Increasing incidence of multidrug resistant Pseudomonas aeruginosa in inpatients of a tertiary care hospital

Background:Pseudomonas aeruginosa is an important pathogen isolated from various clinical infections. The occurrence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains is increasing worldwide and limiting our therapeutic options resulting in high mortality. We aim to study the incidence of multidrug resistant Pseudomonas aeruginosa in inpatients from various departments along with rate of nosocomial infections.Methods:A cross sectional study from January 1, 2013 to December 31, 2013. A total of 167 Pseudomonas aeruginosa were isolated from 764 clinical specimens. The isolates were identified by standard microbiological techniques. The antibiotic susceptibility was done by Kirby Bauer method.Results:The highest number of isolates were from pulmonary samples n=90 (53.89%) followed by pus n=48 (28.74%). Overall, 39 (23.36%) isolates were nosocomial. The nosocomial isolates were mainly isolated from department of surgery, orthopaedics, obstetrics & gynaecology followed by others. Among 167 isolates screened, 53 (31.73%) were found to be MDR (resistant to ≥3 classes of antipseudomonal agents). The resistance was most against cephalosporins [Cefepime (65.26%), cefotaxime (60.47%)], fluoroquinolones [Ciprofloxacin (46.1%), levofloxacin (31.87%)] aminoglycosides [Amikacin (37.72%), gentamicin (31.13%)] followed by ureidopenicillins and carbepenems. About 56.75% isolates were suspected Metallo β lactamases producers.Conclusion:The study suggests that the incidence of nosocomial infection by multidrug resistant Pseudomonas aeruginosa is increasing globally especially the Metallo Beta lactamases producing strains. So there is a continuous need of conduction of surveillance programmes to formulate rational treatment strategies to combat this emerging challenge.

THE SPECTRA OF INTESTINAL PARASITIC INFECTIONS AFFECTING PATIENTS ATTENDING A TERTIARY CARE CENTER IN WESTERN UTTAR PRADESH

Objective: Intestinal parasitic infection is a burgeoning health issue, especially in developing countries owing to low socioeconomic conditions, poor sanitation, poor personal hygiene, and lack of access to potable drinking water. This study aims to determine the prevalence of different intestinal parasites among the patients. Methods: This cross-sectional study was conducted among 470 patients attending our hospital from October 2018 to September 2019. Specimens were collected and examined macroscopically and microscopically using concentration methods and modified Ziehl–Neelsen staining for coccidian parasites. Results: Out of the 470 patients, prevalence of intestinal infections was 4.89%. The helminthic infections were more common (52.17%), which was topped by Hookworm infection (26.09%) followed by Ascariasis (13.04%). Among the protozoa, Giardia lamblia (26.09%) was the most common, followed by Entamoeba histolytica (17.39%). The parasitic infections were more in female (5.62%) than male (4.19%) and highest in the pediatric age group and between 51 and 60 years. Conclusion: The prevalence of intestinal parasitic infections is decreasing due to increasing awareness about sanitation, effects of open defecation, safe drinking water, and personal hygiene. However, the need of intervallic monitoring of intestinal parasitic infections is necessary

Prevalence and fungal profile of pulmonary aspergillosis in immunocompromised and immunocompetent patients of a tertiary care hospital

Background: Aspergillus is a fungus which may present an array of pulmonary manifestations, depending on the patient’s immunological and physiological state. Although the incidence of pulmonary aspergillosis occurs primarily in immunocompromised patients but the incidence is also rising in immunocompetent individuals, especially in developing countries. Aim: The objective of the study was to determine the prevalence and predisposing factors of pulmonary aspergillosis along with species identification. Materials and Methods: One hundred and three patients admitted to the Department of Chest and Tuberculosis and in the Department of Medicine from Jan 2012 to Jan 2013 were included in this study. The patients were epitomized on the basis of clinical signs and symptoms, physical examination, chest radiography, CT scans, histopathological examination, bronchoscopy and fungal examination including potassium hydroxide mount, fungal culture of sputum and bronchoalveolar lavage. Species identification was done by colony characteristics, slide culture and Lactophenol Cotton blue mount. Results: Out of the 103 patients, (63 males and 40 females) Aspergillus species has been isolated from 17 (16.5%) males and 07 (6.79%) females. Various predisposing factors of pulmonary aspergillosis have been identified in which pulmonary tuberculosis, chronic smoking and environmental exposure to asbestos, cement its tops the list. Many of the patients had multiple predisposing factors. Aspergillus species were isolated in 24 (23.3%) cases. Aspergillus fumigatus was the predominant species isolated in 13 (54.16%) cases followed by Aspergillus flavus in 07 (29.16%) cases, Aspergillus niger in 03 (12.5 %) and Aspergillus terrus in 1 (4.16%) cases. Conclusion: It is concluded that the prevalence of pulmonary Aspergillosis is quite high in immunocompromised individuals and low in immunocompetent individuals. An adequate and efficient evaluation of the etiological agents has a crucial role in the management of such patients

