EMERGENCE OF CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII IN THE INTENSIVE CARE UNIT OF A REFERRAL HOSPITAL OF EASTERN INDIA AND ITS THERAPEUTIC OPTION

Background and objective: Multidrug-resistant Acinetobacter baumannii has one of the most serious nosocomially acquired gram negative infection in Intensive Care Unit (ICU). The gradual increase in incidence of this pathogen reflects their de-novo selection due to antibiotic usages and its ability to spread between patients. This study was undertaken to detect resistance to carbapenems in clinical isolates of A. baumannii in our ICU set up and to assess the rate of carbapenemase and MBL production among the isolates with the therapeutic options available against them. Material and methods: A. baumannii was identified by conventional methodology and susceptibility profile was determined by disc diffusion method. Carbapenem resistant isolates were further checked for mettalo beta lactamases (MBL) assay by EDTA disc synergy test and Minimum inhibitory concentration determination by agar dilution method. Results: 71.87% (n=46) of isolates showed resistance to Imipenem by disc diffusion method. 82.6% (n=38) of isolates were MBL producer both by phenotypic EDTA disc synergy test and MIC determination test by agar dilution method. The susceptibility profiles of A. baumannii strains towards colistin, polymyxin B and tigecycline were 90.62%, 57.81% and 78.12% respectively.Conclusion: Detection as well as awareness of this MBL producing A. baumannii in a hospital set up, coupled with judicious antimicrobial therapy based on sensitivity profiles will help us fight against this deadly menace. KEYWORDS: Acinetobacter baumannii; Carbapenemases; Mettalo beta lactamases

EMERGENCE OF CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII IN THE INTENSIVE CARE UNIT OF A REFERRAL HOSPITAL OF EASTERN INDIA AND ITS THERAPEUTIC OPTION

Background and objective: Multidrug-resistant Acinetobacter baumannii has one of the most serious nosocomially acquired gram negative infection in Intensive Care Unit (ICU). The gradual increase in incidence of this pathogen reflects their de-novo selection due to antibiotic usages and its ability to spread between patients. This study was undertaken to detect resistance to carbapenems in clinical isolates of A. baumannii in our ICU set up and to assess the rate of carbapenemase and MBL production among the isolates with the therapeutic options available against them. Material and methods: A. baumannii was identified by conventional methodology and susceptibility profile was determined by disc diffusion method. Carbapenem resistant isolates were further checked for mettalo beta lactamases (MBL) assay by EDTA disc synergy test and Minimum inhibitory concentration determination by agar dilution method. Results: 71.87% (n=46) of isolates showed resistance to Imipenem by disc diffusion method. 82.6% (n=38) of isolates were MBL producer both by phenotypic EDTA disc synergy test and MIC determination test by agar dilution method. The susceptibility profiles of A. baumannii strains towards colistin, polymyxin B and tigecycline were 90.62%, 57.81% and 78.12% respectively.Conclusion: Detection as well as awareness of this MBL producing A. baumannii in a hospital set up, coupled with judicious antimicrobial therapy based on sensitivity profiles will help us fight against this deadly menace. KEYWORDS: Acinetobacter baumannii; Carbapenemases; Mettalo beta lactamases

Ventilator associated pneumonia in a tertiary care hospital in India: Incidence, etiology, risk factors, role of multidrug resistant pathogens

Background: Ventilator associated pneumonia (VAP), a hospital acquired infection (HAI) is seen among critically ill patients on mechanical ventilation (MV) due to various causes, in intensive care units (ICUs). VAP increases morbidity, mortality, as well as the cost of healthcare. Materials and Methods: A prospective study was done over a period of 10 months in a tertiary care hospital in India to determine the incidence, etiological agents, their sensitivity profiles, and risk factors associated with VAP. Combination disc method, ethylenediaminetetraacetic acid (EDTA) disc synergy (EDS) tests, and AmpC disc tests were performed for detection of extended-spectrum beta-lactamases (ESBL), metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively. Results: One hundred and forty adult patients, on MV for 48 h and more, were included and 28 (20%) developed VAP. The incidence density rate of VAP was 21.875 per 1,000 ventilator days. Most of the patients had late onset VAP (60.7%) with average number of days for onset around 8 days. Pseudomonas spp. and Acinetobacter spp. were significantly associated with late onset VAP, whereas Enterobacteriaceae, Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Burkholderia cepacia, and Candida species were commonly isolated from early onset VAP. Polymicrobial infections occurred in 14 cases, so overall 43 VAP pathogens were isolated. Thirty (69.7%) of them were multidrug resistant (MDR), among which ESBL contributed 23.25%, MBL 30.23%, AmpC beta-lactamases 9.30%, and to methicillin resistant S. aureus (MRSA) contributed 6.97%. Prior antibiotic therapy (P < 0.0001), hospitalization for 5 days or more (P < 0.0001), MV for 5 days or more (P < 0.0001), supine head position (P < 0.0001), reintubation (P = 0.0012), and impaired consciousness (P = 0.0191) were significant risk factors for VAP. Conclusions: Proper knowledge of risk factors can help identify high risk groups for VAP, among the critically ill patients on MV. MDR pathogens, with production of ESBL, MBL, AmpC beta-lactamases, and MRSA were commonly associated with VAP. So, judicious use of antibiotic is recommended

A case report of nonhealing leg ulcer infected with Stenotrophomonas maltophilia in an immunocompetent patient in a Tertiary Care Hospital of Eastern India

