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To evaluate the sensitivity and specificity of C-Reactive protein as a single diagnostic inflammatory biomarker of neonatal sepsis in association with the blood culture.In this study, we retrospectively reviewed the medical records of 330 neonates at a tertiary care hospital at Gurugram from Jan, 2015 to Dec, 2020. The study population included neonates Of the 330 neonates screened for sepsis, 32 (10%) had a positive blood culture with raised CRP in 69 (21%) cases. Among the 32 cases with positive blood culture, CRP identified 29 cases. The sensitivity, specificity, positive predictive value, negative predictive values of CRP were 90.6%, 86.5%, 42% and 99% respectively. The area under the curve (AUC) for the CRP ROC analysis was 0.83 with sensitivity of 90.6% and specificity of 91.6% which showed CRP usefulness as the diagnostic inflammatory biomarker of neonatal sepsis.Prematurity (53%) in neonates was the most common risk factor associated with neonatal sepsis. Klebsiella pneumoniae 11 (34%) was the most common pathogen isolated with 73% susceptibility to Ciprofloxacin.C-Reactive protein was found to have a high diagnostic value in terms of sensitivity of 90.6% and specificity of 91.6% when 0.83 is used as a cut off point for diagnosis of neonatal sepsis. Therefore, CRP could be used as diagnostic inflammatory biomarker in resource poor settings.

Purpose: Infections due to invasive non-typhoid salmonella can be dangerous and fatal. The mode of infection and the severity varies from the typhoidal fevers. It is important to find the association between clinical features and the infecting serovar to understand the pathophysiology and course of treatment. Methods: In the present study, extra-intestinal specimens (blood, cerebrospinal fluid and pus) from three patients suffering from septicaemia, meningitis and osteomyelitis were received. Micro-biological and biochemical test for species identification and antibiotic susceptibility was done as per standard protocol. Further, PCR based amplification and sequencing of a portion of the flagellin gene (FliC) was done to confirm the serovar. Results: Salmonella enterica was identified from all the three by microbiological and biochemical examination.The sequence of the Flic gene confirmed the serovar to be S. typhimurium. All the patients were treated successfully for the infection by appropriate antibiotic therapy. Conclusion: The study highlights that serovar Typhimurium is common in invasive non-typhoidal salmonellosis and its pathophysiology and virulence factors expression should be understood in various organ types for better treatment options and outcomes.

This study aims to evaluate the association of orthodontic tooth movement with the concentration of leptin in gingival crevicular fluid (GCF).In thirty orthodontic patients, the concentration of leptin was assessed at baseline, 1 h, 24 h, 7 days, and 1 month after application of orthodontic force. Distalized tooth movement was evaluated by measuring the difference on dental casts at baseline and 1 month after force application.Average concentration of leptin in GCF raises from baseline (T0) to 1 h after application of force (T1). There was a significant association of the overall average concentration of leptin with the degree of tooth movement (correlation coefficient = 0.625).There was a biphasic change in GCF leptin concentration and significant association between rates of tooth movement with GCF leptin concentration.

The aim of the study was to find out the carbapenem resistance rate and prevalence of different carbapenemase genes in Klebsiella pneumoniae and Escherichia coli from a North Indian corporate hospital that receives both Indian and international patients. A total of 528 clinical isolates of E. coli and K. pneumoniae were included in the study. All isolates that were found resistant to carbapenems by MIC testing (Vitek II Compact®) were screened for NDM, OXA-48, VIM, and KPC genes by PCR. Sequencing of NDM gene and transmissibility by conjugation assay were checked on 22 randomly selected NDM-positive isolates. One hundred and fifty-six isolates (29.54%) were carbapenem-resistant. The rate of carbapenem resistance was significantly higher in K. pneumoniae as compared to E. coli (53.9% vs. 15.6%; p E. coli than K. pneumoniae (p . All the tested isolates formed transconjugants and NDM-5 was the most common variant in both species (15/22). The presence of plasmid-based NDM calls for stricter surveillance measures in our hospital settings.

