|Year : 2017 | Volume
| Issue : 3 | Page : 118-130
|Date of Web Publication||20-Jun-2018|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Poster Abstract. J Patient Saf Infect Control 2017;5:118-30
| P-1 Rg No: 315: Analysis of Impact of Various Hand Hygiene Campaigns in Pgimer, Chandigarh, over 8 Years: Are We on the Right Track?|| |
Archana Angrup, Surria Rajpoot, Rupinder Kaur, Kulbeer Kaur, Harinder Kaur, Navneet Dhaliwal1, Manisha Biswal
Departments of Medical Microbiology and 1Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Background: Hand hygiene (HH) is amongst one of the most effective methods to reduce healthcare-associated infections. This is even more important in high-risk units of the hospitals where the patient is usually more susceptible to nosocomial infections. Ours is a tertiary care hospital where regular audits are done to check for the compliance towards HH. We are regularly conducting extensive activities including continuing medical educations, educative interactive sessions, orientation classes, posters for display and direct team supervision of practical training in these drives. This study was undertaken to determine the impact of these sessions on the HH compliance in healthcare workers over a period of 8 years.
Methods: A total of 13 high-risk units were included: main Intensive Care Unit (ICU), respiratory ICU, burn ICU, liver ICU, neurosurgery ICU, neonatal surgical ICU, neonatal ICU (NICU), gastroenterology ICU, coronary care ICU, cardiothoracic and vascular surgery ICU, paediatric ICU, bone marrow transplant unit ICU and transplant ICU. Using the World Health Organisation standardised observation method, four infection control nurses trained in observation and recording of HH activities, conducted this audit. Both washing hands with soap and water and rubbing hands with alcohol products were counted as HH performed. The total number of opportunities and actual HH performed was observed by the observer. We determined the impact of various activities over a period of 8 years from 2009 to 2016.
Results and Discussion: In this study, we found a wide variation in the compliance rates in different ICUs of our hospital over the years. A total of 18,408 HH opportunities were observed. The highest compliance was seen in the NICU and the bone marrow transplant ICU followed by the respiratory ICU. In comparison to the main ICU, the compliance rate was consistently below 40%. The opportunity-wise and healthcare worker category-wise compliance data will be discussed.
Conclusion: HH compliance has improved over the years in some ICUs, whereas the rates are still on the lower side in others. A long-term commitment by hospital management and healthcare workers may be needed for further improvement.
| P-2 Rg No: 260: Environmental Colonisation of Bacteria: a Potential Source of Hospital-Acquired Infection in Intensive Care Units|| |
Bipanchi Mahanta, Achinta Kumar Borthakur, Lahari Saikia
Background: Hospital environment is a potential source of nosocomial infection. For proper infection control, these sources need to be identified. The long-known, methicillin-resistant Staphylococcus aureus is now gradually replaced by multidrug-resistant Gram-negative bacilli. Assam Medical College and Hospital is a tertiary care centre with Intensive Care Units (ICUs) for patients of all age groups. This study aims to identify the potential sources of the emerging Gram-negative bacterial in ICU environment and correlate with clinical isolates for their concordance.
Methodology: A cross-sectional observational study was performed from September to December 2016 in all the ICUs of Assam Medical College and Hospital. Swabs from various inanimate surfaces such as suction tubes, dressing materials and bed surfaces and clinical samples such as urine, tracheal secretions, infected surgical site, blood and cerebrospinal fluid were taken from the patients with active infection admitted >48 h in the ICUs. The isolates were identified, and antibiogram obtained by standard microbiological procedures. The multidrug-resistant strains were further tested for extended-spectrum beta-lactamases (ESBLs) and metallo-beta-lactamases production. The findings from the environment and clinical samples were compared for concordance.
Results: A total of 110 clinical samples from 50 patients with active infection admitted in different ICUs for >48 h of Assam Medical College were processed. Demographic information of the patients was recorded. Of these, highest isolation was from blood in the paediatric population and tracheal secretion and urine from adults. Klebsiella pneumoniae was highest (34.7%), followed by Pseudomonas (21.7%) and Acinetobacter (17.3%). Data when traced back retrospectively for 1 year also showed similar trends. Amongst the forty isolates from the environment, 65% showed growth, and Acinetobacter was highest (31%), followed by Pseudomonas (23%) and Citrobacter (15%). From patient isolates, highest ESBL producer was Klebsiella (12.5%), and from environment, highest ESBL producers were Pseudomonas (30%) and Citrobacter (25%). From antibiogram of environmental and patient isolates, 60% showed concordance.
Conclusion: The similarity amongst the bacterial isolates of clinical and environmental sample reinforces the hypothesis of horizontal transference of pathogens. The emerging multidrug-resistant Gram-negative bacilli need to be identified at the source to prevent their rapid spread.
| P-3 Rg No: 284: Incidence Of Catheter-Related Infections (Central Line-Associated Bloodstream Infection And Catheter-Associated Urinary Tract Infection) In An Intensive Care Unit Of A Tertiary Care Centre|| |
Category: Healthcare Rpidemiology
D. Elantamilan, W. Valarie Lyngdoh, Annie B. Khyriem, Clarissa J. Lyngdoh, Jyotismita Rajbongshi, Prithwis Bhattacharyya1
Departments of Microbiology and 1Anaesthesiology and Critical care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
Background: Catheter-related infections constitute the most common type of hospital-acquired infections. Intravascular catheters and urinary catheters are the two most commonly inserted medical devices, and thereby they remain the most common causes of nosocomially acquired bloodstream infections. In recent studies, >80% of primary bloodstream infections and 95% of urinary tract infections in Intensive Care Units (ICUs) were found to be catheter associated. These rates significantly attribute to morbidity, mortality and healthcare costs. This study aimed at assessing the incidence of catheter-related infections in our ICU, which can guide us to frame strategies to prevent such infections.
Methods: Demographic and clinical parameters of the included patients relevant to the study were collected before insertion, and regular follow-up was done till the removal of catheter. Clinical and microbiological parameters were used to recognise the catheter-related infections.
Results: The rate of central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) was found to be 21.6 and 18/1000 device-days, respectively. The most common organism isolated was Acinetobacter baumannii in CLABSI and Escherichia More Details coli in CAUTI. The antimicrobial profile of all the organisms encountered in catheter-related infections was analysed.
