BACKGROUND AND OBJECTIVES: Increasing antibiotic resistance, particularly among carbapenems, has made the management of sepsis very challenging. Early and aggressive use of appropriate antimicrobials is essential in improving the clinical outcome of these patients. The aim of this study was to find the various risk factors leading to sepsis with carbapenem-resistant organisms (CRO) and also to analyse the various clinical outcomes among sepsis due to CRO. MATERIALS AND METHODS: Blood cultures were processed from patients who presented with signs and symptoms of sepsis. Analysis for predisposing factors and clinical outcome was done for those patients who grew CRO in both blood cultures. For calculation of significance, the same factors were also studied in an equal number of patients who presented with sepsis due to carbapenem-sensitive organisms. RESULTS: Blood cultures were received from a total of 3885 patients in one year, of which 7.6% grew Gram-negative bacilli. Resistance to carbapenems was seen in 17.9% of isolates. The significant risk factors for sepsis with CRO in the present study were chronic liver disease, increased duration of hospital stay and exposure to antibiotics. Carbapenem-resistant sepsis was associated with increased mortality. This may be related to the delay in initiating definitive therapy after the onset of sepsis. INTERPRETATION AND CONCLUSION: Colistin is the drug of choice for carbapenem-resistant sepsis. Being a reserve drug, we recommend Colistin to be restrictively used as an empiric therapy only in those patients who developed sepsis after hospital stay, who had prolonged antibiotic exposure as well as in patients with chronic liver disease.

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With the development of carbapenemase inhibitors such as avibactam, relebactam and vaborbactam, it has become important to detect the type of carbapenemase produced for guiding antibiotic therapy. Among the several methods available for the same, we chose lateral flow assay (Resist-3 O. K. N., Coris BioConcepts, Gembloux, Belgium) and compared it against a commercially available molecular test (Xpert Carba R assay, version 2, Cepheid, Sunnyvale, CA, USA). Sixteen clinical isolates, which were resistant to carbapenems on phenotypic testing, were selected. Fourteen of these were Klebsiella pneumoniae and two were Escherichia coli a total of 22 carbapenemases. (OXA-48-14, New Delhi metallo-beta-lactamase [NDM]-7 and K. pneumoniae carbapenemase [KPC]-1) were detected by the Carba-R assay. Six isolates (K. pneumoniae-5 and E. coli-1) had co-production of OXA-48 and NDM. Resist-3 assay detected all twenty two enzymes. The distribution of enzymes in these 16 isolates was identical to that shown by the Carba-R (100% agreement). Hence, we conclude that lateral flow immunochromatography assay is a simple, rapid and cost-effective method for the detection of carbapenemases. This would help the clinician select the appropriate antibiotic and support antibiotic stewardship in the Indian settings.

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Listeria monocytogenes should be considered as a source of sepsis and meningitis in immunocompromised individuals. Immunosuppressant agents including biologic therapies have transformed the management of various rheumatological and dermatological conditions. We report a case of life-threatening Listeria monocytogenes sepsis and meningitis in a 52-year-old female who was on immunosuppressive therapy.

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BACKGROUND: Sars-Cov2 is a respiratory disease causing virus that originated in Wuhan, China with the officials in the country first reporting it in December 2019. It results in the condition Covid-19, with the main symptoms associated with the virus being a high temperature, a continuous cough and a loss or change of taste and smell. AIMS AND OBJECTIVES: An assessment of service provision was conducted to see how the involvement of different analysers with its different systems, impacted upon the duration that patients spent on Paediatric Assessment Unit (PAU); an intermediary unit linking the Emergency Department to further hospital wards. The preferred screening for the virus by Public Health England (PHE) involves molecular diagnosis by real-time PCR. MATERIALS AND METHODS: Fifty samples were collected between March and July, and the patient duration spent on PAU was seen to decrease as the months progressed. To the best of our knowledge, this is a novel study which has not yet taken place before. RESULTS: As the months progressed, the average time patients spent on PAU from March to July was shown to have reduced. CONCLUSION: The decrease in duration mirrored the change in service provision; namely the implementation of a random-access analyser, allowing for enhanced patient movement within the hospital.

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The clinical microbiology reporting (CMR) for culture and antimicrobial susceptibility test (C and AST) is the most important investigation reported from a microbiology laboratory. However, majority of Indian microbiology laboratories generate a basic level C and AST report comprising of identification of the organism isolated with a list of antimicrobials and their susceptibility results, without any additional comments or messages. This leads to improper communication between the laboratory physicians and clinical physicians. This may further lead to irrational use of antimicrobials, improper specimen collection practices, inappropriate filing of requisition forms and poor infection control practices, which are mainly due to either unawareness or negligence of clinicians. Therefore, it is essential that the laboratory microbiologists of India should uplift themselves to clinical microbiologists and foster their CMR to higher standards by incorporating specific comments, suggestions and advices in the C and AST report, as recommended by the regulatory agencies such as Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing. The comments may be of several types which include report categories, in-progress reports, requisition form filling, specimen collection, footnotes in the AST table, infection control advices, antimicrobial agent-related suggestions, predicted susceptibility related and intrinsic resistance comments, etc. The use of comments will greatly help the clinicians to rationalise their antimicrobial practice, improvise practices of specimen collection, requisition form filling and finally instituting the appropriate infection control practices. These comments mentioned in this article are only author's recommendations; the end users may incorporate according their local practice and need.

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