The whole world is wrestling against SARS-CoV-2 infection (COVID-19). COVID-19-TB co-infection is also reported but there are limited number of studies which analyze the impact of COVID-19 pandemic in TB diagnosis and management. In this retrospective study, we observed that the TB diagnosis was reduced in pandemic time. Before COVID-19 pandemic (March–December 2019), there were 644 TB tests out of which 127 were TB positive. In ongoing COVID-19 pandemic (January–October 2020), 484 TB tests were performed and 146 patients were TB positive. Male accounted for 64%/57% of TB cases in 2019/2020 whereas female patients were 35%/42% in 2019/2020. Increase in female TB positive cases was a noticeable feature. The newly diagnosed with TB cases in 2019/2020 were 112/130 respectively. Though, we have seen only 7 COVID-TB co-infection cases, we could not establish the causal relationship in COVID-TB co-infection. The increase in the number of TB positive cases during COVID-19 pandemic clearly showed how adversely COVID-19 has affected TB diagnosis and management. Anticipating the increase in TB cases in future, we emphasize the need to ensure continuous TB testing and treatment despite the pandemic burden. Further study on the COVID-TB co-infection in high TB-burden countries like India, is required to enable analyses of interactions, risk factors in COVID-19-TB co-infection.

Colistin resistance in Gram negative bacteria is mainly attributed to chromosomal mutations in Two Component Systems(TCS) PhoPQ and PmrAB and plasmid-borne genes(mcr and its variants). The aim of this study was to understand the molecular basis of colistin resistance in Klebsiella pneumoniae and determine clonal transmission, in a North Indian tertiary care hospital over a 2.5 year period. Antimicrobial susceptibility was determined by Vitek and colistin resistance was confirmed by broth microdilution. Carbapenemases(blaKPC, blaVIM, blaIMP, blaNDM, blaOXA-48) and mcr-1 screening was done by PCR. Mutations in chromosomal genes mgrB, phoP, phoQ, pmrA, pmrB were analysed. Sequence typing was performed by Multilocus sequence typing(MLST). OXA-48 was detected in thirteen isolates while three isolates co-expressed OXA-48 and NDM. The mcr-1 gene was absent in all 16 isolates. Deleterious mutations in mgrB included insertion sequences IS903 and ISkpn26 and a premature stop codon. A total of 18 point mutations were identified in PhoPQ and PmrAB TCS; of which, novel mutations were reported in phoQ (K46E, L322V, D152N, F373L, R249G), pmrB (P159R) and pmrA (D149L). Six different sequence types ST231, ST147, ST395, ST42, ST14 and ST101 were identified. Phylogenetic analysis showed that sequence types ST14, ST395 and ST147 are closely related to ST101 and all identified sequence types had a common ancestor ST231. Colistin resistance in K. pneumoniae was attributed to mutations in PhoPQ and PmrAB TCS, while location specific distribution of strains indicates clonal transmission. The results of this study will help in formulation of effective infection prevention and antimicrobial development strategies.

A BSTRACT Typhoid fever continues to be a major public health problem in developing countries especially due to the challenging infrastructure and sanitation facilities. Many cases of abortions due to untreated Salmonella infection have been reported. The present report is about a 25-year-old female who was inadequately treated for typhoid fever with suboptimal doses of oral ampicillin leading to inevitable abortion despite the infection being cleared from blood. Salmonella typhi was isolated from products of conception. The patient was treated with Ceftriaxone injections and has been found to be fine on follow-up visits. Typhoid during pregnancy needs to be treated with higher doses and preferably intravenous antibiotics instead of oral due to the increased volume of distribution and reduced tissue penetration of antibiotics in such patients.

Background: Short-term peripheral venous catheter–associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter–associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available. Methods: Prospective, surveillance study on peripheral venous catheter–associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. Results: We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter–associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter–associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter–associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter–associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter–associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: Escherichia coli (22.9%), Klebsiella spp (10.7%), Pseudomonas aeruginosa (5.3%), Enterobacter spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were Staphylococcus aureus (11.4%). Conclusions: Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter–associated bloodstream infections.

