteriological cultures of medical devices which were inserted in hospitalized patients. Biofilm forming strains were identified by tissue culture plate method & tube method. Biofilm-producing and non-biofilm forming reference strains were used as controls. Assay has been developed for the use with flat bottom, 96-well microtiter plates. Sterile autoclaved PCR tubes were used as pegs which provided surface for the biofilm formation. Amikacin, ciprofloxacin, trimethoprim-sulfamethoxazole, vancomycin, cefoperazone/ sulbactam, gentamycin were tested for MIC and MBEC assay. Statistical Analysis Used: Results will be discussed in the form of percentages. Results: Colonization by Klebsiella pneumoniae, Acinetobacter baumanni and Pseudomonas aeruginosa was prevalent bacterial isolates in medical devices. MBEC was higher for all the antibiotics as compared to MIC except amikacin MBEC for Pseudomonas was the same as MIC. Conclusions: Device associated bacterial biofilms are the major source of infections in patients of critical care setup. MIC misleads physician for organism’s drug susceptibility testing, which results in therapeutic failure. MBEC can guide regarding choice and proper dosing of antibiotics to be given. That’s why major studies for similar testing should be done with clinical evaluation.展开更多
Introduction: Tuberculosis is a major cause of mortality and morbidity world-wide. Anti-tuberculosis drugs have been used for many decades but resistance to them is now widespread. Globally 5% of tuberculosis cases an...Introduction: Tuberculosis is a major cause of mortality and morbidity world-wide. Anti-tuberculosis drugs have been used for many decades but resistance to them is now widespread. Globally 5% of tuberculosis cases and in India 3% among new TB cases. This study was planned to know the pattern of first line anti-tuberculosis drug resistance in south Gujarat, Surat region in newly diagnosed patients of tuberculosis. Material and Methods: 350 samples were processed for homogenisation and concentration using 4% NAOH-2.9% trisodium citrate. Processed samples were inoculated in liquid medium that is MGIT (Mycobacterial growth indicator tube). Positive samples for M. tbwere processed further for first line anti-tuberculosis drugs sensitivity testing (DST). Reading was taken by using MicroMGIT system. Result: Out of 350 samples 59 (17%) were positive samples, of which 48 (13%) were M. tb and 11 (3%) were non tuberculous mycobacteria. Out of 48 samples 2% (1 isolate) was resistant to isoniazid and Rifampicin while 2% were monoresistant to isoniazide, 2% monoresistant to streptomycin. No rifampicin monoresistant was detected. Conclusion: Such study may help in control of tuberculosis at regional and national level which would in turn help in planning of measures to control Multi-drug resistance tuberculosis. Continuous surveillance should be applied to know the periodic changing patterns and trend in Drug resistant tuberculosis.展开更多
It is necessary to determine the susceptibility pattern of clinical isolates especially nosocomial one in the clinical settings for making strategy for effective empirical treatment & to reduce incidence of multid...It is necessary to determine the susceptibility pattern of clinical isolates especially nosocomial one in the clinical settings for making strategy for effective empirical treatment & to reduce incidence of multidrug resistant bugs. Aim of this study was to detect the antimicrobial susceptibility pattern of P. aeruginosa isolates from clinical samples between January 2014 to December 2015, received at department of Microbiology, GMC, Surat. Clinical isolates were confirmed as P. aeruginosa by phenotypic methods/Vitek2 compact system as per availability. Genetic sequencing could not be performed due to unavailability. Antimicrobial susceptibility tests were performed by Kirby-Bauer disc diffusion method/Vitek2 compact system & Interpretation was done according Clinical and Laboratory Standards Institute (CLSI) of that year [1] [2]. Seven hundred fifty seven P. aeruginosa strains were studied during the study period. Most of the isolates were from surgery ward (62%), followed by orthopaedic ward (15%). 65% of the total isolates were from swab samples followed by urine (7%), pus, fluid (5%) & devices (4%). 60% isolates were resistant to Ceftazidime & for other drugs resistance pattern was as follows: Cefepime (52%), Levofloxacin (49%), Ticarcillin/clavulanic acid (49%), Meropenem & Gentamycin (44%), Ciprofloxacin (43%), Amikacin (41%), Tobramycin (39%), Netlimycin (36%), Piperacillin (32%), Aztreonam (31%), Piperacillin/tazobactam (26%), Imipenem (23%) , Doripenem (12%) & Gatifloxacin (10%). As there is predominance of isolates from surgical ward in present study & resistance to carbapenem group of drugs was also found, indicating that most of the infection caused by Pseudomonas aeruginosa may be nosocomial.展开更多
