Bacteraemia in a tertiary care urban hospital in south India

A total of 1727 blood samples were cultured aerobically over a one year period, of which 201(11.8%) were positive. The ratio of Gram positive to Gram negative bacteraemia was 1:1. The three antimicrobials having the highest activities against the Gram positive isolates were amikacin, cefotaxime, and ciprofloxacin to which 88.5, 81.7 and 80.7 percent of the strains were susceptible: and the same agents were equally effective against Gram negative organisms with 84.5, 75.3 and 70.1 percent efficacy respectively. Coagulase negative Staphylococcus spp. was the most frequent organism isolated(60; 29.8%), followed by Pseudomonas aeruginosa (40; 19.9%), and Staphylococcus aureus (34; 16.9%).     

Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital

Aim:

We are using multimodal technique to improve hand hygiene (HH) compliance among all health care staff for the past 1-year. This cross-sectional observational study was conducted in the surgical ICU to assess adherence to HH among nurses and allied healthcare workers, at the end of the training year.

Materials and Methods:

This was a cross-sectional observational study using direct observation technique. A single observer collected all HH data. During this analysis, 1500 HH opportunities were observed. HH compliance was tested for all 5 moments as per WHO guidelines.

Results:

Overall compliance as per WHO Guidelines was 78%. Nurses had an adherence rate of 63%; allied staff adherence was 86.5%. Compliance was 93% after patient contact versus 63% before patient contact. Nurses''compliance before aseptic procedures was lowest at 39%. 92% staff was aware of the facts viz. Diseases prevented by hand washing, ideal duration of HH, reduction of health care associated infections, etc.

Conclusion:

After 1-year of aggressive multimodal intervention in improving HH compliance, we have an overall compliance of 78%. It implies that sustained performance and compliance to HH can be ensured by ongoing training. Direct observation remains a widely used, easily reproducible method for monitoring compliance.     

Carbapenem resistance among Escherichia coli and Klebsiella pneumoniae in a tertiary care hospital in south India

Carbapenem resistance among clinical isolates of Enterobacteriaceae, especially Escherichia coli and Klebsiella pneumoniae, is largely conferred by metallo-β-lactamase (MBL). Fifty-one non repetitive isolates of carbapenem-resistant (Meropenem and Imipenem) E. coli and K. pneumoniae were studied to determine the molecular mechanism for resistance. Presence of blaNDM and blaVIM was determined by polymerase chain reaction (PCR) and DNA sequencing. blaNDM was detected from majority of carbapenem-resistant K. pneumoniae (75%) and E. coli (66.6%). Timely detection and appropriate and aggressive infection control measures are required to control the spread of these bacteria in healthcare settings.     

Mupirocin resistance in nasal carriage of Staphylococcus aureus among healthcare workers of a tertiary care rural hospital

Introduction:

Mupirocin (pseudomonic acid A) is a topical antimicrobial agent with excellent antistaphylococcal and antistreptococcal activity. A nasal formulation is approved by the United States Food and Drug Administration for eradicating nasal carriage in adult patients as well as in health care personnel. Resistance to mupirocin has already been reported worldwide. The increasing prevalence of mupirocin resistance among Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) species could be an important threat to the future use of mupirocin against methicillin-resistant S. aureus (MRSA). Thus, this study was carried out to find the prevalence of mupirocin resistance in S. aureus and CoNS by disc diffusion and to determine the rates of high-level and low-level mupirocin resistance in S. aureus and CoNS by disc diffusion.

Materials and Methods:

A total of 140 healthcare workers (HCWs) (doctor, nursing staff, housekeeping staff) were randomly selected. S. aureus and CoNS isolates were tested for mupirocin resistance by the disk diffusion method using 5 μg and 200 μg mupirocin discs. MRSA isolates were tested for antibiotics by Kirby-Bauer disc-diffusion method as per Clinical and Laboratory Standards Institute guidelines.

Results:

Out of 140 nasal swabs collected from HCWs, S. aureus was isolated in 38 (27.14%), and CoNS was isolated in 73 (52.14%). MRSA was isolated in 20 (14.28%) and methicillin-resistant coagulase-negative Staphylococci (MRCoNS) in 34 (24.29%. Methicillin-sensitive S. aureus (MSSA) and MSCoNS isolates were 100% sensitive to mupirocin, but two isolates from MRSA (1.43%) and five from MRCoNS (3.57%) were mupirocin resistant.

