Severe vivax malaria trends in the last two years: a study from a tertiary care centre, Delhi, India.

BACKGROUND: Plasmodium vivax, once considered benign species, is recently being recognised to be causing severe malaria like Plasmodium falciparum. In the present study, the authors report the trends in malaria severity in P. vivax among patients from a Delhi government hospital. The aim of the study was to understand the disease severity and the burden of severe vivax malaria. METHODS: A hospital based study was carried out from June 2017 to December 2018 at a tertiary care centre from Delhi, India. Patients were tested for malaria using peripheral blood smear (PBS) and/or rapid malaria antigen test (RMAT). The severe and non-severe vivax malaria categorization was done as per the WHO guidelines. Sociodemographic, clinic and paraclinical data were collected from patients and their medical records. RESULTS: Of the 205 patients, 177 (86.3%) had P. vivax infection, 22 (10.7%) had P. falciparum infection and six (2.9%) had mixed infection with both the species. Out of 177 P. vivax cases included in this study one or more manifestations of severe malaria was found in 58 cases (32.7%). Severe anaemia (56.9%), jaundice (15%) and significant bleeding (15%) were the most common complications reported in most of patients, along with thrombocytopenia. CONCLUSIONS: In this study, it is evident that vivax malaria is emerging as the new severe disease in malaria patients, a significant shift in the paradigm of P. vivax pathogenesis. The spectrum of complications and alterations in the laboratory parameters in P. vivax clinical cases also indicate the recent shift in the disease severity.

A pilot study for evaluation of knowledge and common practises of nursing staff regarding use of multidose injection vials and their microbial contamination rate in a super-specialty hospital.

CONTEXT: Multidose injection vials (MDVs) are prone to bacterial contamination, and their use has been reported to be a potential source of infections. AIMS: The aim of this study was to evaluate the knowledge and common practises of nursing staff regarding the use of MDVs and its microbial contamination rate. SETTINGS AND DESIGN: A pilot study was conducted in a super-specialty hospital from June to December 2016. SUBJECTS AND METHODS: Information about knowledge and common practises of 100 nursing staff posted in various Intensive Care Units (ICUs) with respect to the usage of single and MDVs, respectively, was obtained and assessed. About 40 in-use multidose injection vials containing some remnants were collected from different ICUs. The volume of 1 ml content of each of these vials was inoculated into a tube containing 15 ml thioglycolate broth and incubated at 37°C for 10 days. The broth was visually examined every day and subcultured onto blood, chocolate, and Sabouraud Dextrose agar plates on alternate days within 10 days or any time that the appearance seemed turbid. The microbial isolates thus obtained were identified using standard guidelines and recorded. STATISTICAL ANALYSIS USED: Descriptive statistics were used. RESULTS: The study group members had sufficient knowledge about various aspects of handling single and MDVs, respectively, such as hand hygiene, disinfection, checking of vial labels, and expiry date. Low hand hygiene compliance rate of 55% was observed in all ICUs visited during this study. The contamination rate of MDVs injection vials was 25% with Coagulase-negative Staphylococcus spp. being the most common isolate. CONCLUSIONS: The use of MDVs is associated with the risk of contamination and nosocomial outbreaks of life-threatening bloodstream infections. Healthcare professionals must strictly adhere to basic infection control practises as per standard guidelines to minimize the incidence of hospital-acquired infections.

Evaluation of Susceptibility of Glycopeptide-resistant and Glycopeptide-sensitive Enterococci to Commonly Used Biocides in a Super-speciality Hospital: A Pilot Study.

