Catheter associated urinary tract infections in intensive care units patients in a tertiary care hospital

Introduction: Catheter associated urinary tract infections (CAUTI) is the most common health care associated infection (HAI), accounting for 40% of all HAIs in particularly in patients admitted to intensive care units (ICU) due to their more frequent necessity of urinary catheterization and longer duration of catheter use. Knowledge about Microbiological profile and antimicrobial sensitivity pattern of CAUTI is essential to implement the infection control system in a proper manner.Aims and objectives: To study the rate and microbiological profile of catheter associated urinary tract infections and in patients admitted in Intensive Care Units.Materials and methods: A one-year prospective study was conducted in which urine samples were collected from patients admitted in Medical ICUs on indwelling urinary catheter for >48 hours and processed in Microbiology Department according to standard procedures. CA-UTI rate was calculated and their microbiological profile and various resistance patterns were studied as per CLSI guidelines.Results: Out of 1406 enrolled patients, 64 patients developed CAUTI. Overall CAUTI rate was 4.06/1000 catheter days. Most common isolate in CAUTI cases was Klebsiella spp. (32.3%), followed by Escherichia coli (24.6%). Gram negative isolates showed higher sensitivity to aminoglycosides, imipenam and nitrofurantoin as compared to cephalosporins The Enterococcus spp. were 100% sensitive to linezolid and 71.4% sensitive to both vancomycin and teicoplanin.Conclusion: CAUTI rate in our ICUs was high compared to the benchmarks. Antibiotic sensitivity pattern of the pathogens involved was also low. This study provides the data of predisposing risk factors and its causative microbial flora for CAUTI in our tertiary care.

Role of line probe assay in diagnosis and detection of drug resistance in Mycobacterium tuberculosis

Tuberculosis caused by Mycobacterium tuberculosis has remained a major global health problem worldwide. TB requires prolonged period of time for isolation by conventional culture methods. The emergence and spread of multi drug resistant (MDR-TB) poses great threats and challenges in controlling the infection. MDR-TB is resistant to both first line drugs rifampicin and isoniazid. PCR tests are based on targeting the mutation in rpoB, katG and inhA genes which can detect resistance to these drugs. To compare microscopy, conventional culture and Line probe assay for the detection of M. tuberculosis & detect rifampicin and isoniazid resistance using Lineprobe assay in various clinical samples. A total of 347 suspected patients of tuberculosis were included in the study. Demographic details & clinical presentation was noted. Various samples were received & processed for ZN staining, culture on LJ media and Line probe assay. Out of 347 cases, majority of cases were in the age group of 51-60 years (18.4%). Majority of the population was males (65.1%). Among suspected tuberculosis patients, cough with expectoration (55.9%) was the commonest complaint. Microscopy was positive in 17.3%, conventional culture was positive in 16.1% and line probe assay was positive in 26.2%. Out of 347, 91 were diagnosed with MTB, out of which 85.7% were sensitive to both rifampicin and isoniazid whereas 14.3% showed resistance to either rifampicin / isoniazid or both. LPA & direct microscopy are a good screening method for early diagnosis and detection of drug resistance but are not a complete replacement of conventional culture which is still a gold standard.

Migrated K Wire Into Popliteal Fossa From Tension Band Wiring Of Patella: A Case Report

Despite being extensively used, k wires have their own set of complications, with loosening and eakage of these wires being the most significant one of them. We report a case of patella fracture treated with tension band wiring (TBW). After achieving fracture union, patient was lost to follow up. He reported four years later with a oken k–wire which had migrated posteriorly into the popliteal fossa and had to be removed as it was causing symptoms to the patient. We recommend following certain steps to prevent the occurrence of such a complication: following AO principles of fracture fixation, encouraging hardware removal after union of fracture wherever possible, close clinical and radiological follow up to detect the movement, eakage and migration of wires at the earliest and removal of migrated wires on priority basis, irrespective of patient being symptomatic or asymptomatic.