Introduction and objectives Needle stick injuries are associated with a 0.3–30% risk of transmission of Human Immunodeficiency virus, Hepatitis C virus, and Hepatitis B virus. Despite causing psychological trauma they also involve a huge financial burden. A robust process improvement (RPI) toolkit was introduced in order to effectively manage and reduce needle stick injuries, as well as an attempt to report prevalence, post-exposure management, and associated economic burden. Materials and methods Prospective Observational Study (2015–2018) has been design in a Corporate Tertiary Care Hospital. The participants included were needle stick injuries exposed staff. RPI toolkit was implemented (2015–2018) focusing on root cause analysis, availability of safety engineered devices, immunization and post-exposure management of needle stick injuries exposed staff. The main outcome measure was needle stick injuries incidence. Results A total of 211 needle stick injuries were reported (mean – 52.72/year, needle stick injury incidence – 13.18/year/100 beds). Yearly trends showed a decrease of 21.3% in injuries from 2015 (61) to 2018 (48). Half (106, 50%) of the total injuries were reported among nurses. Use of hypodermic needles was involved in 116 (55%) injuries, with 114 (54%) occurring due to nonadherence to hospital policies. Overall, 204 staff had protective immunity, and 135 (64%) of these had completed their Hepatitis B immunizations. The source was known in 165 (78%) cases, and 113 of these cases had an injury from a source with negative viral markers. A 6-month follow-up was completed in 90 cases. No seroconversion was reported. Overall costs incurred in post-exposure prophylaxis was approximately €30,000 (mean cost €143.50/needle stick injury). Conclusion Nurses are most at risk of needle stick injury in healthcare settings. Implementation of RPI toolkit led to a 21.3% reduction in sharps injury incidences. These injuries incur huge financial burden on the hospital. Appropriate immunization strategies saved about €1360 expenditure on post-exposure prophylaxis.

The aim of the study was to find out the carbapenem resistance rate and prevalence of different carbapenemase genes in

Background Short-term peripheral venous catheters-related bloodstream infections (PVCR-BSIs) rates have not been systematically studied in developing countries, and data on their incidence by number of device-days are not available. Methods Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013 to May 31, 2019 in 204 intensive care units (ICUs), members of the International Nosocomial Infection Control Consortium (INICC), from 57 hospitals in 19 cities of India. We applied US INICC definition criteria and reported methods using the INICC Surveillance Online System. Results We followed 7,513 ICU patients for 296,893 bed-days and 295,795 short term peripheral venous catheter (PVC)-days. We identified 863 PVCR-BSIs, amounting to a rate of 2.91/1,000 PVC-days. Mortality in patients with PVC but without PVCR-BSI was 4.14%, and 11.59% in patients with PVCR-BSI. The length of stay in patients with PVC but without PVCR-BSI was 4.13 days, and 5.9 days in patients with PVCR-BSI. The micro-organism profile showed 68% of gram negative bacteria: Escherichia coli (23%), Klebsiella spp (15%), Pseudomonas aeruginosa (5%), and others. The predominant gram-positive bacteria were Staphylococcus aureus (10%). Conclusions PVCR-BSI rates found in our ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs.

Introduction: Bolton ratio is considered as seventh key of normal occlusion. Many orthodontic patients have to undergo premolar extractions as a part of treatment. Aims and objectives: The present study was taken up to investigate the effect of premolar extractions on Bolton’s overall ratios in a sample of north Indian population. Materials and methods: Mesiodistal tooth widths were measured on pretreatment dental casts of 200 subjects (100 males and 100 females). The Bolton’s overall ratios were determined before and after hypothetical premolar extractions and the subjects were divided into small, normal, and large overall ratio groups categorized by the Bolton standard deviation definition. Extractions were performed in the following combinations: (1) all first premolars, (2) all second premolars, (3) maxillary first and mandibular second premolars, and (4) maxillary second and mandibular first premolars. Results: The overall ratios decreased in every group after extraction of any combination of premolars. Maximum discrepancy was observed in the extraction of all first premolars and least in second premolars. Statistically significant differences were seen in the extraction pattern amongst males and females. Conclusions: In cases which require premolar extractions, it is mandatory to check if any discrepancy exists between different extraction patterns since the ratios may shift from normal to abnormal or vice versa as it may affect the interdigitation of teeth.

