DETERMINING THE EFFICACY OF ISOXYL, A MYCOLIC ACID INHIBITOR, IN VITRO AGAINST MYCOBACTERIA OTHER THAN MYCOBACTERIUM TUBERCULOSIS (MOTT) STRAINS

Mycobacteria other than Mycobacterium tuberculosis (MOTT) cause infections more commonly in the presence of predisposing factors and underlying diseases.They are also notably resistant to commonly used antituberculosis drugs. Total 11 clinical isolates MOTT were included in the study.Drug susceptibility testing of these isolates was performed by Resistant Ratio method. Minimum inhibitory concentration (MIC) pattern of these isolates of MOTT to mycelia acid synthesis inhibitors namely, Isoxyl(ISO) and Isoniazid (INH) were determined by agar dilution and broth dilution method. Minimum bactericidal concentration (MBC) pattern of these isolates to ISO and INH werealso determined. Out of 11 MOTT isolates, 3 isolates were characterized as Mycobacteriumscrofulaceum, 3 isolates as Mycobacteriumfortuitum, 2 isolates as Mycobacteriumflavescens, 1 isolates as Mycobacterium terrae and 2 isolates as Mycobacteriumkansasi depending upon the results of biochemical tests.The MBC range of INH was found to be 0.025 to 6.4 μg/ml and of ISO was found to be 0.6 to 20 μg/ml. Bactericidal activity of ISO was 7.25 times lower than the activity of INH. It is well known that most MOTT species are more resistant to chemotherapeutic agents other than tubercle bacilli.The inhibitory activity of ISO was more to MOTT strains than Mycobacterium tuberculosis strains.There was low bactericidal activity of ISO to MOTT strains, but better than for Mycobacterium tuberculosis strains.&nbsp

Impact of an International Nosocomial Infection Control Consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India

SummaryObjectiveTo evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach on central line-associated bloodstream infection (CLABSI) rates in eight cities of India.MethodsThis was a prospective, before-and-after cohort study of 35650 patients hospitalized in 16 adult intensive care units of 11 hospitals. During the baseline period, outcome surveillance of CLABSI was performed, applying the definitions of the CDC/NHSN (US Centers for Disease Control and Prevention/National Healthcare Safety Network). During the intervention, the INICC approach was implemented, which included a bundle of interventions, education, outcome surveillance, process surveillance, feedback on CLABSI rates and consequences, and performance feedback. Random effects Poisson regression was used for clustering of CLABSI rates across time periods.ResultsDuring the baseline period, 9472 central line (CL)-days and 61 CLABSIs were recorded; during the intervention period, 80898 CL-days and 404 CLABSIs were recorded. The baseline rate was 6.4 CLABSIs per 1000 CL-days, which was reduced to 3.9 CLABSIs per 1000 CL-days in the second year and maintained for 36 months of follow-up, accounting for a 53% CLABSI rate reduction (incidence rate ratio 0.47, 95% confidence interval 0.31–0.70; p=0.0001).ConclusionsImplementing the six components of the INICC approach simultaneously was associated with a significant reduction in the CLABSI rate in India, which remained stable during 36 months of follow-up

TO STUDY INCIDENCE OF MULTI DRUG RESISTANT TUBERCULOSIS IN MUMBAI

Ionized and Rifampicin, the two most potent anti-tuberculosis drugs are rendered ineffective in Multidrug-resistant Tuberculosis (MDR-TB). India, China and Russia contribute to more than 62% of MDR-TB globally. In India, endemic areas like Mumbai are “hotspots” for the dissemination of MDR-TB. The aim of the study was to investigate the incidence of MDR-TB in cases of pulmonary tuberculosis in Mumbai. Total hundred and two clinical isolates of.Tuberculosiswas tested in the study. Drug susceptibility testing of these strains were carried by Resistance Ratio method to ant tuberculosis drugs namely Ionized, Streptomycin andEthambutol and by absolute concentration method for Rifampicinand Pyrazinamide. In our study highest resistance (46 %) was observed to INH followed by RF (42.16 %), SM (29.41 %) and EMB (25.49 %). While, resistance to Pyrazinamide (PZ) was least (7.8%). MDR TB cases were found to be 41.18%.There was significant difference between resistance pattern of INH and EMB, INH and SM, PZ and EMB, PZ and SM, EMB and RF, PZ and RF. (chi square with Yates correction =8.5, p<0.01).Detection of MDR TB strain would not only eliminate non-essential use of antibiotics, but would also help in the selection of most effective drug regimen and guide therapy in chronic cases

COMPARISON OF CONVENTIONAL METHOD, RADIOMETRIC METHOD AND METHOD USING OXIDATION-REDUCTION DYE FOR DETECTION OF MULTI DRUG RESISTANT TUBERCULOSIS