文摘Purpose: Needle-stick injury (NSI) is one of the most potential occupational hazards for healthcare workers because of the transmission of blood-borne pathogens. As per recent data, around 30 lakh healthcare workers sustain Needle stick injuries each year. This study was conducted to assess healthcare workers’ knowledge, attitude and practices regarding needle stick injury. Materials & Methods: A cross-sectional study was conducted in a Tertiary Care Hospital over the period of 3 months. The study population consisted of Intern Doctors, Post Graduate resident Doctors, Staff Nurses, laboratory technicians of Government Medical College and New Civil Hospital, Surat (n = 300). The data were collected using a self-administered questionnaire via the means of Google Forms. Questionnaire was made with prior review literature. The data obtained were entered and analysed in Microsoft Excel. Results: The prevalence of NSI in our study was 46%, with a higher prevalence among the PG residents (72%). Overall scores regarding knowledge and attitude were better in PG residents (knowledge score > 7 in 71% and Attitude Score > 7 in 68% of PG Residents). Even though the PG residents scored highest in the knowledge category, the majority of them suffered needle stick injuries as a result of poor practice scores. Among those who had NSI (n = 139/300), 70% of study participants had superficial injuries, only 9% reported the incident, 18% got medical attention within 2 hours of the incident, and 7% followed up to recheck their viral markers status. Most incidents of NSI were due to hypodermic needles while recapping needles. Conclusion: Exposure to needle stick injuries and their underreporting remains a common problem. It is imperative that healthcare workers receive regular training on the proper handling of sharp objects. We can also draw the conclusion that preventing NSIs requires putting knowledge into practice.
文摘Tuberculosis is one of the most important infectious diseases in our country. Also nosocomial infection by tuberculosis can occur, which can be prevented by implementing simple, effective and affordable tuberculosis infection control measures in health care facilities. To evaluate the effectiveness of infection control measures, such study was planned. Questionnaires were administered to all doctors, healthcare workers and servants working in outdoor and indoor department of tuberculosis at tertiary care hospital to assess the knowledge, attitudes and practices on prevention and control of Tuberculosis infection. A scoring system was devised to grade them. One-time audit was also done in outpatient and inpatient department. The analysis showed scoring of poor for doctors, good for nurses and poor forward aids. There is a need to develop strategies for training of health care workers on regular basis in order to reduce the incidence of nosocomial infections. Audit result shows a good level of environmental control measures. Better knowledge, attitude and practices are helpful for the prevention and control of tuberculosis. Also environmental control measures are helpful to prevent infection.
文摘Introduction: Multi-drug resistant tuberculosis (MDR-TB) that is the tuberculosis that is resistant to at least 2 of the first line anti-tuberculosis drugs is fatal infectious disease. Cases of MDR-TB are now increasing with 30,000 cases of MDR-TB reported in 2013 by national TB programme. Rapid diagnosis of MDR-TB is extremely important for rapid treatment of patient and to prevent spread of MDR-TB to other. BACTEC 960 system helps in rapid diagnosis but purchase of expensive instrument for the same is the limitation. However, the same purpose can be solved by use of semi-automated MGIT system. Aims and Objectives: Aim of this study is to do drug sensitivity testing of the first line anti-tuberculosis drugs with the use of semi-automated MGIT systems. 350 newly registered and suspected cases of tuberculosis in tertiary care hospital were included. Samples were processed for digestion and decontamination and inoculated in MGIT tubes and also on LJ medium. Reading was taken using semi-automated MGIT system. Positive tubes were confirmed by rapid test for M. tuberculosis and then drug sensitivity was performed. Result: Out of 350 samples, 62% were sputum;33% were pleural fluid and rest 5% were lymph node, Ascetic fluid, CSF, pus. Average day of positivity by MGIT was 13 - 20 days as compared to 25 - 37 days by solid medium, which was statistically significant with p value Conclusion: Manual MGIT System is a simple, efficient, safe to use diagnostic system. It does not require any expensive/special instrumentation other than the UV lamp for detection of fluorescence. The rapidity by which mycobacteria are detected is the most important advantage of the Manual MGIT. In areas with limited resources where purchase of expensive instruments such as the MGIT960 is out of scope, the use of manual MGIT for rapid susceptibility testing for MDR-TB could be a possibility.
