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Introduction: Healthcare management is undergoing significant changes with the evolution of new and re-emerging infections. A clinical microbiologist plays an important role in giving an accurate and timely report to the clinicians. Quality Indicators (QIs) act as a measure of the quality of services offered by the laboratory and are tools to monitor and evaluate the laboratory's performance throughout the Total Testing Process (TTP). Aim: To measure the performance of the clinical bacteriology laboratory using QIs. Materials and Methods: A retrospective study was conducted in the Department of Microbiology at Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India. The study evaluated QIs from the records of 94,624 samples received in the bacteriology section of the clinical Microbiology laboratory between January 2018 and March 2021. Data analysis was conducted over a six-month period from December 2021 to May 2022. In 2018, one QI was identified for each phase, with an additional QI added in each phase to the pre-existing QI in 2019. In 2020, a QI was added in the preanalytical phase only. In 2021, the acceptable limit for one preanalytical QI was reduced from 2% to 1%. Data analysis was performed using an Excel sheet. Results: Data from records of 94,624 clinical bacteriology samples collected over 39 months were analyzed retrospectively. The preanalytical indicators included the number of samples rejected (135, 0.14%) and the number of requisition forms with three patient identifiers (59,645, 93.95%). Analytical phase QIs consisted of the average External Quality Assurance Scheme (EQAS) performance score (97.44% from January 2018 to March 2021) and outliers in the Internal Quality Control (IQC) (25 from January 2019 till March 2021). Failures in the IQC were not assessed in 2018. Postanalytical phase QIs included Turnaround Time (TAT) (average of 2.55 days for aerobic growth) and reporting time for critical alerts, which was within 24 hours of alert finding (100% for smear and culture-positive results). Conclusion: Regular monitoring of QIs helps to identify potential errors. This laboratory chose to analyse and monitor its processes using practically feasible QIs. It was found that the laboratory consistently maintained its performance throughout the study period. [ABSTRACT FROM AUTHOR]

A 15-year-old boy presented with a sudden onset of breathlessness for 7 days, gradual loss of weight of 17.6 lbs over the last month and progressive hoarseness of voice for 7 months. The contrast-enhanced computed tomography (CECT) scan revealed a heterogeneously enhancing lesion in the anterior mediastinum with multiple discrete lymph nodes in the cervical and mediastinal locations. The GeneXpert MTB/RIF assay performed on the CT-guided biopsy of the mass was negative, but the culture for Mycobacterium tuberculosis was positive at 7 weeks of incubation. There was a suboptimal radiological response after 6 months of treatment. First-line drug susceptibility testing (DST) performed by line probe assay (LPA) on the positive culture detected high-level resistance to isoniazid. The treatment was modified as per DST results to which the patient responded well. [ABSTRACT FROM AUTHOR]

Background: Ventilator‑associated pneumonia (VAP) in acute respiratory distress syndrome patients is expected in the setting of prolonged mechanical ventilation due to abridged immunity and dysregulation of the microorganisms inhabiting the oral cavity. We conducted this study to identify the spectrum of microorganisms causing VAP in patients admitted to the medicine intensive care unit (MICU) and their antibiotic susceptibility patterns. Materials and Methods: We conducted a retrospective cross‑sectional laboratory‑based study from January 2021 to April 2021. Our cohort included patients with respiratory distress who were admitted to the MICU. We observed the incidence of VAP and the risk factors responsible for multidrug resistance (MDR) microorganisms in the MICU, along with 250‑day survival in the existence of specific comorbidities along with VAP. Results: Clinical charts of patients (n = 366) admitted to the MICU between January 2021 and April 2021 were used. The mean age of patients admitted to MICU was 57.3 ± 18.7 years with a male predominance (n = 252, 68.8%). VAP was diagnosed in 69.1% (n = 253) of patients, and the most common microorganism in our cohort was Klebsiella pneumoniae (n = 78, 30.8%), followed by Acinetobacter spp. (n = 77, 30.4%). None of the K. pneumoniae isolates (n = 0/78) and only a minority of Acinetobacter spp. (n = 4/77, 5.2%) and Pseudomonas aeruginosa isolates(n = 8/54, 14.8%) were susceptible to fluoroquinolones. A higher proportion of K. pneumoniae (n = 1/78, 1.3%), Acinetobacter spp. (n = 2/77, 2.6%), and P. aeruginosa isolates (n = 9/54, 16.7%) were susceptible to aminoglycosides. The incidence rate of MDR microorganisms among the 253 patients diagnosed with VAP was 92.8% (n = 219/253). Conclusion: There is a high prevalence of multidrug resistance (MDR) isolates among those causing VAP in the MICU setting. Knowing the broad spectrum of causative pathogens and their susceptibility to various antibiotics may guide the physician in judicious and appropriate use of antibiotics for treatment. [ABSTRACT FROM AUTHOR]