Background Central line-associated bloodstream infections (CLABSI) are associated with significant morbidity, mortality and costs. Multimodal intervention programs are effective in bringing down the rates of CLABSI, but they are difficult to sustain. In an attempt to improve sustainability, we implemented two multimodal intervention programs focusing on high-yield measures and assessed their effect on monthly CLABSI rates over a period of 42 months. Methods The CLABSI rates were tracked on a monthly basis in a 300-bed Indian Corporate hospital and an analysis of the various contributing variables was done. The first intervention programin July 2009 put into practice the central line bundle. The second program went beyond the bundle and introduced high-yield measures like dedicated central line team and trolley, involved the senior management and promoted the ‘Scrub the Hub' campaign while rectifying deficiencies observed in the first intervention program. The rates of CLABSI were statistically analysed in both the pre- and post-intervention periods. Results The CLABSI rates varied between 0 to 9.8 infections per 1000 catheter days in the 42 months period, the mean being 2.9. The difference in mean CLABSI rates before and after the first intervention program was not significant (5.2 versus 4.4 infections per 1000 catheter days ( P >0.05)). However, the next intervention programsaw a significant decrease in the mean rates of CLABSI in the subsequent 24 months (0.7 infections per 1000 catheter days ( P Conclusions Repeated multimodal intervention programs with a focus on high-yield measures resulted in a sustained reduction in CLABSI rates (86.3%).

Summary Objective To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach on central line-associated bloodstream infection (CLABSI) rates in eight cities of India. Methods This was a prospective, before-and-after cohort study of 35650 patients hospitalized in 16 adult intensive care units of 11 hospitals. During the baseline period, outcome surveillance of CLABSI was performed, applying the definitions of the CDC/NHSN (US Centers for Disease Control and Prevention/National Healthcare Safety Network). During the intervention, the INICC approach was implemented, which included a bundle of interventions, education, outcome surveillance, process surveillance, feedback on CLABSI rates and consequences, and performance feedback. Random effects Poisson regression was used for clustering of CLABSI rates across time periods. Results During the baseline period, 9472 central line (CL)-days and 61 CLABSIs were recorded; during the intervention period, 80898 CL-days and 404 CLABSIs were recorded. The baseline rate was 6.4 CLABSIs per 1000 CL-days, which was reduced to 3.9 CLABSIs per 1000 CL-days in the second year and maintained for 36 months of follow-up, accounting for a 53% CLABSI rate reduction (incidence rate ratio 0.47, 95% confidence interval 0.31–0.70; p =0.0001). Conclusions Implementing the six components of the INICC approach simultaneously was associated with a significant reduction in the CLABSI rate in India, which remained stable during 36 months of follow-up.

SUMMARYWe report on the effect of the International Nosocomial Infection Control Consortium's (INICC) multidimensional approach for the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 21 intensive-care units (ICUs), from 14 hospitals in 10 Indian cities. A quasi-experimental study was conducted, which was divided into baseline and intervention periods. During baseline, prospective surveillance of VAP was performed applying the Centers for Disease Control and Prevention/National Healthcare Safety Network definitions and INICC methods. During intervention, our approach in each ICU included a bundle of interventions, education, outcome and process surveillance, and feedback of VAP rates and performance. Crude stratified rates were calculated, and by using random-effects Poisson regression to allow for clustering by ICU, the incidence rate ratio for each time period compared with the 3-month baseline was determined. The VAP rate was 17·43/1000 mechanical ventilator days during baseline, and 10·81 for intervention, showing a 38% VAP rate reduction (relative risk 0·62, 95% confidence interval 0·5–0·78, P = 0·0001).

Problem statement: Increasing Antimicrobial resistance in the World is constantly becoming a Global threat and there is an urgent need to prevent its spread. Various studies of last decade have shown reduced trends of antimicrobial resistance in the pathogens as an outcome of the Antimicrobial Stewardship Programs. In view of this, the present four years’ study was carried out to analyse the impact of Antimicrobial Stewardship Programs on carbapenem resistance in Gram negative isolates in a Tertiary care hospital in India. It involved a retrospective analysis of carbapenem resistance in Gram negatives for one year (July 2007 to June 2008), followed by prospective evaluation of the impact of stewardship interventions on resistance patterns (July 2008 to Jun 2011). Approach: Our study was staged into four parts: (1) July 2007 to June 2008: Resistance patterns of Gram negative isolates-E.coli, Klebsiella, Pseudomonas and Acinetobacter baumannii towards carbapenems were studied. (2) July 2008: Phase I intervention programme Implementation of an antibiotic policy in the hospital. (3) July 2008 to June 2010: The Impact of Phase I intervention programme was assessed subsequently. (4) July 2010 to June 2011: Phase II intervention programme: Formation and effective functioning of the antimicrobial stewardship committee. Results: The percentage resistance towards carbapenems in E.coli, Klebsiella, Pseudomonas and A. baumannii from July 2007-June 2008 was 1.07, 13.1, 21.3 and 12.5% respectively. Phase I intervention programme was initiated in July 2008 and Phase II in July 2010 and a subsequent reduction of 4.03% was observed in the carbapenem resistant Pseudomonas in the last stage of study period following the interventions. However the resistance in the other Gram negatives (E. coli, Klebsiella and A. baumannii) rose and then stabilized. Conclusion: An antimicrobial stewardship programme with sustained and multifaceted efforts is essential to control the increasing resistance of microorganisms towards antibiotics.