Identificación de las especies de Candida en las infecciones sanguíneas / Characterization of Candida species in blood stream infections

Introducción: La candidemia se convirtió en una infección importante del torrente sanguíneo que se asocia frecuentemente con índices elevados de mortalidad y morbilidad. Las especies de Candida generan del 70% al 80% de las infecciones micóticas invasivas del torrente sanguíneo y son la cuarta causa más frecuente de infecciones hospitalarias del torrente sanguíneo. La identificación de las especies de Candida es importante, ya que las especies no albicans son cada vez más numerosas y resistentes a las drogas antimicóticas. El objetivo del estudio fue aislar e identificar diferentes especies de Candida asociadas con candidemia y analizar su patrón de susceptibilidad a los antimicóticos. Materiales y métodos: Los pacientes con sospecha de infecciones del torrente sanguíneo (ITS) fueron reclutados durante un período de un año para el estudio prospectivo. Se analizaron las características demográficas, la duración de la internación y los factores de riesgo asociados y la evolución clínica. El análisis de las muestras de sangre tuvo lugar mediante el sistema automatizado BacTAlert. La identificación y la susceptibilidad antimicótica de las levaduras fueron realizadas mediante el uso de dispositivo VITEK-2. Resultados: Las especies de Candida fueron aisladas en 30 de los 3146 cultivos recibidos (0.9%). La mayoría de los casos de candidemia tuvieron lugar en hombres (66%). Los factores de riesgo más frecuentes fueron el uso de antibióticos de amplio espectro, la vía central y la ventilación mecánica. Entre las levaduras aisladas, las especies de Candida no albicans fueron predominantes (60%), en comparación con la especie C. albicans (40%). La especie albicans presentó una susceptibilidad del 100% a los azoles y la anfotericina, en tanto que las especies no albicans fueron resistentes. De los 30 pacientes mencionados, 5 fallecieron. Conclusión: La prevalencia de Candida no albicans fue mayor en comparación con la prevalencia de Candida albicans. Las especies no albicans fueron más resistentes a los antimicóticos. En consecuencia, los pacientes internados deberían ser evaluados para identificar la candidemia.

Introduction: Candidemia has become an important bloodstream infection that is frequently associated with high rates of mortality and morbidity. Candida species account for 70-80% of invasive bloodstream fungal infections and represent the fourth most common nosocomial bloodstream infections. The identification of Candida species is important as the number of non albicans Candida species is increasing and they are becoming more resistant to antifungal drugs. The aim of the study was to isolate and identify various Candida species associated with candidemia and to study their antifungal susceptibility pattern. Materials and methods: Patients suspected of having BSI were enrolled on a one-year prospective study. Patient's demographic details, duration of hospital stay, associated risk factors and outcome were studied. Blood samples were analyzed by BacTAlert automated system. Identification and antifungal susceptibility testing of yeasts was done using VITEK-2 compact system. Results: Of 3146 blood cultures received, Candida species were isolated in 30 samples (0.9%). The majority of candidemia cases were in males (66%). The most common risk factors were use of broad spectrum antibiotics, central line and mechanical ventilation. Among the yeast isolates, non albicans Candida species were predominant (60%) compared to C. albicans (40%). Candida albicans showed 100% susceptibility to azoles and amphotericin whereas non albicans Candida species showed resistance. Of these 30 patients, 5 patients died. Conclusion: Prevalence of non albicans Candida was greater than C. albicans and cases were more resistant to antifungal drugs. Therefore surveillance for candidemia should be carried out in hospitalized patients.

Endoscopic retrograde cholangiopancreatography in surgically altered anatomy

Endoscopic retrograde cholangiopancreatography (ERCP) in a surgically altered anatomy is a technically challenging undertaking with variable success and adverse event rates. There are several potential challenges to successfully perform an ERCP in patients with surgically altered anatomy such as identification of afferent limb, accessing and visualization of the papilla, and selective cannulation of the biliary and pancreatic ducts from altered orientation of the papilla. Several strategies to improve the success rate have been recommended by various endoscopy experts. In this review, we discussed the published literature involving various ERCP techniques described for surgically altered anatomies.

Variation in the Number and Position of Nutrient Foramina of Long Bones of Lower Limb in North Indians.