Conclusion: Infections related to catheters complicate the management of pre-existing illness in the patients admitted to ICUs. The regular monitoring of such infections and implementation of prevention strategies are very much essential.
| P-4 Rg No: 285: Prevalence of Carbapenemase-Producing Enterobacteriaceae Isolates and Their Antimicrobial Resistance Profile in Intensive Care Unit of a Tertiary Care Centre|| |
Category: Healthcare Epidemiology
Jyotismita Rajbongshi, Wihiwot Valarie Lyngdoh, Prithwis Bhattacharya1, Annie Bakorlin Khyriem, Elantamilan Durairaj
Departments of Microbiology and 1Anaesthesiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
Background: Enterobacteriaceae are amongst the most common human pathogens, causing community-acquired as well as hospital-acquired infections. Carbapenem-resistant Enterobacteriaceae are a worldwide challenge and associated with the high mortality rate in critically ill patients. They have been increasingly reported worldwide since their first identification more than 20 years ago. There is no established antibacterial therapy for these difficult-to-treat diseases. Resistance to colistin and newly introduced drug, tigecycline is also on the rise! This grim scenario warrants active surveillance and antibiotic stewardship to prevent selection pressure and spread. This study was conducted to determine the prevalence of carbapenemase-producing Enterobacteriaceae isolates in Intensive Care Unit (ICU) of North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong. The antimicrobial susceptibility pattern of the isolates was also studied.
Methods: This was a prospective study conducted in the Department of Microbiology from January 2014 to December 2014. All clinical isolates of the family Enterobacteriaceae showing resistance to carbapenems obtained from ICU were included in the study.
Results: One hundred and eighty-four (22.2%) non-duplicate, consecutive patient-specific Enterobacteriaceae isolates showed resistance to carbapenems (disc diffusion method). Majority of the organisms were Klebsiella pneumoniae followed by Escherichia coli.
Conclusion: Multidrug resistance infections are an emergency situation and calls for immediate redress. This study highlights an increasing prevalence of carbapenem resistance amongst Enterobacteriaceae isolates in ICU.
| P-5 Rg No: 259: A Study on Knowledge, Attitude and Practice on Nosocomial Infection Amongst Nursing Staff in Assam Medical College and Hospital|| |
Category: Hand Hygiene
Kumari Punam, Achinta Kumar Borthakur, Lahari Saikia
Department of Microbiology, Assam Medical College and Hospital, Dibrugarh, Assam, India
Background: Infection due to hospital-acquired microbes is an evolving problem worldwide, and horizontal transmission of bacterial organism continues to cause a high nosocomial infection rate in healthcare settings. Most nosocomial infections are thought to be transmitted by the hands of healthcare workers. Hence, hand hygiene is the most effective means to reduce the hospital-acquired infection. Nursing staff are the healthcare professionals who have the obligation to protect patients and prevent deterioration in their health. Therefore, nursing staff should have sound knowledge and strict adherence to infection control standard precautions to prevent spread of nosocomial infection; thus, this study is conducted to analyse the knowledge, attitude and practice amongst nurses about standard precautions for hospital infection.
Methods: A self-administered, questionnaire-based, cross-sectional study was done amongst the nursing staff at our institution (Assam Medical College and Hospital). The sample population was selected by simple random sampling. Based on their responses, a scoring system was devised and their knowledge, attitude and practice were graded as good (>75%), moderate (50%–74%) and poor (<50%).
Results: Of the 136 participants involved in the study, we found that majority of the nurses had good knowledge (86%) on hand hygiene. The overall attitude of the respondents regarding hand hygiene was also satisfactory (92%), but practice on hygiene maintenance to prevent the spread of nosocomial infection showed poor results (43%).
Conclusion: The results indicate an adequate awareness amongst the personnel about hospital infection but reveal the wide gaps in the knowledge, attitude and practice of hand hygiene amongst the nursing staff, hence the need for conducting regular training. The present study highlights the need of repeated training sessions regarding hand hygiene practices amongst the healthcare workers to provide the current knowledge in the area with a behavioural change in attitudes and practices, leading to a reduction of nosocomial infections.
| P-6 Rg No: 318: Pattern of Bacterial Isolates and Antibiotic Sensitivity in Icu Acquired Infections : Three Year Experience in a Tertiary Care Hospital in North East India|| |
Category: Healthcare Epidemiology
Department of Emergency Medicine, Guwahati Medical College and Hospital, Guwahati, Assam, India
Background: Antimicrobial resistance has emerged as an important determinant of outcome for patients in the intensive care unit (ICU). The incidence of nosocomial infections in ICU is 4-5 times greater than in general ward. The study was carried out with the following objectives (a) To detect the pattern of bacterial isolates in ICU-acquired infections (b) To detect the antibiotic susceptibility & resistance pattern of the isolates in ICU-acquired infections.
Methods: A retrospective observational study done in patients admitted in ICU in the department of Emergency Medicine, GMCH for 3 years. Specimens collected from respiratory tract, urine, blood and wound. The specimens collected sent to laboratory to identify the isolates.
Results: Respiratory tract infections were most prevalent with 79.5% followed by urinary tract (11.1%), blood born infection (8.1) and wound infection 1.2%. Gram negative organisms like Klebsiella, were the most frequent species with 54.6% followed by E coli(15.8%) and pseudomonas(14.2%).
Conclusion: Gram negative infections were the predominant cause of icu acquired infection in the region of North East India. Pattern and prevalence of bacterial isolates in ICU tends to change with time.
| P-7: Assessment of the Cautionary Antimicrobial Consumption Pattern Using Defined Daily Dose as a Part of the Antimicrobial Stewardship Program|| |
Category: Antimicrobial Stewardship
Sharmin Bala, Vinay Pawar
Department of Clinical Pharmacology, Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
Background: The growing antimicrobial resistance in India has become an important public health issue that needs prioritisation. In a recently built 345-bedded tertiary care hospital in South Mumbai, the Antimicrobial Stewardship Program (ASP) was implemented.
Methods: A prospective analysis of dispensing quantity of cautionary antibiotics was conducted by studying the consumption pattern using World Health Organization-defined daily dose (DDD). Dispensing quantity was retrieved through 'prescription trend report' from SAP.
Results: The consumption pattern of cautionary antibiotics was analysed for a period of 1 year. In the pre-intervention phase (January 2016 to June 2016), the total sum of average DDD/1000 patients-days was carbapenems (251.5).
Conclusion: An evident reduction in the consumption of cautionary antibiotics was observed following the ASP interventions. The increased consumption of cautionary antifungals requires further emphasis on minimising their utilisation.
| P-8 Rg No: 287: Knowledge, Attitudes and Practices of Healthcare Personnel Towards Waste Disposal Management at Assam Medical College and Hospital|| |
Category: Prevention Strategies
Simi Bora, Achinta Kr. Barthakur, Lahari Saikia
Department of Microbiology, Assam Medical College and Hospital, Dibrugarh, Assam, India
Background: Healthcare establishments generate huge quantities of both hazardous and non-hazardous wastes. Therefore, adequate knowledge, proper technique and methods of handling and practice of safety measures lead to the safe disposal of hospital waste and protect the community from various adverse effects of the hazardous waste. With this background, the study was conducted to assess the knowledge, attitude and practice of biomedical waste management amongst healthcare personnel in Assam Medical College and Hospital, Dibrugarh.
