“NEWS ON AIR!” - AIR SURVEILLANCE REPORT FROM INTENSIVE CARE UNITS OF A TERTIARY CARE HOSPITAL

ABSTRACTBackground: The role of airborne microorganisms in the nosocomial infections is debatable since past. Very limited and inconclusive data availableabout the contribution of the air microflora, especially the multidrug resistant (MDR) one, to the hospital-acquired infections in the Intensive CareUnits (ICUs).Objective: To analyze the microbial population and their antimicrobial susceptibility pattern of the indoor air in relation to the nosocomial infectionsin the different ICUs at different periods in the tertiary care hospital.Methods: Microbial monitoring of the air was performed in 5 different ICUs for 1 year by passive sampling method.Results: A total of 221 air samples were collected for 1 year from five different ICUs. 92.53% were Gram-positive bacteria and 8.11% were Gramnegativebacteria. Staphylococcus spp. (34.21%) and Acinetobacter spp. (63.04%) were the most common isolated bacteria among Gram-positiveand Gram-negative organisms, respectively, and among the fungal isolates, all of them were Aspergillus spp. (5.84%) from the air sample. Ventilatorassociatedpneumonia was the most common nosocomial infection and Acinetobacter spp. was the frequently isolated MDR organism.Conclusion: Air could be the major source of nosocomial infections by MDR Gram-negative organisms in the ICUs which require special attention andsurveillance.Keywords: Air sampling, Intensive Care Units, Multidrug-resistant organisms, Nosocomial infection

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

STAPHYLOCOCCUS AUREUS INFECTIONS AND THEIR ANTIBIOTIC SUSCEPTIBILITY PROFILE AT A TERTIARY CARE HOSPITAL

  Objective: Staphylococcus aureus remains an important bacterial pathogen causing diverse infections which are both nosocomial and community acquired. Increasing resistance among S. aureus to various antibiotics is a cause of concern.Methods: A prospective observational study of 4 months duration was conducted to analyze the spectrum of infections caused by S. aureus and to study its antimicrobial resistance to commonly used antibiotics. Specimens from various clinical sites received in the laboratory for culture and sensitivity were processed as per standard techniques. Identification and susceptibility testing of S. aureus isolates were done using automated systems.Results: A total of 234 S. aureus isolates were obtained during the study period. Males accounted for 70.1% (n=164) of patients with S. aureus infections. These patients were uniformly distributed across all age groups. S. aureus was most commonly isolated from pus and exudates (64.5%) followed by respiratory specimens (20.5%) and mainly cultured from the skin and soft tissue infections (56%). Methicillin-resistant S. aureus (MRSA) accounted for 47% (n=110) of isolates. Higher rates of susceptibility were noted for tetracycline (95.3%), gentamicin (85.4%), and trimethoprim/ sulfamethoxazole (88%). Low susceptibility rate was seen for ciprofloxacin (11.2%). Inducible clindamycin resistance was seen in 22.4% (n=50) isolates. Methicillin-sensitive S. aureus isolates were found to be more susceptible to non-beta lactam antibiotics than the methicillin-resistant isolates.Conclusion: A high frequency of MRSA was found in our study. Regular surveillance of antimicrobial resistance profile of this most frequent pathogen is necessary to aid in providing appropriate empirical antibiotic therapy

Disseminated Nocardia asiatica infection in an immunocompromised individual: A rare entity needs careful vigilance

Nocardia asteroides complex and Nocardia brasiliensis are common etiological agents of disseminated nocardiosis among immunocompromised individuals. Here we reported an uncommon case of disseminated nocardiosis with the involvement of lung, brain, soft tissue & pancreas by a rarely isolated species Nocardia asiatica in a HIV infected individual. Diagnosis was initially misinterpreted as tuberculosis based on the clinical and radiological findings. The isolate was identified to the species level with a 16S rRNA gene analysis & in vitro susceptibility was done as resistance is not uncommon among them. Clinical cure & radiological regression of lesions was observed except for brain after treatment with meropenem, amikacin & cotrimoxazole. Keywords: Nocardia asiatica, disseminated nocardiosis, HIV, Pancreatic absces

Typhoid spondylodiscitis mimicking tuberculosis in a teenage girl

Salmonella Typhi cause a broad spectrum of human illnesses like gastroenteritis, typhoid fever, and bacteremia. It has also been recognized as a causative organism of osteomyelitis for more than a century but the incidence appears to be uncommon. Microbiological workup plays important role in the diagnosis of Typhoid spondylodiscitis as most of the time it mimics tuberculosis and misguide the clinician, especially in the developing world. Here, we reported an uncommon case of lumbar spondylodiscitis by Salmonella Typhi in an immunocompetent teenager, with the help of clinical, microbiological and radiological evidence. The case was managed conservatively after posterior spinal stabilization. Keywords: Salmonella, spondylodiscitis, Immunocompeten

Hospital Acquired Bloodstream Infection by Multi Drug Resistant Organisms-Alarming and Challenging Issue in the Intensive Care Units at Present Era

Hospital-acquired bloodstream infections (BSIs) cause high mortality in the intensive care units (ICUs) compared to wards. Furthermore, the isolation of multidrug resistant (MDR) organisms in ICUs add to the gravity of the condition making the treatment a bigger challenge. The present study was aimed to evaluate the prevalence, spread, and the possible MDR organisms contributing to ICU-acquired BSI & the source of the secondary BSI in the ICUs. A prospective study was conducted in four ICU of tertiary teaching hospital over a period of six months. Patient that developed features of BSI within 48 hours after hospital admission were included in the present study Blood culture was performed by an automated BacT/ALERT®3D system. The source of secondary BSI was identified by analysing culture results for the samples other than blood. These samples were taken within 48 hours of the patient’s blood culture test being positive. A total of 50 patients (25%) had an ICU acquired bloodstream infection. Out of 50 patients, 74% of them had bacterial etiology. Thirty one patients (62%) among them developed multidrug resistant bacteraemia. Fifty six percent of Gram negative bacilli were multi drug resistant. The resistance to carbapenem was 42%. The most common MDR Gram negative isolate was identified as Klebsiella pneumoniae (n=12; 38.7%,) and the most common source was pulmonary infection (26.7% (n=12). 42% of isolates in our study were carbapenem resistant suggesting the need for a proper antibiotic policy in the ICUs. Prolonged stay in the ICU with mechanical ventilation was the critical risk factor and ICU mortality was high (38%)