Microorganisms Profile and Antimicrobial Resistance Pattern in Outborn Neonates in Northern India: A Hospital-Based Observational Study.

BACKGROUND: Neonates born somewhere else (outborn) and treated in a referral centre have different microbiological profile. We report the microorganism's profile and antimicrobial resistance (AMR) in blood culture proven sepsis in outborn neonates. METHODS: Culture positive neonatal sepsis from a neonatal unit of a referral institute catering to outborn neonates was studied over an 18 months duration. Data from the hospital information system were used to analyse the culture positivity rates, the spectrum of the microorganisms isolated and AMR pattern. RESULTS: Out of 5258 admitted neonates, 3687 blood samples were sent for suspect sepsis. The blood cultures were positive in 537 (14.6%) samples from 514 neonates. Gram-positive cocci (GPC) were the most common [240 (45%)] followed by gram-negative bacilli (GNB) [233 (43.4%)] and fungi [64 (11.9%)]. Coagulase negative staphylococcus (CONS) contributed to two-thirds of GPC followed by Klebsiella [93 (17.3%)] and Acinetobacter species [52 (9.7%)]. In 403 (75%) neonates, organisms grew in the samples sent at or within 24 h of admission. The case fatality rate was significantly higher in those with culture positive sepsis. The resistance to meropenem and imipenem was documented in 57.1% and 49.7%, respectively and 48% of the GNB was multidrug resistant. CONCLUSIONS: CONS followed by Klebsiella species were the most common organisms isolated. Three-fourths of the neonates had organisms grown at or within 24 h from admission. More than half of the GNB were multidrug resistant. The case fatality rate was significantly higher in those with culture positive sepsis.

Sepsis is the third most common cause of neonatal mortality globally. Outborn neonates differ in their microorganisms' profile and antimicrobial resistance (AMR) pattern in comparison to inborn neonates. In this study, we report the microorganisms profile and their AMR pattern in blood culture proven sepsis in a large cohort of outborn (extramural) neonates admitted to the index institute. We have also presented the state-wise profile and have compared their AMR pattern. Out of the 5258 admitted neonates, 3687 blood samples were sent for culture for suspect sepsis. The blood cultures were positive in 537 (14.6%) samples from 514 neonates. Coagulase-negative staphylococcus (CONS) followed by Klebsiella species were the most common organisms isolated from this large cohort of outborn neonates. More than 75% of the neonates grew the organisms within 24 h from admission indicating that many of them harboured the organisms at admission. Case fatality rate was significantly higher in those neonates with culture positive sepsis in comparison to culture negative sepsis. Close to 50% of the gram-negative bacilli isolates were multidrug resistant and half of them were extensively drug resistant. A significant between-state difference in organism profile and their AMR patterns were observed.

Cholera pulse vaccination: A possible elimination strategy for cholera in endemic countries.

Cholera is a diarrheal disease causing major health issue in developing countries where it is endemic and causes outbreaks. India ranks first with an estimated 675,188 number of cases and 20,256 number of deaths annually with one-third of its population at risk. The two broad approaches for cholera control are improving sanitation and vaccination. Now both live and killed oral vaccines are available. Live vaccines are advantageous in respect of intestinal colonization and rapid immune response and also lead to in vivo exposure of bacterial products leading to good immunological response against wild Vibrio cholerae infection. The three major delivery strategies which can be considered for the implementation of oral cholera vaccine are preemptive vaccination, reactive vaccinations, and National Immunization Program. We propose the use of cholera live oral vaccines for achieving control of this disease by repeated vaccination of the susceptible population in a series of pulses to control it from the entire population.

Isolation and Characterization of an Unknown Chrysosporium sp. Producing Subcutaneous Mycosis in an Immunocompromised Patient.

We report a case of subcutaneous fungal abscess over the great toe caused by a keratinophilic fungus, an unknown Chrysosporium sp., in a 60-year-old diabetic female who was treated successfully with oral fluconazole. The fungus was isolated from aspirated pus, and septate hyphae were seen in fine needle aspiration cytology. Ovoid- to club-shaped hyaline one-celled conidia (aleuriconidia) with broad truncated bases were seen, and sequencing of ITS1-5.8S-ITS2 rDNA revealed belonging to the order Onygenales and most closely related to Chrysosporium spp. isolated from a fowl. Of the 65 species within the genus Chrysosporium, very few have been reported as pathogenic.

Haemophilus influenzae bacteremia: A 5-year (2016-2020) retrospective study analysing the clinical and laboratory features.

Haemophilus influenzae (H. influenzae) causes invasive disease like bacteremia which is rarely diagnosed. We conducted this retrospective study of H. influenzae bacteremia diagnosed between January 2016 and December 2020. Nineteen patients were identified. Majority were children ≤5 years of age (84.2%), inpatients (89.5%), males (78.9%) and admitted in ICUs (26.6%). The most common underlying primary diagnosis was malignancy. These isolates were most susceptible to carbapenems (100%) followed by cefotaxime (83.3%) and ampicillin (82.4%). The overall mortality rate was 33.3%. Increased mortality resulted in those admitted in ICUs with H. influenzae bacteremia episode along with polymicrobial/co-isolates infection.