Methods: A cross-sectional study was conducted amongst 140 healthcare personnel including doctors, nurses, laboratory technician, ward assistant and cleaners. A pre-designed questionnaire containing forty items was used for data collection. Simple random sampling technique was used to select the study unit. Data were collected, compiled and tabulated and analysed using Microsoft Excel.
Results: Professional categories that have participated in the study include 52 doctors, 37 laboratory technicians, 24 nurses, 14 cleaners and 13 ward assistants. The demographic data discussed were gender, age, education, profession, duration of work experience, working department and hepatitis B vaccination status. Out of all respondents, 45% were male and 55% were female. The respondents were from medicine (17%), surgery (17%), paediatrics (7%), obstetrics and gynaecology (10%), psychiatry (7%), biochemistry (5%), microbiology (14%), pathology (11%), ophthalmology (4%), ear, nose and throat (1%) and dermatology (2%). Regarding biomedical waste segregation and disposal, doctors had good knowledge (94%), followed by nurse (90%), laboratory technician (88%), ward assistant (87%) and cleaners (82%). Attitude scores towards biomedical waste management were found to be doctors (94%), nurse (92%), laboratory technician (89%), ward assistant (89%) and cleaners (86%), respectively. On practice level, their scores were doctors (74%), nurse (73%), laboratory technician (72%), ward assistant (72%) and cleaners (70%).
Conclusion: It is observed that the healthcare personnel possess good theoretical knowledge as well as attitude. However, a gap is observed between theoretical knowledge and practice score of the respondents. This study indicates that there is a need for creating awareness amongst healthcare workers regarding biomedical waste management. Regular training programmes should be organised for all hospital staff and strict implementation of guidelines of biomedical waste management.
| P-9 Rg No: 235: Study of Conjunctival Bacterial and Fungal Flora in Congenital Dacryocystitis|| |
Snigdha Singha, Ravinder Kaur, Om Prakash
Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
Aims and Objectives: The aims and objectives of the study were to isolate and identify the bacteria and fungi from conjunctival swabs of cases of congenital dacryocystitis and determine their antimicrobial susceptibility pattern.
Materials and Methods: The study was done in the Department of Microbiology, Lady Hardinge Medical College (LHMC), New Delhi. A total of 50 cases, which included children <1 year of age with a provisional diagnosis of congenital dacryocystitis attending/referred to the Ophthalmology Department, LHMC, were studied. Three conjunctival swabs were taken from the affected eye for microscopic examination and culture. The normal eye served as a control. The inoculated culture plates were incubated, and the organisms were isolated and identified. Antibiotic sensitivity testing was performed in each case.
Results: Of the 50 cases with a clinical diagnosis of congenital dacryocystitis, majority (80%) had a history of development of symptoms in the first 6 months of life. Males (62%) were more affected than females. Unilateral (92%) eye was more commonly affected than bilateral. Of the total 50 cases, 30 yielded positive cultures. Gram-positive cocci were the most common type of organisms isolated, of which 21% were identified as coagulase-negative staphylococci, 12% were Streptococcus pneumoniae and 6% were found to be Enterococcus spp. Acinetobacter spp. was the most common Gram-negative isolate (8%).
Conclusion: Congenital dacryocystitis is associated with a higher proportion of bacterial as compared to fungal aetiology. Amongst the bacterial isolates, Gram-positive organisms outnumbered the Gram-negative organisms.
| P-10 Rg No: 110: Save the Vein: Prevalence and Risk Factors of Thrombophlebitis|| |
V. Narinder, R. Benson, D. Deodhar1, R. Jairus2
Infection Control Supervisors, 1Infectious Disease Physician, 2College of Nursing
Introduction: Intravenous catheters are indispensable, but thrombophlebitis remains a major concern with these devices as it may lead to bacteraemia. Thrombophlebitis is recognised as warmth, erythema, swelling, tenderness or palpable venous cord and it can be graded according to the visual infusion phlebitis (VIP) Score. Tan et al. demonstrated an incidence rate of 35.2% amongst patients with peripheral cannulas.
Methodology: It is an observational study conducted over a 2-month of period in wards of tertiary care hospital. Each peripheral cannula was observed; demographic profile of the patient and grade of the thrombophlebitis were noted according to the VIP score. Data collected were entered in a predesigned pro forma, and the descriptive analysis was expressed as mean and categorical variables as percentages.
Results: There were a total of 285 cannulas inspected. The thrombophlebitis rate was found to be 68.07%. According to the VIP score, majority of the cannulas were showing Grade 2 (68, 35%) thrombophlebitis followed by Grade 1 seen in 57 (29.4%) cannulas [Figure 1].
Most of the cannula studied was of 20 gauge (108, 55.7%). Amongst the inspected cannulas, 82 (42.4%) were inserted in the dorsum of the hand. The 55% of the cannulas having thrombophlebitis were found to be with duration of 24–<48 h. Emergency room insertion had higher incidence (69.6%) of phlebitis compared to cannulas inserted in the wards.
Conclusion: The present study shows a higher rate (68.7%) of thrombophlebitis compared to Tan et al.'s (35.2%) and Jisal et al.'s (50%) study. Predictors of phlebitis can be place of insertion, gauge of the cannula and duration of cannula.
| P-11 Rg No: 300: Infection Control Practices' Compliance In Cardiothoracic Intensive Care Units In Chennai: A Snapshot|| |
Background: Hospital-acquired infections (HAIs) after cardiac surgery cause substantial mortality and economic burden to the patients. Most of the infections were preventable if good infection control practices were followed. Here, we report the compliance to infection control practices followed in Cardiothoracic Intensive Care Units (CT-ICUs) in Chennai.
Methods: This cross-sectional study was carried out using infection prevention audit tool in five major CT-ICUs in Chennai. Patients who underwent cardiac surgery and staying in the ICU on the day of audit were studied.
Results: A total of 51 patients were studied. The compliance to major infection prevention recommendations was shown in [Table 1].
|Table 1: Cardiac surgery infection prevention guidelines compliance by Cardiothoracic Intensive Care Units in Chennai|
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Conclusion: The HAI following cardiac surgery in Chennai is 3.92%. The compliance to key infection prevention guidelines in most CT-ICUs was suboptimal. Large prospective studies are urgently required to confirm this finding.
| P-12 Rg No:240: Epidemiology of Occupational Exposure to Blood-Borne Viruses Amongst Healthcare Workers and Impact of Preventive Strategies: an 8-Year Retrospective Study|| |
Priyanka Patil, Sheeba John, Satyajeet Bhoite, Seema Rohra, Aruna Poojary
Infection Control Team, Breach Candy Hospital Trust, Mumbai, Maharashtra, India
Background: Healthcare workers (HCWs) are at risk for occupational exposure to blood-borne viruses (BBVs) such as hepatitis B virus, hepatitis C virus and human immunodeficiency virus. Exposures occur through needle sticks or cuts with contaminated sharp instruments or through blood or body fluid exposure of skin or mucous membranes.