文摘Background: Tuberculosis is a highly infectious disease and India has the highest burden with it. Diagnosis of tuberculosis in many countries is still dependent on microscopy. Although its sensitivity is low in comparison to culture and molecular methods, its sensitivity can still be improved by using fluorescence staining method and processing of samples by homogenization and concentration method. Material and methods: Samples were collected from all newly registered suspected cases of tuberculosis in tertiary care hospital from outward and indoor department during a period of one year. Smears were prepared for Ziehl Neelsen stain and fluorescence stain both before and after homogenization and concentration procedure by 4% NAOH-2.9% sodium citrate method and results of them were interpreted according to RNTCP criteria for grading of sputum samples. All the samples were cultured in liquid culture MGIT system (Mycobacterial Growth Indicator Tube) and results of microscopy were compared with liquid culture taken as gold standard. Data were analyzed by using SPSS software version 16. Result: 350 samples were collected during study period. Out of 350 samples, 48 samples were positive for M. tuberculosis by MGIT system. In comparison with MGIT system, sensitivity of Z N stain for detection of acid fast bacilli was 77% before decontamination procedure, which was increased up to 85.42% after decontamination and concentration process. Sensitivity of fluroscence stain was 85.42% before processing, which was increased up to 91.67% after processing of samples. Conclusion: Sensitivity of smear microscopy can be enhanced by use of fluroscence microscopy and concentration method.
文摘Haemophilus species are Gram-negative coccobacilli that require factor X and factor V for growth. Beyond this, it is a finicky bacterium to culture, and any modification of culture procedures greatly reduces isolation rates. Poor quality of laboratories in developing countries results in its poor isolation rates. This study was done with the objective of finding out the optimal cultural environment and media so that it could be maintained for a longer period in economical settings like ours which was done using H. influenzae ATCC 49,766. In this study, several culture media were tested as a means to preserve H. influenzae ATCC like TSB + glycerol + sheep blood, BHI broth, BHI broth + glycerol, BHI broth+ glycerol + sheep blood, Chocolate agar slant and satellitism plate. Three sets of respective media were inoculated with 18 - 24 hours growth of H. influenzae. They were incubated at 37?oC 48 hours in a candle extinction jar. The media were checked for growth by subculturing them on chocolate agar plates and identified by biochemical reactions. Each set was maintained at 2 oC - 8?oC, -20?oC and at room temperature and checked for the viability 24 hourly by subculturing them on chocolate agar. Results showed best growth of H. influenza on chocolate agar slants for 15 - 20 days, followed by BHI + glycerol + sheep blood broth and satellitism plate for 4 - 6 days followed by BHI broth for 2 - 4 days. There was no growth in TSB + glycerol + sheep blood broth and BHI + glycerol broth media. Present study showed similar results as done by NS Srikanth et al. 2003 with growth on chocolate agar & satellitism plate for 3 - 5 days but no growth in TSB + Glycerol + Sheep blood broth media. Chocolate agar slant is by far the most long term preserving media for H. influenzae. However, growth on BHI broth with various modifications is also showed a good preservation for 3 - 5 days, so with further experiments we can hope to maintain the organism in these media also.