Chemiluminescence based immunoassay for the detection of heroin and its metabolites

Introduction: Continuous use of opiates causes drug-related illnesses, which poses an alarming situation to develop sensitive detection platform. In this study, a highly sensitive and reliable chemiluminescence immunoassay (CI) has been developed for the detection of heroin and its major metabolites in spiked urine samples. Methods: To develop robust immunoassay, monoacetyl morphine-bovine serum albumin (MAM-BSA) conjugate was synthesized and characterized thoroughly by physicochemical techniques. The anti-MAM antibodies were developed, labeled with horseradish peroxidase (HRP) and immunoassay was developed to detect the presence of target drug in spiked urine samples. Results: A competitive CI was developed, where heroin, MAM, morphine, and codeine concentration were ranged from 0-1000 ng/ mL in spiked urine samples and limit of detection were 80, 95, 90, 75 pg/ mL. Conclusion: The developed CI is highly sensitive, specific, point of care, cost-effective and can be used as a routine technique for quantitative analysis for screening of narcotic drugs

Antiboitic susceptibility pattern of common uropathogens isolated at a tertiary care hospital of Bihar

Introduction: Urinary tract infections (UTIs) are amongst the most common infections encountered in clinical practice. The present study was undertaken to assess the current antibiotic resistance pattern in the common uropathogens isolated in a tertiary care hospital in south India. Material & Methods: A secondary data analysis was carried out in the department of Microbiology, Jan Nayak Karpuri Thakur Medical College, Madhephura, Bihar, India, for the samples collected during January 2019 to December 2019. Samples received included mid-stream clean catch urine, suprapubic aspirate, urine collected from Foley's catheter and from the nephrostomy tube under sterile precautions, in patients who had undergone percutaneous nephrostomy. Samples were processed and isolates were identified as per standard methods. The chi-square test or Fisher's exact test was used to compare different groups. Statistical software SPSS 16.0 (SPSS Inc, Chicago, Illinois, USA) was used to analyse the data. Results: Data from a total of 1000 consecutive urine samples received in the dept during the period of data collection were included in the study. Of these, 680 (68%) were sterile, 180 (18%) showed significant growth, 20 (2%) showed insignificant growth and 120 (12%) were found contaminated. Of the 180 culture positives, E. coli was the most common isolate. The percentage of Klebsiella pneumoniae, Acinetobacter spp, Pseudomonas spp, Staphylococcus spp, Enterococcus faecalis was higher in patient females and patients with history of prior treatment with antibiotics, compared to the rest. Almost three-fourth of all E.coli isolates were found to be resistant to ciprofloxacin. Ciprofloxacin resistance was comparatively less among the other Gram-negative uropathogens like Pseudomonas spp, Proteus spp and K. pneumoniae as mentioned. Resistance to the aminoglycosides, amikacin and gentamicin was also considerable especially among isolates of Acinetobacter. Conclusion: The present results in increasing antibiotic resistance trends in UTI patients indicate that it is imperative to rationalize the use of antimicrobials and to use these conservatively

A Study On Prevalence Of Catheter Associated Urinary Tract Infections In A Tertiary Care Facility Of Bihar