CONTEXT: Although existence of a probable association between glycopeptide and biocide resistance among enterococci has often been hypothesized, all studies conducted so far on this subject have been inconclusive. AIMS: The aim of this study was to explore the possibility of the existence of an association between glycopeptide resistance and reduced susceptibility to biocides among Enterococcus spp. SETTINGS AND DESIGN: This was a pilot study conducted in a super-speciality hospital situated in New Delhi, India, between June and November, 2015. PATIENTS AND METHODS: Fourteen isolates of Enterococcus spp. obtained from various clinical samples of inpatients were subjected to susceptibility testing by modified Kirby-Bauer disk diffusion method to the following antibiotics: ampicillin (30 µg), gentamicin (120 µg), linezolid (30 µg), teicoplanin (30 µg), and vancomycin (30 µg). Based on the preliminary glycopeptide susceptibility results, all the isolates were classified into glycopeptide-sensitive and glycopeptide-resistant groups, respectively. Isolates belonging to both of these groups were subjected to tube dilution method for determining minimum inhibitory concentration of three biocides, namely, sodium hypochlorite, povidone-iodine, and absolute ethanol, respectively. Minimum bactericidal concentration of these disinfectants was also determined as per standard guidelines. STATISTICAL ANALYSIS USED: Not applicable. RESULTS: More number of glycopeptide-sensitive strains exhibited reduced susceptibility to sodium hypochlorite than glycopeptide-resistant strains of enterococci. However, more number of glycopeptide-resistant isolates exhibited lower susceptibility to povidone-iodine than glycopeptide-sensitive isolates of enterococci. Both glycopeptide-sensitive and glycopeptide-resistant enterococci were equally susceptible to absolute ethanol. CONCLUSIONS: It seems that biocide resistance is an important issue and may have links with antibiotic resistance. This study points towards a possible association between glycopeptide resistance and reduced susceptibility to povidone iodine among enterococci. More studies should be conducted in order to further explore this supposedly enigmatic issue.

Time trends of seroepidemiology of hepatitis C virus and hepatitis B virus coinfection in human immunodeficiency virus-infected patients in a Super Specialty Hospital in New Delhi, India: 2012-2014.

BACKGROUND: Hepatitis viruses and human immunodeficiency virus (HIV) coinfection is a major cause of liver diseases worldwide. High prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Asia makes it important to understand HBV and HCV coinfection with HIV in this part of the globe. This study was done with the aim of assessing the time trends of seroepidemiology of HBV and HCV coinfection in HIV patients over the last 3 years. MATERIALS AND METHODS: Year wise retrospective analysis of data between January 2012 and December 2014 was done. RESULTS: The prevalence of HIV infection among 0-20 years and >60 years age group decreased over the last 3 years (2012-2014), 8.4%, 6.4%, and 3.1% and 3.6%, 3.8%, and 1.5%, respectively. While increasing prevalence was seen among 21-40 years age group, 57.8%, 60.2%, and 67.1%, respectively in 2012, 2013, and 2014. There was no significant relationship between age/gender and HBV/HCV seropositivity among HIV-positive patients. The risk of acquiring HBV infection was more in HIV-positive patients who were >60 years of age (odds ratio = 3.3182; 95% confidence interval: 0.3669-30.005). The prevalence of HCV seropositivity is less in HIV-positive patients as only one case was anti-HCV antibody positive in last 3 years who was a male patient in the age group 21-40 years. A declining trend was observed for HIV positive cases over 2012-2014 while no significant trend change is seen in HBV/HCV seropositivity among HIV patients from 2012 to 2104. CONCLUSION: It is recommended to screen HIV patients routinely for concurrent HBV/HCV infection as hepatotropic viruses with HIV increase the risk of liver mortalities.

Knowledge and attitude of doctors and nurses regarding indication for catheterization and prevention of catheter-associated urinary tract infection in a tertiary care hospital.

BACKGROUND AND AIMS: Catheter-associated urinary tract infection (CAUTI) is one of the most common health care acquired infection encountered in clinical practice. The present study was planned to assess the knowledge and attitude of health care providers regarding the indications for catheterization and methods of preventing CAUTI. METHODS: A prospective questionnaire-based survey was done from March 2011 to August 2011. A structured questionnaire comprising of 41 items related to demographic details of the respondents, their knowledge regarding indications for catheterization and methods of preventing CAUTI was given to 54 doctors and 105 nurses. The response was evaluated for statistical correlation using a computer software. RESULTS: The mean years of experience of the respondents in the health care setup was 6.8 years. Only 57% of the respondents could identify all the measures for prevention of CAUTI. The knowledge regarding the indication for catheterization though suboptimal was significantly better amongst the doctors as compared to nurses. CONCLUSION: The knowledge regarding indication and preventive measures was suboptimal in our study group. There is a tremendous scope of improvement in catheterization practices in our hospital and education induced intervention would be the most appropriate effort toward reducing the incidence of CAUTI.