Conclusion:

The presence of mupirocin resistance in MRSA and MRCoNS is a cause for concern. It could be limited by regular surveillance and effective infection control initiatives so to inform health care facilities to guide therapeutic and prophylactic use of mupirocin.     

Distribution of the different genotypes of HCV among patients attending a tertiary care hospital in south India.

BACKGROUND: Genotyping of the hepatitis C virus (HCV) and assessment of viral load is important for designing therapeutic strategies and region specific diagnostic assays. OBJECTIVES: To determine the distribution of HCV genotypes among patients attending a tertiary care hospital in south India, and to correlate this with viral load. STUDY DESIGN: Ninety HCV RNA positive patients were recruited for the study. HCV genotyping was carried out using type-specific primers from the core region of the viral genome [J. Clin. Microbiol. 35 (1997) 201]. Viral load estimations were carried out using the Amplicor HCV Monitor (Versions 1.5 and 2, Roche Diagnostics, Branchburg, NJ, USA). Clinical details were elicited from patients' hospital records. RESULTS: Genotype 3 was detected most frequently (62.2%) followed by infection with HCV genotype 1 (18.8%). There was no significant difference seen in alanine aminotransferase (ALT) values between the two genotypes. Genotype 1 was associated with a significantly higher viral load as compared with genotype 3 (P=0.001). Parenteral transmission accounted for 61% of all infection caused. Infection with genotype 1 was significantly associated with a history of haemodialysis (P=0.01). Genotype 3 was detected more frequently in patients from east India, as compared with its detection in patients from south India (P=0.004). Similarly, genotype 1 was detected with greater frequency in individuals from south India as compared with patients from east India (P=0.004). The concordance between Ohno's genotyping assay and nucleotide sequencing, for genotypes 1 and 3, was 75%. CONCLUSIONS: HCV genotypes 1 and 3 accounted for 81% of HCV infections in patients from this geographical region. HCV genotype distribution showed regional differences and genotype 1 was associated with higher viral loads. Parenteral transmission was the major route for acquisition of HCV infection. Ohno's type-specific primer based genotyping assay can be used for distinguishing between HCV genotype 1 and non-1 HCV genotypes in laboratories that do not possess nucleotide sequencing facilities.     

Detection of Enterobacteriaceae producing CTX-M extended spectrum beta-lactamases from a tertiary care hospital in south India

A total of 23 clinical isolates (15 Escherichia coli and 8 Klebsiella pneumoniae), resistant to cefotaxime and ceftazidime recovered during 2002 and 2003, were investigated for production of CTX-M extended spectrum beta-lactamase (ESBL) by phenotypic and molecular methods. The presence of ESBL was tested by NCCLS phenotypic confirmatory test using cephalosporin/clavulanate combination discs and E-test ESBL strips. Determination of MIC of cefotaxime and ceftazidime was done with and without the presence of clavulanic acid by agar dilution technique. Polymerase chain reaction revealed the presence of CTX-M type ESBLs in 19 isolates. Further sequencing resulted in identification of CTX-M-15 ESBLs. This is the first report identifying CTX-M type ESBL from clinical isolates of E. coli and K. pneumoniae from a tertiary care hospital in south India.     

Risk factors for acquiring Strongyloides stercoralis infection among patients attending a tertiary hospital in south India

Purpose: Strongyloides stercoralis causes persistent and fatal disseminated infections in immunocompromised hosts. In this study, we aimed to determine the risk factors for acquiring strongyloidiasis and the associated morbidity in south India. Materials and Methods: The study was carried out in two parts. This included a 6-month chart review of cases with strongyloidiasis and randomly selected controls conducted to determine the association with immunocompromised states. Secondly, a cross-sectional study was conducted to investigate hyperinfection in human immunodeficiency virus (HIV)-infected adults where the stool and sputum samples were examined by microscopy for Strongyloides larvae. Results: In the chart review, 118 cases were compared with 240 controls. A higher proportion of patients on corticosteroids [8 (53.3%)] and with HIV infection [3 (60%)] had the risk of acquiring strongyloidiasis than not, although the difference was not statistically significant in this population. In the cross-sectional study, 14/239 HIV-positive individuals had Strongyloides larvae in the stool samples but none had Strongyloides detectable in their sputum samples. The CD4 cell counts were significantly lower in cases with Strongyloides compared with HIV-infected individuals with no parasites in their stool samples (P < 0.001). Conclusions: In this setting, strongyloidiasis was seen more often in patients on corticosteroid therapy and with HIV infection. In HIV, an association with lower CD4 counts indicates the need for inclusion of Strongyloides as an opportunistic parasite. Gram negative sepsis was an important complication of strongyloidiasis hyperinfection in both HIV and steroid therapy. Further prospective studies on the risk of developing complicated Strongyloides infection are required.     

