Antimicrobial resistance pattern in aerobic bacteria isolated from endotracheal aspirate in ventilator-associated pneumonia: Ten years observation from a tertiary care hospital.

Background and Aims: Ventilator-associated pneumonia (VAP) is a nosocomial infection associated with high morbidity and mortality. This study was undertaken to monitor the trend of the demographical details, comorbid conditions, bacterial etiological agents, and their antibiogram causing VAP in adults in the year 2008, 2013 and 2018. Material and Methods: A retrospective study conducted at the Department of Microbiology, Hospital Infection control and Quality Control at a tertiary care teaching hospital. All the adult patients with more than 48 h of the mechanical ventilator with endotracheal intubation with Clinical Pulmonary infection Score >6 with suspicion of VAP were included in the study at a difference of 5 years, i.e., 2008, 2013, and 2018. Results: A total of 338 patients were included in the study, of which males accounted for more than two-third of the patients studied. Nearly 45% of the patients belonged to geriatric (>60 years) age group. The most common comorbid conditions were chronic obstructive pulmonary disease, hypertension and diabetes mellitus. Among the gram-negative isolates, Klebsiella pneumoniae, Acinetobacter species, and Pseudomonas aeruginosa were the most common. There is an emergence of resistance to most commonly administered antimicrobial agents like aminoglycosides, levofloxacin, piperacillin/tazobactum, and carbapenems during the study period. Conclusion: This is a ten-year study on the antibiotic resistance pattern of organisms causing VAP. As far as the authors are aware, this is the first study addressing the pattern of change in drug resistance in the organisms causing VAP over a decade. The emergence of multi-drug resistant (MDR) MDR pathogens, especially in intensive care unit (ICU), is a great concern for the intensivist and infection control physicians. Preventive measures need to be undertaken to control the spread of these pathogens to the patients in the ICU.

Audit of toxic effects of body paint in the tiger dancers (Hulivesha) of Mangalore, India: an investigational study.

INTRODUCTION: Tiger dancing or Hulivesha, where the volunteers paint their bare body like a tiger and dance in a ritual during the Navarathri festival in Mangalore, India. There are no scientific studies done with the Hulivesha dancers at all, and therefore, we investigated the adverse effects of painting body like a tiger and dancing in the volunteers. OBJECTIVE/AIM: In this study, we investigated the clinico-haematological effects of topical application of lead-containing paint and dancing for three consecutive days in these dancers to ascertain the toxic effects of whole body painting and dancing. MATERIALS AND METHODS: This was a case-control study and was conducted during the Dasara festival in 2013 in the Huliveshadaris (study group) and the accompanying drummers (controls). Clinical, dermatological, and musculoskeletal examination were done before (day 0) and after the three days of the function (day 3). Blood was also collected and examined for alterations in the hematological parameters, lead, antioxidant glutathione, and lipid peroxidation levels. RESULTS: The results indicated that the all Hulivesha volunteers had severe musculoskeletal pain, while few also complained of skin reactions (61.6%), headache (25%) and nausea, and vomiting (18.75%). The results also indicated that topical application increased the levels of blood lead, caused a change in the haematological profile, decreased glutathione and increased lipid peroxidation (p < 0.03-0.0001). CONCLUSIONS: The results from this study clearly shows that topical application of the acrylic paint increases lead, changes haematological parameters and imparts adverse skin reactions.

Surgical Site Infection in Head and Neck Cancer Patients: Observations from A Tertiary Care Hospital.

Ramakrishna Pai JakribettuBackground Surgical site infections (SSIs) in head and neck cancer (HNC) patients can significantly affect the outcome of the surgery. Appropriate antimicrobial prophylaxis is needed for prevention of SSI. Aim To study the causative agents causing SSI among the HNC patients and their drug resistance pattern. Materials and Methods This was a retrospective study. The antibiotic suspectibility pattern of the aerobic bacteria isolated from the wound infection in the patients underwent surgery for head and neck cancer, admitted from January 2015 to December 2016 were added in the study. The demographic details of patients, pathogens isolated, and their antimicrobial susceptibility were collected, entered into Microsoft Excel, and statistical analysis was done as per percentage of isolates and drug resistance. Results A total of 130 culture-positive pus samples were included in the study. The majority of the samples were from males (71.5%), one-third of the patients belonged to the sixth decade of their life. Buccal mucosa and tongue were the common cancer in the head and neck region. The common gram-negative pathogens were Klebsiella sp. and Acinetobacter sp. and Staphylococcus aureus and Enterococcus sp. among the gram-positive bacteria. Methicillin-resistant S. aureus isolation rate was noted to be as high as 64.28%. High levels of resistance to aminopenicillins, third generation cephalosporins, co-trimoxazole and fluoroquinolones among the gram-negative pathogens. Anti-MRSA drugs such as vancomycin, linezolid, and teicoplanin resistance was not seen among S. aureus . Conclusion The resistance pattern among the pathogens isolated from SSI in HNC patients is alarming. So, implementation of strict infection control practices to prevent SSI rather than treating them with high end antimicrobials is the best option.