Aim: The aim of the study was to study the epidemiology of occupational exposure to BBVs and demonstrate the effectiveness of preventive strategies.
Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Mumbai, from January 2009 to December 2016. We documented and monitored all exposures to BBVs as part of our policy for the prevention of occupational exposure to BBVs amongst HCWs. The data were periodically analysed, and specific prevention strategies were introduced along with periodic training of HCWs.
Results: One hundred and sixty-one incidences were reported over a period of 8 years. Nearly 96.2% of injuries were due to sharp objects. Almost 3.8% of injuries were due to exposure to mucous membranes. Seventy-six nurses, 51 housekeeping staff, 20 doctors, 11 phlebotomists, 2 external waste handlers and 1 barber reported with injuries during the study period. About 18% received post-exposure prophylaxis. In 2011, we introduced an onsite sharp disposal device, which reduced our needle-related injuries by 56% in the subsequent years. HGT needles caused 16 injuries from 2010 to 2012. After introduction of safety lancets in 2012, no injuries were reported. With the introduction of single-use insulin needles in 2015, our needle stick injury rates due to insulin needles were reduced from eight cases in 2014 to one case in 2015 and 2016.
Conclusion: A continuous surveillance mechanism with periodic analysis and specific interventions is essential for a successful occupational exposure programme. Use of safety-engineered products and periodic training of HCWs are important for prevention of occupational exposure to BBVs.
| P-13 Rg No: 061: Antibiotic Susceptibility Pattern of Common Bacterial Uropathogens Isolated from Suspected Cases of Urinary Tract Infections in a Tertiary Care Hospital|| |
S. Jangir, G. Gole, A. De, L. Dash, J. S. Shastri
Department of Microbiology, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
Introduction: Urinary tract infection (UTI) remains one of the common infections in outpatients and hospitalised patients. Current knowledge of antimicrobial susceptibility pattern is essential for appropriate therapy. The distribution of uropathogens and their susceptibility pattern to antibiotics vary regionally, and even in the same region, they change over time. Therefore, knowledge of the causative microorganisms and their susceptibility to various antibiotics are necessary for a better therapeutic outcome.
Aims and Objectives: The aim was to study the common uropathogens in cases of UTI and their antibiotic susceptibility pattern in a tertiary care hospital.
Materials and Methods: A retrospective study of bacterial uropathogens in clinically suspected cases of UTI over a period of 6 months (January–June 2016) was conducted in a tertiary care hospital. The culture and sensitivity data of the uropathogens were collected from the records of Microbiology Department. Midstream clean catch urine samples freshly collected in a sterile wide mouth leak proof screw-capped container had been processed for microscopy and culture. The organisms had been identified by standard methods, and antibiotic susceptibility testing performed by Kirby–Bauer disc diffusion method according to Clinical and Laboratory Standards Institute guidelines (2015).
Results: Out of 6035 urine samples, 543 (8.9%) samples showed significant bacteriuria. The most common organism isolated was Escherichia coli (55.61%), followed by Klebsiella pneumoniae (19.52%). Isolation of Enterococcus spp. was 0.9%, of which 60% were high-level aminoglycoside resistant. Multidrug resistance was seen in 66.6% of E. coli and 63.07% of K. pneumoniae. Antimicrobial susceptibility testing showed most of the E. coli to be sensitive to nitrofurantoin (67.39%), imipenem and meropenem (67.93% each). K. pneumoniae showed 100% sensitivity to imipenem and meropenem. High degree of resistance was seen in E. coli and K. pneumoniae to ampicillin, cephalosporins, nalidixic acid, trimethoprim-sulphamethoxazole and norfloxacin.
Conclusion: E. coli remains the most common uropathogen. Nalidixic acid, ampicillin, trimethoprim-sulphamethoxazole and cephalosporins have limited value for the treatment of UTI. Sensitivity to imipenem and nitrofurantoin is still retained and may be prescribed for UTI. Routine monitoring of drug resistance pattern will help to identify the resistance trends regionally. This will help the clinicians in the empirical treatment of UTIs.
| P-14 Rg No: 274: One-Year Retrospective Study Post-H1n1 Vaccination Amongst Healthcare Workers at a Tertiary Care Hospital in Mumbai|| |
Sheeba John, Satyajeet Bhoite, Priyanka Patil, Seema Rohra, Aruna Poojary
Infection Control Team, Breach Candy Hospital Trust, Mumbai, Maharashtra, India
Background: World Health Organization (WHO) declared the H1N1 pandemic on 11th June 2009. In 2015, India reported 31,974 cases and 1895 deaths due to H1N1. In Maharashtra alone, around 4000 positive cases and 394 deaths were reported. WHO strongly recommends that all countries vaccinate their healthcare workers (HCWs) as a first priority to protect patients and HCWs.
Aim and Objectives: The aim and objective of the study was to monitor the efficacy and adverse effects of the H1N1 intramuscular (IM) vaccine in HCWs.
Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Mumbai, for a period of 1 year (April 2015–March 2016). HCWs were encouraged to get vaccinated by the Infection Control Team. Review of health cards and interview of vaccinated HCWs was carried out retrospectively for immediate adverse effects (local and systemic) and flu-like symptoms for a period of 1-year post-vaccination.
Results: Three hundred and fifteen HCWs were vaccinated with the H1N1 vaccine. Two hundred and sixteen (68.57%) HCWs were available for follow-up. Nearly 99 (31.42%) HCWs were lost to follow-up during the study period. Immediate adverse effects, i.e. local pain were experienced by 2 (0.93%) HCWs. Immediate systemic effects such as cough/cold/fever/sore throat/weakness/body ache were experienced by 9 (4.16%) HCWs. Two (0.93%) HCWs were diagnosed with H1NI disease during the study period. Fifty (23.1%) HCWs suffered from upper respiratory tract infections due to other causes, within a year of vaccination. Thirty-two (14.81%) HCWs were absent for one or more day due to flu-like symptoms within a year of vaccination.
Conclusion: The IM H1N1 vaccine is a safe and efficacious vaccine with minimal adverse effects. H1N1 vaccination must be encouraged amongst HCWs to reduce sickness absenteeism and protect them against H1N1.
| P-15 Rg No: 187: Stethoscope: a Potential Source of Infection in Healthcare Practices|| |
Sandeep Rana, Mukesh Sharma, Dinesh Kumar, Shobha Broor
SGT Medical College and Hospital, Gurgaon, Haryana, India
Introduction: Nosocomial infections remain a significant hazard for hospitalised patients. Stethoscopes because of their universal use by medical professionals can prove to be a potential source of nosocomial infections. This study was undertaken to determine bacterial contamination of stethoscopes and their cleaning practices by medical health providers.