Assessment of knowledge, attitude and practices among healthcare workers in a tertiary care hospital on needle stick injury.

PURPOSE: The study aims to assess healthcare workers' needle-stick injury (NSI) knowledge, attitudes and practices (KAP). DESIGN/METHODOLOGY/APPROACH: A cross-sectional study was conducted in a 600-bedded hospital throughout six months. The data were collected using an anonymous, self-reporting questionnaire. Participants were various healthcare workers (HCW) drawn through stratified random sampling and their knowledge, attitude and practice regarding NSI were assessed. FINDINGS: There is significant difference in the mean knowledge, attitude and practice scores among healthcare workers. Even though scores are better for doctors and nurses, practice scores were better for technical staff. Healthcare workers, who had better practice scores, had suffered fewer NSIs. Since this study is a cross-sectional, the population's NSI incidence could not be calculated. PRACTICAL IMPLICATIONS: This study emphasizes that applying knowledge to practice is required to prevent NSIs. Various recommendations to help prevent and deal with NSIs are made. ORIGINALITY/VALUE: This study analyses healthcare workers' NSI knowledge, attitude and practices, and also assesses their correlation with NSI incidence, which has not been done previously.

Patient satisfaction survey of microbiological tests done in G.B. Pant Hospital.

PURPOSE: Measuring patient satisfaction plays an increasingly important role in the growing push toward healthcare provider accountability. This study seeks to evaluate G.B. Pant Hospital (a North Indian tertiary care centre) patient satisfaction with clinical laboratory services. DESIGN/METHODOLOGY/APPROACH: A total of 100 out- and in-patients were randomly selected and interviewed about microbiological services using a standard format, a method which can be easily used to compare patient satisfaction with laboratory services elsewhere. FINDINGS: Patients represented all age groups: females and males were balanced. Few were from poor socio-economic backgrounds. Patients do not have problems getting tests done, but the laboratory's inconvenient location caused dissatisfaction. Patients do not have problems communicating with staff, but medical terms are not understood by patients. Hospital cleanliness needs improving, especially toilets, which causes the most patient dissatisfaction. Hospital staff were deemed highly competent and judged to give excellent technical help to patients. The questionnaire's financial subscale shows 100 per cent satisfaction because all tests in the microbiology department are free. The overall satisfaction with services stood at 83 per cent. Satisfaction scores for G.B. Pant Hospital appear to be satisfactory. RESEARCH LIMITATIONS/IMPLICATIONS: This study does not compare patient satisfaction in two or more hospitals and findings may not be generalisable. PRACTICAL IMPLICATIONS: Patient satisfaction surveys are the best way to identify deficiencies and improve hospital services. Repeating studies at six monthly intervals is a useful managerial intervention aimed at delivering and maintaining quality healthcare. ORIGINALITY/VALUE: This laboratory satisfaction survey is the first of its kind for government hospitals in India. The survey revealed a positive feedback and helped to identify the areas of concern along with estimating the patient satisfaction scores. This is the best way to identify the areas of deficiencies and improving the services provided by the hospital. The authors feel that repeating such studies at a regular interval of six months would be a useful guide for the managerial interventions.

Candiduria in catheterized intensive care unit patients: emerging microbiological trends.

OBJECTIVES: Urinary tract infection (UTI) as a result of Candida spp. is becoming increasingly common in hospitalized setting. Clinicians face dilemma in differentiating colonization from true infection and whether to treat candiduria or not. The objective of the present study was to look into the significance of candiduria in catheterized patients admitted in the ICUs and perform microbiological characterization of yeasts to guide treatment protocols. MATERIALS AND METHODS: One hundred consecutive isolates of Candida spp. from the urine sample of 70 catheterized patients admitted in the ICU were collected and stocked for further characterization. A proforma was maintained containing demographic and clinical details. Blood cultures were obtained from all these 70 patients and processed. Species identification of yeasts was done on VITEK. RESULTS: Candiduria was more common at extremes of age. The mean duration of catheter days was 11.1 ± 6 days. Other associated risk factors such as diabetes mellitus and antibiotic usage were seen in 38% and 100% of our study group. Concomitant candidemia was seen in 4.3% of cases. Non-albicans Candida spp. (71.4%) emerged as the predominant pathogen causing nosocomial UTI. CONCLUSION: The present study reiterates the presence of candiduria in catheterized patients, especially in the presence of diabetes and antibiotic usage. Non-albicans Candida spp. are replacing Candida albicans as the predominant pathogen for nosocomial UTI. Hence, we believe that surveillance for nosocomial candiduria should be carried out in hospitalized patients.