Molecular characterization of nosocomial CTX-M type beta-lactamase producing Enterobacteriaceae from a tertiary care hospital in south India

CTX-M group of extended spectrum beta lactamases (ESBLs) represents a rapidly emerging problem in many countries. The prevalence of nosocomial bla CTX-M-1 producing Enterobacteriaceae strains has not been reported earlier in Indian hospitals. This study describes molecular subtyping of nosocomial bla CTX-M producing strains of Enterobacteriaceae . Polymerase chain reaction with primers specific for bla CTX-M-1 coding genes was used to identify 95 Enterobacteriaceae strains producing bla CTX-M positive isolates. Of the 95 bla CTX-M producing isolates, 45 strains were positive for bla CTX-M-1 . bla CTX-M-1 was found to be most prevalent in Klebsiella strains.     

Prevalence of malnutrition in a tertiary care hospital in India

Introduction:

Malnutrition adversely affects clinical outcome of hospitalized patients. This observational prospective study was done to assess the prevalence of malnutrition and its grade among patients admitted in a mixed intensive care unit (ICU) of a tertiary care hospital in order to help devise a comprehensive nutrition program for the malnourished.

Materials and Methods:

A total of 500 sequential patients admitted to the ICU were screened on admission over a year period for malnutrition using the Subjective Global Nutritional Assessment (SGNA) score. Distribution of the degree of malnutrition according to co-morbidities was also documented.

Results:

Of the total, 198 (39.6%) patients were malnourished, including one patient qualifying as severely malnourished; 68% patients were male, however, there was no statistically significant difference between nutrition status between sexes. Hypertension, diabetes, and cancer were the three most commonly encountered co-morbidities among the malnourished. A total of 86% of all cancer patients admitted were malnourished against only 12% of trauma patients.

Conclusion:

This study showed that almost two-fifth of the patients admitted were malnourished in this tertiary care hospital and that there is an urgent need to develop a comprehensive nutritional care program in many such Indian ICUs.     

Colonisation of methicillin resistant Staphylococcus aureus among health care workers in a tertiary care hospital of Delhi

Methicillin resistant strains of Staphylococcus aureus have been responsible for many nosocominl epidemics. Colonised employees of hospital such as asymptomatic nasal and hand carriers act as reservoirs for the spread of this organism within hospital. During a period of three months 150 HCW were screened for nasal and hand colonisation by MRSA. 6.6% (10) HCW were colonised by MRSA and 50% of these were carrying MRSA on both hands and anterior nares. 30% (3) of MRSA strains were multidrug resistant and 60% (6) were resistant to ciproflox. Whether the eradication of MRSA carrier state will lead to decreased rate of MRSA infection is yet to be documented.     

Awareness and practices regarding bio-medical waste management among health care workers in a tertiary care hospital in Delhi

Health care institutions are generating large amount of Bio-Medical Waste (BMW), which needs to be properly segregated and treated. With this concern, a questionnaire based cross-sectional study was done to determine the current status of awareness and practices regarding BMW Management (BMWM) and areas of deficit amongst the HCWs in a tertiary care teaching hospital in New Delhi, India. The correct responses were graded as satisfactory (more than 80%), intermediate (50–80%) and unsatisfactory (less than 50%). Some major areas of deficit found were about knowledge regarding number of BMW categories (17%), mercury waste disposal (37.56%) and definition of BMW (47%).     

Biomedical waste management: Study on the awareness and practice among healthcare workers in a tertiary teaching hospital

Bio-medical waste has a higher potential of infection and injury to the healthcare worker, patient and the surrounding community. Awareness programmes on their proper handling and management to healthcare workers can prevent the spread of infectious diseases and epidemics. This study was conducted in a tertiary care hospital to assess the impact of training, audits and education/implementations from 2009 to 2012 on awareness and practice of biomedical waste segregation. Our study reveals focused training, strict supervision, daily surveillance, audits inspections, involvement of hospital administrators and regular appraisals are essential to optimise the segregation of biomedical waste.     