文摘Context: MIC results can be misleading for treatment of biofilm associated. The Minimum Biofilm Eradication Concentration (MBEC) measures the determination to be made for a biofilm susceptibility to antibiotics. Aims: Assessment of biofilm production and comparison of the MIC and MBEC assays evaluate differences in the antibiotic sensitivity patterns of different clinical bacterial isolates from patients implanted with medical devices. Settings and Design: Random sampling with experimental study at tertiary care institute. Methods and Material: The study was carried out during January 2014 to March 2014 on 50 positive bacteriological cultures of medical devices which were inserted in hospitalized patients. Biofilm forming strains were identified by tissue culture plate method & tube method. Biofilm-producing and non-biofilm forming reference strains were used as controls. Assay has been developed for the use with flat bottom, 96-well microtiter plates. Sterile autoclaved PCR tubes were used as pegs which provided surface for the biofilm formation. Amikacin, ciprofloxacin, trimethoprim-sulfamethoxazole, vancomycin, cefoperazone/ sulbactam, gentamycin were tested for MIC and MBEC assay. Statistical Analysis Used: Results will be discussed in the form of percentages. Results: Colonization by Klebsiella pneumoniae, Acinetobacter baumanni and Pseudomonas aeruginosa was prevalent bacterial isolates in medical devices. MBEC was higher for all the antibiotics as compared to MIC except amikacin MBEC for Pseudomonas was the same as MIC. Conclusions: Device associated bacterial biofilms are the major source of infections in patients of critical care setup. MIC misleads physician for organism’s drug susceptibility testing, which results in therapeutic failure. MBEC can guide regarding choice and proper dosing of antibiotics to be given. That’s why major studies for similar testing should be done with clinical evaluation.
文摘Introduction: Tuberculosis is a major cause of mortality and morbidity world-wide. Anti-tuberculosis drugs have been used for many decades but resistance to them is now widespread. Globally 5% of tuberculosis cases and in India 3% among new TB cases. This study was planned to know the pattern of first line anti-tuberculosis drug resistance in south Gujarat, Surat region in newly diagnosed patients of tuberculosis. Material and Methods: 350 samples were processed for homogenisation and concentration using 4% NAOH-2.9% trisodium citrate. Processed samples were inoculated in liquid medium that is MGIT (Mycobacterial growth indicator tube). Positive samples for M. tbwere processed further for first line anti-tuberculosis drugs sensitivity testing (DST). Reading was taken by using MicroMGIT system. Result: Out of 350 samples 59 (17%) were positive samples, of which 48 (13%) were M. tb and 11 (3%) were non tuberculous mycobacteria. Out of 48 samples 2% (1 isolate) was resistant to isoniazid and Rifampicin while 2% were monoresistant to isoniazide, 2% monoresistant to streptomycin. No rifampicin monoresistant was detected. Conclusion: Such study may help in control of tuberculosis at regional and national level which would in turn help in planning of measures to control Multi-drug resistance tuberculosis. Continuous surveillance should be applied to know the periodic changing patterns and trend in Drug resistant tuberculosis.
文摘It is necessary to determine the susceptibility pattern of clinical isolates especially nosocomial one in the clinical settings for making strategy for effective empirical treatment & to reduce incidence of multidrug resistant bugs. Aim of this study was to detect the antimicrobial susceptibility pattern of P. aeruginosa isolates from clinical samples between January 2014 to December 2015, received at department of Microbiology, GMC, Surat. Clinical isolates were confirmed as P. aeruginosa by phenotypic methods/Vitek2 compact system as per availability. Genetic sequencing could not be performed due to unavailability. Antimicrobial susceptibility tests were performed by Kirby-Bauer disc diffusion method/Vitek2 compact system & Interpretation was done according Clinical and Laboratory Standards Institute (CLSI) of that year [1] [2]. Seven hundred fifty seven P. aeruginosa strains were studied during the study period. Most of the isolates were from surgery ward (62%), followed by orthopaedic ward (15%). 65% of the total isolates were from swab samples followed by urine (7%), pus, fluid (5%) & devices (4%). 60% isolates were resistant to Ceftazidime & for other drugs resistance pattern was as follows: Cefepime (52%), Levofloxacin (49%), Ticarcillin/clavulanic acid (49%), Meropenem & Gentamycin (44%), Ciprofloxacin (43%), Amikacin (41%), Tobramycin (39%), Netlimycin (36%), Piperacillin (32%), Aztreonam (31%), Piperacillin/tazobactam (26%), Imipenem (23%) , Doripenem (12%) & Gatifloxacin (10%). As there is predominance of isolates from surgical ward in present study & resistance to carbapenem group of drugs was also found, indicating that most of the infection caused by Pseudomonas aeruginosa may be nosocomial.
