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   Table of Contents - Current issue
July-December 2017
Volume 19 | Issue 2
Page Nos. 75-123

Online since Tuesday, December 26, 2017

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Academy news p. 75
Manjusree Shanmughan
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Colistin: Pharmacology, drug resistance and clinical applications p. 77
Parijat Das, Kasturi Sengupta, Gaurav Goel, Sanjay Bhattacharya
Colistin is an important antibiotic against multidrug-resistant (MDR) Gram-negative bacteria (GNB), particularly Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii. Although it is an old antibiotic, Colistin has emerged as an important agent in the treatment of GNB infections, especially those caused by MDR pathogens in hospitalised patients. Limited therapeutic option against Carbapenem-resistant Gram-negative bacilli (E. coli, Klebsiella, Pseudomonas and Acinetobacter) is one of the major problems in clinical practice. The current review discusses the pharmacology, toxicity, drug resistance, importance of therapeutic drug level monitoring and cost of one of the most important antibiotics in the current practice.
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Oropharyngeal candidiasis among HIV seropositive patients in Chennai, South India: An evaluation of Polymerase chain reaction-Restriction Fragment Length polymorphism for speciation and Antifungal drug resistance p. 86
Abirami Lakshmy Jayachandran, Radhika Katragadda, Ravinder Thyagarajan, KV Leela, K Shanmugam, Amutha Chelliah
CONTEXT: Oropharyngeal candidiasis is a common opportunistic manifestation of HIV/acquired immunodeficiency syndrome. Non-albicans Candida and drug-resistant strains are on the rise leading to treatment difficulties. AIMS: The present study aims to speciate, perform antifungal susceptibility, and also to evaluate the significance of antifungal drug resistance by correlating the prior exposure to Fluconazole and CD-4 counts. SETTINGS AND DESIGN: This was a cross-sectional study. MATERIALS AND METHODS: A total of 115 HIV patients with clinical evidence of oropharyngeal candidiasis were included in the study. Two swabs were collected from the lesions. Speciation and antifungal susceptibility by microbroth dilution method for fluconazole, itraconazole, and amphotericin B were done as per the standard microbiological techniques. Polymerase chain reaction and restriction fragment length polymorphism (PCR and RFLP) were performed for speciating the Non-albicans candida. The association between prior exposure to Fluconazole, CD-4 counts, and antifungal resistance was assessed (Fisher's exact test, Chi-square test P < 0.05 was considered as statistically significant). RESULTS: Among the 115 patients, 60 (52.17%) showed culture positivity for Candida species. Candida albicans 35 (56.45%) was the predominant species isolated followed by Candida tropicalis 12 (19.30%). PCR RFLP produced specific products for 19 of the non albicans Candida. A resistance of 17 (27.41%) and 18 (29.00%) was seen to fluconazole and itraconazole, respectively. A significant association was observed between prior exposure to Fluconazole and drug resistance (P = 0.0201).The correlation between CD-4 counts and antifungal resistance was not statistically significant (P = 0.595). CONCLUSION: Antifungal susceptibility testing should be performed routinely along with species-level identification whether it is the first or recurrent episode of oral candidiasis and therapy should be modified accordingly to prevent the morbidity and mortality.
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A study to assess the knowledge, attitude and practices of hand hygiene in a health-care setting p. 93
Georgeena Elsa Jose, Chithra Valsan
CONTEXT: In the wake of a growing burden of health care associated infections (HAIs), health-care workers (HCWs) are advised to revert to simple tools like hand hygiene (HH). AIMS: The aim of this study is to explore the existing knowledge, attitudes and practices with regard to HH, the total HH compliance and the various barriers to HH in our hospital so as to plan the strategies for bridging these gaps, thus improving patient care. SETTINGS AND DESIGN: A cross-sectional study was conducted among 300 HCWs of Jubilee Mission Medical College and Research Institute, Thrissur, belonging to six different categories, for a period of 2 months. MATERIALS AND METHODS: Knowledge, attitude and practices were evaluated using a validated WHO HH questionnaire, a self-structured attitude questionnaire and an observation checklist based on the concept of Five Moments of HH by WHO, respectively. Total compliance and the profile of missed opportunities were also assessed. STATISTICAL ANALYSIS USED: SPSS was used for data analysis. RESULTS: The knowledge on HH was good (190 out of 300, 63.3%), attitudes were poor with nursing staff having significantly better attitude than doctors (P < 0.05). In the observational study, physicians and nursing staff had better practice. Lack of time was the major barrier pointed out. The overall compliance was 46% among the HCWs of whom only 16% had proper HH practice. Rest of the 30% performed HH, but the technique was wrong. CONCLUSIONS: The study highlights the need for reinforcing the existing HH training programmes to address the gaps in knowledge, attitude and practice and thereby improving the level of HH compliance and enhancing patient safety.
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Susceptibility of uropathogenic multidrug-resistant Escherichia coli to Fosfomycin p. 101
Deepak Kumar, Arghya Das, Manish Kumar Purbey, Nidhi Gupta, Gopal Nath
CONTEXT: Escherichia coli is one of the most important causes of urinary tract infections (UTIs). Increased antibiotic resistance may limit the therapeutic options for the treatment of E. coli infections. Fosfomycin an orally dispensed antibiotic has shown promising in vitro activity against multidrug-resistant (MDR) urinary E. coli pathogen; however, current resistance data from India are scarce. AIM: The aim of this study is to evaluate the in vitro Fosfomycin activity against uropathogenic MDR E. coli. MATERIALS AND METHODS: A total of 150 previously confirmed MDR E. coli urinary isolates were included in this study. Susceptibility testing and result interpretation of isolates to Fosfomycin was performed by the disc diffusion method as per the Clinical and Laboratory Standards Institute M100-S25 recommendations. RESULTS: Fosfomycin appears to exhibit excellent in vitro activity against the MDR E. coli urinary isolates. The susceptibility for Nitrofurantoin was fair, whereas for Ampicillin, Ofloxacin, Norfloxacin, Cefazoline and Trimethoprim/Sulphamethoxazole was found poor. CONCLUSION: In view of the high in vitro susceptibility to Fosfomycin in this population and the lack of cross-resistance between Fosfomycin and other agents, Fosfomycin may be considered a useful reserve drug in the treatment of uncomplicated UTIs caused by MDR E. coli.