Prevalence and molecular characteristics of MRSA nasal carriage among hospital care workers in a tertiary hospital in the Philippines

BackgroundHospital-care workers (HCWs) are at risk for MRSA carriage, subsequent infection and potential transmission of nosocomial infection. Epidemiological typing of MRSA among HCWs would provide data that can be used for control measures.MethodsThis is a cross sectional study that involved 92 participants from pediatric and surgery department of a tertiary hospital. Nasal swabs were collected and inoculated onto MRSASelect Chromogenic Media. Samples characterized as MRSA underwent SCCmec typing and detection of Panton Valentine leucocidin (PVL) by PCR.ResultsThe overall prevalence of MRSA was 13%. Six were from Pediatrics and another six were from Surgery. Seven out of 12 MRSA isolates carried SCCmec type I gene and five isolates carried SCCmec type IV gene. Six samples were found positive for PVL, four of which PVL-SSCmec IV, while the other two isolates were PVL-SCCmec I. The isolates were grouped into four main sequence types (STs) namely ST 1147, ST30, ST5 and ST97. Two samples from both departments were found to be PVL-positive SCCmec I ST 30; PVL-positive SCCmec IV ST 97 was found in two MRSA samples from Pediatrics and PVL-positive SCCmec IV ST 30 from Surgery.ConclusionData collected from a non-outbreak setting suggest the presence of different clones of MRSA from nasal swabs of HCWs belonging to the Department of Pediatrics and Surgery. The data collected by this study can be used as reference for other succeeding studies on the surveillance of MRSA among HCWs.     

Adverse drug reactions to fluoroquinolones at a tertiary care hospital in northern India

Use of fluoroquinolones has increased considerably in the last 5-6 years in our hospitals. With a view to ascertain their safety and the type of adverse drug reactions (ADRs) in our population, spontaneous reports were collected and analysed to ciprofloxacin (the most prescribed fluoroquinolone in our hospital) over a period of three and a half years. The pattern of reactions were rash in 18, severe reactions like Steven Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in 4, gastritis and diarrhoea in 3, shivering and rigors in 2, hemorrhagic purpuric spots in 2 and oedema of eye and lids with topical application in 1 patient. Most cases recovered on stoppage of the drug and symptomatic treatment. However, one case of SJS and one of TEN proved fatal. Care needs to be exercised in their use and they do not appear to be innocuous to severe and disturbing ADRs.     

Evaluation of SARS-CoV-2 antibody responses in healthcare workers at a tertiary care COVID 19 dedicated hospital in Delhi

PurposeAmidst the on-going SARS-CoV-2 pandemic, healthcare workers have been at a greater risk of disease exposure as they are working in environments chiefly involved in the COVID-19 patient care since March 2020. SARS-CoV-2 antibody testing can prove to be a valuable tool for better understanding of prevalence of disease exposure in this population. Therefore, we conducted this study to grasp the sero-prevalence of COVID-19 antibodies in our hospital to better comprehend the duration of IgG response.MethodsThis was a longitudinal study involving 305 healthcare workers at Rajiv Gandhi Super Speciality Hospital spanning over a period of four months starting from October 2020 to January 2021. Serum samples were obtained from the study group taken as Day 0 of the study and were screened for the presence of SARS-CoV-2 IgG antibodies using semi-quantitive enzyme linked immunoassay technology from ERBAlisa (India). The Antibody Index was determined. Those showing reactive in the screening test were further followed up on a monthly basis till January 2021 for serial antibody testing.ResultsThe overall seroprevalence for IgG response among the workers was found to be 21.96%. Seropositivity rate was observed to be significantly higher in those having a history of RT-PCR confirmed COVID-19 infection (45.09%)ConclusionsOur study demonstrated that healthcare workers have a higher sero-prevalence. Our study also demonstrated that the antibodies developed following COVID-19 infection had a waning effect of protective response following infection.     

Increasing erythromycin resistance among group A streptococci causing tonsillitis in a tertiary care hospital in southern India

Group A streptococci (GAS) (n = 1313) isolated from patients with clinical symptoms of pharyngitis or tonsillitis attending a tertiary care hospital in southern India during 1986-2002 were tested for susceptibility to penicillin and erythromycin. The overall erythromycin resistance rate was 2.7% (n = 36). During 1986-1993, erythromycin resistance was observed in only one (2%) isolate in 1987, but reappeared in 1994 (2.7%), increased to 5.8% in 1999, and reached a maximum frequency of 13.8% in 2002. All isolates were susceptible to penicillin. The data indicate the need for continued surveillance of susceptibility patterns among GAS isolates in order to monitor the development of antibiotic resistance.