Acinetobacter infections in a tertiary level intensive care unit in northern India: epidemiology, clinical profiles and outcomes.

BACKGROUND: Nosocomial Acinetobacter infections are an increasing concern in intensive care units (ICU). OBJECTIVES: To study the demographic and clinical characteristics and the outcomes of ICU patients with Acinetobacter infections. METHODS: A retrospective, 1-year audit of all Acinetobacter infections diagnosed in ICU patients between January 1 and December 31, 2009. RESULTS: Acinetobacter infection occurred in 94 patients (108 episodes). The most common site of infection was the respiratory tract (83 patients, 76.85%), with medical patients being more susceptible than surgical patients to Acinetobacter lung infections (P=0.04), particularly late-onset ventilator-associated pneumonia (VAP) (P=0.04). The majority (63.8%) of infections were acquired in the ICU, and patients with ICU acquired infections were intubated significantly longer than the other patients (P=0.02). Seventy percent of the infections were caused by multidrug-resistant (MDR) strains, and the overall crude mortality rate was over 70%. The most important factors affecting mortality were the duration of intubation (P=0.001) and the inappropriate use of antibiotics (P=0.021) after diagnosis of the infection. CONCLUSIONS: Acinetobacter infections are highly prevalent in the ICU, with medical patients being more susceptible to lung infections, particularly late-onset VAP. The early and appropriate selection of antibiotics is the most important determinant of survival among these patients.

Complications in acute stroke in India (CAST-I): a multicenter study.

The prognosis and final outcome in patients who sustain stroke are significantly affected by medical complications occurring during the acute phase of stroke. Only limited information is available from India and other developing countries regarding acute complications of stroke. This study examined the frequency of acute stroke and the factors associated with complications of stroke in India. In this prospective multicenter study, running from March 2008 to September 2009, 6 hospitals collected information on complications of first-ever stroke during admission. Complications were defined in accordance with standard criteria. Outcome at 30 days poststroke was assessed using the modified Rankin Scale. Stroke characteristics, length of hospital stay, and stroke severity (based on the National Institutes of Health Stroke Scale) were documented. Hematologic (ie, hemoglobin) and biochemical (ie, total proteins and albumin) parameters also were obtained. A total of 449 patients out of the recruited 476 completed follow-up. The mean age was 58.1 ± 13.7 years (range, 16-96 years), and the majority were men (n = 282; 62.8%). The mean National Institutes of Stroke Scale score was 10.2 ± 5.3. Overall, 206 patients (45.9%) experienced complications during admission. In the logistic regression analysis, limb weakness (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.02-0.67; P = .01), anemia (OR, 0.35; 95% CI, 0.15-0.81; P = .01), length of hospital stay (OR, 0.89; 95% CI, 0.85-0.94; P < .0001), and stroke severity (OR, 0.27; 95% CI, 0.10-0.72; P = .01) were the variables associated with complications. Such complications as urinary tract infection (OR, 0.31; 95% CI, 0.13-0.78; P = .01), chest infection (OR, 1.81; 95% CI, 1.12-2.93; P = .02), bedsores (OR, 3.52; 95% CI, 1.02-12.08; P = .05), other pain (OR, 0.21; 95% CI, 0.09-0.49; P < .0001), and depression (OR, 2.22; 95% CI, 1.30-3.80; P < .01) were associated with poor outcome. Our study shows high rates of complication in acute stroke. Limb weakness, stroke severity, length of hospital stay, and anemia were the factors associated with complications. Other complications, such as urinary tract infection, chest infection, bedsores, other pain, and depression, can lead to poor outcome.

Awareness of neurocysticercosis: A study from northwest India.

BACKGROUND: Neurocysticercosis (NCC) is a common cause of epilepsy in developing countries. In order to plan and implement prevention programs, it is essential to study the awareness of NCC. OBJECTIVE: To study the awareness of NCC among patients with NCC and compare with age- and gender-matched controls without NCC. SETTING AND DESIGN: Hospital based case-control study. MATERIALS AND METHODS: Two hundred and fourteen subjects were studied (109 NCC patients, and 105 age- and gender-matched controls without NCC). The participants were selected from neurology and medical wards of a tertiary referral hospital in northwest India. They were interviewed by trained medical interns using a questionnaire. RESULTS: 64.2% of the NCC patients and 19% of control group had heard about NCC (P < 0.001). Knowledge regarding organ affected by NCC in the NCC group was 61.4% and in the control group was 80% (P = 0.09). Only 12.9% of the NCC group and none in the control group identified tape worm as a causative agent for NCC (P = 0.092). Negative effects of NCC on marriage and social life were more often cited by the NCC group but in the control group it was towards education (P = 0.004). CONCLUSIONS: The awareness of NCC was poor in both the groups. Educational programs are needed to improve the awareness about NCC among the patients and the public.