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   Table of Contents - Current issue
July-December 2021
Volume 23 | Issue 2
Page Nos. 51-91

Online since Thursday, January 27, 2022

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Phaeohyphomycosis and role of internal transcribed spacer p. 51
Lokeshwari Gopal, G Balajee, KS Mouleeswaran, Anupma Jyoti Kindo, Subramanian Swaminathan, G Srividhya, Selva Seetharaman, Arun Kumar, Muthukumar Periasamy, Nigel Peter Symss
Phaeohyphymocosis is caused by a heterogeneous group of black-pigmented fungi. Clinical manifestations range from small localised subcutaneous lesion to life-threatening invasive and disseminated infection. With increase in immunocompromised patients due to various conditions, phaeoid fungus has gained its role as a pathogen in human diseases. There is no pathognomonic clinical or radiological feature to diagnose phaeohyphomycosis. Thus, the role of diagnostics in histopathology and microbiology is important in identification and diagnosis of this clinical condition. Specimens received for fungal identification were cultured on Sabouraud's Dextrose Agar with 10 mg/L Chloramphenicol (SCA) and identified by conventional methods. Few phaeoid fungi, which did not sporulate even after prolonged incubation under appropriate conditions in routine culture media, were identified by Internal Transcribed Spacer sequencing. Here, we present case series of five patients presented to our hospital with brain abscess, post traumatic wound, two post renal transplant recipients with skin and soft tissue infections, diabetes-associated soft tissue swelling and diagnosed with phaeohyphomycosis from 2017 to 2019.
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Assessment of hand hygiene compliance amongst health-care workers during COVID-19 pandemic in intensive care unit's p. 59
Chandana Devaraj, Jayasree Shivadasan
BACKGROUND: Hands are the main pathway of germ transmission during health care delivery. Health care associated infections are important cause for morbidity and mortality, reduced quality of life, prolonged hospital stay and are associated with increase in the health care cost each year1,2. Hand hygiene is a simple and low-cost measure to reduce health care associated infection. Hand hygiene has been recommended as an important strategy to help prevent the spread of COVID-19 infection in hospitals3. This study aims at assessing the hand hygiene compliance among health care workers during Covid 19 pandemic in ICU settings. AIMS AND OBJECTIVES: To assess the compliance of hand hygiene among health care workers during COVID -19 pandemic in ICU's settings. To increase the compliance of hand hygiene among health care workers during COVID-19 pandemic. SETTINGS AND DESIGN: A prospective study was conducted in a 250 bedded tertiary care multispeciality hospital from March 20 to November 20. We followed direct observation method for assessing WHO's five moments of hand hygiene during this covid -19 pandemic in ICU's which included MICU-1, MICU-2, SICU, NICU, NSICU, CCU, CTICU. Study was carried on health care workers like doctors, nurses and others which included housekeeping, food and beverage, dietary, pharmacy staff and physiotherapy staff. METHODS AND MATERIAL: Hand hygiene is assessed by direct observation method.5 moments of hand hygiene has been observed like before aseptic task, before patient contact, after patient contact, after touching patient surroundings and after exposure to contaminated fluids. STATISTICAL ANALYSIS USED: Microsoft excel RESULTS: We used direct observation method for assessing 5 moments of hand hygiene which is a gold standard method. Percentage of compliance for hand hygiene for nurses, doctors and others were 72.4, 71.4 and 68.1 and overall compliance was 70.55 respectively during March 20. Later by November 20, percentage of compliance for nurses, doctors and others were 91.9, 88.5 and 84.5 and overall compliance was 88.2. So, there was a improvement in the compliance among nurses, doctors and others from 72.4, 71.4, 68.1 to 91.9, 88.5, 84.5 respectively. CONCLUSION: The overall percentage of compliance was 70.55 in the month of March 2020, which showed improvement by November 2020 to 88.2 during the Covid-19 pandemic in seven ICU's.
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Detection of Metallo-β-lactamase production amongst Acinetobacter species from a tertiary care hospital p. 63
Vrushali Harsh Thakar, Ankana Chakraborthy, M Modak, Lahiri Krunal
INTRODUCTION: In the past few years, resistance to antimicrobial drugs has been increasing in Acinetobacter spp., which will likely become a substantial treatment challenge in the future. Carbapenems have potent activity against Acinetobacter spp. and are usually the drugs of choice against multidrug-resistant Acinetobacter baumannii. Acinetobacter spp. may develop resistance to carbapenems by producing Metallo-β-lactamases (MBLs). The emergence of MBL-encoding genes is worrisome, since they are usually carried by mobile genetic structures with great ability to spread. AIMS AND OBJECTIVES: The aim of this study was undertaken to find out the prevalence of MBL producing Acinetobacter species from a tertiary care hospital. MATERIALS AND METHODS: Acinetobacter species were identified by conventional methods and antimicrobial susceptibility tests were done by the Kirby Bauer's technique. The presence of MBL was detected by the combination disc method and by VITEK 2. Verona integrin-encoded MBL (VIM) gene was detected in 15 MBL positive strains by polymerase chain reaction (PCR). Five PCR positive strains were sent for sequence analysis. RESULTS: A total of 72 Acinetobacter strains were processed. Thirty-two strains were MBL positive phenotypically. All MBL positive strains were susceptible to colistin. Of 32 MBL positive strains, PCR was done on 15 strains. VIM gene was detected in all 15 strains. CONCLUSION: This study highlights the emergence of MBL strains. Hence, proper hospital infection control practices and rapid MBL detection by laboratory is important to avoid treatment failures.