The use of implantable devices as direct adjuncts to orthodontic treatment as compared to the use of conventional dental implants is relatively less in number. Currently, a limited number of such devices are used to aid in orthodontic treatment. The options include conventional titanium endosseous dental implants, palatal implants, titanium miniscrews (also known as micro- or mini-implants), and mini-bone plates. Integration of dental implants or implantable devices into contemporary orthodontic practice has the following possible advantages: Serving as a means of increasing orthodontic anchorage, virtually eliminating patient compliance issues with regard to wearing of appliances, decreasing overall treatment time, and occasionally permitting orthodontic treatments previously thought to be impossible without surgery. This article is a review of the currently available options for use of implantable devices as sources of temporary skeletal anchorage in orthodontics.

Introduction: The surgical antibiotic prophylaxis guidelines are developed to provide surgeons with a standardised approach to the rational, safe and effective use of antimicrobial agents for the prevention of surgical-site infections based on international, national and local recommendations. However, despite the availability of these guidelines, the adherence to the set protocols is a challenge. This study was carried out to evaluate the adherence to presurgical antibiotic prophylaxis in a tertiary care hospital. Materials and Methods: The antibiotic audit was prospectively carried out for 29 months January 2014—May 2016 for randomly selected clean and clean-contaminated surgeries. Measurable parameters for each selected case were choice of antibiotic, timing of administration and duration. The results were statistically analysed (Minitab 17.0 software). Results: A total of 1549 surgeries were audited. Out of this, 1501 (96.9%) surgeries fulfilled the inclusion criteria and 76.8% were clean. Mean age of the patients was 42.9 ± 18 years with the majority being females 52.5%. The most commonly used antibiotics were amikacin 32.5%, cefuroxime 29.5% and cefazolin 22.9%. The three parameters tested for adherence showed individual compliance of 87.3% for appropriate selection of antibiotic, 85.3% for appropriate administration and 34.9% for appropriate duration of antibiotic, respectively. Overall adherence to presurgical antibiotic prophylaxis guidelines by the surgeons showed significant results (69.2%, P Conclusion: The present study highlights the adherence and challenges faced in transforming hospital-specific guidelines into practice. The adherence to SAP protocols by surgeons was found comparable with that of the developed countries. This is due to their involvement in the formulation of antibiotic guidelines.

OBJECTIVETo report the International Nosocomial Infection Control Consortium surveillance data from 40 hospitals (20 cities) in India 2004–2013.METHODSSurveillance using US National Healthcare Safety Network’s criteria and definitions, and International Nosocomial Infection Control Consortium methodology.RESULTSWe collected data from 236,700 ICU patients for 970,713 bed-daysPooled device-associated healthcare-associated infection rates for adult and pediatric ICUs were 5.1 central line–associated bloodstream infections (CLABSIs)/1,000 central line–days, 9.4 cases of ventilator-associated pneumonia (VAPs)/1,000 mechanical ventilator–days, and 2.1 catheter-associated urinary tract infections/1,000 urinary catheter–daysIn neonatal ICUs (NICUs) pooled rates were 36.2 CLABSIs/1,000 central line–days and 1.9 VAPs/1,000 mechanical ventilator–daysExtra length of stay in adult and pediatric ICUs was 9.5 for CLABSI, 9.1 for VAP, and 10.0 for catheter-associated urinary tract infections. Extra length of stay in NICUs was 14.7 for CLABSI and 38.7 for VAPCrude extra mortality was 16.3% for CLABSI, 22.7% for VAP, and 6.6% for catheter-associated urinary tract infections in adult and pediatric ICUs, and 1.2% for CLABSI and 8.3% for VAP in NICUsPooled device use ratios were 0.21 for mechanical ventilator, 0.39 for central line, and 0.53 for urinary catheter in adult and pediatric ICUs; and 0.07 for mechanical ventilator and 0.06 for central line in NICUs.CONCLUSIONSDespite a lower device use ratio in our ICUs, our device-associated healthcare-associated infection rates are higher than National Healthcare Safety Network, but lower than International Nosocomial Infection Control Consortium Report.Infect. Control Hosp. Epidemiol. 2016;37(2):172–181