Background: Meningitis can be attributed to bacterial, fungal, or viral agents. In this study, we demonstrate the common bacterial agents causing meningitis along with their antibiotics susceptibility pattern in patients of all age groups. Material and Methods: This retrospective, observational study was carried out in the Department of Microbiology with cerebrospinal fluid (CSF) samples collected from November 2019 to May 2022. We collected 1986 nonrepeat CSF samples from clinically suspected patients of bacterial meningitis, and clinical information about the patients was extracted from the hospital information system. Results: Out of the 1986 CSF samples included in our study, 150 (7.55%) were found to be positive on bacterial culture. Most of our patients were in the age group of 0-20 years. Common clinical manifestations observed in our patients were: high-grade fever, 87 patients (58%); severe headache, 126 patients (84%); neck rigidity, 47 patients (31.3%); altered mental status, 76 patients (50.7%) and photophobia, 83 patients (55.3%). The most commonly isolated bacteria was Acinetobacter species (30%). The mean length of hospitalization (37.76 ± 25.30), the mean total cell count, high levels of protein (mg/dl) and low levels of glucose (mg/dl) of CSF were statistically significant in meningitis caused by multidrug-resistant bacteria. Conclusion: We recognized the spectrum of pathogens causing meningitis at our center along with the antibiotic resistance pattern to guide and facilitate early treatment by primary health care professionals and family medicine practitioners. [ABSTRACT FROM AUTHOR]

Background: Cerebrospinal infections are the cause of poor prognosis among post-neurosurgery patients owing to delay in improvement of neurological functions, leading to increased length of hospital stay, proceeding to disability or death. Methods and materials: This retrospective observational study was performed at a tertiary care center in Northern India, where all patients with bacterial cerebrospinal infections from July 2019 to July 2022 were evaluated for post-neurosurgery cerebrospinal shunt infections, and all demographic data and risk factors were extracted from the hospital information system (HIS). Results: The study includes 150 (150/1986, 7.55%) culture-confirmed cases of bacterial meningitis out of 1986 cases of suspected bacterial meningitis patients. Ninety-six (96/150, 64.0%) post-neurosurgery patients with cerebrospinal fluid (CSF) leaks were managed using external ventricular drain (EVD) or ventriculo-peritoneal (VP) shunt. Seventy-four (74/96, 77.08%) patients were managed only on EVD, whereas 22 (22/96, 22.92%) patients were managed only on VP shunt. Eighty-two (82/96, 85.4%) multidrug-resistant microorganisms (MDROs)were isolated and 70 (70/82, 85.36%) were Gram-negative bacteria, of which 56 (56/74, 75.68%) Gram-negative bacteria showed extended-spectrum betalactamase (ESBL)-producing character in those with an EVD, 14 (14/22, 63.63%) with a VP shunt. Among Gram-negative bacteria, Acinetobacter baumannii showed high rates of resistance: 21 (21/23, 91.30%) and 8 (8/8, 100%) were ESBL-producing A. baumannii in patients managed on EVD and VP shunt, respectively. Conclusion: This study determines the risk factors, the spectrum of pathogenic microorganisms, multidrug resistance, and the nature of intracranial lesions isolated among the patients who developed bacterial cerebrospinal infections in post-neurosurgery patients. [ABSTRACT FROM AUTHOR]

The genus Aerococcus spp. comprise microaerophilic, catalase-negative, Gram-positive cocci that show alpha-haemolytic growth on blood agar. They have a tendency to divide on two planes at a 90° angle, and rapid multiplication leads to the formation of Grampositive cocci in tetrads and irregular clusters. Aerococcus spp. are capable of causing invasive and fatal systemic illnesses, such as endocarditis, bactereamia, arthritis, and meningitis. Due to evolving diagnostic tools, it is now identified as a pathogen in a variety of disorders instead of being considered a contaminant. Most isolates are susceptible to penicillins, but there is increasing resistance to cephalosporins, ciprofloxacin, cotrimoxazole, clindamycin, vancomycin, and tetracycline. Here, authors present a rare case of Aerococcus viridans meningitis in a patient who underwent surgical excision of a left trigeminal Schwannoma, along with the drug susceptibility pattern resistant to most first-line antibiotics used against isolates from Streptococci spp., except doxycycline. [ABSTRACT FROM AUTHOR]