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Care bundles: A boon to prevent health care-associated infections p. 69
Roopa Bhandary, Amitha Marla, KB Anita
INTRODUCTION: Health care-associated infection (HCAI) is one of the most common threats to patient safety and is associated with a significant mortality and morbidity. Evidence-based practices can be adopted to prevent HCAI. Care bundle is one of the prevention strategies designed to ensure uniform application of best practices to all patients. AIMS:
  1. To study the impact of care bundles on device-associated infection
  2. To study the compliance in execution of the care bundles.
MATERIALS AND METHODS: A time series study was conducted in a 17-bedded medical intensive care unit (ICU). Care bundles were uniformly implemented in the ICU from January 2015. Surveillance and identification of HCAI were done on the basis of CDC guidelines. Statistical analysis was performed using the SPSS software version 2.0. RESULTS: During the pre-implementation phase, the ventilator-associated pneumonia, catheter-associated urinary tract infection and central line-associated bloodstream infections rates were 9.57, 27.28 and 4.62/1000 device days which reduced to 1.51, 1.25 and 1.20/1000 device days, respectively, in the post-implementation phase. The compliance percentage for the execution of care bundles for central line, urinary catheter and ventilator improved, respectively, from 80%, 90% and 85% in 2016 to 85%, 97% and 92%, in 2017. CONCLUSION: Care bundles can have a significant impact on health care-associated infections. However, to have a sustained impact on HCAI continuous training and monitoring is required.
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Primary drug resistance among Mycobacterium tuberculosis isolates from treatment naïve and new pulmonary tuberculosis patients in relation to their socio-economic status p. 75
Thushara Balakrishnan, N Girish
BACKGROUND: Multidrug-resistant Tuberculosis (TB) has become an area of growing concern throughout the World, despite the global efforts in eliminating TB. Detection of primary drug resistance in treatment naïve patients, either due to spontaneous mutation or due to transmission of drug-resistant strains is an important indicator of the presence of drug-resistant strains in the community. OBJECTIVES: The objective is to estimate the prevalence of primary drug resistance in treatment naïve pulmonary TB patients and to identify the socio-economic class of the resistant population. MATERIALS AND METHODS: A total of 272 treatment naïve presumptive TB patients were enrolled in the study from September 2018 to December 2020. The samples were subjected to GeneXpert, for detecting the presence of Mycobacterium TB (MTB) along with Rifampicin (RIF) resistance detection. Phenotypic drug susceptibility testing (DST) was performed on all positive mycobacterial cultures using the 1% proportion method against first-line anti-tuberculous drugs. Socioeconomic status of the patients was also assessed based on updated Kuppuswamy Socioeconomic scale (2018). RESULTS: Of the 272 samples subjected to GeneXpert MTB/RIF assay, MTB was detected in 193 (71%) samples and RIF resistance (rpoB gene) was detected in 25 (9%) samples. Phenotypic DST detected multidrug-resistant (MDR) in 22 (8%) samples. Majority of the MDR patients (55%) were belonging to the upper lower (IV) class of Kuppuswamy socio-economic scale. CONCLUSION: High prevalence of MDR-TB among treatment naïve pulmonary TB patients was noted in patients belonging to Class IV of Kuppuswamy socio-economic scale.
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Lactobacillus bacteraemia p. 82
Sherin Susan Abraham, Marina Thomas, Renu Mathew, Reena Anie Jose, Tribeni Goswami, Anjali Ann Jacob
Lactobacilli exist as a commensal flora in the gastrointestinal tract and can be pathogenic once it is isolated from sterile sites such as bloodstream, spinal fluid and endocardial tissue. Here, we report a case of Lactobacillus bacteraemia in a patient who had many comorbidities.
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Pyogenic liver abscess due to multidrug-resistant Klebsiella pneumoniae p. 85
Nivetha Subramanian, Udhayasankar Ranganathan, Gopal Rangasamy, Mangaiyarkarasi Thiyagarajan, Sunil S Shivekar
Pyogenic liver abscess (PLA) is a space-occupying lesion in the liver associated with high morbidity and mortality. There are many risk factors associated with PLA such as underlying hepatobiliary disease, gastrointestinal malignancy, diabetes mellitus and alcoholism. Most PLA cases are polymicrobial caused by mixed enteric facultative and obligate anaerobic bacteria. Here, we present a case of multiple liver abscess caused by Klebsiella pneumoniae in a 46-year-old elderly patient who presented with gastrointestinal symptoms.
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Strongyloides hyperinfection syndrome in a patient with COVID 19 p. 88
Beena Philomina Jose, Shivapriya P Charu, Vishnu Kaniyarakkal
The severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) which started the corona virus disease 2019 (COVID 19) outbreak is an RNA virus commonly spread via respiratory droplets. The infection may remain asymptomatic or present with mild upper respiratory symptoms or take a severe form with pneumonia and severe acute respiratory distress syndrome (ARDS) that requires assisted ventilation and presents complications with negative outcome. Rate of co-infections and super-infections in hospitalised COVID 19 patients even though low when compared to other respiratory infections, may cause severe disease with worse outcome when present. Here we present a case of strongyloides hyperinfection syndrome complicating SARS CoV-2 infection possibly brought on by the use of immune altering therapy for COVID 19.
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