Objectives: To carry out a retrospective study on Acinetobacter baumannii isolates from various clinical samples in a tertiary carehospital in India and analyze its epidemiology, antibiotic susceptibility patterns, pathogenic potential and nosocomial status.Materials and methods: The clinical specimens over a period of 14 months from December 2008 to January 2010 were analyzedand the A.baumannii isolates obtained by an automated identification system (Vitek 2 Compact) were segregated for furtherstudy. Their antibiograms were studied and a clinical correlation was made to assess their pathogenic status and mode of acquisition.Further, the nosocomial infections acquired during this period were studied and the contribution made by A.baumannii wascalculated to assess its nosocomial status.Results: A.baumannii was isolated in 155 samples out of 1632 gram negative isolates (9.4% prevalence) from the entire hospital.Maximum isolates were from respiratory secretions (57.4%) followed by blood (23.8%). Prevalence of A.baumannii rose to 22.7%(119 out of 525) in intensive care unit (ICU) and 65 isolates (54.6%) proved to be pathogenic. A.baumannii contributed to 30.4%ventilator associated pneumonia, 35.2% Catheter Associated Blood Stream Infections, 12.5% Surgical Site Infections and 2.94%Catheter Associated Urinary Tract Infections. Overall resistance of A.baumannii towards carbapenems was 90% from all hospitalisolates. ICU isolates showed higher resistance (93.2%) as compared to Inpatient Department (82.7%) and Out-patient Department(57.1%).Conclusion: In this study, A.baumannii isolates showed a pathogenic potential of around 54.6% and a majority were found to becarbapenem resistant. We must be cognizant of the fact that all A.baumannii isolations doesn’t necessarily mean infection andantibiotics should only be given in clinically proven infections. J Microbiol Infect Dis 2012; 2(2): 57-63Key words: A.baumannii; prevalence; resistance patterns; clinical correlation; nosocomial status