Today Tuberculosis (TB) has become the most important communicable disease in the world. The emergence of multidrug resistant (MDR) TB has become the main threat to TB treatment and control programs. Rapid detection of TB is critical for the effective treatment of patients. Recently, a method using the Oxidation - Reduction dye has been proposed for drug susceptibility testing of Mycobacterium tuberculosis (M.tuberculosis). In the present study, we have compared Drug Susceptibility Testing (DST) by conventional method, Radiometricmethod like BACTEC460TB (B460TB) System and Oxidation-Reduction Assay such as Microplate Alamar Blue Assay (MABA) for detection of MDR TB. Total 60 clinical isolates of M.tuberculosis were included in the study. The results obtained by MABA for DST of M.tuberculosis were compared with those obtained by B460TB system and Conventional method. DST results obtained by MABA showed good agreement with results obtained by B460TBsystem and Conventional method for Isoniazid and Rifampicin. In our study specificity and sensitivity for susceptible and resistant strain was found to be 98% and 100% for Rifampicin respectively and 100% and 95% for Isoniazid respectively for MABA.MABA appears to be a reliable method for the rapid and simultaneous detection of MDR-TB and DST of M. tuberculosis. It is simple and inexpensive method for DST of M.Tuberculosis with minimal biohazard risk.&nbsp

RELATIONSHIP BETWEEN RPOB MUTATIONS AND MINIMUM INHIBITORY CONCENTRATIONS OF RIFAMPICIN IN MULTI DRUG RESISTANT STRAINS OF MYCOBACTERIUM TUBERCULOSIS

Tuberculosis is an infectious disease caused by obligate intracellular bacteria Mycobacterium tuberculosis, which has created a health problem worldwide. Incidence of Multi-drug resistance tuberculosis creates the scenario dangerous, which is resistant to both the first line drugs namely Rifampicin and ionized. Mutation in rpoB and inhA confers resistance to rifampicin and ionized respectively. In the present study we studied the relationship between rpoB mutations and minimum inhibitory concentrations of Rifampicin in Multi drug resistant(MDR) strains of Mycobacterium tuberculosis. Total 20 MDR strains were selected for the study. The mutations in the rpoB gene were identified by sequencing the PCR products. The minimum inhibitory concentrations of Rifampicin, was determined by Absolute Concentration method. Mutations conferring resistance to Rifampicin in Mycobacterium tuberculosis occurs in the defined region of 81 base pair of rpoB gene. The most frequent mutation found in Rifampicin resistant strain is at position 532, 526 and 516. Mutation occurring at this position results in high level of Rifampicin resistance. Mutation at 511, 518 and 522 is associated with low level of Rifampicin resistance.&nbsp

DETERMINATION OF EFFICACY OF ISOXYL, A MYCOLIC ACID INHIBITOR, IN VITRO AGAINST MYCOBACTERIUM.TUBERCULOSIS STRAINS

The enzymes involved in the biosynthetic pathways of the critical components including mycolic acids offer attractive and selective targets for the developments of novel anti-mycobacterial agents. Isoxyl (ISO), a mycolic acid inhibitor, is an old drug, which was used for the treatment of tuberculosis was evaluated. Determination of Minimum Inhibitory Concentration (MIC) pattern of clinical isolates of Mycobacterium tuberculosis (M. tuberculosis) to mycolic acid inhibitors namely ISO, Isoniazid (INH) and Ethionamide (ETH) by agar and broth dilution Method was done. Also the Minimum bactericidal concentrations were evaluated. Total 40 MDR and 20 susceptible strains of M tuberculosis were tested. The result of the MIC studies showed that ISO is capable of inhibiting the growth of M. tuberculosis in a range of 1-20μg/ml. Inhibitory activity of ISO was higher than activity of ETH in solid media. Amongst three antituberculosis drugs, INH showed highest bactericidal activity against M. tuberculosis strains followed by ETH. While ISO exhibited lowest bactericidal activity. Amongst, three drugs tested, ISO shows highest MBC/MIC ratio with lowest bactericidal activity. ISO showed significantly lower bactericidal activity against MDR strains than susceptible strains of M. tuberculosis. MBC/ MIC ratio of ISO was similar to MDR and susceptible strains of M. tuberculosis. Overall study implies that ISO may be suitable for the treatment of Tuberculosis, particularly multi-drug resistant kind

The impact of the International Nosocomial Infection Control Consortium (INICC) multicenter, multidimensional hand hygiene approach in two cities of India

The fundamental tool for preventing and controlling healthcare-acquired infections is hand hygiene (HH). Nonetheless, adherence to HH guidelines is often low. Our goal was to assess the effect of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach (IMHHA) in three intensive care units of three INICC member hospitals in two cities of India and to analyze the predictors of compliance with HH. From August 2004 to July 2011, we carried out an observational, prospective, interventional study to evaluate the implementation of the IMHHA, which included the following elements: (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance and (6) performance feedback. The practices of health care workers were monitored during randomly selected 30-min periods. We observed 3612 opportunities for HH. Overall adherence to HH increased from 36.9% to 82% (95% CI 79.3–84.5; P=0.0001). Multivariate analysis indicated that certain variables were significantly associated with poor HH adherence: nurses vs. physicians (70.5% vs. 74%; 95% CI 0.62–0.96; P=0.018), ancillary staff vs. physicians (43.6% vs. 74.0%; 95% CI 0.48–0.72; P<0.001), ancillary staff vs. nurses (43.6% vs. 70.5%; 95% CI 0.51–0.75; P<0.001) and private vs. academic hospitals (74.2% vs. 66.3%; 95% CI 0.83–0.97; P<0.001). It is worth noticing that in India, the HH compliance of physicians is higher than in nurses. Adherence to HH was significantly increased by implementing the IMHHA. Programs targeted at improving HH are warranted to identify predictors of poor compliance

Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC)

Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69 248 admissions followed for 283 069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2.03 days (95% CI 1.52-2.54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity