An overview of hospital acquired infections and the role of the microbiology laboratory

Every year, many lives are lost because of the spread of infections in hospitals. These nosocomial infections, also called hospital acquired infections (HAI) are infections that patients acquire during the course of receiving healthcare treatment for other conditions. HAIs are a cause of significant morbidity and mortality in patients receiving healthcare, and the costs direct and indirect of these infections deplete the already limited financial resources allocated to healthcare delivery

Aerobic bacteriology of chronic suppurative otitis media: a hospital based study

Background: Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide, affecting diverse racial and cultural groups both in developing and industrialized countries. It involves considerable morbidity and can cause extra- and intra-cranial complications. The aim of this study was to determine the microbial diversity and the antibiogram of aerobic bacterial isolates among patients suffering from CSOM who attended the ENT Department of SMHS hospital, a tertiary care centre located in the heart of the Kashmir valley.Methods: A total of 154 patients clinically diagnosed with CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and cultured for microbial flora. Drug susceptibility testing for aerobic isolates was conducted using Kirby-Bauer disc diffusion method.Results: Out of total 154 ear swabs processed, microbial growth was seen in 138 (89.61%) while 16 (10.38%) samples showed no growth. In 102 (66.23%) samples mono-microbial growth was seen whereas 26 (16.88%) samples showed poly-microbial growth. The most frequent organism isolated was Pseudomonas aeroginsa followed by Staphylococcus aureus and Proteus sp. The most effective antibiotic against Pseudomonas aeroginsa was amikacin followed by imipenem and piperacillin plus tazobactam, while as Staphylococcus aureus showed maximum sensitivity to vancomycin.Conclusion: Otitis media linked with high levels of multiple antibiotic resistant bacteria is a major health concern in all age groups of the study population. An appropriate knowledge of the etiology and antibacterial susceptibility of microorganisms would contribute to a rational antibiotic use and the success of treatment for chronic supportive otitis media.

Aerobic bacteriological analysis of bronchoalveolar lavage fluid in patients with pulmonary infection: a tertiary care hospital study

Background: Respiratory tract infection are an important cause of mortality and morbidity worldwide. The prevalent bacterial agents and their antimicrobial resistance patterns differs, both geographically and over time. Bronchoalveolar lavage has improved sensitivity and specificity of diagnostic techniques in diagnosis of pulmonary infections. The present study aimed to determine the current aerobic bacterial isolates and their sensitivity pattern obtained from the bronchoalveolar lavage (BAL) fluid of patients with pulmonary infection.Methods: BAL samples received from the patients of suspected respiratory tract infections over a period of one year, from June 2018 to May 2019 were processed by standard methods for isolation and identification. The antimicrobial susceptibility was done by the Kirby-Bauer disc diffusion method as per the CLSI guidelines.Results: Out of 322 BAL samples, 84 (26.08%) were found to be culture positive for bacterial isolates. Of those, 44 samples (52.38%) from among males and 40 samples (47.61%) from among females were culture positive .The predominant organism isolated was Pseudomonas aeruginosa 46 (54.76%) followed by Acinetobacter baumanii 13 (15.47%), Escherichia coli 10 (11.90%), Klebsiella pnuemoniae 6 (7.14%) Enterobacter sp 3 (3.57%), Staphylococcus aureus 3 (3.57%), Enterococcus sp 2 (2.38%) and Sphingomonas sp 1 (1.19%). The Gram-negative organisms showed maximum sensitivity to colistin (100%) while as vancomycin and linezolid were the most effective drugs against Gram positive organisms.Conclusions: Bronchoalveolar lavage has improved sensitivity and specificity in diagnosis of pulmonary infections. It is important to have an updated local antibiogram for each hospital and regular surveillance and monitoring of antibiotic resistance and the changing patterns of the bacterial pathogens is a must for better patient management

A rare case of bacteremia due to Acinetobacter junii in an immunocompetent adult

The genus Acinetobacter comprises a complex and heterogeneous group of bacteria, many of which are capable of causing a range of opportunistic, often nosocomial, infections in humans. Acinetobacter junii is a rare human pathogen associated with bacteraemia in neonates and paediatric oncology patients. We report a unique case of bacteremia caused by Acinetobacter junii, in a patient with no risk factors identified

Spectrum of non-fermenting gram negative bacilli isolated from patients with blood stream infections in a tertiary care hospital in North India