Aims: The aims of the study were to determine bacterial contamination of stethoscopes and their antimicrobial susceptibility pattern in our hospital setup and to study the effect of cleaning with alcohol-based disinfectant on microbial growth.
Materials and Methods: A total of 47 randomly selected participants (different healthcare workers) with stethoscope were selected for this study. Surface of each stethoscope (diaphragm) was swabbed with a sterile swab moistened in sterile saline before and after cleaning with alcohol-based disinfectant. Swabs were inoculated directly onto blood agar and MacConkey agar and incubated aerobically. Identification of bacteria and antimicrobial susceptibility testing were done as per Clinical and Laboratory Standards Institute guidelines.
Results: This study included stethoscopes from 35 adult and 12 paediatric healthcare workers. Of the studied stethoscopes, 27 (57.4%) were shared amongst the health workers, whereas 20 (42.5%) were used by a single individual. Bacterial growth was obtained from 45 of 47 studied stethoscopes before cleaning with alcohol-based disinfectant. Fifteen out of 47 (31.9%) had potential pathogens, for example, Staphylococcus aureus (9 [60%]), Acinetobacter spp. (5 [33.3%]) and Enterococcus spp. (1 [6.6%]). Of the nine S. aureus, methicillin-resistant S. aureus (3 [33.3%]) and methicillin-sensitive S. aureus (6 [66.7%]) were seen. In none of the swabs taken after cleaning with 70% ethyl alcohol, bacterial growth was seen.
Conclusion: Our study reveals that stethoscopes can be a potential source for spreading HAIs. Stethoscope disinfection with alcohol-based disinfectants should be seriously considered by health workers to minimise cross-contamination and ensure improved patient safety in hospitals to effectively reduce HAIs.
| P-16 Reg No: 181: High Hand Hygiene Non-Compliance Rate in Paediatric Critical Care: Are Physicians' Responsible More Than Other Healthcare Workers?|| |
Category: Hand Hygiene
Pooja Shukla, Varnit Shanker1, Brajpal Singh Tanwar2
Department of Microbiology, JNMC, KLE University, Belgaum, Karnataka, Departments of 1Pediatrics and 2Neonatology, DACH, Jaipur, Rajasthan, India
Background: Hand hygiene (HH) is a single most effective preventive strategy for nosocomial infections, though awareness is satisfactory, but compliance rates remain low. This study estimated HH compliance amongst healthcare workers (HCWs) and also compared non-compliance in physician and non-physician HCWs groups.
Methods: An observational study design was carried out in Intensive Care Units (ICUs) of 52-bedded tertiary-level paediatric speciality hospital at DACH, Jaipur. Amongst 26 HCWs designated exclusively in critical care area, a total of 1236 HH opportunities were observed by two junior residents.
Results: The overall observed non-compliance rate amongst HCWs was 76%. The factors examined with non-compliance were HCW job profile (physicians – odds ratio [OR]: 5.8; 95% confidence interval [CI]: 1.5–7.6 and allied health professionals – OR: 2.3; 95% CI: 1.2–5.2).
Conclusion: Overall HH non-compliance was high in ICUs of our hospital despite monthly Hospital Infection Control Workshops. The hierarchical order of HCWs in work setting was an important factor associated with non-compliance. Compliance was highest amongst technicians and lowest amongst physicians.
| P-17 Rg No: 159: Antibiotic Resistance Trends of Uropathogenic Escherichia Coli Isolated from Inpatients in Rims, Imphal, Manipur|| |
Monika Yadav, Ksh. Mamta Devi, Kh. Sulochana Devi
Department of Microbiology, RIMS, Imphal, Manipur, India
Introduction: Urinary tract infections (UTIs) pose a serious health threat with respect to antibiotic resistance and high recurrence rates. Escherichia coli is the predominant organism causing UTIs. The aim of the study is to isolate and identify E. coli from inpatient cases of UTIs, to find out its antibiotic susceptibility pattern and to correlate with biofilm production.
Methods: A total 150 strains of E. coli showing significant count (>105 cfu/mL) were isolated from cases of UTIs in wards and Intensive Care units (ICUs). The organisms were isolated by conventional methods and identified by standard biochemical reactions Antibiotic sensitivity test was performed by Kirby–Bauer disc diffusion method according to the latest Clinical and Laboratory Standards Institute guidelines. Biofilm production was shown by Christensen's tube method (CTT), Congo red agar (CRA) method and tissue culture plate (TCP) method.
Results and Discussion: Of the total of 150 uropathogenic E. coli isolates, 140 isolates were from wards and 10 from ICU. Antibiotic sensitivity is maximum for amikacin 93%, followed by nitrofurantoin 90% and meropenem 88%, whereas least for ceftazidime 5%, amoxiclav 9% and ampicillin 10% [Table 1]. Biofilm producers are found to be more resistant to all antibiotics in comparison to non-biofilm producers. TCP method detected 76% isolates, CTT method 72% and CRA method 64% as biofilm producers.
|Table 1: Antibiotic sensitivity pattern of uropathogenic Escherichia coli|
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Conclusion: The sensitivity pattern of microorganisms to various antibiotics varies over time and amongst different geographical locations. Therefore, continuous analysis of the antibiotic resistance pattern acts as a guide in initiating the antibiotic stewardship for UTI. This study suggests the inclusion of amikacin and nitrofurantoin as the empirical treatment for UTI. We also advocate that carbapenem should be used as a last-line antibiotic to prevent the occurrence of carbapenem resistance. Hence, they should not be given for empirical treatment.
| P-18 Rg No: 028: Tuberculous Meningitis: Clinico-Laboratory Correlation and Their Role in Outcome and Prognosis|| |
Upasana Bora, Reetika Dawar, Leena Mendiratta, Hena Rani, Raman Sardana, P. N. Renjen1, Vineet Suri1, Charu Gauba1
Departments of Microbiology and 1Neurology, Indraprastha Apollo Hospitals, New Delhi, India
Objectives: Tuberculous meningitis (TBM) can lead to mortality and morbidity if not diagnosed early. Confirming the clinical suspicion of TBM has always been problematic despite various existing laboratory tests. We evaluated the existing array of tests and GeneXpert assay in clinically suspected cases of TBM.
Materials and Methods: Cerebrospinal fluid (CSF) samples over a period of 9 months with clinical suspicion of tubercular infection were analysed retrospectively for clinical presentation and tests, namely, Ziehl–Neelsen (ZN) stain, adenosine deaminase assay (ADA), Real-time polymerase chain reaction (RT-PCR) for tuberculosis (MTBC/NTM), acid-fast bacilli (AFB) culture and GeneXpert.
Results: Of 129 CSF samples of suspected cases of TBM, ZN stain was negative in all 98 patients tested, ADA in 10, GeneXpert detected mycobacterial genome in 8 of 60, RT-PCR in 1 and AFB culture in 3. Majority presented with altered sensorium.
