Search

Background: Acinetobacter, a nonfermenting Gram-negative coccobacilli, have emerged as significant pathogens causing multidrug-resistant (MDR) ventilator-associated pneumonia (VAP). Metallo-beta-lactamase (MBL)-producing Acinetobacter spp. have become an emerging therapeutic concern worldwide due to the MDR isolates. Aim and Objectives: Phenotypic detection of MBL producing MDR Acinetobacter isolates in patients with VAP and to study the antibiotic susceptibility pattern of MBL-producing isolates. Materials and Methods: This was a prospective observational and noninterventional study conducted on patients with VAP over a period of 2 years. This study was conducted at a tertiary care teaching hospital in the intensive care unit. A total of 164 MBL-producing MDR AB isolates were included in the study. MBL was detected by imipenem-EDTA double-disc synergy test (DDST), imipenem-EDTA combined disc synergy test (CDST-IPM), and MBL-E test. Results: A total of 188 samples were enrolled for the study, fulfilling the inclusion criteria of VAP. Total MDR Acinetobacter spp. isolates were 188 (76.42%) of them, 164 (87.23%) were MBL producing and 24 (12.76%) were nonMBL (P

Background: Ventilator-associated pneumonia (VAP) is the most frequent Intensive Care Unit acquired infection. Aims: The aim is to determine the incidence, bacteriology and factors affecting VAP and to determine the multi-drug resistant (MDR) pathogens. Settings and Design: This was a prospective observational study conducted over a period of 1 year from April 1, 2011, to March 31, 2012. Materials and Methods: The patients fulfilling criteria of VAP were included in this study. Statistical Analysis: This was performed using SPSS trial version 11.0 software (SPSS Inc., Chicago, Illinois, USA) and the values of P < 0.05 were considered statistically significant. Results: Totally 74 (27.71%) patients were developed VAP. Of total 74 patients with VAP 53 (71.62%) were females and 21 (28.37%) were females (P < 0.0001). Total 13 (17.56%) patients had early-onset VAP and 61 (82.43%) had late-onset VAP (P < 0.0001). The overall incidence of VAP rate per 1000 ventilator days was 39.59. Total 126 bacterial isolates found in 74 patients with VAP. Predominant isolates were Gram-negative 52 (70.27%). Total 41 (55.40%) patients had polymicrobial VAP, and 33 (44.59%) had single isolate. Total 55 (43.65%) isolates were MDR organisms. Total 22 patients with VAP succumbed during treatment with overall case fatality rate of 29.72%. Of total 55 MDR isolates in VAP, 13 (26.63%) were Klebsiella spp., 11(20%) Pseudomonas aeruginosa, 14 (25.45%) Acinetobacter, 8 (14.54%) Escherichia coli, and 9 (16.36%) coagulase positive Staphylococcus aureus. Total 12 (21.41%) patients succumbed among MDR isolates. Conclusions: There was a high incidence of MDR pathogens in late-onset VAP. The Gram-negative organisms Klebsiella, Pseudomonas E. coli and Acinetobacter were the most commonly isolated organisms with high mortality rates.

Background: AIDS has become chronic illness which is well treated with antiretroviral therapy and management of opportunistic infections (OIs). Aims and Objectives: The study clinical profile and outcome of human immunodeficiency virus (HIV) seropositive patients. Materials and Methods: This was retrospective observational study carried out over a period of 1 year (January 2011–December 2011). All HIV patients admitted in medicine ward, and ICU were enrolled. Statistical analysis was performed using SSPE statistical software trial version 11. The P< 0.05 was considered as statistically significant. Results: Of total 111 patients with a diagnosis of HIV/AIDS, 75 (67.56%) were male and 36 (32.43%) were female patients. A total 52 (46.84%) patients presented with respiratory manifestations, of them 23 (44.23%) had pulmonary tuberculosis (TB), 6 (11.53%) had tubercular effusion, and 3 (5.76%) had Pneumocystis jirovecii pneumonia. Respiratory manifestations including pulmonary TB were the most common presentation (P< 0.001). Total 27 (24.32%) patients were presented with the neurological manifestation of them 8 (29.62%) had a cerebro-vascular accident, 5 (18.51%) had cryptococcal meningitis, 4 (14.81%) had tubercular meningitis, and 1 (3.70%) had progressive multifocal leukoencephalopathy. Total 12 (38.70%) had acute gastroenteritis 6 (19.35%) had oral candidiasis, 8 (25%) had general tonic clonic seizure and 7 (21.87%) had pyrexia of unknown origin, 6 (18.75%) had septicemia, 6 (18.75%) had acute renal failure, and 6 (94.11%) had anemia. A total 11 (9.90%) patients succumbed. Conclusions: Overall respiratory manifestations were the common presentation in a present cohort of HIV seropositive patients and TB was the most common OI and the cerebrovascular accident was the most common neurological manifestation.

