Comparative Evaluation of Colistin Broth Disk Elution Method With Two Commercially Available Systems for Colistin Susceptibility Testing Against Carbapenem-Resistant Klebsiella pneumoniae: A Single-Center Exploratory Study.

PURPOSE: The purpose is to explore the diagnostic utility of colistin broth disk elution (CBDE) as a simple and reliable method of colistin susceptibility testing. MATERIALS AND METHODS: An exploratory study was undertaken in a tertiary care teaching hospital in Uttarakhand, from September 2021 to March 2022, after obtaining approval from the Institute Ethics Committee. Twenty-five non-repetitive carbapenem-resistant Klebsiella pneumoniae clinical isolates were included in the study. Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) and BD Phoenix M50 system were used to perform species-level identification and antibiotic susceptibility testing (AST), respectively, as per the manufacturer's instructions. AST results (including those of colistin) were interpreted as per the CLSI guidelines 2022. The test isolates were further subjected to additional in vitro colistin susceptibility testing using a commercially available Mikrolatest colistin susceptibility testing kit and CBDE, respectively. RESULTS: The in vitro colistin resistance rates varied from 8% by BD Phoenix system to 20% by Mikrolatest kit and 32% by CBDE, respectively. For colistin susceptibility, a higher CA was observed between the BD Phoenix system and CBDE (64.71%) than between the Mikrolatest kit and CBDE (31.60%). Overall, a statistically significant fair agreement was observed between the BD Phoenix system and CBDE (Kappa: 0.312; 95% CI: 0.036 to 0.660) and Mikrolatest MIC colistin kit and CBDE (Kappa: 0.286; 95% CI: 0.111 to 0.683), respectively. CONCLUSIONS: In vitro colistin testing remains a significant challenge globally. Although the present study results are inconclusive due to the small sample size, we should conduct multi-centric studies globally, taking a considerable sample size representing different Gram-negative bacilli to generate conclusive evidence on the utility of CBDE as a reliable method of colistin susceptibility testing.

Cyclically Loaded Copper Slag Admixed Reinforced Concrete Beams with Cement Partially Replaced with Fly Ash.

Generally, the concrete with higher strength appears to produce brittle failure more easily. However, the use of mineral admixture can help in enhancing the ductility, energy dissipation, and seismic energy in the designed concrete. This paper presents energy absorption capacity, stiffness degradation, and ductility of the copper slag (CS) admixed reinforced concrete with fly ash (FA) beams subjected to forward cyclic load. The forward cyclic load was applied with the help of servo-hydraulic universal testing machines with 250 kN capacity. Twenty-four beams with a size of 100 mm × 150 mm × 1700 mm made with CS replaced for natural sand from 0% to 100% at an increment of 20%, and FA was replaced for cement from 0% to 30% with an increment of 10% were cast. Beams are designed for the grade of M30 concrete. Based on the preliminary investigation results, compressive strength of the concrete greatly increased when adding these two materials in the concrete. Normally, Grade of concrete can change the behaviour of the beam from a brittle manner to be more ductile manner. So, in this work, flexural behaviour of RC beams are studied with varying compressive strength of concrete. Experimental results showed that the RC beam made with 20% FA and 80% CS (FA20CS80) possesses higher ultimate load-carrying capacity than the control concrete beam. It withstands up to 18 cycles of loading with an ultimate deflection of 60 mm. The CS and FA admixed reinforced concrete composite beams have excellent ultimate load carrying capacity, stiffness, energy absorption capacity, and ductility indices compared to the control concrete beam.

Incidental Finding of Nocardia: A Case Series from a Tertiary Care Centre in Uttarakhand.

Nocardiosis is a rare bacterial infection that may lead to a severe disease. These infections are rare among normal population and are showing an increasing trend worldwide attributable to the increase in the immunosuppressed population. Most of these patients present with nonspecific clinical features such as fever, productive cough, and exertional dyspnoea as seen in our series of patients which makes it difficult to be diagnosed. Pulmonary nocardiosis is rarely clinically suspected and often diagnosed very late in the course of disease resulting in high mortality. A similar observation was made in one of our cases where the patient was being treated on the lines of pneumonia, and in the end she was diagnosed with pulmonary nocardiosis. In view of the limited literature available, we report here a case series of pulmonary nocardiosis in immunosuppressed patients diagnosed incidentally by fungal KOH mount. The most common conditions causing immunosuppression were type II DM, COPD, and pulmonary tuberculosis.