Conclusions: GeneXpert can substantially improve diagnostic confirmation of TBM by giving quick results and should be part of the initial algorithm on the diagnosis of TBM. Early diagnosis is very essential to minimise hospital infection transfer.
| P-19 Rg No: 176: Investigation of an Outbreak of Rickettsial Fever from Western Maharashtra|| |
Ashwini Kacharu Dedwal, S. Bhamre, A. Sadafale, M. Palewar, S. Pol, R. Bharadwaj
Department of Microbiology, B. J. Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
Category: Outbreak Management
Introduction: There was Sudden increase of febrile illness in Shindewadi and Shirur, Pune (Western Maharashtra) in August 2016. Fever was the most common presenting symptom and two children died at the start of the outbreak. A team was sent from B. J. Government Medical College and Sassoon General Hospital, Pune, to investigate the cause of the outbreak.
Objective: The objective of the study was to identify causative agent of outbreak so that appropriate therapy could be instituted early.
Methods: Blood samples were collected from 25 patients with febrile illness. All the samples were tested for battery of test for fever of unknown origin.
Results and Discussion: All affected patients were children age group ranging from 2 to 14 years. Clinically, no other symptoms and signs other than fever were observed. No rash was seen in any patient. Out of 25 samples, 7 (28%) gave evidence of rickettsial disease by the Weil–Felix test. Due to high Weil–Felix positivity suggestive of typhus fever, samples were retested for typhus infection by Rickettsia IgM ELISA kit. Nearly 21 (84%) samples were positive for typhus group. All the patients were treated with doxycycline and responded well to the treatment. There was no mortality subsequently.
Conclusion: Rickettsial infections seem to be re-emerging in India, so a high index of suspicion must be maintained, and tests for rickettsial diseases should be included in a battery of test for fever of unknown origin.
| Chlamydia trachomatis Infection In A Sexually Transmitted Infection Clinic: Need For Extragenital Screening"> P-20 Rg No: 228: Chlamydia Trachomatis Infection In A Sexually Transmitted Infection Clinic: Need For Extragenital Screening|| |
Nazneen Arif, Deepak Juyal, Sujeesh Sebastian, Neena Khanna, Benu Dhawan
AIIMS, New Delhi, India
Background: Sexually transmitted infections (STIs) due to Chlamydia trachomatis (CT) continue to be an important public health problem. In addition to the usual genital route of transmission of CT, extragenital sites are believed to serve as hidden reservoirs for ongoing transmission. In addition, treatment for rectal chlamydia infection is different from that of genital chlamydia infection. Many extragenital cases may be missed if only genital testing is performed. The present study is a retrospective analysis of laboratory data describing characteristics and trends in chlamydia testing and diagnosis. To the best of our knowledge, this is the first study from India reporting extragenital chlamydia infections.
Materials and Methods: Between September 2015 and August 2016, all male and female attendees at an STI clinic of a tertiary care hospital with genital and/or extragenital discharge were screened for CT infection. Samples included endocervical swabs in women and urethral swabs and urine samples in men. Rectal and pharyngeal samples were collected in patients with anorectal symptoms or with a history of receptive anal or oral intercourse. Laboratory diagnosis of CT was based on performing an in-house nucleic acid amplification test on the samples received.
Results: A total of 439 samples collected from 417 patients (245 women and 172 men). Women had a high positivity rate for CT than men (13.6% and 11%). CT positivity rate varied according to anatomical site. CT detected in men was rectal, 30.4%; genital 8% and pharyngeal, 0%. CT detected in women was rectal, 100%; genital, 11% and pharyngeal, 0%. Rectal CT was detected in 30.43% of patients. The proportion of infected patients with isolated extragenital infections (i. e. extragenital infections without genital infection) was 13.2%.
Conclusions: This study not only confirms a large reservoir of extragenital infection but also supports extragenital screening of men and women attending STI clinics in our country. Screening for extragenital CT infections is a crucial component for STI management. These data will be an important resource for understanding chlamydia epidemiology and help from national guidelines on extragenital screening for CT.
| P-21 Rg No: 107: A Study on Antibiotic Resistance Pattern of Pseudomonas Species Isolated from Clinical Samples in a Tertiary Care Hospital|| |
Debjita Debnath, M.Kalyani H, S. S. M. Umamageswari, Neelu Sree, Tasneem Banu, Archana Nagrajan
Department of Microbiology, Saveetha Medical College and Hospital, Kancheepuram, Tamil Nadu, India
Aim: This study is done to analyse the common antibiotic resistance pattern of Pseudomonas species isolated from patients' samples in a tertiary care hospital.
Introduction: Pseudomonas species is a leading cause of nosocomial infections ranking third amongst Gram-negative bacteria, after Escherichia coli and Klebsiella spp. Pseudomonas is a large group of aerobic organisms, Gram-negative, non-sporing and motile by polar flagella. Evidence suggests growing resistance to commonly used higher antibiotics, antiseptics and disinfectants such as ammonium compounds, chloroxylenol and hexachlorophene. Extended-spectrum beta-lactamase (ESBL) and metallo-beta-lactamase production is almost comparable with other Gram-negative organisms. Nosocomial infections due to ESBL-producing Pseudomonas species are treated with carbapenemas, but sometimes carbapenamase production renders the drug inactive.
Materials and Methods: This is a retrospective study that includes data from June 2016 to November 2016. Various clinical specimens were collected from inpatient and outpatient department. A total number of samples collected were 7744, of which 170 samples were culture positive for Pseudomonas species. Samples were processed as per standard protocol. Antimicrobial susceptibility testing was performed on Mueller-Hinton Agar by Kirby–Bauer disc diffusion method as per Clinical and Laboratory Standards Institute guidelines.
Results: In this study, of all the Pseudomonas species isolated from clinical samples, 55.5% were sensitive to ofloxacin, 52.5 to ciprofloxacin, 45.5% to ceftazidime, 45% to cefepime, 44% to amikacin and 97% to second-line antibiotics such as imipenem, 64% to gentamicin, 42% to cefoperazone-sulbactam, 22% to co-trimoxazole and 65% piperacillin-tazobactam.
Conclusion: It is found that 55.5% are resistant to ceftazidime (55.5%), but in gentamicin and beta-lactam-beta-lactamase inhibitor combination drugs, resistance was less common (30%). Most of the Pseudomonas species cultured were sensitive to amikacin, imipenem and gentamicin in our study. To prevent the development of resistance, antibiotics must be used according to antibiotic policy guidelines. Multidrug-resistant strains were found in <20% of total Pseudomonas.
| P-22 Rg No: 253: A Retrospective Study On The Effects Of H1n1 Vaccination Amongst Healthcare Workers At A Tertiary Care Hospital In Mumbai|| |
Aruna Poojary, Sheeba John, Satyajeet Bhoite, Priyanka Patil, Seema Rohra
Infection Control Team, Breach Candy Hospital Trust, Mumbai, Maharashtra, India
Background: World Health Organization (WHO) declared the H1N1 pandemic on 11th June 2009. In 2015, India reported 31,974 cases and 1895 deaths due to H1N1. In Maharashtra alone, around 4000 positive cases and 394 deaths were reported. The WHO strongly recommends that all countries vaccinate their healthcare workers (HCWs) as a first priority to protect patients and HCWs.