Stenotrophomonas maltophilia is an aerobic, motile Gram-negative, nonfermentative bacillus considered as an opportunistic pathogen causing infection typically in individuals with immunosuppression, organ transplantation and malignancies. Contaminated water or medical devices in the hospital environment are the primary causes of infection. Here, we report a case of nonhealing leg ulcer infected with S. maltophilia in an immunocompetent individual

Does the benefit of salvage amputation always outweigh disability in drug-failure mycetoma?: A tale of two cases

It is popularly believed that eumycetoma cases should be dealt with using surgical amputation for a better chance of cure especially when chemotherapy has failed. However, amputation leads to disability on one hand and on the other it may also fail to be curative. We present two cases with contrasting treatment options and outcome. In the eumycetoma case reported here, a 40-year-old male presented with right foot swelling for 16 years, from which Scedosporium apiospermum was isolated. He responded poorly to antifungal therapy and refused below-knee amputation 12 years ago. With counseling and wound care his condition improved, and Foot and Ankle Ability Measure (FAAM) score remained almost stable at 90% for 16 years, which is much better than the average functional outcome after amputation. Another 46-year-old female underwent below-knee amputation after receiving incomplete courses of antibiotics and antifungals for mycetoma of unknown etiology. She presented to us after recurrence of mycetoma on an amputated stump and was successfully treated by proper courses of antibiotics after detecting the causal agent, Actinomadura madurae. Her post-amputation disability and depression could have been avoided if the hasty decision of amputation had not been taken. In our opinion, living with drug-non-responsive mycetoma, supported by symptomatic management, may be a better option than amputation and its associated morbidities. So before taking the path of salvage amputation, we must consider many aspects, including patient′s livelihood, psychological aspects and chances of recurrence even after the procedure

A case report of white grain eumycetoma caused by Scedosporium apiospermum in a tertiary care hospital of the Eastern India

Scedosporium apiospermum and its asexual state Pseudallecheria boydiiare increasingly recognized as an opportunistic pathogen. Here, we describe a white grain eumycetoma of left foot of a 48-year-old female caused by S. apiospermum. Treatment with oral voriconazole was successful

An unusual case of chronic nonhealing periorbital ulceration due to a new species of Corynebacterium sp. strain UCL557

Nondiphtherial Corynebacterium (diphtheroids) has been related to blood and wound infections but are an uncommon cause for soft tissue infection. We report a case of periorbital soft tissue infection with ulceration caused by multidrug-resistant Corynebacterium spp. in a 9-year-old girl who is apparently immunocompetant. Computed tomography scan showed soft tissue involvement of right periorbital region with no bony destructions or focal calcifications. Vision remained unaffected. Patient was treated by debridement and skin grafting, but condition did not improve. Pus collected from the periorbital ulcerated area was cultured in blood agar and Corynebacterium spp. was isolated from the pure culture, which was identified as a new species Corynebacterium sp. strain UCL557 using 16S rDNA- based molecular technique based on nucleotide homology and phylogenetic analysis. Antibiogram showed multiresistance pattern with sensitivity to ceftriaxone-sulbactum vancomycin and linezolid. After initiation of treatment with vancomycin infusion and oral linezolid, the patient responded well and lesion started to heal. To the best of our knowledge, this is the first ever case report of periorbital ulceration by new species of Corynebacterium sp. strain UCL557

ESTIMATION OF PREVALENCE OF HEPATITIS C VIRUS INFECTION BY SEROLOGICAL TEST AND REAL TIME RT-PCR TEST AMONG SUSPECTED VIRAL HEPATITIS CASES ATTENDING TERTIARY CARE HOSPITAL, KOLKATA : PREVALENCE OF HEPATITIS C VIRUS INFECTION BY SEROLOGICAL TEST AND REAL TIME RT-PCR TEST

Objective: Hepatitis C virus(HCV) infection is a major public health problem in India and worldwide. Majority remain asymptomatic until they develop serious complications like liver cirrhosis or hepatocellular carcinoma with fatal outcome. Hence early diagnosis of active HCV infection and prompt initiation of treatment is important. Treatment with directly acting antivirals(DAAs) resulted in high sustained virological response(SVR) rates of &gt;95% globally. This study was done to estimate sero-prevalence and prevalence of active HCV infection among study population. After initiation of treatment, SVR rates were estimated. Methods: This was hospital based cross-sectional observational study. Screening was done by 3rd-generation ELISA to detect anti-HCV antibody, then confirmatory real time RT-PCR test was done for detection of active cases and determining their viral load. Treatment of 12 weeks duration was initiated by DAAs and followed up to estimate SVR by doing real time RT-PCR after 12 weeks of treatment completion. Result: Among 17,752 consecutive non-repetitive blood samples, seroprevalence was 1.78%. Prevalence of active cases was1.52%. HCV active infection was prevalent more among male(64.21%) and among 40-60 years age group. History of multiple blood transfusion(58%) was most common risk factor, followed by multiple sex partners(13.3%). Coinfections with HBV and HIV was seen in 13.65% cases. 92% patients completed their treatment. SVR was 97.87%. Conclusion: High SVR of 97.87%, is evidence-based data that supports that proper treatment can eliminate HCV infection. Detection by real time RT-PCR and highly effective DAA has made a paradigm shift to approach of HCV diagnosis and management in recent times