Occupational Exposure to Blood among Healthcare Workers in National Capital Territory of Delhi

A cross-sectional study on occupational exposure to blood (OEB) among healthcare workers (HCWs) revealed that out of 416 HCWs a total of 139 HCWs encountered 174 OEBs during preceding 6 months, either in the form of high-risk OEBs (OEB-HR, n=101) or potentially risky OEBs (OEB-PR, n=73) with an occurrence rate of 0.49 and 0.35 per person year respectively. The occurrence of OEB-HR was found to be the highest among nurses followed by residents and interns although occurrence of OEB-PR was found to be the highest among laboratory technicians. The occurrence rate of OEB was found to decrease with increasing duration of working experience. Coverage of immunization against HBV and training on safety precautions were less among HCWs with shorter duration of experience. Manipulation of needle or sharp was the major type of activity associated with both OEB-HR and OEB-PR (48.5% and 60.3% respectively) while fatigue was mainly considered by the HCWs to be responsible for the subgroup of exposures in both categories that were unrelated to adherence to safety precautions. Seroconversion for HBV (HBsAg) was recorded in two exposures (one each OEB-HR and OEB-PR categories), both in private setting, from sources with unknown serostatus. The present study points out the need for due recognition of the risk involved in exposure of intact skin to blood in healthcare, expansion of HBV vaccination coverage and mandatory training on standard precautions in healthcare at the entry point in their profession

The Pro-inflammatory Markers and Cytokine Profile in Acute Chikungunya Virus Infections in a Rural Community from North India

Analysis of pro-inflammatory markers, i.e., nitrite, citrulline, tumor necrosis alfa (TNF-α ) and Th1 and Th2-specific cytokines, viz., IL-2 and IL-4 respectively were analyzed in 30 sera positive for IgM antibodies to Chikungunya virus (CHIKV) from a rural hospital-attending population in comparison to 40 sera from cases with other febrile illness (OFI) and 30 healthy controls. Levels of nitrite, citrulline, TNF-α and IL-4 were found to be increased in serum while serum level of IL-2 was found to be depressed in anti-CHIKV IgM positive cases compared to OFI and control groups. The serum nitrite levels in anti-CHIKV IgM positive cases showed positive correlation with citrulline, TNF-α and IL-2 and negative correlation with IL-4 level. The IL-2 level showed negative correlations with that of IL-4 level in serum.

Antimicrobial Resistance in Staphylococci Special Emphasis on Methicillin Resistance among Companion Livestock and Its Impact on Human Health in Rural India

Antimicrobial resistance (AMR) is a global threat worldwide. Inappropriate and irrational use of antibiotics are the responsible causes for the development of AMR in the pathogenic microorganisms. In the developing countries like India the data encountered a higher burden of resistance in the rural communities. In such scenario the AMR may lead to difficulty in treatment of various ailments among human as well as companion livestock. In India cows and buffalo are considered as companion livestock. However the definition of companion livestock is slightly different in the developed countries. Most of the rural population in India is dependent on the livestock for their livelihood as the dairy farming in the rural community may contribute in the financial status of the rural population. Staphylococcus aureus (S. aureus) is one of the foremost causative agent of skin and soft tissues infections among humans as well as in companion livestock. The situation is further complicated by methicillin resistance in S. aureus. The carriage of MRSA by humans and companion livestock may lead to further AMR spread to the community. In the civic health point of view, it is important to initiate appropriate interventions to tackle the problem at the rural population

Urban Migrant Labourers as Potential Source for Transfer of Antimicrobial Resistance to Rural Community

The aim of the study was to investigate potential evidence for spread of antimicrobial resistance (AMR) from urban migrant labourers to labourers from local resident rural community due to sharing of common residential premises and other civic amenities. Two groups of unskilled labourers, enrolled for civil construction in a peri-urban area viz. (i) labourers having migrated from urban zone and (ii) labourers from local resident village community were compared in terms of demographic profile, history of various risk factors towards acquisition of AMR and prevalence of extended-spectrum beta-lactamase (ESBL), carbapenemase and New Delhi metallo-beta-lactamase type 1 (NDM-1) categories of AMR at enrolment and after one year of sharing of common residential premises with associated sanitation facilities using Escherichia coli as indicator organism. Higher percentage of urban migrant labourers were characterised by low literacy level, history of inhabitation in makeshift shelters without dedicated access to drinking water or cooking space, practice of defecation in open, episodes of illness suggestive of bacterial infections, faulty treatment seeking behaviour and intestinal carriage rate of E. coli with various categories of AMR compared to the non-migrant labourers from rural community. The later group showed an increase in the prevalence of carbapenem resistance with NDM-1 production during the duration of co-inhabitation with urban migrant labourers. The present study provided potential evidence for transfer of AMR by urban migrant labourers to non-migrant labourers from rural community that may serve as vehicle for further transmission of AMR to the rural community hitherto unexposed or less exposed to the problem

Livestock Manure as Potential Reservoir of CTX-M Type Extended-spectrum β-lactamase Producing Escherichia coli and Klebsiella pneumoniae Associated with Carbapenemase Production

Increasing faecal carriage rate of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) among livestock is responsible for abundance of these bacteria in livestock manure which is being extensively used as organic fertilizer in developing countries including India. Use of this manure can be a potential source for spread of these microorganisms to the human community, posing a serious public health threat especially, to manure handlers. There is paucity of data regarding the possible contamination of environment through use of livestock manure from rural India. Analysis of a total of 1080 manure sample pools from different segments of 40 manure heaps each year during the three years period (2015 to 2017) showed a total of 491(45.5%) E. coli and 85 (7.9%) K. pneumoniae to be detected as ESBL producers by double disc synergy test and 3 (0.6%) ESBL-EC and 3 (3.5%) ESBL-KP as carbapenemase producers by CarbaNP test. Among the ESBL producers, 436 (88.8%) ESBL-EC and 59 (69.4%) ESBL-KP were found to harbour blaCTX-M genes by PCR. The present study showed an alarmingly high prevalence of ESBL production and emerging evidence of carbapenemase production among E. coli and K. pneumoniae isolates in the manure samples from rural North India. The antibiotic resistance pattern of the ESBL producing isolates revealed high degree of co-resistance to cephalosporin and non-cephalosporin group of antibiotics

Carbapenemase and NDM-1 Production by Escherichia coli and Klebsiella pneumoniae from Patients belonging to a Rural Community in North India Hospitalized with Community- Acquired Infections

Carbapenem-resistant Enterobacteriaceae, especially New Delhi metallo-β-lactamase type-1-producing strains, exhibit multidrug resistance, thus posing a serious public health threat for treatment of infections caused by Gram-negative bacteria. However, most of the studies on the problem have been confined tohospitalized patients from urban population. The present study was carried out to detect carbapenemase production among Escherichia coli and Klebsiella pneumoniae Isolated from rural population hospitalized with community acquired infections. A total of 296 non-repetitive isolates of E. coli and K. pneumoniae were subjected to Modified Hodge test for carbapenemase detection, Metallo-β-lactamase detection by MIC test strip MBL and molecular detection of blaNDM gene by Polymerase Chain Reaction (PCR). Twenty three (7.8%) of the 296 isolates were detected as carbapenemase producers, of which five (21.7%) were found to harbor blaNDM genes by PCR. Gene sequencing of all the five isolates revealed blaNDM-1 genes. The present study showed the prevalence of carbapenemase-producing E. coli and K. pneumoniae in the ruralcommunity of North India and spread of NDM-1