Aim: The aim of the study was to monitor the efficacy and adverse effects of the H1N1 intramuscular (IM) vaccine in HCWs.
Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Mumbai for a period of 1 year, April 2015 to March 2016, post-H1N1 vaccination. HCWs were encouraged to get vaccinated by the Infection Control Team. Review of health cards and interview of vaccinated HCWs was carried out retrospectively for immediate adverse effects (local and systemic) and flu-like symptoms for a period of 1-year post-vaccination.
Results: Three hundred and fifteen HCWs were vaccinated with the H1N1 vaccine. Two hundred and sixteen (68.57%) HCWs were available for follow-up. Nearly 99 (31.42%) HCWs were lost to follow-up during the study period. Immediate adverse effects i.e., local pain was experienced by 2 (0.93%) HCWs. Immediate systemic effects such as cough/cold/fever/sore throat/weakness/body ache were experienced by 9 (4.16%) HCWs. Two (0.93%) HCWs were diagnosed with H1NI disease during the study period. Fifty (23.1%) HCWs suffered from upper respiratory tract infections due to other causes, within a year of vaccination. Sickness absenteeism was documented in 32 (14.81%) HCWs due to upper respiratory infections other than H1N1 flu.
Conclusion: The IM H1N1 vaccine is a safe and efficacious vaccine with minimal adverse effects. H1N1 vaccination must be encouraged amongst HCWs to reduce sickness absenteeism and protect them against H1N1.
| P-23 Rg No: 316: Decreasing Trend of Central Line-Associated Bloodstream Infections in the Neonatal Intensive Care Unit of a Quaternary Care Hospital in Mumbai|| |
Sweta Shah, Tanu Singhal, Havovi Fouzdar, Reshna Tejam
Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
Introduction: Central line-associated bloodstream infection (CLABSI) can lead to increased length of stay, increased use of antibiotics and high mortality in Neonatal Intensive Care Unit (NICU) and has adverse economic challenges.
Methods: A prospective surveillance study was conducted amongst neonates admitted to the NICU in a quaternary care hospital in Mumbai to determine the incidence rates and microbial aetiology of CLABSI. CLABSI was defined as per the Centers for Disease Control definitions. Outcomes included incidence rates of CLABSI/1000 catheter-days and microbial aetiology. Training and surveillance was done at regular defined intervals. Root cause analysis and corrective and preventive action were taken after each episode of CLABSI. Prevention bundle of CLABSI included aseptic precaution while insertion and dressing, skin preparation with chlorhexidine gluconate, scrub the hub with the alcohol swab for 20 s and hand hygiene.
Results: A total of 1645 neonates were included in the surveillance from January 2010 to December 2016, representing 19,626 bed-days. A total of 396 central lines were inserted with 4372 central line days. The overall CLABSI rate was 1.16/1000 central line device-days (51 cases) and ranged from 13.78 in 2010 to 1.5 per 1000 central line device-days in 2016. There is a significant reduction in bloodstream infection rate over the years. A total of 87% of all CLABSIs were caused by Gram-negative bacilli (GNB), 7% were caused by Gram-positive cocci (GPC) and 6% were caused by Candida species. Klebsiella pneumoniae is the most common GNBs. Methicillin-resistant Staphylococcus aureus was not the cause of any CLABSI.
Conclusion: There is a significant decrease in the incidence of CLABSI over the years. Continuous training and strict adherence to the prevention bundle of CLABSI has reduced the CLABSI.
| P-24 Rg No: 186: Comparison Of Different Methods To Detect Biofilms In Candida Species As Virulence Marker|| |
Dinesh Kumar, Mukesh Sharma, Sandeep Rana, Shobha Broor
SGT Medical College and Hospital, Gurgaon, Haryana, India
Introduction: Pathogenic fungi in the genus Candida have the ability to produce several infections extending from superficial to deep-seated mycoses. The formation of Candida biofilms carries important clinical repercussion because of their increased resistance to antifungal therapy. Biofilm formation on a medical device can lead to failure of device and serve as a reservoir or source of future infection.
Aim: This study was undertaken to detect biofilm production in Candida species isolated from various clinical samples and to compare different phenotypic methods for the detection of biofilm formation.
Methods: A total of 82 Candida species were subjected to speciation using germ tube, chlamydospore formation and CHROM agar method and biofilm production using test tube method, % transmission method and crystal violet (CV) method.
Results: Of the 82 Candida isolates, 56 (68.3%) were non-albicans Candida species and 26 (31.7%) were Candida albicans. Amongst the non-albicans Candida species, the most common isolate was Candida tropicalis (25 [44.6%]). Of all the Candida species tested, 16 (19.5%) were found to be biofilm producers. Biofilm production was found to occur most frequently amongst non-albicans Candida (11 [19.6%]) than in C. albicans (5 [19.2%]). Biofilm production in C. albicans was seen in 5 (19.2%) by tube method, 3 (11.5%) by % transmission method and 3 (11.5%) by CV method, whereas in non-albicans Candida, biofilm production was seen in 11 (19.6%) by tube method, 7 (12.5%) by % transmission method and 7 (12.5%) by CV method.
Conclusion: Biofilms have been considered as virulence factors contributing to candidal infections; therefore, it is required to detect them by easy and reliable methods. This study concludes that non-albicans Candida are the emerging pathogens nowadays and have the ability to form strong biofilms. In this study, CV method for biofilm detection was found to be more reproducible and easy to interpret compared to other methods, for example, tube and % transmission methods.
| P-25 Rg No: 241: Ventilator-Associated Pneumonia In Intensive Care Units Of A Tertiary Care Hospital|| |
Veenu Gupta, Deepinder Chhina, Rajoo Singh Chhina, Parshotam Lal Gautam
Departments of Microbiology, Gastroenterology and Critical care, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
Introduction: Healthcare-associated infections from invasive medical devices in Intensive Care Unit (ICU) are a major threat to the patient. Amongst these, ventilator-associated pneumonia (VAP) poses the highest risk prolonging the hospital stay and cost for the patients. The aetiology of VAP varies with different patient populations. Early and correct diagnosis of VAP is an urgent challenge for an optimal antibiotic treatment.
Objectives: The aim of this study was to assess the incidence, the most common pathogens and resistance pattern of isolates of VAP in ICUs of a tertiary care hospital.
