Incidence of metallo-beta-lactamase-producing <i> Pseudomonas aeruginosa</i> in diabetes and cancer patients

Metallo-beta-lactamase (MBL)-producing Pseudomonas aeruginosa strains have been reported to be an important cause of nosocomial infections. There is not enough information from India regarding their prevalence in diabetic and cancer patients. The present study was undertaken over a period of one year from January to December 2006 to study the incidence of MBL P. aeruginosa and the clinical outcome in diabetes and cancer patients admitted to S.L. Raheja Hospital, Mumbai. Two hundred and thirty isolates of P. aeruginosa were obtained from different samples of patients. These isolates were subjected to susceptibility testing to anti-pseudomonal drugs as per CLSI guidelines. They were further screened for the production of MBL by disc potentiation testing using EDTA-impregnated imipenem and meropenem discs. Of the 230 isolates of P. aeruginosa, 60 (26&#x0025;) isolates were found resistant to carbapenems (both imipenem and meropenem) and 33 (14.3&#x0025;) were found to be MBL producers. Of the 33 MBL-producing isolates, 24 (72.7&#x0025;) were diabetic patients, six (18.1&#x0025;) were cancer patients and three (9&#x0025;) patients had both diabetes and cancer. Five (15.1&#x0025;) patients responded to the combination therapy of colistin, piperacillin with tazobactam and amikacin, while 28 (84.8&#x0025;) patients responded to the combination therapy of amikacin, piperacillin with tazobactam and gatifloxacin. Thus, the rapid dissemination of MBL producers is worrisome and necessitates the implementation of not just surveillance studies but also proper and judicious selection of antibiotics, especially carbapenems

Meningitis in a Neonate Caused by Salmonella enterica Subspecies Enterica: A Case Report

A 14-day-old female baby was admitted to the neonatal Intensive Care Unit (ICU) with complaints of fever for one week, along with reduced intake of feeds and weight loss. Routine investigations, blood culture, Cerebrospinal Fluid (CSF) routine analysis, and CSF culture were performed. Both cultures grew non typhoidal Salmonella enterica subspecies enterica. Magnetic Resonance Imaging (MRI) brain with contrast revealed leptomeningeal enhancement and basal exudates, both suggestive of meningitis, as well as ventriculitis and arachnoiditis. The baby was treated with intravenous Ceftriaxone and Meropenem. Follow-up CSF analysis showed improvement, and the cultures were sterile

A Prospective, Observational and Comparative Study of In-Vitro Susceptibility of Isepamicin against Clinical Isolates from Various Clinical Sources (Triple I Study - Isepamicin in India)

Objectives: This study aims to investigate the in-vitro susceptibility of clinical isolates against Isepamicin and compared it with Gentamicin and Amikacin. Patients and Methods: In this multicentre prospective study, clinical specimens of patients were collected from three different regions of India. Clinical isolates from urine, intra-abdominal, broncho-alveolar lavage, endotracheal secretion, and sterile blood were included. The E-test was used to quantify the minimal inhibitory concentration (MIC) for Isepamicin, Gentamicin, and Amikacin. The percentages of bacterial isolates were categorized as susceptible, intermediate, and resistant according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines as per Comité de l'Antibiogramme de la Société Française de Microbiologie (CA-SFM) recommendation. Results: A total of 8 different bacterial isolates were collected from 150 clinical samples obtained from 50 patients. Respiratory (63 [42%]) and urine (44 [29.3%]) specimens were the most common sources for bacterial strains. The most identified bacterial isolates were K. pneumoniae (40 [26.6%]) and P. aeruginosa (38 [25%]). Isepamicin was found to be highly effective in urine samples and showed excellent sensitivity against E. coli (93.3%), followed by P. aeruginosa (57.9%) and K. pneumoniae (55.0%). Antimicrobial sensitivity was highest for Isepamicin (60/108 [56%]) at MIC≤1 mg/L and was most effective against Gram-negative bacterial isolates from the intensive care units (ICUs). Conclusions: Isepamicin could treat E. coli infections and could be an effective therapy in the treatment of urinary tract infections (UTIs). Moreover, it could also be used as an alternative to Gentamicin and Amikacin against resistant cases. Keywords: Aminoglycosides, Amikacin, E. coli, Gentamicin, Gram-negative bacteria, Isepamicin

Forum for Injection Technique 2.0 Addendum 1: Insulin use in indoor settings

Insulin is a frequently used drug in the indoor setting. Comprehensive recommendations for best practice in insulin injection technique have been published by the forum for injection technique (FIT), India. This addendum focuses on insulin use in indoor settings, and complements the FIT 2.0 recommendations. It discusses insulin use and disposal in critical care and noncritical care settings. It also highlights the need to ensure continuing nursing and medical education, and frame insulin policies for such use

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 204 intensive care units of 57 hospitals in 19 cities of India: International Nosocomial Infection Control Consortium (INICC) findings

•We report peripheral venous catheters (PVC)-related BSI rates from 2013 to 2019.•We collected prospective data from 204 ICUs in 57 hospitals in 19 cities of India.•We followed 7,513 ICU patients for 296,893 bed-days and 295,795 PVC-days.•We identified 863 PVC-related BSIs, amounting to a rate of 2.91/1,000 PVC-days. Short-term peripheral venous catheters-related bloodstream infections (PVCR-BSIs) rates have not been systematically studied in developing countries, and data on their incidence by number of device-days are not available. Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013 to May 31, 2019 in 204 intensive care units (ICUs), members of the International Nosocomial Infection Control Consortium (INICC), from 57 hospitals in 19 cities of India. We applied US INICC definition criteria and reported methods using the INICC Surveillance Online System. We followed 7,513 ICU patients for 296,893 bed-days and 295,795 short term peripheral venous catheter (PVC)-days. We identified 863 PVCR-BSIs, amounting to a rate of 2.91/1,000 PVC-days. Mortality in patients with PVC but without PVCR-BSI was 4.14%, and 11.59% in patients with PVCR-BSI. The length of stay in patients with PVC but without PVCR-BSI was 4.13 days, and 5.9 days in patients with PVCR-BSI. The micro-organism profile showed 68% of gram negative bacteria: Escherichia coli (23%), Klebsiella spp (15%), Pseudomonas aeruginosa (5%), and others. The predominant gram-positive bacteria were Staphylococcus aureus (10%). PVCR-BSI rates found in our ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs

Six-year study on peripheral venous catheter-associated BSI rates in 262 ICUs in eight countries of South-East Asia: International Nosocomial Infection Control Consortium findings

Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available. Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter-associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter-associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter-associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: (22.9%), spp (10.7%), (5.3%), spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were (11.4%). Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter-associated bloodstream infections