A rare urinary tract infection of multidrug-resistant Chryseobacterium urinae sp. nov. isolated from a diabetic, non-catheterized patient.

Chryseobacterium demonstrates a diverse environmental presence and a significant pathogenic potential across various ecosystems. This clinical case showcases a rare instance of bacterial infection in a 75-year-old male with untreated diabetes and recurrent urinary tract infections (UTIs). The patient presented symptoms of abdominal pain, burning urination, fever, and an elevated eosinophil count. A subsequent urine culture identified a Chryseobacterium-related bacterium as the causative agent, exhibiting sensitivity to piperacillin/tazobactam, trimethoprim/sulfamethoxazole, and nitrofurantoin, which led to successful treatment using oral nitrofurantoin. Analysis of the 16S rRNA gene sequence of APV-1T revealed a close relationship of 98.2% similarity to Chryseobacterium gambrini strain 5-1St1aT (AM232810). Furthermore, comparative genome analysis, incorporating Average Nucleotide Identity (ANI), Digital DNA-DNA Hybridization (dDDH) values, and comprehensive phylogenetic assessments utilizing 16S rRNA gene sequences, core genes, and amino acid sequences of core proteins, highlighted the unique phylogenetic positioning of APV-1T within the Chryseobacterium genus. Distinct carbon utilization and assimilation patterns, along with major fatty acid content, set APV-1T apart from C. gambrini strain 5-1St1aT. These findings, encompassing phenotypic, genotypic, and chemotaxonomic characteristics, strongly support the proposal of a novel species named Chryseobacterium urinae sp. nov., with APV-1T designated as the type strain (= MCC 50690 = JCM 36476). Despite its successful treatment, the strain displayed resistance to multiple antibiotics. Genomic analysis further unveiled core-conserved genes, strain-specific clusters, and genes associated with antibiotic resistance and virulence. This report underscores the vital importance of elucidating susceptibility patterns of rare pathogens like Chryseobacterium, particularly in immunocompromised individuals. It advocates for further analyses to understand the functional significance of identified genes and their implications in treatment and pathogenesis.

Payment for participation in clinical research: Review of proposals submitted to the ethics committees.

OBJECTIVE: In view of dearth of information in national and international guidelines on payment practices in research, the present study was done to find out payments for participation allowed by 3 Ethics committees (ECs) and reasons for payment. METHOD: This was a retrospective observational study which analysed research proposals reviewed by 2 institutional and 1 non-institutional ECs over a period of 2 years. The permission of ECs was obtained and confidentiality of data was maintained. RESULTS: Of the 73 studies requiring payment, 89.04% were interventional and 10.96% observational. Reimbursement of travel expenses (60%) was the major reason for payment followed by inconvenience due to participation, loss of wages and time spent. The queries raised by EC in more than 50 % of studies were related to informing patients about the payment in the informed consent document. The investigators complied with the EC requirements regarding payment (15/21) and the remaining provided explanations. The median amount of payment in pharmaceutical sponsored studies was higher compared to investigator initiated studies. Higher payments were approved by ECs on case to case basis in a few studies. The ECs did not have any policy/ standard operating procedure for payment practices. CONCLUSION: The present study first of its kind in India, demonstrated that quantum of payment was not uniform for pharmaceutical sponsored and investigator initiated studies and payments were not considered for majority of observational studies. Travel reimbursement was the most common reason for payment. There is a need to develop guidelines for determining appropriate payment/incentives to participants for specific types of research related activities.

Knowledge and Awareness of the Health Care Workers about the Hepatitis B Infection and their Vaccination Status in a Newly Started Medical College.

