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

Subcutaneous Phaeohyphomycosis in a Renal Transplant Patient by a Rare Fungus Medicopsis romeroi

Medicopsis romeroi is a dematiaceous fungus that rarely causes subcutaneous phaeohyphomycosis. Here, we report a subcutaneous phaeohyphomycosis caused by a rare dematiaceous fungus, M. romeroi, in a 56-year-old male renal transplant patient. The patient was admitted for graft dysfunction and was found to have painless swelling over the anterior aspect of the right knee, which was aspirated twice within 40 days. Broad septate hyphae (determined by microscopy) and growth of phaeoid in a culture were observed in both the specimens. No sporulation was observed in the slide culture. Swelling recurred even after treatment with voriconazole, so the lesion was surgically excised. Genotypically, the isolate was identified as M. romeroi in both specimens. He was discharged on voriconazole. During a 6-month follow-up, no relapse was noticed. Phaeohyphomycosis caused by M. romeroi is rare, with only a few cases reported in India. Laboratory diagnosis of Medicopsis by conventional methods is challenging. Medicopsis species should be considered one of the etiological agents for subcutaneous phaeohyphomycosis. Molecular methods should be used for the identification of unusual pathogens

Candidemia in intensive care units and their antifungal susceptibility pattern

Candida species are the commonest opportunistic fungal infections worldwide. The most common Candida species causing infection is Candida albicans. Candidemia is described as presence of candida species in bloodstream. It is a fatal fungal infection with mortality ranging from 35% to 75%. In ICU patients, the incidence varies from 0.24-34.3 patients per 1000 ICU admissions according to western literature. Antifungal susceptibility testing is a tool of increasing importance in clinical microbiological labs. The goal of AFST is to produce MIC values that may be used to guide patient therapy. Objective: Candidemia in intensive care units and their antifungal susceptibility pattern. Materials and Methods: Blood specimens from clinically suspected cases of BSI were processed by conventional blood culture or automated blood culture system as per availability. Blood from the bottles was subcultured on Sabouraud Dextrose Agar, antifungal susceptibility was performed on Candida isolates against antifungal drugs by broth microdilution. Results: A total of 1816 patients of suspected BSI were admitted in the ICUs during the study period. 75 of these samples were positive for growth of Candida species. Candidemia among males and females was almost equal. Commonest non-albicans species isolated were C. tropicalis. Posaconazole and flucytosine are the two most susceptible antifungal drugs for all the isolated candida species. Conclusion: Antifungal susceptibility plays an important role in targeted therapy of infection caused by common and uncommon Candida species. This will help to prevent emerging antifungal resistance and thereby reduce patient morbidity and mortality