Time trends in the epidemiology of microbial infections at a tertiary care center in west India over last 5 years.

INTRODUCTION: Microbiological surveillance data is of crucial importance in appropriate management of patients with infectious diseases. The current study was conducted to study the microbiological surveillance data along with antibiotic sensitivity patterns for isolates collected at a single tertiary care center from Western India over last four years and to analyze the change in the patterns of nosocomial infections seen over the last four year period. DESIGN: Retrospective study. Culture reports data were retrospectively collected from microbiology department of Sterling hospital Ahmedabad. Isolates from clinical specimen from blood cultures, surgical site swabs, abdominal drain fluid, urine samples and bronchoscopy samples were analysed in present study. Isolates from respiratory secretions includind endotracheal, tracheostomy and sputums were excluded from analysis, Frequency of different organisms which were isolated as well the sensitivity patterns to major antibiotics were recorded. RESULTS: Among the blood isolates there was a clear trend regarding the emergence of gram positive organisms with Staphylococcus being the most common isolate from 149 blood culture specimens in the period 2008-09 (27.4%). Majority (> 85%) of gram negative isolates causing blood stream infections were sensitive to Amikacin, Cefoperazone-Sulbactam, Piperaciln-Tazobactam, Meropenem and Colistin. On the other hand, sensitivity of gram negative isolates from other sites to these antibiotics was much more variable. Incidence of candidemia went down from 20.3% to 13.4% in 2005-6 and in 2008-09 respectively. CONCLUSION: Staphylococcus aureus has emerged as the dominant pathogen causing the blood stream infections in last two years. Piperacilin-tazobactum, cefaperazone-sulbactum or meropenem may be appropriate as empiric antibiotic choice for gram negative blood stream infections along with Amikacin for patients with serious infections.

Clinical Outcome of Novel H1N1 (Swine Flu)-Infected Patients During 2009 Pandemic at Tertiary Referral Hospital in Western India.

BACKGROUND: The first case of 2009 pandemic influenza A (H1N1) virus in Gujarat, India, was reported in August 2009. Oseltamivir was used for treatment of pandemic influenza in India. We discuss the clinical characteristics and outcome of the hospitalized patients with H1N1 infection during 2009 pandemic influenza season. MATERIALS AND METHODS: Hospitalized patient with laboratory-confirmed H1N1 flu during August 2009 to February 2010 were included in this retrospective study. Data were collected from hospital ICU charts. Patients discharged from hospital were considered cured from swine flu. Data analysis was performed using CDC software EPI Info v3.5.3. Both univariate and multivariate analyses were conducted. RESULTS: A total of 63 patients were included in the study, of them 41 (65%) males and 22 (35%) females. Median age was 34 (3-69) years and median duration of symptoms before hospitalization was 5 (2-20) days. Common presenting symptoms include fever 58 (92.06%), cough 58 (92.06%), breathlessness 38 (60.31%), common cold 14 (22.22%), vomiting 12 (19.04%), weakness 9 (14.28%), throat pain 7 (11.11%), body ache 5 (7.93%), and chest pain 4 (6.34%). Co-morbidities were seen in 13 (20.63%) patients. Steroids were used in 39 (61.90%) patients, and ventilatory support was required in 17 (26.98%) patients. On presentation chest x-ray was normal in 20 (31.74%) patients, while pulmonary opacities were seen in 43 (68.26%) patients. Forty-seven (74.60%) patients were cured and discharged from hospital, 14 (22.22%) patients died, and 2 (3.17%) patients were shifted to other hospital. Ventilatory requirement, pneumonia, and co-morbidities were the independent predictors of mortality, while age, sex, and steroid use were not associated with increased mortality. CONCLUSION: 2009 pandemic influenza A had the same clinical features as seasonal influenza except vomiting. Mortality rate was high in 2009 H1N1-infected patients with pneumonia, co-morbid conditions, and patients who required ventilatory support.

Antibiotic susceptibility patterns of Pseudomonas aeruginosa at a tertiary care hospital in Gujarat, India.

OBJECTIVES: The present study was undertaken to assess the antibiotic susceptibility patterns of Pseudomonas aeruginosa at a tertiary care hospital in Gujarat, India. Due to significant changes in microbial genetic ecology, as a result of indiscriminate use of anti-microbials, the spread of anti-microbial resistance is now a global problem. MATERIALS AND METHODS: Out of 276 culture positive samples, 56 samples of Pseudomonas aeruginosa were examined and 10 different types of specimen were collected. Microbial sensitivity testing was done using disk diffusion test with Pseudomonas species NCTC 10662, as per CLSI guidelines. RESULTS: The highest number of Pseudomonas infections was found in urine, followed by pus and sputum. Pseudomonas species demonstrated marked resistance against monotherapy of penicillins, cephalosporins, fluoroquinolones, tetracyclines and macrolides. Only combination drugs like Ticarcillin + Clavulanic acid, Piperacillin + Tazobactum, Cefoperazone + Sulbactum, Cefotaxime + Sulbactum, Ceftriaxome + Sulbactum and monotherapy of amikacin showed higher sensitivity to Pseudomonas infections; however, the maximum sensitivity was shown by the Carbapenems. CONCLUSION: From the present study, we conclude that urinary tract infection was the most common hospital acquired infection. Also, co-administration of beta -lactamase inhibitors markedly expanded the anti-microbial sensitivity of semi-synthetic penicillins and cephalosporins. The aminoglycoside group of antibiotics - amikacin - demonstrated maximum sensitivity against pseudomonas species. Therefore, use of amikacin should be restricted to severe nosocomial infections, in order to avoid rapid emergence of resistant strains. Periodic susceptibility testing should be carried out over a period of two to three years, to detect the resistance trends. Also, a rational strategy on the limited and prudent use of anti-Pseudomonal agents is urgently required.