Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study

Background Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a bloodstream infection due to Enterobacteriaceae. Methods The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) bloodstream infections. We excluded patients who had previously been enrolled in the study and those not treated with curative intent at the time of bloodstream infection onset. There were no age restrictions. Central laboratories in India and the UK did confirmatory testing and molecular characterisation, including strain typing. We applied proportional subdistribution hazard models with inverse probability weighting to estimate the effect of carbapenem resistance on probability of discharge alive and in-hospital death, and multistate modelling for excess length of stay in hospital. All patients were included in the analysis. Findings Between Aug 1, 2014, and June 30, 2015, we recruited 297 patients from 16 sites in ten countries: 174 with CSE bloodstream infection and 123 with CRE bloodstream infection. Median age was 46 years (IQR 15–61). Crude mortality was 20% (35 of 174 patients) for patients with CSE bloodstream infection and 35% (43 of 123 patients) for patients with CRE bloodstream infection. Carbapenem resistance was associated with an increased length of hospital stay (3·7 days, 95% CI 0·3–6·9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio 1·75, 95% CI 1·04–2·94), and decreased probability of discharge alive (0·61, 0·45–0·83). Multilocus sequence typing showed various clades, with marginal overlap between strains in the CRE and CSE clades. Interpretation Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with bloodstream infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE infections in LMICs

Emergence of vanA gene among vancomycin-resistant enterococci in a tertiary care hospital of North - East India

Background & objectives: Vancomycin-resistant enterococci (VRE) have become one of the most challenging nosocomial pathogens with the rapid spread of the multi-drug resistant strain with limited therapeutic options. It is a matter of concern due to its ability to transfer vancomycin resistant gene to other organisms. The present study was undertaken to determine the emergence of vancomycin-resistant enterococci and the vanA gene among the isolates in a tertiary care hospital of North-East India. Methods: A total of 67 consecutive enterococcal isolates from different clinical samples were collected and identified by using the standard methods. Antibiogram was done by disk diffusion method and VRE was screened by the disk diffusion and vancomycin supplement agar dilution method. The minimum inhibitory concentration (MIC) value for vancomycin was determined by E-test. The VRE isolates were analyzed by PCR for vanA gene. Results: A total of 54 (81%) Enterococcus faecalis and 13 (19%) E. faecium were detected among the clinical isolates and 16 (24%) were VRE. The VRE isolates were multidrug resistant and linezolid resistance was also found to be in three. MIC range to vancomycin was 16-32 µg/ml among the VRE. The vanA gene was found in nine of 16 VRE isolates. Interpretation & conclusions: Emergence of VRE and presence of vanA in a tertiary care hospital setting in North-East India indicate toward a need for implementing infection control policies and active surveillance

Socio-demographic association with confirmed hepatitis C virus infection: A cross-sectional analysis from a teaching institute

Introduction: Hepatitis C virus (HCV) infection is the most common chronic blood-borne disease and is more commonly associated with chronic active hepatitis leading to cirrhosis, hepato-cellular carcinoma and end-stage liver disease. Methodology: 160 consecutive screening positive (Enzyme linked immuno sorbent assay positive) Hepatitis C samples were tested by HCV RNA Real Time-PCR for confirmation. Result: Prevalence of confirmed hepatitis C among screening positive patient in the present study was found to be 24.4%. Vaccinated individual with Hepatitis A and Hepatitis B had significant association with PCR positivity in screening positive Hepatitis C patient (p< 0.05). IV drug users and patient having multiple sex partners have significant association with PCR positivity among screening positive Hepatitis C patients (p< 0.05). Conclusion: Due to the lack of an effective vaccine and the increased risk of serious complications, it is important to focus on prevention and early detection of HCV

Umbilical Cord Blood Culture as an Aid to the Diagnosis of Early Onset Neonatal Sepsis: A Cross-sectional Study