Materials and Methods: A prospective study was performed over a period of 6 months from January to June 2016, enrolling patients undergoing mechanical ventilation for >48 h. Endotracheal aspirates and bronchoalveolar lavage samples were collected from patients suspected of VAP, and semi-quantitative cultures were performed on all samples. VAP was diagnosed by modified Clinical Pulmonary Infection score (≥6).
Results: A total of 4897 patients were admitted in ICUs, of which 875 patients were on ventilator assistance (4904 ventilator days). Out of these, 16 (1.8%) patients developed VAP. The VAP rate was 3.26/1000 ventilator-days. The most common pathogen was Acinetobacter spp. followed by Klebsiella spp. Most of the Acinetobacter spp. were resistant to cephalosporins and ciprofloxacin and showed maximum susceptibility to tigecycline and polymyxin B.
Conclusions: This study highlights the predominance of Gram-negative pathogens in VAP cases. Hence, there is a need for prompt diagnosis when VAP is suspected. Simple and effective preventive measures should be instituted such as diligent respiratory care, hand hygiene and judicial use of antibiotics to cut down the rate of VAP.
| P-26 Rg No: 297: Diagnostic Utility Of Vitek-Ms (Matrix-Assisted Laser Desorption Ionisation-Time-Of-Flight) As An Aid In Antimicrobial Stewardship|| |
Rupashree Patkar, Neetu Mundra, Shashikala Shivaprakash
Department of Microbiology (Laboratory Medicine), Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India
Background: Matrix-assisted laser desorption ionisation-time-of-flight (MALDI-TOF) is a revolutionary technique for rapid identification of various bacterial and yeast isolates. Early identification and its intimation to clinicians help in the early channelling of antimicrobial therapy against the likely pathogen. The aim of this study was to identify bacterial and yeast isolates by VITEK-MS based on MALDI-TOF technique from respiratory samples.
Methods: A total of 519 respiratory samples (endotracheal secretions, bronchoalveolar lavage and sputum) were tested during January to December 2016. Well-isolated, pure colonies of organisms from significant growth were picked and subjected to identification by MALDI-TOF VITEK-MS (bioMerieux). Results were obtained within 1 h. Identified isolates with confidence levels >90% were chosen and repeated after purity to confirm. Significant pathogens were informed to Intensive Care Unit (ICU) clinicians on a priority basis.
Results: A total of 319 (80.75%) bacterial and 76 (19.24%) yeasts were isolated from 519 samples. Nearly 51.72% of bacteria and 63.15% of yeasts were isolated from ICUs and 45.5% of bacteria and 36.48% of yeasts were isolated from other wards. Variety of uncommon bacteria and Candida species were isolated from all respiratory samples [Chart 1]a and [Chart 1]b.
Conclusion: Early identification of organisms reduced the reporting time, improved guidance in choice of antimicrobial and had a positive effect on antimicrobial stewardship, especially in ICUs.
| P-27 Rg No: 132: Ventilator-Associated Pneumonia: Prevalence and Microbiology in a Tertiary Care Hospital in Maharashtra|| |
M. Palewar, S. Mudshingkar, A. Sadafule, V. Dohe, A. Kagal, R. Bharadwaj
Department of Microbiology, B. J. Medical College, Pune, Maharashtra, India
Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection acquired by patients in the Intensive Care Unit (ICU). However, there are scarce clinical data, particularly from Indian ICUs on the occurrence of this infection.
Aims: The present study aims at determining the prevalence of VAP and identifying prevalent microbial pathogens and their susceptibility patterns associated with VAP in a Medical ICU (MICU) of a tertiary care hospital in Pune.
Methods: Over a 6-month period in MICU from June 2016 to November 2016, of the 1081 patients admitted, 524 patients were kept on a ventilator. Patients who received mechanical ventilation for >48 h were included in the study. Patients having pneumonia, pulmonary oedema and adult respiratory distress syndrome before mechanical ventilation were excluded from the study. Thus, a total of 218 patients were included in the study. Endotracheal aspirates from clinically suspected VAP patients were subjected to microbiological analysis. Isolated pathogens were identified by standard microbiological techniques.
Results: Out of 218 patients, 20 patients were clinically and microbiologically diagnosed as VAP (9.37%). The total number of ventilation days was 3349. VAP rate was 5.97 cases/1000-ventilation days. Out of 20 patients, 5 (25%) developed early-onset VAP and 75% developed late-onset VAP. The infections were predominantly caused by Gram-negative bacteria such as Acinetobacter spp. (36%), followed by Klebsiella pneumoniae (32%), Enterobacter spp. (16%), Pseudomonas aeruginosa (8%), Proteus mirabilis (4%) and Staphylococcus aureus (4%). Majority of these isolates were multidrug resistant.
Conclusion: Knowledge of prevalent organisms causing VAP and their susceptibility pattern is a must to formulate an effective empiric antibiotic policy and to reduce morbidity, hospital stay and cost of treatment of ICU patients.
| P-28 Rg No: 112: An Outbreak Of Acinetobacter Sepsis In A Neonatal Intensive Care Unit At A Tertiary Care Centre|| |
Swati Shankarrao Mudshingkar, Shweta Sonawane, Renu Bhardwaj, Vaishali Dohe
Department of Microbiology, B. J. Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
Background: Acinetobacter species are ubiquitous in hospital environment. Multidrug-resistant Acinetobacter spp. are emerging as a cause of nosocomial infections. An outbreak was suspected when Acinetobacter was isolated from blood cultures of eight infants admitted in Neonatal Intensive Care Unit (NICU). An investigation was carried out to identify the source.
Methods: BACTEC blood cultures were collected from 14 infants with suspected sepsis. Positive bottles were plated on Blood agar and MacConkey's agar, and isolates were identified. To identify the source of infection, swabs were collected from the infected infants to look for colonisation. Samples were also collected from medicine trolleys, incubators, washbasin and hands of healthcare workers (HCWs) in an effort to look for the source. They were plated on Acinetobacter CHROMagar media. Settle plates were kept at a distance of 1, 2 and 3 feet from infected infants for ½ h. All isolates were confirmed by standard methods. Antimicrobial susceptibility was done as per the Clinical and Laboratory Standards Institute guidelines.
Results: A total of 14 blood samples were received from NICU in the 2nd week of January 2016. Eight of the blood cultures grew Acinetobacter. They were also isolated from a medicine trolley, HCW's hand and an incubator. One infant was colonised with Acinetobacter, and Acinetobacter was isolated on a settle plate also. Cohorting of the infants was done. NICU was asked to clean extensively with 1% hypochlorite solution. Handwashing was enforced. The outbreak was then aborted.
Conclusion: This study highlights the role of environment in the spread of nosocomial Acinetobacter infections and the importance of supervised infection control measures to prevent such infections.
[Table 1], [Table 2]