Search

Objective: The incidence of hard-to-heal wound infection, especially as a result of multidrug-resistant Gram-negative organisms, has increased in recent years. The reason for the increase is multifactorial and the ability of these pathogenic isolates to form biofilms is one of the important risk factors in wound infection. This study aimed to evaluate the risk factors associated with such cases. Method: This prospective analytical study, conducted over a period of two months, included pus or tissue samples from hospital inpatients with Gram-negative hard-to-heal wound infection. The samples were processed with conventional microbiological techniques. Patient demographic details and the presence of various risk factors were recorded. Biofilm production was detected by tissue culture plate method in the laboratory. The data were analysed using SPSS version 21 (IBM Ltd., US). Results: The experimental cohort comprised 200 patients. Klebsiella spp. was the most common identified organism, followed by Escherichia coli and Pseudomonas spp. Carbapenem resistance was observed in 106 (53%) strains. Almost 66% of the strains showed biofilm formation. On evaluation of associated risk factors, age (p=0.043), presence of biofilms (p=0.0001), diabetes (p=0.002), hypertension (p=0.02) and medical device use (p=0.008) had significant association, whereas sex, previous surgery and prior antibiotic use had no significant impact on the chronicity of the wound. Conclusion: In this study, chronicity of wounds was observed to be associated with multiple risk factors, especially the biofilm-forming ability of the strain. Biofilms are difficult to eradicate and additional measures, such as physical debridement, are important for resolving chronicity. Knowledge about specific risk factors would also allow clinicians a better understanding of the healing process and drive appropriate wound care interventions. Declaration of interest: A grant was received from the Indian Council of Medical Research (ICMR) for this work (grant ID: 2017-02686). The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Objectives: Providing safe drinking water is essential for maintaining healthcare quality. The presence of biofilms in the water supply protects the organism from the antimicrobial effects of disinfectants leading to the formation of the MDR pathogen pool. Therefore, this study was taken up to determine the prevalence of biofilm formation in the bacteria isolated from the water system of a tertiary health care setup and study the effect of disinfectants on biofilms. Methods: Thirty-four drinking water samples were collected in sterile glass stopper bottles and transported to the lab. Standard bacteriological procedures identified isolates. Biofilm detection was carried out by the tissue culture plate (TCP) method. The effect of disinfectant (sodium hypochlorite) at various concentrations (0, 0.25, 0.5, 1, 2, and 4 %) on biofilm-producing organism were studied for 30 minutes and analyzed. Results: The culture positivity was 76.4% (26/34). Twenty samples showed monomicrobial growth, while only six samples showed polymicrobial growth of organisms. The most common organism isolated was Pseudomonas aeruginosa. Biofilm production was seen more in polymicrobial organisms, 91.66 % (11/12). A high level of resistance to chlorine compounds was seen in biofilm-producing microorganisms, especially those that produced robust biofilms. Conclusion: Resistance of biofilms against high levels of chlorine has implications for the delivery of safe drinking water. Drug resistance was seen in these organisms, which can be transmitted from drinking water sources to humans. Therefore, it is recommended that biofilm production should be evaluated in drinking water samples regularly. [ABSTRACT FROM AUTHOR]

Introducation: Multi-drug resistant nosocomial infections are one of the leading causes of mortality and morbidity amongst hospitalized patients throughout the world, accounting a major burden on the patients and public health system of any country Method :To determine the prevalence of aerobic bacterial in different clinical specimens received from various Intensive Care Units (MICU, SICU, CCU, PICU, and NICU) and their antibiotic susceptibility pattern in the isolated organisms in a tertiary care hospital in Jaipur, Rajasthan. Result : Out of 500 samples, 213 (43%) samples showed growth while 287 (57%) did not show any growth. In the 213 positive samples 183 (85.92%) were Gram Negative bacilli while 25(1.74%) were Gram Positive Cocci and 5 (2.34%) were candida spp.Out of Gram Negative Isolates Acinetobacter Spp. was found to be maximum 35.2% followed by E.coli 19.7%, Klebsiella spp.19.2%, Pseudomonas 12.2%, Citrobacter 0.93% and Proteus Spp. 0.93%. Among Gram Positive Isolates Staphylococcus aureus was maximum 6.5% followed by Enterococcus 3.75%, CONS 0.93% and streptococcus spp.0. 46%. Candida spp. contributes 2.34% of all positive culture. Conclusion: Isolates are sensitive to combination drugs while more resistant to single drug. Among gram negative bacteria most common isolate was Acinetobacter spp. 75 (35.2%) which were resistant to most of the antibiotics like amoxycillin- clavulanic acid (83%), cefotaxime (76%), imipenem (71%), piperacillin- tazobactam (53%),cefepime (57%) while sensitive to aztreonam (64%) and cotrimoxazole (64%). [ABSTRACT FROM AUTHOR]

