Surveillance Health-Care assoziierter Infektionen auf einer Intensivtherapiestation in einem Krankenhaus der Tertiärversorgung in Zentralindien

Introduction: Because the risk of health-care associated infections (HAIs) is high in intensive care units, and HAIs are one of the causes of morbidity and mortality and affects the overall quality of health care, the continuous monitoring of HAIs in intensive care patients is essential.Aim and objectives: This descriptive cross-sectional study was carried out over a period of five years in a tertiary-care teaching hospital. The aim of the study was to investigate the main and specific types of health-care associated Infections and determine the microbiological profile and antimicrobial susceptibility rates of isolates in patients with HAI.Methods : The active surveillance method was used to detect HAIs in patients who spent over 48 hr in a targeted ICU. Patients with blood stream infections (BSI), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infections (CAUTI) and ventilator-associated events (VAE) were included in the study. HAI were diagnosed based on the Centre for Disease Control (CDC)'s National Healthcare Safety Network (NHSN) updated definitions of HAIs.Results: A total of 121,051 patient days, including 7,989 central line days, 64,557 urinary catheter days, and 18,443 ventilator days, were recorded in the study population and 832 HAIs were diagnosed (incidence rate 6.9%). The overall rates of BSI, CLABSI, CAUTI and possible ventilator-associated pneumonia (p-VAP) were 3.7, 10.6, 2.1 and 13.4/1,000 device days, respectively. The most common organism isolated from BSI was Acinetobacter baumanii (n=322, 29%), followed by Klebsiella pneumoniae 225 (n=225, 20.3%). 79.8% of Acinetobacter baumanii strains were resistant to imipenem, 77.1% to ciprofloxacin and 76.4% to ampicillin. The most common organisms isolated from CAUTI were non-albicans Candida species (n=38, 18%), followed by E. coli and Citrobacter spp. (each n=33, each 15.7%). Conclusions: A trend of increasing resistance of Acinetobacter baumannii to carbapenems was observed. Risk factor analysis showed invasive procedures during sepsis and organophosphorous poisoning as significant factors.Einleitung: Weil die Gefährdung durch Health-care assoziierte Infektionen (HAI) in Intensivtherapieeinheiten besonders hoch ist, HAI eine wesentliche Ursache für Morbidität und Letalität sind und die Gesamtqualität der Gesundheitsversorgung durch HAI beeinträchtigt wird, ist ein kontinuierliches Monitoring von HAI bei Intensivtherapiepatienten unerlässlich.Zielsetzung: Die deskriptive Querschnittsstudie wurde über einen Zeitraum von fünf Jahren in einem Lehrkrankenhaus der Tertiärversorgung durchgeführt. Ziel war es, die wichtigsten und spezifischen Arten von HAI zu untersuchen sowie das mikrobiologische Profil und die Antibiotikaempfindlichkeit der Isolate zu bestimmen.Methode: Es wurde die Methode der aktiven Surveillance eingesetzt, um HAI bei Patienten zu erkennen, die mehr als 48 h auf den Intensivstationen untergebracht waren. In die Studie wurden Patienten mit Blutstrominfektionen (BSI), ZVK-assoziierten Infektionen (CLABSI), Katheter-assoziierten Harnweginfektionen (CAUTI) und Beatmungsassoziierte Pneumonien (VAP) aufgenommen. Die HAI wurden auf der Grundlage der aktuellen Definitionen für HAI des National Healthcare Safety Network (NHSN) des Centers for Disease Control (CDC) diagnostiziert.Ergebnisse: Es wurden 121.051 Patiententage, 7.989 Zentralvenenkathetertage, 64.557 Harnkathetertage, 18.443 Beatmungstage erfasst und 832 HAI diagnostiziert (Inzidenzrate 6,9%). Die Gesamtraten von BSI, CLABSI, CAUTI und möglicher VAP betrugen 3,7, 10,6, 2,1 bzw. 13,4/1.000 Devicetage. Die am häufigsten bei Blutstrominfektionen isolierte Species war Acinetobacter baumanii (n=322, 29 %), gefolgt von Klebsiella pneumoniae (n=225, 20,3%). 79,8% der Acinetobacter baumani i Stämme waren gegen Imipenem, 77,1% gegen Ciprofloxacin und 76,4% gegen Ampicillin resistent. Die häufigsten Mikroorganismen, die bei CAUTI isoliert wurden, waren non-albicans Candida- Spezies (n=38; 18%), gefolgt von E. coli und Citrobacter spp. (je n=33; je15,7%).Schlussfolgerung: Es wurde ein Trend zur zunehmenden Resistenz von Acinetobacter baumannii gegen Carbapeneme beobachtet. Die Analyse der Risikofaktoren ergab, dass invasive Eingriffe während Sepsis und phosphororganische Vergiftungen einen wichtigen Risikofaktor darstellen

Unusual case reports: Tardive oculogyric crisis (tardive syndromes)

We report, we believe for the first time in India, two cases of tardive oculogyric crisis in patients of schizophrenia, paranoid subtype (DSM IV code 295.30) during olanzapine therapy. Relevant data on this rare condition is discussed

Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples

Purpose: Clindamycin is commonly used in the treatment of erythromycin resistant Staphylococcus aureus causing skin and soft tissue infections. In vitro routine tests for clindamycin susceptibility may fail to detect inducible clindamycin resistance due to erm genes resulting in treatment failure, thus necessitating the need to detect such resistance by a simple D test on routine basis. Materials and Method: 247 Staphylococcus aureus isolates were subjected to routine antibiotic susceptibility testing including oxacillin (1ìg) by Kirby Bauer disc diffusion method. Inducible clindamycin resistance was detected by D test, as per CLSI guidelines on erythromycin resistant isolates. Results: 36 (14.5%) isolates showed inducible clindamycin resistance, nine (3.6%) showed constitutive resistance while remaining 35 (14.1%) showed MS phenotype. Inducible resistance and MS phenotype were found to be higher in MRSA as compared to MSSA (27.6%, 24.3% and 1.6%, 4% respectively). Conclusion: Study showed that D test should be used as a mandatory method in routine disc diffusion testing to detect inducible clindamycin resistance

Recent Development Of Four Wheel Steering System

In city life, the driving circumstances of the vehicle with higher Wheelbase and track breadth face problems of turning as space is captive, the same problem is faced in low speed to gain control over Four wheel steering is a method developed in the automobile industry for the effective turning of the vehicle and to increase the flexibility. For a vehicle, working on all wheel drive (AWD) it is necessary to achieve adjustability. This calls for a continuous need and demand of a car to attain flexibility. With this attribute, handling and operating at the minimum speed achieved is till 6.2 mph. The main aim is to come up with effective steering response resulting increase in vehicle adjustability while manoeuvring at high speed and to decrease turning radius at low speed with keeping up as less weight as possible of the vehicle