Introduction: Neonatal sepsis is one of the leading causes of neonatal morbidity and mortality globally, accounting for an estimated neonatal mortality rate of 23.9 per 1000 live births. Due to overlapping signs and symptoms, a specific diagnosis of sepsis poses a diagnostic challenge. Blood collected from a peripheral vein for sepsis screening and blood culture remains the gold standard for diagnosing neonatal sepsis. The umbilical cord is still not routinely used as a site for collecting blood for sepsis screening and blood culture. Aim: To determine the diagnostic efficacy of Umbilical Cord Blood Culture (UCBC) compared to Peripheral Venous Blood Culture (PVBC) in Early Onset Neonatal Sepsis (EONS). Materials and Methods: This cross-sectional observational study was conducted at the Neonatology Unit, Department of Paediatrics, Assam Medical College and Hospital (AMCH), Dibrugarh, Assam, India, involving 110 neonates with two or more risk factors for EONS over a one-year period (August 2021-July 2022). Umbilical cord blood and peripheral venous blood were collected and cultured, and the neonates were monitored throughout their hospital stay. Statistical significance was determined using the Chi-square test for categorical variables and the t-test for continuous variables (with a p-value <0.05 considered statistically significant). The validity of UCBC for diagnosing early neonatal sepsis was assessed based on sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). Results: The mean gestational age was 34.95±3.314 weeks and mean birth weight was 2.08±0.790 grams. Of the 110 high-risk neonates, sepsis screening was positive in 67 (61%), while UCBC and PVBC were positive in 19 (17.3%) and 10 (9.09%), respectively. Acinetobacter was the most common organism found in both cultures. The sensitivity and specificity of sepsis screening were 100% and 47.25% compared to UCBC and 90% and 42% compared to PVBC. In comparison to PVBC, UCBC demonstrated a sensitivity and specificity of 70% and 88%, with a diagnostic accuracy of 86.36%. Conclusion: The UCBC exhibits good diagnostic accuracy for diagnosing EONS and can be utilised due to it being a painless and technically less challenging method of blood sampling, with high sensitivity and specificity

<span style="font-size:15.0pt;mso-bidi-font-size: 10.0pt;background:white;mso-bidi-font-weight:bold" lang="EN-GB">Prevalence and identification of extended spectrum β-lactamases (ESBL) in <i>Escherichia coli </i>isolated from a tertiary care hospital in North-East India </span>

108-114<span style="font-size:9.0pt;mso-bidi-font-size: 12.0pt" lang="EN-GB">Extended-spectrum β-lactamases (ESBLs) are rapidly evolving group of β-lactamase enzymes produced by the Gram negative bacteria. In this study, we determined the antimicrobial sensitivity pattern of <i style="mso-bidi-font-style: normal">Escherichia coli isolates and prevalence of TEM, SHV and CTX-M genes in ESBL positive E. coli isolated from the patients admitted to a tertiary care hospital in North-East India. A total of 85 multidrug-resistant isolates of E. coli obtained from clinical samples; urine (n=80), sputum (n=3), body fluid (n=1), vaginal discharge (n=1) were screened for resistance to third generation cephalosporins. ESBL production in resistant isolates was determined by double disk synergy test (DDST) and phenotypic confirmatory test (PCT). ESBL positive isolates were subjected to PCR for detection of TEM, SHV and CTX-M genes. Imipenem was found to be most effective against <i style="mso-bidi-font-style: normal">E. coli (susceptible isolates 96.47%) while ciprofloxacin was the least effective antibiotic (resistant isolates 60%). Among 33 ESBL positive isolates confirmed via PCT, preponderance in female population (60.6%) was noted. The most prevalent gene was blaSHV (63.04%) followed by blaTEM and blaCTX-M (60.86 and 54.34%, respectively) in ESBL positive E. coli. Most of the extensively used antibiotics, appear to be ineffective against the ever-mutating bacteria. This resistance urges cautious antimicrobial management on priority. Further, it helps in effectively designing the chemotherapeutic regimen for patients of a particular geographic area. </span