Background and Aims: Catheter-associated urinary tract infection (CAUTI) is one of the most common health care acquired infection encountered in clinical practice. The present study was planned to assess the knowledge and attitude of health care providers regarding the indications for catheterization and methods of preventing CAUTI. Methods: A prospective questionnaire-based survey was done from March 2011 to August 2011. A structured questionnaire comprising of 41 items related to demographic details of the respondents, their knowledge regarding indications for catheterization and methods of preventing CAUTI was given to 54 doctors and 105 nurses. The response was evaluated for statistical correlation using a computer software. Results: The mean years of experience of the respondents in the health care setup was 6.8 years. Only 57% of the respondents could identify all the measures for prevention of CAUTI. The knowledge regarding the indication for catheterization though suboptimal was significantly better amongst the doctors as compared to nurses. Conclusion: The knowledge regarding indication and preventive measures was suboptimal in our study group. There is a tremendous scope of improvement in catheterization practices in our hospital and education induced intervention would be the most appropriate effort toward reducing the incidence of CAUTI. [ABSTRACT FROM AUTHOR]

Introduction: Rickettsia diseases are now established as re-emerging zoonotic bacterial infections in the Indian subcontinent. Objectives: The retrospective study was conducted to see the trends of scrub typhus with cofactors like disease & sex ratio significance and impact of seasons on the disease outcome in the Jaipur, Rajasthan. Methods: A total of 2233 samples were processed between January 2013 to November 2016 suspecting rickettsia infection with complaints of fever, rash, oedema, hepatosplenomegaly, lymphadenopathy and an eschar, with or without a history of tick exposure at Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan. IgM antibodies to Orientia tsutsugamushi antigen were tested by ELISA method. Results: A total of 2233 samples were processed from january 2013 to november 2016. Out of 2233 samples 475 samples were IgM antibody reactive by ELISA method. In 2013 positivity is 36.38% while in 2014 positivity is 24.34%. In 2015, 21.49% positivity rate while jannov16, 12.43% positvity. Females are more prone to infection then male patients specially with rural background. Maximum numbers of cases were reported from the month of August to October. Conclusions: Scrub typhus is prevalent but an underdiagnosed disease in India. The prevalence is gradually decreasing with increasing sample size every year with female patients predominence. Trends are more in late rainy season between August and October months. Rickettsia - specific IgM ab ELISA tests can help in early diagnosis & early empiric therapy which can be given to reduce serious complications and mortality. [ABSTRACT FROM AUTHOR]

Hemoglobin (Hb)-F inducers are known to improve Hb level and transfusion dependence in thalassemia. This pilot study was conducted to assess the efficacy and safety of Hb-F inducer thalidomide compared to hydroxyurea (HU) in Hb E-β thalassemia patients. This was a prospective interventional single-centre study with 45 Hb E-beta thalassemia patients equally divided into group-I (thalidomide+folic acid), group-II (HU + folic acid) and group-III (folic acid). Response was assessed at various time intervals with 12-months follow up period. Primary end points were increment in Hb, Hb-F level and improvement in transfusion requirement; secondary end point were tolerability and safety. There was 100% responder (R: Hb-increment ≥1 g/dl) in group-I with 66.67% major responder (MaR: Hb-increment ≥2 g/dl), while there were 40% and 0% responder in group-II and III respectively. Hb-increment was significantly (p-value <0.0001) better in thalidomide arm compared to HU. The Hb-increment was attributable to both increase in Hb-F levels and reduction in ineffective erythropoiesis in thalidomide arm. Transfusion reduction was significantly better in group-I compared to group-II (100% vs 34%). No severe adverse effects was reported by patients of any group. Thalidomide showed a persistent significant Hb-increment and transfusion independence in Hb E-β thalassemia patients compared to HU. [ABSTRACT FROM AUTHOR]

The mortality associated with lower respiratory tract infection is high. Indiscriminate use of antimicrobials leads to alteration of respiratory tract flora and development of multi-drug resistance. Rapid diagnostic tests to confirm infection can guide the clinicians about antimicrobial treatment. So the present study was planned to evaluate the role of direct gram stain examination as a rapid and simple test to help clinicians for appropriate patient management. The present study was conducted on 1000 respiratory specimens which were processed using conventional microbiological techniques. Gram stain smear and culture results were compared statistically to assess the sensitivity, specificity, positive and negative predictive value. The agreement between gram stain smear examination and culture was calculated using kappa statistics. Potential pathogens were obtained from 28 of 209 deeply coughed out sputum samples (13.3%) and from 19 of 315 saliva mixed sputum samples (6%). Out of 473 tracheal aspirates, 115 (24.3%) had potential pathogens. The sensitivity for predicting infection was higher for good quality sputum samples (54%) as compared to poor quality sputum samples (37%). The gram stain and culture of tracheal samples had a good agreement for predicting infection whereas there was only moderate agreement for sputum sample. Gram stain smear examination from respiratory samples can be used to guide empiric antibiotic therapy pending final culture sensitivity results if the attending physicians ensure appropriate sample collection and transport. In absence of these supportive measures smear examination should not be relied upon for empiric treatment. • Gram stain and culture of tracheal aspirates has good agreement for predicting infection. • Only moderate agreement for sputum sample. • Sputum Gram stain can be used to guide empiric antimicrobial therapy provided proper collection and transport are ensured. [ABSTRACT FROM AUTHOR]