Background. Among the most significant yet often ignored health issues worldwide are trauma and accidental injuries. India accounts for 11% of global deaths in road accidents, the highest in the world, according to the World Bank report. There are limited data about the bacterial contamination of road traffic accident (RTA) wounds and their antibiotic susceptibility patterns. Materials and Methods. This prospective study was conducted in a tertiary care centre in northern India from January 2023 to January 2024. Wound deep swabs or aspirates were collected from RTA patients with traumatic injuries at different time intervals. Gram stain and culture were performed, and positive aerobic culture was subjected to antibiotic susceptibility testing. Organism identification was done using MALDI-TOF MS and routine biochemical tests. Blood samples were also collected to rule out bloodstream infections during follow-up if the patient became febrile or showed symptoms of systemic infection. Sepsis was defined in those patients who had two or more scores in the systemic inflammatory response syndrome criteria with a positive microbiological culture. Risk factors were evaluated for sepsis on the basis of the patient's vitals, injury characteristics, procalcitonin, Glasgow Coma Scale (GCS) score, need for mechanical ventilation and complete blood count, which were obtained from the patient's admission file. Results. A total of 189 wound samples were collected, of which 99 (52.38%) samples showed the growth of microorganisms. The aerobic isolates included 69 (69.69%) Gram-negative bacilli, of which the majority were Klebsiella pneumoniae , 28 (28.28%) Gram-positive cocci, of which the majority were Staphylococcus aureus and 2 (2.02%) anaerobic isolates. Among the Gram-negative isolates, none of the isolates were resistant to colistin. All S. aureus isolates were susceptible to vancomycin, teicoplanin and levonadifloxacin. Sepsis developed in 50 (26.45 %) patients. Significant risk factors evaluated for sepsis were a raised procalcitonin level, a low GCS score, a higher injury severity score, the need for mechanical ventilation and a raised quick sequential organ failure assessment score. Conclusion. It is essential to ascertain the profile of microorganisms isolated from RTA wounds in order to reduce antibiotic resistance and deliver efficient treatment., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2024 The Authors.)

Introduction: Chryseobacterium species are emerging bacteria capable of causing nosocomial infections in immunocompromised patients or patients with indwelling medical devices., Hypothesis/ Gap Statement: Information about the incidence of Chryseobacterium bacteremia from worldwide literature is limited., Aim: We aimed to recognize the clinical characteristics, frequency of distribution of different Chryseobacterium species isolates, and their antimicrobial susceptibility profile from bloodstream infections., Methods: We performed a retrospective cohort study to identify all isolates of Chryseobacterium species from bloodstream infection from January 2018 to November 2022 at a university hospital in North India., Results: We identified 42 non-duplicate isolates of Chryseobacterium species from bloodstream infection in the duration of our study. Mean age of the patients was 48.35±16.63 years. Men (22/42, 52.2 %) were more commonly affected in comparison to women (20/42, 47.6 %) but the difference was not significant. The most common species identified was C. indologenes (40/42, 95.24 %) followed by C. gleum (2/42, 4.76 %). The co-morbidities commonly encountered in our study were chronic kidney disease (21/42, 50.0 %) followed by diabetes mellitus (12/42, 28.6 %) and chronic obstructive pulmonary disease (8/42, 19.05 %). All patients had intravenous access to medications or fluid management via a central or peripheral line and mechanical ventilation was observed in 39 (39/42, 92.86 %) patients. All the isolates were susceptible to minocycline (100 %), followed by doxycycline (97.6 %) and trimethoprim-sulfamethoxazole (95.2 %)., Conclusion: Chryseobacterium species are capable of causing pneumonia, bacteremia and urinary tract infection in immunocompromised patients. Early diagnosis and prompt treatment with appropriate antibiotics can prevent progression to septicemia., Competing Interests: All authors read and approved the final version of the manuscript., (© 2023 The Authors.)

Introduction: Achromobacter is a Gram-negative, motile, obligate aerobic and non-fermentative bacterium. It is an emerging pathogen in the hospital environment as it is frequently found in various solutions., Hypothesis/gap Statement: Information about the incidence and risk factors of Achromobacter bacteremia from India is limited., Aim: We conducted this study to identify the risk factors and underlying conditions predisposing to bacteremia by Achromobacter spp. and analyse the antibiotic resistance pattern of the isolates., Methodology: We performed a retrospective observational study where automated blood cultures positive for Achromobacter spp. were assessed for clinical characteristics and antibiotic susceptibility patterns from January 2022 to December 2022 in the microbiology laboratory of a tertiary care centre in Northern India., Results: A total of 14 cases (14/2435, 0.57 %) of Achromobacter spp. were identified from bloodstream infections in one year. The mean age of the patients was 37.59±23.17 years with a male predominance (8/14, 57.1 %). All patients were managed on intravenous antibiotics and intravenous access as peripheral line catheters and only 5(5/14, 35.7 %) patients were managed on central line catheters. The isolates were found highly susceptible to ticarcillin-clavulanic acid (14/14, 100.0 %) followed by fluoroquinolones (12/14, 85.72 %) and trimethoprim-sulphamethoxazole (12/14, 85.72 %). Only 57.14 % (8/14, 57.14 %) of the patients were susceptible to piperacillin-tazobactam. The all-cause 40 day mortality was observed in 35.7 % (5/14, 35.7 %) with two deaths that were directly attributable to sepsis., Conclusion: This study provides insight into the incidence of Achromobacter bacteremia at our centre and the necessary antibiotic therapy to combat it., Competing Interests: The authors declare that there are no conflicts of interest., (© 2023 The Authors.)