Antimicrobial resistance in Shigella species: Our five years (2015-2019) experience in a tertiary care center in north India.

PURPOSE: Shigella is the second leading cause of diarrhoeal mortality especially in children <5 years of age in African and Asian countries. Rapid changes are occurring in the epidemiology of shigellosis and Shigella are increasingly becoming highly drug resistant. To determine the serogroup distribution and antimicrobial resistance of Shigella isolated at our tertiary care centre in North India. METHODS: A retrospective study was conducted where demographic details along with antimicrobial susceptibility data of Shigella isolated from stool specimens from 1st January 2015 till 31st December 2019 were retrieved from records and analyzed by WHONET 2019 software. RESULTS: Shigella species was isolated in 1.31% (n = 137) of a total of 10,456 stool samples. Males predominated (n = 82; 59.8%) and majority of cases were admitted (n = 94; 68.6%). Children ≤5 years of age (n = 47; 34.3%) were the most commonly affected. Adults in the 21-40 age group contributed 27% of cases (n = 37). Overall, Shigella flexneri (n = 87; 63.5%) was the most common serogroup followed by non-agglutinable Shigella (n = 28; 20.4%) while Shigella sonnei (n = 12, 8.8%) and Shigella boydii (n = 9, 6.6%) fluctuated over the years. Shigella dysenteriae reappeared in 2019 after a hiatus of ten years. Overall, 45.3% (n = 62) of isolates were multidrug resistant to CLSI recommended drugs and high resistance was noted for ampicillin/amoxicillin (68.1%), cotrimoxazole (75.8%) ciprofloxacin (61.5%) and ceftriaxone/cefotaxime (45.2%). CONCLUSIONS: Shigella have become highly drug resistant to fluoroquinolones and cephalosporins. Community based studies are required to truly assess the burden of AMR in India.

HIV-TB co-infection with clinical presentation, diagnosis, treatment, outcome and its relation to CD4 count, a cross-sectional study in a tertiary care hospital in coastal Karnataka.

INTRODUCTION: Tuberculosis (TB) is the leading killer and the commonest opportunistic infection (OI) in human immunodeficiency virus (HIV) infected individuals with 0.3 million deaths in 2017. When HIV and TB co-infection occurs, they form a deadly combination with each accelerating the progression of the other, resulting in increased morbidity and mortality. AIM AND OBJECTIVES: To study the demographic pattern, clinical presentation, opportunistic infections, radiological and laboratory profile, management, and outcome of HIV-TB coinfected individuals. MATERIALS AND METHODS: A prospective cross-sectional study was carried out on confirmed HIV cases already diagnosed with TB and those newly detected with TB after admission, where diagnosis was carried out following standard operative procedures. RESULTS: In our study of 58 HIV-TB co-infected individuals, 40-50 years was the most common age group affected. Males were affected more with majority being married. The most common presentation was fever (67%) followed by gastrointestinal symptoms. Majority of TB cases were newly diagnosed (65.5%), with predominance of pulmonary tuberculosis (PTB) (n = 35) followed by those having only extrapulmonary tuberculosis (EPTB) (n = 12) and both (n = 11). TB was diagnosed by microscopy in 32.7%, while radiologically, chest X-ray was most common (36.2%). Also, 50% were infected with other OIs where oral candidiasis was the most common (37.93%). The overall mean CD4 count was 220 cells/µL and those with EPTB had lesser CD4 counts than those with PTB. All were on DOTS regimen and majority showed improvement. CONCLUSION: In a country like India where both these diseases are rampant, we recommend better information, education, understanding and awareness for prevention, care, early diagnosis, and treatment of these two notorious infectious diseases with prevention of relapse and default of TB cases in HIV-TB co-infected individuals a priority.

Seroprevalence of HIV-2 and dual infection among HIV-infected individuals with clinical and laboratory features at a Tertiary Care Teaching Hospital, Mangalore: The present scenario.

