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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]

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: 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]

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.)