Background: Non-fermenting Gram-negative bacilli (NFGNB) are emerging as important causes of blood stream infections (BSI) and they are a major cause of morbidity and mortality worldwide. High intrinsic resistance of NFGNB to antimicrobial compounds makes the treatment of BSIs caused by them difficult and expensive. The aim of this study was to assess frequency and antibiotic susceptibility pattern of non-fermenting gram-negative rods isolated from blood culture of patients.Methods: A total of 3016 blood samples were received in the Department of Microbiology during the study period. All samples were processed according to standard microbiological procedures. Blood culture was done by automated blood culture system, (BacT/Alert) and identification and antibiotic susceptibility of non-fermenting gram negative bacilli was done by VITEK2 Compact System.Results: A total of 120 NFGNB were identified out of which the most common non-fermenters isolated were Acinetobacter sp. (95) followed by Pseudomonas aeruginosa (11), Burkholderia cepacia (09) Sternotrophomonas maltophilia (03) and Sphingomonas sp. (02). Most of the non -fermenters were multi drug resistant showing a high level of antibiotic resistance to most of the first- and second-line drugs. The most effective drugs were colistin and tigecycline.Conclusions: This study underlines the need to identify NFGNB in tertiary care hospitals and to monitor their susceptibility pattern to guide the clinician for better care and management of patients. Improved antibiotic stewardship and strict infection control measures especially hand washing need to be implemented to prevent emergence and spread of multidrug resistant NFGNB in health care settings

Study of prevalence and antimicrobial susceptibility pattern of blood culture isolates from a tertiary care hospital of North India

Background: Bacterial bloodstream infections (BSIs) are important causes of morbidity and mortality world-wide. The choice of antimicrobial therapy for bloodstream infections is often empirical and based on the knowledge of local antimicrobial activity profiles of the most common bacteria causing such infections. The objective of the study was to determine the pattern of bacterial isolates from the blood cultures in a teaching hospital and determine their antibiotic resistance and provide guidelines for choosing an effective antibiotic therapy in cases of septicaemia.Methods: The etiological and antimicrobial susceptibility profile of blood cultures over a period of one year at a tertiary care hospital was studied. Blood culture positive isolates were identified by BacT/Alert3D, an automated blood culture system, while as identification of the isolates from these samples and their antimicrobial sensitivity testing was performed with Vitek2 Compact.Results: There were 2231 blood culture samples, of which 565 (25.3%) were identified to be culture positive. Out of 565 positive cultures, 447 (79.1%) showed bacterial growth; Gram positive were 306 (54.2%) and Gram negative were 141 (24.9%). Candida species were isolated from 118 (20.9%) of positive samples. The most frequently identified Gram-positive bacteria were Coagulase-negative staphylococci 208 (67.9%) and the most common Gram-negative isolates were Acinetobacter species 89 (63.1%). The most sensitive drugs for gram-positive isolates were vancomycin, and linezolid while as gram-negative isolates showed 100% sensitivity to colistin and tigecycline.Conclusions: This study reveals a significant prevalence of bacterial isolates in blood and it highlights the need for periodic surveillance of etiologic agent and antibiotic susceptibility to prevent further emergence and spread of resistant bacterial pathogens

Frequency of Different Ligament Tears in Knee Injury On Magnetic Resonance Imaging

Background: MRI had been useful in the diagnosis of ligament injuries and the tears were detected by non-invasive procedure. Objective: To determine the frequency of different ligament tears in knee injury on Magnetic Resonance Imaging. Methods: A descriptive cross-sectional was conducted with the sample size of 206 patients of both genders by selecting the convenient sampling from Ghurki Trust Teaching Hospital, Lahore. Out of 206 patients, 157 were males while 49 were females. Data was analyzed with the help of SPSS version 24. The results were derived by mean, frequency and standard deviation. Results: Findings shows that among 206 patients, with in age limit of 12 years to 70 years. 157(76.2%) were males and 49(23.7%) were female while 96(46.6%) were presented with ACL tear, 19(9.2%) were presented with PCL tears, 51(25.7%) were presented with MCL tears, 33(16.0%) patients were presented with LCL tears and all of these 206 patients were suffering from pain. Conclusion: We concluded that males are more prevalent than females and in this population the incidence of ACL tears is more than other ligament tears. Hence, ACL is proved to be the most injured ligament. Keywords: Anterior cruciate ligament, Posterior cruciate ligament, Medial collateral ligament, Lateral collateral ligament and Magnetic resonance imaging. DOI: 10.7176/JHMN/71-06 Publication date: February 29th 202

