Coexistence of blaNDM and blaOXA-48 Genes in Carbapenem-Resistant Burkholderia pseudomallei Isolated From Pus: A Rare Phenomenon.

Burkholderia pseudomallei causes melioidosis in both humans as well as animals and is classified as a tier 1 pathogen by the US CDC. Melioidosis is a disease that occurs predominantly in subtropical and tropical regions. It is endemic to northern Australia and parts of Southeast Asia, as well as the Indian subcontinent. Diagnosis can be made through history, clinical examination, imaging, and microbiological studies. We report a case where Burkholderia pseudomallei was isolated froma 41-year-old man who complained of pain in the left hip and the left shoulder and swelling in both lower limbs. Chest X-ray showed bilateral consolidation. USG of the left shoulder and bilateral hips showed a mass in the anterior region of the left upper arm and the lateral region of the left thigh. Pus aspirated from left shoulder grew Burkholderia pseudomallei on culture and was carbapenem-resistant. The isolate harbored two carbapenemase genes, blaNDM and blaOXA-48, which is a novel finding.

Perceived Barriers in Delivering Optimal Healthcare Services in a Dedicated COVID-19 Hospital: Perspectives of Health-Service Providers.

Background The coronavirus disease 2019 (COVID-19) pandemic challenged the healthcare infrastructure, with health-service providers (HSPs) offering unconditional and unprejudiced service to admitted patients. During the first wave, due to the novelty of the disease and the lack of clarity regarding its transmission in the initial phases of the evolution of the disease, the predominant fear was of contracting the disease while caring for patients. With the prevailing uncertainty in knowledge and management, this study was planned to identify the barriers to delivering optimal healthcare to COVID-19 patients. Methodology A cross-sectional study was conducted among HSPs working in the first phase of a dedicated 500-bed government COVID-19 hospital at Kalinga Institute of Medical Sciences using an online questionnaire with the following five aspects: workplace guidelines and support, protective equipment, access to information regarding updates on the epidemic, overall self-reported stress and workplace stress about self-infection with COVID-19 and family being infected, and demographics. All HSPs aged 18 years or above, who were working either on a full- or a part-time basis, were able to understand the English language, and who were working in the COVID-19 hospital and gave digital informed consent (via Google Forms) were included in the study. All data were collected, coded, tabulated, and analyzed using Google Forms in an Excel format and Epi Info software version 7.2.5.0. Results Of the 144 respondents contacted, 132 completed the survey, with a participation rate of 91.67%. About 52.27% of respondents were aged 21-30 years, 68.18% were females, and 56.06% were nurses. Challenges faced were "working in a new context" (40.91%), "the uncertainty and fear of being infected and infecting others"(31.06%), and "exhausted by the workload and protective gear" (18.94%). Moreover, 64.12% were aware of a workplace policy. Only 0.75% felt that their workload needed to be reduced; 2.27% felt the need for a penalty policy for hiding travel history, lack of quarantine compliance, avoiding the accumulation of face masks, and price inflation of face masks. The overall self-reported stress level was significantly associated with a lack of awareness of workplace policies and the fear of getting infected. Furthermore, 93.94% reported that they had an adequate supply of personal protective equipment. As high as 81.06% of the HSPs were "worried about being infected from COVID-19 during work," and 94.69% were "worried about their family being infected from COVID-19 due to their working in COVID-19 hospitals." Conclusions HSPs' perception of barriers in providing healthcare gave an insight into the problems being faced and helped improve the quality of services. The study highlighted the need of increasing awareness regarding the existing workplace policies among HSPs to promote preparedness during crisis management.