Objectives: With the objective of establishing a simple, cost-effective, and effective screening tool for the screening of Human Papilloma Virus infection, the study was undertaken., Material Methods: This pilot study was conducted on 20 urine samples of women whose cervical swabs were tested positive while screening for Human papilloma virus in asymptomatic women., Results: HPV genotypes were detected in 94% (16/17) patients in urine samples by real-time PCR while a 100% detection rate (15/15) was observed in the cervical swab samples. The results of the urine and cervical swab samples, tested by the TRUPCR ®HPV high-risk genotyping kit, are shown in Table 2. HPV genotype 68 was found in 82.3% urinary samples and 100% of self-collected vaginal swab samples. Out of 16 positive urine samples, 2 were positive for HPV genotype 16 and 5 were positive for HPV genotype 18, and in cervical swab testing out of 15 positive samples, 3 were positive for HPV genotype 16, and 5 were positive for HPV genotype 18. Diagnostic accuracy of urine was found to be 98.8% (95% CI 79.43% - 100.00%)., Conclusion: This pilot study aims to assess the accuracy of urine samples in the screening of HPV infection among asymptomatic women and establish the distribution of prevalent HPV genotypes. This may further contribute to standardizing the urine and cervical swab testing methods for cervical cancer screening strategies.

Introduction. As the world was still recovering from the 2020 pandemic, the devastating impact of Covid-19 driven by the Delta variant shook the world in 2021. As the second wave was declining, there was an unusual surge in Covid-19 positive cases by the end of 2021 which led to global concern about the change in virus characteristics. Hypothesis/gap statement. Whole genome sequencing is critical for understanding a rapidly progressing pandemic. Aim . To provide an insight into the major differences encountered in the changing characteristics between the second and third waves of the pandemic at a tertiary care hospital in India. Methods. A retrospective observational cohort analysis was conducted on Covid-positive patients during the second wave of the Covid-19 pandemic (from March 2021 to April 2021) and the third wave of the Covid-19 pandemic (from December 2021 to January 2022). Results. Out of 303 Covid-19 positive cases, 52 samples were tested by whole genome sequencing during the second wave and 108 during the third wave. A decline of 18.5 % was observed in the case fatality rate from the second wave to the third wave. There was a 5 % decline in the number of patients admitted with ARDS and a 16.3 % decline in the number of patients with co-morbidities.In total, 51.9 percent of cases were due to the Delta variant during the second wave and 95 percent due to the Omicron variant during the third wave. We found that 36.5 % of Covid-positive patients during the second wave had been vaccinated compared to 40 % in the third wave. Conclusion. Whole genome sequencing of clinical samples from a wide range of individuals during a viral epidemic will enable us to develop a more rapid public health response to new variants and identify the required vaccine modifications more quickly.

Introduction. India is home to the most significant number of tuberculosis (TB) cases around the globe. The COVID-19 crisis has massively affected TB healthcare services in the country. Hypothesis/Gap Statement. Are we sufficiently equipped to fight against TB during emergencies? Aim. Our study aims to provide a true insight into the disruption of TB care during the pandemic period at a tertiary care hospital in India. Methods. A retrospective observational cohort analysis was conducted on 6491 patients who accessed the TB diagnostics at the tertiary care hospital during the study period, i.e. the COVID-19 pandemic period (March 2020 to March 2021) compared with 14 665 in the control period (March 2019 to Feb 2020). Results. Out of the total tested, 3136 patients were notified as new TB cases in the study period than 4370 in the control period ( P -value=0.0000001), i.e. 28.23 % decline in notifications. A drastic decline of 69 % in notifications was observed during the lock down months in the pandemic period, i.e. March to June 2020 ( P -value=0.00001). A reduction of 44 % in treatment accession by 3690 TB patients in the control period compared with 2062 in the study period ( P -value=0.0000001) was noted. Lost to follow-up patients increased by 65 % from 460 in the control period to 760 in the study period ( P -value=0.0000001). Also, an increased death rate by 43 % from control to study period ( P -value=0.0000001) was reported. Conclusion. There is an urgent need to maintain the continuity of essential TB services to reduce the rising burden in vulnerable populations. The need of the hour is to undertake novel strategies for tuberculosis control to combat such emergencies in the coming future.