Low Back Pain Among Nurses in a Tertiary Care Teaching Hospital at Malappuram Kerala.

Background: Numerous nurses suffer from low back pain of various origins, which causes them to lose productivity, obtain unwanted medical reports, and sometimes even retire before their time. Age, heredity, obesity, bad posture, poor body mechanics, pregnancy, tension, personal stress, and traumatic incidents like falls or vehicle accidents are all potential causes of musculoskeletal injuries on the job. Methodology: A descriptive study was done with the help of a semi-structured questionnaire to determine the burden of low back pain among nurses in a tertiary medical college. The data were entered into a Microsoft Excel sheet (Redmond, USA) before being transferred to SPSS. The frequency was expressed in proportion. A Chi-square was done to test the association. Result: Among 220 nurses, 89 (40.4%) complained of mild low back pain, 86 (39.09%) complained of moderate pain, and seven (0.03%) of them had severe low back pain. Due to low back pain, among the 182 (82.7%) nurses who have low back pain, 46 of them had to take one or more days' leave from work. Thirty-six nurses have had low back pain for more than four years. As a mode of treatment, 43 nurses have taken either medicine or injection; 25 of them have taken rest; four are on Ayurvedic treatment, and 110 nurses haven't taken any treatment. Conclusion: The majority of the nurses complained of low back aches. Care must be taken to take adequate rest after prolonged standing and proper treatment. Frequent bending and using an abnormal posture must be avoided. The use of ergonomically designed chairs should be emphasized for the protection of the back.

Bacteriological Profile of Pathogens in Burns Unit of a Tertiary Care Center: A Retrospective Observational Study.

OBJECTIVE: This retrospective observational study analyzes the bacteriological profile of pathogens causing burn wound infections in a tertiary care center. MATERIALS AND METHODS: This study was conducted at Father Muller Medical College Hospital, Karnataka, India, from January 2014 through December 2016. The specimens (ie, pus or a wound swab) were collected from patients with suspected of infection and processed as per standard microbiological techniques. The antibiotic sensitivity testing was performed by the Kirby Bauer's disk diffusion test on Mueller-Hinton agar as per Clinical and Laboratory Standards Institute guidelines. RESULTS: During the study period, a total of 124 eligible patient samples were collected; 22 samples were excluded as there was no significant growth/colonization. Among the 102 patients included in the study, 56 (54.9%) were females and the majority (33, 32.35%) of the patients were between 18 to 30 years. Acinetobacter species and Pseudomonas aeruginosa (26.56% each) were the most common pathogen among gram-negative bacteria and Staphylococcus aureus (36, 11.25%) was the most common gram-positive bacteria. Methicillin resistance was 30.5% among the Staphylococcus aureus isolates. Most of Acinetobacter species isolates were resistant to piperacillin tazobactum (84.71%), meropenem (80%), and amikacin (87.06%). Other gram-negative bacteria were also emerging with multidrug resistance. CONCLUSIONS: The current study revealed the non-fermenting Gram-negative bacteria as the leading cause of burn wound infection and are highly resistant to available high-level antibacterial agents.

Lower Respiratory Tract Infections (LTRIs): An Insight into the Prevalence and the Antibiogram of the Gram Negative, Respiratory, Bacterial Agents.