Maghsoudi, Behzad/0000-0002-1279-8799; Kritsotakis, Evangelos/0000-0002-9526-3852; Yalcin, Ata Nevzat/0000-0002-7243-7354; Mikaszewska-Sokolewicz, Malgorzata A/0000-0002-1148-7817; ALDEMIR KOCABAS, Bilge/0000-0002-6396-5243; Masjedi, Mohammad Reza/0000-0002-6871-382X; Masjedi, Mansoor/0000-0001-6175-9289; Gan, Chin Seng/0000-0002-6758-4798; Oncul, Oral/0000-0002-1681-1866; Sabetian, Golnar/0000-0001-8764-2150; YAMAN, Ayhan/0000-0002-5651-1286; Ozdemir, Halil/0000-0002-7318-1688; Leon, Hector Armando Rincon/0000-0003-0715-200X; Delia, Muntean/0000-0001-9100-4530; Atasay, Fatma Begum/0000-0002-9114-5293; Zand, Farid/0000-0003-3489-3372; Kuchenbecker, Ricardo/0000-0002-4707-3683; Medeiros, Eduardo A/0000-0002-6205-259X; ROMERO LOPEZ-ALBERCA, CRISTINA/0000-0001-5856-8668; Salomao, Reinaldo/0000-0003-1149-4598; ozdemir, sonay incesoy/0000-0003-2863-901X; Meco, Basak Ceyda/0000-0003-2951-9634; Horoz, Ozden Ozgur/0000-0001-7590-650X; Horhat, Florin George/0000-0001-6133-0204; Kazi, Mohammad Mukhit/0000-0003-3824-5540; Ciftci, Ergin/0000-0002-4955-160X; Abouqal, Redouane/0000-0002-6117-4341; Leblebicioglu, Hakan/0000-0002-6033-8543; Garcell, Humberto Guanche/0000-0001-7279-0062; Kendirli, Tanil/0000-0001-9458-2803; de Souza, Maria Cecilia B V/0000-0003-0318-3087; Sanaei Dashti, Anahita/0000-0002-2827-3575; UNAL, SERHAT/0000-0003-1184-4711; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Barahona G., Nayide/0000-0003-3559-6900; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Karabay, Oguz/0000-0003-0502-432X; Kaya, Sehnaz/0000-0003-0002-1517; ERDEVE, OMER/0000-0002-3193-0812; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Gikas, Achilleas/0000-0002-8455-9631; Baylan, Orhan/0000-0002-6529-7824; Mitrev, Zan/0000-0001-7859-8821; yildizdas, dincer/0000-0003-0739-5108; Ngo, Quy Chau/0000-0002-6787-2757; Duszynska, Wieslawa/0000-0002-5880-4904; KAYA, ZEYNEP/0000-0002-8468-2103; Dragan, Barbara/0000-0003-3108-4211; Gupta, Umesh/0000-0001-7717-1404; Navarro Fuentes, Karla Reyna/0000-0002-6894-8872; zali, Mohammadreza/0000-0002-9027-4560; Morocho Tutillo, Diego Rolando/0000-0002-4974-7856; El Kholy, Amani/0000-0002-0645-7664; Kanj, Souha/0000-0001-6413-3396; Assiri, Abdullah/0000-0002-5605-2876; Unal, Necmettin/0000-0002-9440-7893; Jayatilleke, Kushlani/0000-0002-3931-6630; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000341307100001 PubMed: 25179325 We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U. S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Salomao, Reinaldo/0000-0003-1149-4598; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Medeiros, Eduardo A/0000-0002-6205-259X; Leblebicioglu, Hakan/0000-0002-6033-8543; Yalcin, Ata Nevzat/0000-0002-7243-7354; Barahona G., Nayide/0000-0003-3559-6900; Mitrev, Zan/0000-0001-7859-8821; Kanj, Souha/0000-0001-6413-3396; Unal, Necmettin/0000-0002-9440-7893; Matta, Lorena/0000-0002-5215-3215 WOS: 000309340400006 PubMed: 22711598 We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95 % confidence interval [CI] 0.55-0.72)], showing a 37 % rate reduction. Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries. Foundation to Fight against Nosocomial Infections The authors declare that they did not receive any personal funding, and the funding for the activities carried out at the INICC headquarters were provided by the corresponding author, Victor D. Rosenthal, and Foundation to Fight against Nosocomial Infections. The authors state that they do not have any conflicts of interest to declare. Every hospital's Institutional Review Board agreed to the study protocol, and patient confidentiality was protected by codifying the recorded information, making it only identifiable to the infection control team (ICT).

Background Catheter Associated Urinary Tract Infections (CAUTI) contribute 30%-40% of all the nosocomial infections and they are associated with substantially increased institutional death rates. A multimodal supervision program which incorporates training of the staff with respect to infection control measures can be effective in reducing the CAUTIs in hospitals. Aim To assess the impact of a multimodal UTI supervision program on the CAUTI rates over a year, from January 2009 to December 2009, in a tertiary care hospital in India. Setting A 215 bedded tertiary care private hospital. Materials and methods The CAUTI rates were analyzed for the first 6 months (January 2009-June 2009). A UTI supervision program was instituted in the month of July 2009, which included training with respect to the standard protocols for the sample collection and diagnosis, the bundle components of the urinary catheter checklist and hand hygiene practices. The impact was assessed as per the CAUTI rates in the subsequent months. Results The average CAUTI rate was reduced by 47.1% (from 10.6 to 5.6) after the introduction of the supervision program. This study presented the mean age of the patients with CAUTIs as 54.5 years and it showed an approximately equal contribution of both the sexes (52.94% in males and 47.05% in females). The impact analysis of the supervision program showed a reduction of 8.7% (from 23 days to 21 days) during the average duration of the catheterization. The adherence to the components of the urinary catheter check list was increased by 44.4% (p=0.069) and the hand hygiene compliance was increased by 56.4% (p=0.004) respectively after the interventions. Components like bladder irrigation and practising perineal cleaning were found to show no effect on the CAUTI rates. Conclusion The most common labour and cost effective infection control measures as revealed by the supervision programme were adherence to the urinary catheter checklist components (indication for catheter insertion and change, asepsis maintenance during and after the catheter insertion and avoiding urine reflux) and hand hygiene practices, whereas bladder irrigation and practising perineal cleaning thrice a day were unnecessary measures.