Nosocomial blood-stream infections from extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella pneumonia from GB Pant Hospital, New Delhi.

BACKGROUND: Nosocomial septicemia due to extended spectrum beta-(Beta)-lactamase (ESBL) producing Klebsiella pneumoniae and Escherichia coli are a therapeutic challenge due to resistance. Knowledge of disease burden and resistance patterns is required for proper and timely management. We report the prevalence and antimicrobial susceptibility of ESBL producing E. coli and K .pneumoniae from septicemia at a tertiary care hospital. METHODOLOGY: A total of 2,870 blood samples of suspected cases of septicemia were studied between January and December 2009. Antimicrobial susceptibility was determined by Kirby Bauer's disc diffusion method and MICs for imipenem, meropenem, and ertapenem were determined using the E-test. All isolates of E. coli and K. pneumoniae were tested for ESBL production by E-test method. RESULTS: Forty-one (70.7%) K. pneumoniae isolates and ten (41.7%) E. coli isolates were ESBL producers. Two (5%) of ESBL producing K. pneumoniae isolates, but no E. coli isolates, were resistant to carbapenems. In vitro, all ESBL producers were sensitive to tigecycline. CONCLUSION: Our data indicated that the prevalence of ESBL-producing E. coli and K. pneumonia strains isolated from blood cultures from hospitalized patients is high. ESBL-producing organisms were found to be more susceptible to meropenem than to imipenem and ertapenem. Tigecycline is active against all the ESBL or multidrug resistant (MDR) E. coli and Klebsiella spp. isolates.

Pseudomonas aeruginosa meningitis in post neurosurgical patients

Background and Objective: Pseudomonas meningitis is a rare complication following neurosurgical procedures and is associated with high mortality and mortality. The aim of the study was to describe the clinical characteristics and risk factors associated with mortality in patients who developed nosocomial Pseudomonas meningitis following neurosurgical procedure. Methods: All patients with nosocomial post-surgical meningitis due to Pseudomonas aeruginosa diagnosed in the year were reviewed retrospectively. Results: During the period of the study, 121 cases of post surgical meningitis were diagnosed. Ten (9.9%) nosocomial Pseudomonas meningitis were identifi ed. Eight patients had external ventricular drain. The antibiotic susceptibility of 10 strains was: imipenem (9/10), meropenem (7/10), amikacin (7/10), piperacillin / tazobactum (5/10), ceftrizxone (4/10), cefepime (3/10). The overall mortality was high at 80%, despite most receiving appropriate antibiotics. Conclusion: Postoperative Pseudomonas meningitis is associated with high mortality.

Cryptococcal granulomas in an immunocompromised HIV-negative patient.

Disseminated cryptococcosis usually occurs in immunocompromised individuals with defective cell-mediated immunity, most commonly seen with HIV infection. We present a case of disseminated cryptococcosis in an HIV-negative male patient who presented with headache, fever, altered sensorium of short duration and multiple cutaneous lesions. An emergency CT scan of the head showed multiple intracranial and intraventricular granulomas. Routine laboratory investigations were within the normal range. A CSF examination revealed capsulated yeasts on India ink and a culture yielded cryptococcus neoformans. A cryptococcal antigen test by latex agglutination kit was positive. A biopsy revealed multiple capsulated yeasts cells in the cutaneous lesions, which were consistent with cryptococcus neoformans. The patient was successfully treated with Amphotericin B and Fluconazole with regression of cranial and cutaneous lesions.