Spectrum of candidal species isolated from neonates admitted in an Intensive Care Unit of teaching hospital of Kashmir, North India

BACKGROUND: Candidal infections are an important cause of morbidity and mortality in Neonatal Intensive Care Unit. Neonatal candidiasis is increasing in frequency, mainly because of increase in the survival of babies with low-birth weight, preterm births, advancement in medical field, life support systems, relative immunodeficiency, and extensive use of broad-spectrum antibiotics. Over the past few decades, there has been a progressive shift from the predominance of Candida albicans to nonalbicans Candida species. AIMS AND OBJECTIVES: The objective of the current study was to know the prevalence of nonalbicans candidemia in neonates and their antifungal susceptibility pattern. Materials and Methods: In this study, a total of 424 samples from clinically diagnosed septicemic neonates were included. Identification of Candida isolates from these samples as well as their antifungal sensitivity testing was performed with Vitek 2 Compact (Biomerieux France) using Vitek 2 cards for identification of yeast and yeast-like organisms (ID-YST cards). Results: A total of 246/424 (58.01%) cases were blood culture positive. Out of these, 80/246 samples tested positive for candidemia (32.5%). Candida tropicalis (13.8%) was the predominant species isolated among the non-albicans Candida followed by Candida krusei (4.8%), Candida parapsilosis (3.2%), Candida guilliermondii (2.8%), and Candida dubliniensis (2.0%). We found an increase in the antifungal drug resistance, especially for the azole group of drugs, both in C. albicans and non-albicans Candida species. All the isolates were uniformly sensitive to micafungin, voriconazole, and caspofungin. Conclusions: Candidemia in neonates is an ominous prognostic sign and is an important entity in our region. The present study highlights the mycological shift of Candida species in neonatal candidemia with a preponderance of nonalbicans Candida species

Community perceptions of flood risks and their attributes: A case study of rural communities of Khipro, District Sanghar, Pakistan

Globally, the frequency, regularity, and severity of floods are all increasing due to climate change, and climate change's effects on developing nations are significant. In 2022, the worst floods in Pakistan's recorded history occurred. One-fifth of the nation experienced significant destruction, which led to significant economic losses and fatalities. However, the resilience of the local population to withstand the effects of calamities has not received enough attention in rural villages along the Indus River. This descriptive cross-sectional research examined how three communities in high-risk locations in Khipro, Sanghar District, Sindh, Pakistan, perceived and responded to flood dangers based on their past experiences. A survey was conducted with a total of 50 individuals in three villages. To measure flood risk perception, three variables—awareness of floods, concerns about floods, and preparedness—were used. Descriptive statistics, the chi-square test, and Pearson's correlation were applied to find correlations and differences across variables. The study adds valuable knowledge about how people perceive the risk of flooding and how factors like age, education, differences in monthly income levels, low-risk awareness, and preparedness influence that perception in rural areas. This study's findings can be used to evaluate flood risks and adopt local adaptation strategies in flood prone areas

Current mycological profile of onychomycosis in Kashmir valley: A hospital-based study

INTRODUCTION: Onychomycosis is a common nail ailment associated with significant physical and psychological morbidity. It is caused by dermatophytes, nondermatophytic molds, and yeasts. Increased prevalence in the recent years is attributed to enhanced longevity, comorbid conditions such as diabetes, avid sports participation, and emergence of HIV. AIMS AND OBJECTIVES: This study was undertaken to identify the mycological profile and etiological agents associated with this infection. MATERIALS AND METHODS: One hundred and twenty-nine cases of clinically suspected onychomycosis were included in this study. Clinical patterns were noted, and samples collected from most severely affected nail. They were subjected to direct microscopy and culture. RESULTS: The microscopic and/or culture examination was positive in 64.34% of cases. The most common clinical type was distal lateral subungual onychomycosis in 42 (50.60%) Candida sp. was the most common fungal agent among yeasts, followed by Trichophyton sp among dermatophytes and Aspergillus among nondermatophytic molds. Females were affected more than males and fingernails were affected more frequently than toenails. CONCLUSION: Onychomycosis is a significant and important disease which can cause many physical, physiological, and occupational problems, considerably impairing patient quality of life. Hence, fungal cultures are of paramount importance in all suspected cases of onychomycosis because the antifungal agent with an appropriate spectrum of activity can only be used if the underlying fungal pathogen is identified correctly