Introduction: Urinary tract infection (UTI) is one of the most common infections in humans, accounting for more than 150 million cases worldwide. Beyond the initial urinary infection, catheter-associated UTIs (CAUTIs) can lead to complications including bacteremia, endocarditis, osteomyelitis, septic arthritis, and meningitis. With this background, the current study was designed to provide baseline information of such infections in the hospital and to identify the microbial pathogens associated with these infections. Methodology: A cross-sectional study was carried by the Department of Microbiology, Jan Nayak Karpuri Thakur Medical College and Hospital, Bihar, from January 2021 to July 2021. Both adult males and females were included in the study group. Before starting the study, the purpose of the study was explained to the subjects, and informed consent was obtained. Approval was acquired from the Ethical Committee. Results: The present study comprised of 150 catheterized urine samples collected with proper aseptic precautions. Mean age of the participating patients was 47.5 years with a standard deviation of 7.2 years. The age range was 17 years to 81 years. The male to female ratio was calculated and approximated to 1.5:1. The incidence rate of CAUTI calculated for this study for ICU and wards were 3.7 and 17.2 per 1000 catheter-days, respectively and catheter utilization ratio was 0.59 and 0.07 in ICU and ward, respectively. Conclusion: The study underscores the pressing need for the development of antimicrobial urinary catheters and their deployment when longer duration of catheter access is required

Determination of EOQ in terms of optimum degrees of horizontal and vertical cooperation at a node of supply chain

In a complex supply chain network, the production nodes, seller nodes, and buyers are connected randomly. We assume a process of joining two random nodes leading to the bivariate Poisson probability mass function. There exist two types of links - one is horizontal (H) and the other is vertical (V), which support the continuous flow of commodities through the supply chain. This induces competition among workers at a node to manage these two types of links within fixed constraints and creates bargaining to decide the optimal degree of both types of links at a node. We use the Nash security point to obtain the bargaining solution describing the optimal links. We reduce the carrying cost and ordering cost of inventory, which are contrary in their nature by introducing horizontal and vertical links, respectively. We modify the total cost function and establish a new economic order quantity (EOQ), optimal shortage quantity, and total optimal cost in terms of the optimal degree of H and V cooperation

Extended Dissipative Control for Markovian Jump Time-Delayed Systems with Bounded Disturbances

In this work, the result of reachable set bounding and extended dissipative control synthesis of the Markovian jump time-delayed system is studied subject to stochastic actuator failures and partially known transition probabilities. Specifically, a novel actuator fault model is designed, in which the actuator fault matrix satisfies a certain probabilistic condition. Under the construction of an appropriate Lyapunov–Krasovskii functional (LKF), as well as reciprocal convex approach, Jensen’s integral inequality, and reachable set lemma, delay-dependent sufficient criteria are obtained in terms of linear matrix inequalities (LMIs) for finding an ellipsoid to bound the reachable sets of the Markovian jump time-delayed system with bounded disturbances. Finally, two numerical examples are provided to validate the effectiveness of the proposed strategy

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Strategies for attraction and retention of health workers in remote and difficult-to-access areas of Chhattisgarh, India: Do they work?

Background: To address the acute shortages of health workers in underserved, remote, and difficult-to-access areas, the Government of Chhattisgarh and the National Rural Health Mission (NRHM) launched the Chhattisgarh Rural Medical Corps (CRMC) in 2009. CRMC has enabled provisions such as financial incentives, residential accommodation, life insurance, and extra marks during admission at the postgraduate (PG) level to eligible doctors for the attraction and retention of health workers, i.e., doctors, staff nurses, auxiliary nurse midwives (ANMs), and rural medical assistants (RMAs) in underserved areas. Objectives: This study aims to understand the CRMC scheme in terms of implementation, challenges, gaps, and outcome in achieving the attraction and retention of health workers in the remote and difficult-to-access areas of Chhattisgarh. Materials and Methods: The study adopts a mix of both qualitative and quantitative research methods. The purposive sampling method was used for the selection of three districts having normal, difficult, and inaccessible areas. Data were collected through key informant (KI) interviews with beneficiaries and non-beneficiaries of CRMC or district and state government officials, and reviews of document were analyzed using a thematic analysis approach. Results: CRMC has made positive outcome as 1319 health workers, including doctors, have joined the service in 2010-11, reducing the vacancy of doctors from 90% to 45%. The scope of CRMC was primarily limited to payment of monthly financial incentives. The fund utilization rate of CRMC has increased (from 27% in 2009-10 to 98% in 2011-12), though there are delays in payment of incentives. The majority of staff lack awareness about CRMC during job applications. The payment of incentives based on facility performance has demotivated staff. Conclusions: Establishment of a performance management system, activating the CRMC cell to make it functional, and wide publicity of CRMC benefits are likely to improve attraction and retention of staff