Pathogens Isolated and Their Association With the Long-Term Outcome in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

BACKGROUND: Most of the acute exacerbations of chronic obstructive pulmonary disease (COPD) are due to infections, mostly due to bacteria and viruses. There is a need to study the outcome of microbe-induced airway inflammation. MATERIALS AND METHODS: It is an observational follow-up study from the pulmonary medicine department of Kalinga Institute of Medical Sciences with the participation of the Regional Medical Research Center, Bhubaneswar, from October 2018 to February 2022. Patients who were admitted with acute exacerbation of COPD and treated as per GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2021 guidelines were included in the study. Those patients in the severe category, who had clinically recovered, had undergone pulmonary physiotherapy, were on prescribed medications and home oxygen therapy after discharge, were followed up every three months by telephone calls. Any exacerbation, clinical stability, or mortality information was recorded. RESULTS: Out of 197 cases, the majority were elderly, males, smokers, and belonged to urban areas; in total, 102 (51.8%) microbes were isolated as etiological agents of infective exacerbation in which 19.79% were viruses and 23.35% were bacteria, while coinfection was found in 8.62% cases. Among the viruses, rhinovirus, influenza virus, and respiratory syncytial virus were the major isolates. Among the bacteria, mostly gram-negative organisms such as Acinetobacter baumannii, Klebsiella pneumoniae, and  Pseudomonas aeruginosa were isolated. Readmission was more among patients with coinfection. CONCLUSION:  Acute exacerbation of COPD was mostly seen in males in the age group of 61-80 years. Rhinovirus and influenza A virus were the two most common viral isolates, and among the bacterial isolates, Acinetobacter baumannii and Klebsiella pneumoniae were predominantly detected. Poor clinical outcomes were noticed more among the coinfection group.

The Microbial Profile and Resistance Pattern of Pathogens Isolated From Long COVID Pneumonia Patients and Their Correlation to Clinical Outcome: Our Experience From a Tertiary Care Hospital.

Background Coronavirus disease 2019 (COVID-19) patients with persistent symptoms for at least four weeks in spite of being reverse transcriptase-polymerase chain reaction (RTPCR) negative for COVID infection are defined as long COVID (wherein pulmonary involvement is seen in a significant proportion of cases). The history of prolonged use of corticosteroids, broad-spectrum antibiotics, and associated comorbid conditions in these patients increases the possibility of infection with multidrug-resistant microbial strains. It may lead to a grave prognosis, hence appropriate microbiological evaluation and management at the earliest can have a better outcome. Methods A retrospective observational study was carried out among long COVID patients admitted to the Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, a tertiary care hospital. Eighty-four patients admitted to the ICU or non-ICU ward in the hospital from April to October 2021 were included in the study. Antibiotics, as prescribed by our hospital antibiotic policy, were administered wherever required and were subsequently changed according to culture and sensitivity reports of the samples (sputum, endotracheal aspirates, or blood). An analysis of the antibiotic sensitivity patterns of the pathogens isolated was performed. The outcome after optimum medical management was assessed for survivors, discharge, or death. Results Out of the total of 84 patients, 41 samples (sputum, endotracheal aspirates or blood) were collected and sent for culture, of which 32 (78.1%) were found to be culture positive for pathogens. Among the pathogens isolated, there were 22 (69%) drug-resistant and 10 (31%) sensitive organisms. Among the 22 resistant pathogen isolates, 18 were Gram-negative species, the most common species being Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumanii; two were Gram-positive species, one each from Staphylococcus aureus and Enterococcus faecalis, and three were Candida tropicalis. Of five deaths reported among 22 cases with resistant isolates, extensively drug-resistant (XDR), multi-drug resistance (MDR), and pan drug resistance (PDR) strains were detected in three, one, and one cases, respectively, and were harboured by K.  pneumoniae, P. aeruginosa, and A. baumanii. Of the total eight deaths, there were two deaths among the 43 patients who received an empiric antibiotic in the wards, and six deaths were reported in the ICU. Despite raised biomarkers of inflammation, comorbid illnesses, renal impairment, and immunocompromised states, there was 91% survival and discharge, which was statistically significant (p-value = 0.00). Conclusion To conclude, K. pneumoniae, P. aeruginosa, A. baumanii, C. tropicalis, S. aureus, and E. faecalis were the most commonly isolated organisms among long COVID pneumonia cases, of which some were MDR, PDR and XDR strains. Early microbiological evaluation with targeted, proper antimicrobial usage along with optimized medical management and, wherever needed, critical care support in the ICU may lead to a better prognostic outcome in those groups of patients.