BACKGROUND: Community acquired respiratory tract infections are one of the commonest health issues globally, which demand frequent visits to the family practitioners. The emergence of antibiotic resistance in the frequently isolated pathogens has complicated the use of the empiric therapy with traditional agents. AIM: This study was focused on obtaining a comprehensive insight into the microbial profile, its prevalence and the susceptibility patterns of the gram negative bacilli isolates in lower respiratory tract infections. METHODS AND MATERIALS: Respiratory samples which were received from the patients at a Medical College Hospital in North Kerala, India were processed according to the standard protocol over a period of one year, from April 2011 to March 2012. The antimicrobial susceptibility was tested by the Kirby-Bauer disc diffusion method as per the CLSI guidelines. The data was interpreted by using the WHO Net antibiotic susceptibility surveillance soft ware Results: Out of 1750 respiratory samples, 298(17.03%) were culture positive for gram negative bacilli. The highest isolation rate was observed in the 61-80 years age group with a male preponderance and Klebsiella pneumoniae (41.95%) was found to be the predominant organism. The resistance pattern varied for different organisms. Among the different groups of antibacterial agents which were tested, levofloxacin was found to be an effective oral antibacterial against the pathogens which were isolated. The carbapenems (imipenem and meropenem), the betalactum/betalactamase inhibitors (piperacillin/tazobactum) and the aminoglycosides (amikacin) were effective among the parenteral antibacterials. The selection of the appropriate antibacterial therapy should be based on the organisms which are isolated and on the emerging resistance to the conventional therapies. CONCLUSION: Owing to the increased concern which surrounds antibiotic resistance and the changing patterns of the bacterial pathogens, the ongoing surveillance of disease and a regular review of the management guidelines are critical.

Subcutaneous nodule: A case of Dirofilaria.

Human subcutaneous dirofilariasis is a rare helminthic infection. It is caused by filarial worms of the Genus Dirofilaria, which is the natural parasites of dogs, cats, foxes, and wild mammals. Zoonotic filariasis caused by Dirofilaria species is rarely seen in the region of Dakshina Kannada. Most of them are seen in patients who are along the border of the district which shares its boundary with the state of Kerala, where dirofilariasis is constantly reported to occur. Here, we report a case of subcutaneous dirofilariasis, presenting as a subcutaneous nodule on the left cheek of a 28-year-old male from Cochin (Ernakulam), Kerala, South India. Two live worms were recovered from the subcutaneous nodular swelling.

Characterisation of aerobic bacteria isolated from endotracheal aspirate in adult patients suspected ventilator associated pneumonia in a tertiary care center in Mangalore.

BACKGROUND AND OBJECTIVES: Despite advances in antimicrobial therapy, better supportive care modalities and use of a wide range of preventive measures, ventilator-associated pneumonia (VAP) continues to be an important cause of morbidity and mortality in intensive care unit (ICU). VAP requires a rapid diagnosis and initiation of appropriate antibiotic treatment, to prevent mortality and morbidity. Inappropriate and inadequate antibiotic treatment causes emergence of drug resistance in pathogens and poor prognosis in patients. Early detection of pathogens causing VAP helps to control their spread by administration of suitable antibiotics and proper infection control measures. The study was conducted to know the pathogens causing VAP in Fr. Muller Medical College Hospital, Mangalore, and their susceptibility pattern. METHODS: A total of 100 patients, on mechanical ventilation for more than 48 h, who were suspected to have VAP were included in the study between December 2008 and November 2009. Their endotracheal aspirates (ETAs) were collected and processed. From 100 ETA, 138 isolates of count > 10(5) CFU/ mL were characterized and antibiogram was determined using standard antibiotics regime. RESULTS: Incidence of VAP was found to be 44.2% among the mechanically ventilated patients. Klebsiella pneumoniae (34%) was the most common pathogen isolated, followed by Pseudomonas aeruginosa (20%). Among them, most of the K. pneumoniae and P. aeruginosa isolates were resistant to penicillins, cephalosporins, fluoroquinolones was observed but were sensitive to piperacillin/tazobactum, cefaperazone/sulbactum, and carbapenems. All isolates were sensitive to amikacin. INTERPRETATION AND CONCLUSION: The present study shows prevalence of multidrug-resistant organisms in the study region. Klebsiella species was the most common pathogen isolated in ETA. Acinetobacter species were the most resistant pathogens prevailing in our ICU setup, leading to the increased mortality in the ventilated patients. Patients with chronic obstructive pulmonary disease is the most common predisposing factor for VAP in the study group.