The incidence of surgical site infections (SSI) depends upon the patient risk-factors, surgical procedure, and practices observed by the operating team. This review aims at examining existing guidelines upon prevention of SSI. Various recommendations pertaining to pre-operative, operative and postoperative phase were evaluated. Implementation of measures like meticulous surgical scrubbing, and surgical site preparation, appropriate antimicrobial prophylaxis (right antimicrobial, dose, timing, and duration), right operative environment, observing strict antisepsis, and glucose control have majorly contributed towards reducing infections. Surveillance strategies towards SSI are essential as they help in guiding towards appropriate implementation of various measures.

Development of drug resistance, insecticide resistance and appearance of newer antiparasitic strains are some of the current challenges being faced by healthcare professionals in the field of parasitology. Highlighting the opportunities for antiparasitic drug discovered and the progress in recent years is the main objective of this review. Very few antiparasitic drugs have been discovered in the recent past, as compared to the other drugs of the pharmaceutical industry. Public-private partnerships have proven beneficial in providing funds to some parasite-focused projects. Some countries, especially the poor, undeveloped still have a problem due to the neglect of certain parasitic diseases which are unique to their epidemiology. There is a need to change prescribing patterns of clinicians, promote research in anti-parasitic drugs, and increase awareness of infection prevention and control in order to minimize the spread of parasitic diseases especially as newer anti-parasitic agents are scarce on the horizon.

Infection prevention is a mind set and the reasons for non compliance are related to psychological barriers, preconceived notions, cultural influences and ineffective time management rather than lack of available resources or knowledge. Our mind is the most powerful tool. Can we harness the power of the mind in oneself and others to understand the psychology of non compliance as also ways to improve implementation of infection control practices and subsequently reduce healthcare associted infections ( HAI's ).

The emergence of Acinetobacter baumannii as an epidemiologically significant nosocomial agent based on its epidemiology, antibiogram patterns and clinical correlation was explored in a 25 month study at a tertiary care hospital in India.

This document is an executive summary of the APSIC Guide for Prevention of Central Line Associated Bloodstream Infections (CLABSI). It describes key evidence-based care components of the Central Line Insertion and Maintenance Bundles and its implementation using the quality improvement methodology, namely the Plan-Do-Study-Act (PDSA) methodology involving multidisciplinary process and stakeholders. Monitoring of improvement over time with timely feedback to stakeholders is a key component to ensure the success of implementing best practices. A surveillance program is recommended to monitor outcomes and adherence to evidence-based central line insertion and maintenance practices (compliance rate) and identify quality improvement opportunities and strategically targeting interventions for the reduction of CLABSI.

Background The objective of this study was to assess the impact of antimicrobial stewardship programs on the multidrug resistance patterns of bacterial isolates. The study comprised an initial retrospective analysis of multidrug resistance in bacterial isolates for one year (July 2007-June 2008) followed by prospective evaluation of the impact of Antimicrobial Stewardship programs on resistance for two years and nine months (July 2008-March 2011). Setting A 300-bed tertiary care private hospital in Gurgaon, Haryana (India) Findings Methods Study Design • July 2007 to June 2008: Resistance patterns of bacterial isolates were studied. • July 2008: Phase I intervention programme Implementation of an antibiotic policy in the hospital. • July 2008 to June 2010: Assessment of the impact of the Phase I intervention programme. • July 2010 to March 2011: Phase II intervention programme: Formation and effective functioning of the antimicrobial stewardship committee. Statistical correlation of the Defined daily dose (DDD) for prescribed drugs with the antimicrobial resistance of Gram negatives. Results Phase I intervention programme (July 2008) resulted in a decrease of 4.47% in ESBLs (E.coli and Klebsiella) and a significant decrease of 40.8% in carbapenem-resistant Pseudomonas. Phase II intervention (July 2010) brought a significant reduction (24.7%) in carbapenem-resistant Pseudomonas. However, the resistance in the other Gram negatives (E.coli, Klebsiella, and Acinetobacter) rose and then stabilized. A positive correlation was observed in Pseudomonas and Acinetobacter with carbapenems and cefoperazone-sulbactam. Piperacillin-tazobactam showed a positive correlation with Acinetobacter only. E.coli and Klebsiella showed positive correlation with cefoparazone-sulbactam and piperacillin-tazobactam. Conclusion An antimicrobial stewardship programme with sustained and multifaceted efforts is essential to promote the judicious use of antibiotics.

Central line associated blood stream infections (CLABSI) in the ICU are associated with significant morbidity, mortality and costs. Supervision programmes have shown to decrease CLABSI rates but repeated interventions are required.