Introduction: Human immunodeficiency virus (HIV) belongs to the Genus Lentiviruses and is made up of two main types HIV-1 and HIV-2 which are the causative agents of acquired immune deficiency syndrome (AIDS). It is well documented that HIV-1 infection is predominantly found, but HIV-2 infection has also been detected occasionally now and then. Objective: The objective of this study is to determine the seroprevalence of HIV-2 and dual infection in HIV-infected individuals along with the clinical presentation, co-infections, laboratory profile, and outcome of these patients. Materials and Methods: This descriptive cross-sectional study was carried out at a Tertiary Care Teaching Hospital for 2 years from August 2013 to July 2015, after obtaining approval from the Institutional Ethics Committee. Patients confirmed having HIV infection, as per the National AIDS Control Organization guidelines were included in the study. The sociodemographic pattern along with clinico-laboratory details and outcome were noted. Results and Discussion: In the present study, out of a total of 214 confirmed HIV-infected individuals, 2.8% (n = 6) were HIV-2 and 1.4% (n = 3) were dual infected where 40-50 years age group were most commonly affected. Males were more commonly affected than females in a ratio of 8:1. The most common presentation was fever (n = 5) followed by gastrointestinal (n = 5) symptoms. The most common opportunistic infection (OI) was tuberculosis (TB) (n = 4) followed by oral candidiasis (n = 2). Majority had anemia (n = 5) with raised erythrocyte sedimentation rate. Furthermore, majority (n = 7) showed improvement on discharge, whereas two (n = 2) left against medical advice and outcome is unknown. Conclusion: We conclude that the incidence of HIV-2 and dual infection does occur in our setup with males of older age group being more commonly affected where TB is the most common OI. Hence, clinicians should keep in mind that HIV-2 infection does occur and differentiating as HIV-1, HIV-2, or dual infection is important, to provide appropriate treatment which will result in decreased morbidity and mortality rates.

RésuméIntroduction: Le virus de l'immunodéficience humaine (VIH) appartient au genre Lentivirus et se compose de deux types principaux VIH-1 et VIH-2 qui sont les agents responsables du syndrome d'immunodéficience acquise (SIDA). Il est bien documenté que l'infection à VIH-1 est principalement retrouvée, mais Une infection par le VIH-2 a également été détectée à l'occasion de temps en temps. Objectif: L'objectif de cette étude est de déterminer la séroprévalence de VIH-2 et double infection chez les personnes infectées par le VIH ainsi que le tableau clinique, les co-infections, le profil de laboratoire et les résultats de ceux-ci les patients. Matériels et méthodes: Cette étude transversale descriptive a été réalisée dans un hôpital universitaire pour soins tertiaires pendant deux ans à compter du Août 2013 à juillet 2015, après approbation du comité d'éthique de l'établissement. Les patients confirmés infectés par le VIH, conformément au Les directives des organisations nationales de lutte contre le sida ont été incluses dans l'étude. Le schéma sociodémographique ainsi que les détails clinico-laboratoires et les résultats ont été notés. Résultats et discussion: Dans la présente étude, sur un total de 214 personnes confirmées infectées par le VIH, 2,8% (n = 6) ont été Le VIH-2 et 1,4% (n = 3) étaient bi-infectés, le groupe d'âge de 40 à 50 ans étant le plus souvent affecté. Les hommes étaient plus souvent touchés que les femmes dans un rapport de 8: 1. La présentation la plus courante était la fièvre (n = 5) suivie des symptômes gastro-intestinaux (n = 5). Le plus commun l'infection opportuniste (OI) était la tuberculose (TB) (n = 4) suivie de la candidose orale (n = 2). La majorité avait une anémie (n = 5) avec érythrocyte élevé taux de sédimentation. De plus, la majorité (n = 7) a présenté une amélioration à la sortie, alors que deux (n = 2) sont partis contre l'avis d'un médecin et les résultats. est inconnu. Conclusion: nous concluons que l'incidence de l'infection à VIH-2 et de la double infection se produit effectivement dans notre structure, les hommes de plus communément touchés, où la tuberculose est l'IO la plus courante. Par conséquent, les cliniciens doivent garder à l'esprit que l'infection à VIH-2 se produit et en raison de l'importance du VIH-1, du VIH-2 ou de la double infection, le traitement approprié doit permettre de réduire les taux de morbidité et de mortalité.

Screening of methicillin-resistant Staphylococcus aureus in healthcare workers and students and its susceptibility to mupirocin in a tertiary care teaching hospital in South India.

BACKGROUND: Staphylococcus is the most common pathogen causing infection in hospitals. They also colonize the healthcare workers who serve as reservoir of infection. Emergence of methicillin-resistant Staphylococcus aureus (MRSA) is a burning issue throughout the world contributing to significant morbidity and mortality. Use of mupirocin to eradicate the carrier state is the need of the hour. OBJECTIVES: To screen healthcare workers (HCWs) and medical students for MRSA and to know the susceptibility of mupirocin in this group. MATERIALS AND METHODS: A total of 432 students, nursing staff, doctors and house-keeping staff were screened for MRSA for 4 months. The MRSA and methicillin-resistant coagulase-negative Staphylococcus (MRCoNS) isolates were then tested for mupirocin resistance. RESULTS: Out of 432 samples, 24 (5.55%) were MRSA and 104 (24.07%) were MRCoNS. Only 4.16% (n = 1) showed high-level resistance to mupirocin among the MRSA isolates, while resistance among MRCoNS was higher at 6.7% (n = 7) for low-level resistance and 17.30% (n = 18) for high-level resistance. CONCLUSION: MRSA colonization of HCWs may serve as a source of infection and mupirocin resistance should be screened for all whether working in Intensive Care Units or not and if detected, alternative treatment should be used which will result in appropriate use of this antibiotic for decolonization.