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An in vitro evaluation of bacterial penetration through different kinds of surgical drapes p. 105
Susanta Kumar Sahu, Bimal Krushna Panda, Swetalina Jena, Uday Hembram, Satyabrata Thakur
PURPOSE: Surgical site infection is a major cause of increased post-operative morbidity. The surgical drape functions as a barrier between the surgical field and the potential sources of microorganisms in the environment and operating room personnel. The extent to which the materials act as barrier depends on the closeness of the weave and water-resistant properties of the fabric. This is an in vitro study to evaluate the ability of different types of surgical drapes to prevent bacterial strike through. MATERIALS AND METHODS: Four types of fabrics used as surgical drapes were tested for their ability to prevent strike through when exposed to different bacteria for varying spans of time. We tested the drapes with Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. RESULTS: Drapes made of cotton (CC) or polyester-cotton (PC) textile exhibited least resistance to bacterial penetration. Disposable woven continuous filament polyester fabrics showed better resisting powers. The disposable non-woven polythene fabrics were found to resist bacterial penetration most effectively. The penetration through the woven fabrics was found to be dose- and time-dependent. CONCLUSION: The practice of using reusable textile clothes as surgical drapes should be discontinued and be replaced by non-woven seamless disposable fabric. Surgical drapes should be tested for their penetrability before introducing in operation theatre.
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Disseminated histoplasmosis p. 109
O Sasikumari, S Anupama
Histoplasma capsulatum is a dimorphic fungus which produces systemic infection, especially in immunocompromised patients. We report a case of histoplasmosis in a patient with diabetes who presented with fever of unknown origin of 1-year duration. He expired due to discontinuation of treatment.
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Ascaris in an intercostal drainage tube p. 112
Sujit Bharti, Neeraj Kumar, Sourav Pal, Tuhina Banerjee
Ascaris or roundworms are the most common intestinal nematode infecting man with high disease prevalence in developing countries. Besides migrating to respiratory systems of the body as an integral part of its life cycle, adult Ascaris has been associated with occasional case reports of erratic migration from abnormal sites. In this case report, we present the isolation of this worm from the proximal portion of the intercostal drainage tube in a traumatised young male patient. Such cases remind us about the ubiquity of the worm and persistence in unfavourable host conditions.
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Role of cartridge-based nucleic acid amplification test in detection of pulmonary tuberculosis in people living with human immunodeficiency virus p. 114
Rajneesh Tripathi, Sumedha Kashyap, Prince Chaubey, Alok Prakash Pandey, Shampa Anupurba
INTRODUCTION: Tuberculosis (TB) in human immunodeficiency virus (HIV)-infected people remains a major global public health challenge. Cartridge-based nucleic acid amplification test (CBNAAT) has been proved to have a key role in diagnosing TB in patients having HIV infection. METHOD: In this study, we intend to present a retrospective data of HIV-TB co-infected patients during our routine diagnostic algorithm under Revised National TB Control Program (RNTCP). RESULT: A total of 59/207 (28.8%) HIV patients were diagnosed to be positive for TB by CBNAAT in the period January to December 2015.
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Blood stream infections as a predictor of length of hospital stay and cost of care in patients with cancer p. 118
Sara Devereux, Gaurav Goel, Kasturi Sengupta, Sanjay Bhattacharya
CONTEXT: Blood stream infection (BSI) is a serious clinical condition often associated with morbidity, hospital admission, significant health care costs and sometimes mortality. AIMS: To investigate the correlation between suspected or confirmed BSIs with length of hospital stay (LOS) and cost of health care. SETTINGS AND DESIGN: Retrospective study done in a cancer hospital in eastern India. MATERIALS AND METHODS: Blood culture from patients admitted was used as a surrogate for suspected or confirmed BSI. Study was done over a 40 day period (in July-August 2015) involving 683 patients. STATISTICAL ANALYSIS USED: Welch's unpaired t-test has been used to compare means between data groups. RESULTS: The overall mean LOS, cost of management per patient admission, and all-cause mortality were 5.9 days (range: 0–64 days), Rs. 95,208 (USD 1,413) (range INR 220-27,50,653) and 5.7% (39 out of 683 patients) respectively. The LOS and the average health care costs increased progressively between the following patients cohorts: No blood cultures taken < blood cultures taken but negative < blood cultures taken and positive < blood cultures positive with multi-drug resistant organisms. CONCLUSIONS: The data from this study would be useful to clinicians and hospital administrators, as well as help in counseling patients regarding approximate LOS and cost of health care related to infections.
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A fulminant case of community-acquired pneumonia due to Acinetobacter baumanii p. 121
Parimala Subramani, Sagar Mali, Beena Parvangada Madappa, Raveesha Anjanappa
We report a fulminant case of community-acquired pneumonia due to Acinetobacter baumanii. This pathogen is an important cause of hospital-acquired infections. In the recent years, it has gained importance as an important pathogen associated with community-acquired pneumonia. This case report highlights the clinical significance of isolating Acinetobacter baumanii in sputum samples.
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