INTRODUCTION: Healthcare workers (HCWs) are at high risk of hepatitis B virus infection (HBI) and so the present study was carried out to assess the knowledge of HCWs in a tertiary care medical college about HBI and hepatitis B vaccine (HBV). METHOD: After obtaining approval from Institutional Ethics Committee and informed consent from the study participants, HCWs that included teaching faculty, resident doctors, medical students, nurses, laboratory technicians, administrative staff and support staff (ward boys, attendants and sweepers) were administered a validated questionnaire. Descriptive statistics was applied for the categorical variables and the Chi-square test of association was used to assess the statistical significance of variables. RESULTS: A total of 300 HCWs were recruited for the study. Although, the overall knowledge amongst all the HCWs was found to be 68%, only 35.3%HCWs knew the transmission risk by needle stick injury (NSI). Similarly, only 40% correctly knew the precautions to be taken for preventing an NSI and 17% for the steps to be taken to disinfect a blood splash. Almost 92.7% (278/300) HCWs were aware about the availability of a vaccine, of which only 41% (1123/300) knew that vaccine will not work in case the patient is already infected. When asked about the steps to be taken in case of an NSI in non-vaccinated HCWs, only 54.7% (164/300) replied about treatment with both immunoglobulin and vaccination. A total of 160 (53.3%) HCWs were found to be vaccinated. The most common reason for not taking vaccination included an improper understanding of HBV and the infection it causes. CONCLUSION: To conclude, the study highlights good knowledge about hepatitis B infection with requirement of more emphasis on the practical aspects of management in a case of NSI/blood splash and can guide to improve the vaccination status and knowledge of HBI amongst HCWs.

The Ever Increasing Reservoirs of Infection in the Health Care Environment - Time for a Sixth Moment of Hygiene.

OBJECTIVES: The study was carried out to determine the extent and type of contamination of the hands and accessories of staff from different settings and also to determine the phenotypic similarity between the isolates recovered from the same staff. DESIGN: Prospective cross-sectional study. SETTING: Tertiary care center. PARTICIPANTS: Health care workers (HCWs') and administrative staff. METHODS: Samples were collected and processed for bacteriology from the dominant hand, mobiles, aprons, stethoscopes and computer keyboards of 280 staff working in different settings after consent. Isolates were identified and antimicrobial susceptibility testing was carried out. A comparison of data sets was performed using chi square test. p value < 0.05 was considered significant. RESULTS: 817 samples were screened, 616 yielded growth. Contamination rate was found to be 75%. Of the 1254 isolates recovered, Gram positive and gram negative accounted for 80% and 18% respectively. Hands and accessories of HCWs from clinical settings showed significant contamination with potential pathogens as compared to the non-clinical settings. (p<0.0001) All computer keyboards and stethoscopes used by ICU doctors were contaminated. MRSA was recovered only from clinical settings. Two salmonella isolates were isolated from apron of laboratory health care workers. In 102 staff, similar isolates were recovered from hand and any accessory. CONCLUSIONS: The risk of contamination of any accessory with potential pathogens is high in the clinical setting. The five moments of hand hygiene should be strengthened. A policy for decontamination of all accessories should be formulated.

Strongyloides stercoralis hyperinfection syndrome in patients on prolonged steroid treatment: two case reports.

Two cases of Strongyloides hyperinfection have been reported who were on prolonged steroid therapy for frequent exacerbations of respiratory problems. One patient presenting with acute respiratory distress, rapidly deteriorated, did not give any time for management and died whereas the second patient survived because of early diagnosis of hyperinfection due to Strongyloides stercoralis.

HTLV infection and strongyloidal hyperinfection syndrome.

Strongyloides stercoralis can affect humans in the form of asymptomatic infections, Strongyloidal hyperinfection syndrome and disseminated Strongyloidiasis depending on the immune response of the host. We report a case of strongyloidial hyperinfection syndrome that subsequently tested positive for HTLV infection.

Report: Medical students for monitoring biomedical waste segregation practices--why and how? Experience from a medical college.

The cornerstone for an effective biomedical waste (BMW) management is appropriate waste segregation. Improper waste segregation practices can have an adverse impact on public health and increase the cost of treatment. Deficiencies in waste segregation practices can be corrected by continuous monitoring and education. Manpower for monitoring waste segregation in a large teaching hospital is scanty. We utilized the undergraduate medical students as monitors and studied the impact on waste segregation practices. A prospective observational study was carried out from August 2004 to January 2005. For monitoring waste segregation, the different areas of the hospital were divided amongst the II M.B.B.S students. They were provided with an observation sheet wherein the status of waste segregation and overall hygiene was recorded on a scale of 1-5. The impact of this programme was then analysed over the study period. The results indicated that a statistically significant improvement in waste segregation practices occurred in all areas. Thus, a large hospital with a medical college can identify students or a similar group for monitoring waste segregation or other aspects of biomedical waste management. This will improve their understanding of good practice in BMW management in future.