Candidemia in neonatal intensive care unit: a cause of concern

Background: Candidemia in neonates is a serious and common cause of late onset sepsis. Candida species are the third most frequent organism isolated in late onset sepsis in very low birth weight (VLBW) infants (i.e., <1,500 g). Methods: This study was performed to evaluate epidemiology, species distribution, antifungal susceptibility and outcome of candida blood stream infections at a tertiary care centre.Results: About 1-2 ml of blood was collected aseptically in suspected cases of septicaemia and inoculated in 20 ml of Brain Heart Infusion(BHI) broth. Candida species isolates were confirmed by germ tube production, chlamydospore formation on corn meal agar(HiMedia), pigmentation on Hichrome Candida differential agar (Himedia), and carbohydrate assimilation tests. Non-albicans candida spp. are of special concern, due to their high virulence and low azole susceptibility characteristics, augmenting the high mortality rates.Conclusions: The emergence on non-albicans Candida merits attention as they display higher degree of resistance to azoles and are associated with higher mortality rates. Additional studies are required to define more accurately the prevalence and sensitivity pattern of Candida spp. which may serve as a template for development of preventive and therapeutic strategies for neonatal candidemia especially at peripheral health centres

Candida tropicalis: insight into the characteristics and outcome of adult patients admitted in medical and surgical intensive care units

Background: Non albicans species are emerging increasingly as significant ICU pathogens.  The increasing incidence of C. tropicalis infections is a significant problem because of its ability to develop rapid resistance to fluconazole.Methods: The study was designed to isolate, evaluate the risk factors and outcome of C. tropicalis infection from intensive care units. Identification was done by the biochemical methods. A total of 89 patients culture positive for C. tropicalis were selected for retrospective analysis over a period of one year. We collected various data about risk factors and outcome from the medical records.Results: A total of 89 patients culture positive for Candida tropicalis were analysed. Majority of these culture isolates were obtained from their blood (59.55%) followed by urine samples (31.46%). The indwelling devices (93.2%) remained a highest risk followed by prolonged administration of antibiotic therapy (92.1%) and admission in ICU for more than a week (88.8%). Overall mortality rate was 31.5%. Mortality was higher in patients with longer total length of stay in hospital (89.3%; p 1.000), indwelling devices (85.7%; p 0.5663) and in whom the antimicrobial therapy was administered for prolonged duration (82.1%; p 0.7581), although these factors remained statistically insignificant. 92.1% of isolates were sensitive to amphotericin B and showed 52.8%; 9.0% sensitivity to itraconazole and fluconazole respectively.Conclusions: C. tropicalis is now classified as the third or fourth NAC species being commonly isolated from clinical samples and associated with persistent systemic infections leading to a longer stay in the hospital. Several virulence factors seem to be responsible for high dissemination and mortality

Bacteriological profile and antibiogram of surgical site infection/ post-operative wound infection

Background: Surgical site infections (SSI) constitute a major public health problem worldwide and are the second most frequently reported as Nosocomial infections. Surgical site infections are responsible for increasing the treatment cost, length of hospital stay and significant morbidity and mortality. Objectives: Bacteriological profile and antibiogram of Surgical Site Infection /Post-operative wound infection and to find drug useful for empirical treatment. Material and Methods: The retrospective study was conducted for a period of one year (January 2015 to Dec 2015) in the Department of Microbiology of BPSGMC Khanpur Kalan, Sonepat, Haryana.Samples were collected using sterile cotton swabs. 1687 patients clinically diagnosed of having SSIs were processed as per standard microbiological techniques. Antimicrobial susceptibility testing was done using modified Kirby-Bauer disc diffusion method. Results: Among 1687 patients screened for SSIs, 971 (57.5%) were culture positive. Staphylococcus aureus (25.5%) was the commonest organism followed by Escherichia coli (23.5%), Citrobacter species (17.3%) and Pseudomonas aeruginosa (9.9%). Antimicrobial profile of gram positive isolates revealed maximum sensitivity to Linezolid and Vancomycin, whereas among gram negative isolates Imipenem, Gentamicin, Piperacillin-Tazobactam, and Amikacin were found to be most sensitive. Conclusion: Staphylococcus aureus was the commonest pathogen isolated followed by E.coli (23.5%). Imipenem, Piperacillin/ Tazobactum, Gentamicin and Amikacin can be used as empirical treatment for gram negative bacilli and for gram positive organism Vancomycin and Linezolid can be used as empirical treatment in patients with Surgical Site Infectio

Seropositivity of hepatitis b surface antigen in tertiary care centre: issues & considerations

Background: Hepatitis B virus (HBV) infects more than 300 million people worldwide and is common cause of liver disease and liver cancer. HBV, a member of the Hepadnaviridae family, is a small DNA virus with unusual features similar to retroviruses. HBV replicates through an RNA intermediate and can integrate into the host genome. The unique features of the HBV replication cycle confer a distinct ability of the virus to persist in infected cells. Aims &amp; Objective: This study was designed to determine HBsAg Seropositivity among rural population attending inpatients and outpatients at tertiary care center with special consideration to childbearing age women. Material &amp; Method: This retrospective study was conducted in the Department of Microbiology for three months in a tertiary care center catering rural population. A total of 1463 patients attending outdoor and indoor, were screened for HBsAg by lateral flow based rapid immunochromatographic card test (ICT) manufactured by J Mitra &amp; Co Pvt Ltd. Results: Seropositivity of HBsAg was 41/1463(2.80%). Seropositivity was seen more in males 27/756(3.57%) as compared to females 14/707(1.98%). Age range 31-45 years was found to have highest prevalence rate with seropositivity of 15/279(5.38%). Among patients screened for HbsAg, we observed seropositivity of 2.37% (12/505) among women of childbearing age with age range 16 to 45 years. Conclusion: Findings in this study significantly contribute to the understanding of actual epidemiology of HBsAg in rural population especially women of childbearing age. Therefore, we should make efforts to prevent HBV infection by focusing on associated risk factors

Dengue serology–role of NS1 antigen: evaluation and future prospect

Introduction: According to the estimates, nearly 70% of the disease burden occurs in Asia and is on constant rise. Dengue virus infection has emerged as a major public health concern across the globe in terms of mortality, morbidity and public health cost. Aims &amp; Objectives: This study was undertaken to evaluate the significance of NS1 Ag detection in dengue IgM negative sera as marker for early detection and to compare the rapid detection test kits (RDT’s) with Enzyme linked immunosorbent assay (ELISA). Material &amp; Method: A total of 5283 samples from, were screened for dengue serology by Immunochromatography based lateral flow assay for presence of IgM and IgG anti Dengue antibody and NS 1 Ag. Results of 169 samples were further confirmed using ELISA technique for NS1 Ag in an attempt to compare RDT’s with ELISA. Results: Out of 5283 samples screened, 146/5283 (2.76%) tested positive for dengue antibody, out of which 85/146(58.21%) were positive for DEN Ig M and 61/146(41.78%) showed presence of both IgG and IgM. Out of 5137 seronegative samples, 1930(37.57%) were positive for DEN NS1 Ag. Overall, sensitivity of RDT was 100.00%, specificity-90.16%, PPV- 94.73%, NPV-100.00 % and Efficiency of test -96.44%. Conclusion: NS1 Ag assay holds promise as useful tool in early diagnosis for detecting dengue infection during acute phase of infection when IgM antibodies are not formed to the detectable levels. Also, accurate and affordable diagnostic tests are a crucial component of combating this debilitating mosquito-borne infection