Evaluation of Antimicrobial Efficacy of various Intracanal Medicaments in Primary Teeth: An in vivo Study.

INTRODUCTION: Bacteria and their products play a primary etiological role in the initiation and perpetuation of pulpoperiapical pathosis. Intracanal medication is important for endodontic success as it eliminates microorganisms that persist after chemomechanical preparation. AIM: To compare antimicrobial efficacy of calcium hydroxide powder, triple antibiotic paste, calcium hydroxide with 2% chlorhexidine solution, and triple antibiotic paste with 2% chlorhexidine solution. MATERIALS AND METHODS: A total of 48 nonvital primary teeth were included in this study. After access opening first microbiological sample (s1) was collected by using absorbent paper point introducing into canal. Second microbilogical sample (s2) was taken following chemomechanical preparation and the teeth were divided into four groups: Group I: calcium hydroxide (CH) powder with distilled water; group II: CH with 2% chlorhexidine solution; group III: triple antibiotic powder with distilled water; group IV: triple antibiotic paste with 2% chlorhexidine solution. Then the canals were filled with any one group of the medicament and cavity was temporarily sealed with zinc oxide eugenol. After 1 week, a postmedication sample (s3) was collected. Then the canal was filled with Metapex, restored with glass ionomer cement. CONCLUSION: From the experiments carried out in this study, with the limitations, an inference can be drawn that a combination of antimicrobial agent used as intracanal medicament is definitely better than single agent like Ca(OH)2. HOW TO CITE THIS ARTICLE: Dutta B, Dhull KS, Das D, Samir PV, Verma RK, Singh N. Evaluation of Antimicrobial Efficacy of various Intracanal Medicaments in Primary Teeth: An in vivo Study. Int J Clin Pediatr Dent 2017;10(3):267-271.

Prevalence of ESBL in Escherichia coli Isolates Among ICU Patients in a Tertiary Care Hospital.

INTRODUCTION: Resistance to common antibiotics is a matter of grave concern in treating infections in hospital settings especially in Intensive Care Units (ICUs). One of the most commonly used and effective group of antibiotics, cephalosporins, exhibit resistance due to production of Extended Spectrum Beta- Lactamases (ESBLs). The prevalence of ESBL producing Escherichia coli (E.coli) has increased throughout the world and is a major cause of treatment failure in ICUs. As per our knowledge studies were not available on the prevalence of ESBL producing E.coli in ICUs of this region. AIM: To determine the prevalence of ESBLs among Escherichia coli isolates in ICUs of a tertiary care hospital. MATERIALS AND METHODS: A cross sectional study was conducted over a period of 4 years (Sept 2011 to Sept 2015) in the Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar. Consecutive non-duplicate isolates of E.coli recovered from 6800 clinical samples of patients admitted to different Intensive Care Units (ICUs) were subjected to ESBL screening test and then to CLSI recommended Phenotypic Confirmatory Disc Diffusion Tests (PCDDT) for ESBL production determination. RESULTS: Out of 6800 samples, 1038 were E.coli isolates and 452(44%) were resistant to third generation cephalosporins. ESBL producing Escherichia coli among them were 276 (61.1%). Paediatric ICU showed the highest prevalence of ESBL E.coli at 80.9%. The highest prevalence of ESBL E.coli was in urine samples (82.6%) followed by pus (9.8%). The most effective antibiotic for ESBL producers was imipenem (96.7% sensitive), followed by amikacin (88.4%) and piperacillin- tazobactum (87%). CONCLUSION: This study has highlighted the high prevalence of ESBL producing E.coli in the ICUs of our hospital. An in depth analysis of their antibiogram will be helpful in formulating the antibiotic policy and prevent spread of ESBL strains. It is recommended that ESBL testing should be done routinely to curtail antibiotic resistance and to effectively implement infection control measures.