Context: Central venous catheter-related bloodstream infection (CRBSI) is associated with high rates of morbidity and mortality in critically ill patients. Aims: This study was conducted to determine the incidence of central venous catheter-related infections (CRIs) and to identify the factors influencing it. So far, there are very few studies that have been conducted on CRBSI in the intensive care unit in India. Settings and Design: This was a prospective, observational study carried out in the medical intensive care unit (MICU) over a period of 1 year from January to December 2004. Materials and Methods: A total of 54 patients with indwelling central venous catheters of age group between 20 and 75 years were included. The catheters were cultured using the standard semiquantitative culture (SQC) method. Statistical analysis used SPSS-10 version statistical software. Results: A total of 54 CVC catheters with 319 catheter days were included in this study. Of 54 patients with CVCs studied for bacteriology, 39 (72.22%) catheters showed negative SQCs and also negative blood cultures. A total of 15 (27.77%) catheters were positive on SQC, of which 10 (18.52%) were with catheter-associated infection and four (7.41%) were with catheter-associated bacteremia; the remaining one was a probable catheter-associated bacteremia. CRIs were high among catheters that were kept in situ for more than 3 days and emergency procedures where two or more attempts were required for catheterization (P < 0.05). In multivariate analysis of covariance duration of catheter in situ for >3 days, inexperienced venupucturist, more number of attempts and emergency CVC were associated with more incidence of CVCBSIs, with P

Context: Complicated Plasmodium falciparum Malaria is a syndrome and a disease of protean, clinical manifestations including jaundice, ARF, ARDS and multi-organ failure. Aims: The objectives of the present study are to study clinical features, complications and factors affecting outcome of patients with complicated P. falciparum Malaria. Settings and Design: This retrospective descriptive study was conducted at tertiary care centre in western Maharashtra from January 2010 to December 2010. Methods and Material: Total 73 patients with complicated P. falciparum malaria who presented with fever having positive trophozoites of P. falciparum in blood smear were included. SPSS (version-10) software was used for all statistical calculations. Results: A total 73 patients had complicated P. falciparum malaria with 52 were males and 21 were female patients. Total 9 (12.32 %) patients were presented with shock as a presenting feature. Four (5.47 %) patients had hypoglycaemia at the time of admission. Total 43 (58.90 %) patients had jaundice, 37 (50.68 %) had anaemia, 28 (38.35 %) had cerebral malaria, 7 (9.58 %) had acute renal failure, 5 (6.84 %) had ARDS and 5 (6.84 %) had thrombocytopenia. Total 46 patients had single complication in the form of cerebral malaria 14 (19.17 %), jaundice 15 (20.54 %) and anaemia 16 (21.91 %). Total 14 patients had two complications in the form of jaundice with ARF 02 (2.73 %) with one (50 %) death and jaundice with anaemia 12 (16.43 %). Total 9 (12.32 %) patients had three complications in the form of cerebral malaria with jaundice with anaemia with 3 deaths (33.33 %). Total 5 (6.84 %) patients had multiple complications in the form of cerebral malaria with ARF with ARDS with thrombocytopenia with 4 (80 %) death. Case fatality rate was 10.95 %. The case fatality rate with ARDS was 80 % (4/5), with ARF was 57.14 % (4/7) and with cerebral malaria it was 25 % (7/28). Case fatality rate was highest in patients with pulmonary complication (ARDS) compared to ARF, cerebral malaria, jaundice and anaemia with 'p' < 0.001. Conclusions: Acute renal failure and ARDS were least common presentation with poor outcome. In present study most common presentation was with jaundice and anaemia next to that was cerebral malaria. The case fatality rate of P. falciparum malaria was 10.95 %. Overall case fatality rate was highest with multi-organ dysfunction (80 %). Unusual early renal and pulmonary complications were the presenting features of complicated P. falciparum malaria were observed in present study. Presenting feature as a shock was invariably associated with either ARDS or ARF with high mortality. This study highlights the burden of complicated malaria including multi-organ dysfunction in western Maharashtra.

Background: Leptospirosis is an emerging spirochetal zoonosis world wide. Leptospirosis is common zoonosis that is under reported and under diagnosed in India. The aim of this study was to study the clinical profile outcome and prognostic factors in human leptospirosis at tertiary care centre. Settings and Design: This was a retrospective study of leptospira positive patients who were admitted in tertiary care centre. The study was conducted in 2010, over a period of 6 month from July to December. Materials and Methods: All patients who presented with clinical features and tested IgM positive for leptospirosis were taken into the study and analyzed based on modified Faine's criteria. Results: Out of total 23 patients there were 21 males and 2 females, with mean age was 32 years. Maximum incidence of cases was found in month of July and August. Out of total 23 patients, 18 (78.26%) were farmers and 5 (21.73%) were laborers. Predominant complaints were fever, jaundice, myalgia, and headache. All 23 had positive results for IgM against leptospira. Liver function tests were deranged in 16 (69.56%) and renal functions were deranged in 12 (52.17%). Total 7 (30.43%) patients had Weil's syndrome and 7 (30.43%) had acute respiratory distress syndrome (ARDS). Total 7 (30.43%) patients had neuroleptospirosis, out of which 5 (21.73%) had aseptic meningitis, one had paraparesis secondary to lumbar radiculopathy and one had meningoencephalitis. Hyperkalemia was present in 6 (26.08%) patients, 7 (30.43%) patients had hypokalemia. Total 11 (47.82%) patients had metabolic acidosis (pH Conclusions: Leptospirosis was unexpectedly found to be positive in many of our patients who were having pyrexia with multiorgan dysfunction during the monsoons. Hepatic dysfunction, acute renal failure, ARDS, and neuroleptospirosis in decreasing frequency were the commonest complication. Daily dialysis, ventilatory support and intensive care management has definitely reduced morbidity and mortality associated with leptospirosis with multi-organ failure.