Aims and Objectives: The major blood supply of the long bones is through the nutrient arterywhich enter through the nutrient foramina leadinginto an oblique nutrient canal. The presence, number, position and distances from the various prominent landmarks on the bone have medical as well as surgical significance. The present study was done on the long bones of North Indians to know the mean values of the number, position of nutrient foramina and distance from various landmarks on the bones and ultimately to compare with other populations. Materials and Methods: The present study consists of 180 long bones of lower limb (60 femora, 60 tibiae, 60 fibulae) which were taken from Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah (Amritsar), India and studied carefully for the number, position and distance of nutrient foramina in relation to length and from the proximal epiphysis of the long bones. Also the anteroposterior and lateromedial diameter of the bone at the level of nutrient foramen were studied. Main outcome measure: Variations in number, position and distance in relation to length and from proximal epiphysis of long bones was seen. Results: The nutrient foramen of femur was located on the linea aspera in 76.50% of cases(39% in interstice 9.5% on the lateral lip and 28.00% on the medial lip of the linea aspera), 18.50 %on the medial surface and 5%.on the lateral surface. Nutrient foramen of tibia was located in 95.50% of cases under the soleal line at the average distance of 119.8 mm from intercondylar eminence to the nutrient foramen, on the soleal line in 4%and on the lateral border in 0.50% of cases. Nutrient foramen of fibula was found on the posterior surface in 65 % of cases, in 15% on the medial surface, on the interosseous border in 10% ,on the lateral surface in 7% and on the posterior border in 3% of cases. Conclusion: This study will provide the ethnic data for comparison among various populations. It is also helpful in various surgical procedures and in interpretation of radiological images.

Variation in the Number and Position of Nutrient Foramina of Long Bones of Lower Limb in North Indians.

Aims and Objectives: The major blood supply of the long bones is through the nutrient arterywhich enter through the nutrient foramina leadinginto an oblique nutrient canal. The presence, number, position and distances from the various prominent landmarks on the bone have medical as well as surgical significance. The present study was done on the long bones of North Indians to know the mean values of the number, position of nutrient foramina and distance from various landmarks on the bones and ultimately to compare with other populations. Materials and Methods: The present study consists of 180 long bones of lower limb (60 femora, 60 tibiae, 60 fibulae) which were taken from Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah (Amritsar), India and studied carefully for the number, position and distance of nutrient foramina in relation to length and from the proximal epiphysis of the long bones. Also the anteroposterior and lateromedial diameter of the bone at the level of nutrient foramen were studied. Main outcome measure: Variations in number, position and distance in relation to length and from proximal epiphysis of long bones was seen. Results: The nutrient foramen of femur was located on the linea aspera in 76.50% of cases(39% in interstice 9.5% on the lateral lip and 28.00% on the medial lip of the linea aspera), 18.50 %on the medial surface and 5%.on the lateral surface. Nutrient foramen of tibia was located in 95.50% of cases under the soleal line at the average distance of 119.8 mm from intercondylar eminence to the nutrient foramen, on the soleal line in 4%and on the lateral border in 0.50% of cases. Nutrient foramen of fibula was found on the posterior surface in 65 % of cases, in 15% on the medial surface, on the interosseous border in 10% ,on the lateral surface in 7% and on the posterior border in 3% of cases. Conclusion: This study will provide the ethnic data for comparison among various populations. It is also helpful in various surgical procedures and in interpretation of radiological images.

Prevalence of metallo- beta-lactamase-producing [MBL] Acinetobacter species in a tertiary care hospital

Acinetobacter causes a wide variety of illness in debilitated and hospitalized patients. Carbapenem resistance in Acinetobacter is an emerging problem and is a cause of concern as many nosocomial infections with Acinetobacter are resistant to most other antibiotics. The present study was aimed to study metallo-beta-lactamase [MBL] production in Acinetobacter species. During one year prospective study, all isolates of Acinetobacter obtained from various clinical samples like respiratory, pus, blood and others were included. Antimicrobial susceptibility testing was done by standard Kirby Bauer disk diffusion method. Metallo beta-lactamase [MBL] detection was done by imipenem-EDTA combined disk method. Among 1017 isolates, 964 were A. baumannii, 48 were A. lwoffii and 5 were A. hemolyticus. Out of these, majority of the isolates were obtained from respiratory samples, followed by pus. A. baumannii showed high level of resistance to cephalosporins, cotrimoxazole and piperacillin. A. lwoffii and A. hemolyticus showed lesser resistance to all antibiotics. Imipenem resistance was observed in 389 [40.3%] isolates of A. baumannii and MBL activity was seen in 80.3% of isolates.MBL positive isolates of A. baumannii showed higher resistance as compared to MBL negative isolates. This study demonstrated that multidrug resistant strains of Acinetobacter are common in tertiary care hospitals. Unwarranted and unrestricted usage of antibiotics is associated with emergence of resistance in nosocomial pathogens. Regular monitoring and documentation of carbapenem resistant is crucial in developing strategies to control infection due to these bacteria

The Proximal Femoral Nail - A Minimal Invasive Treatment for the Stabilization of Pertrochanteric and Subtrochanteric Femoral Fractures.

This study reports the outcome in pertrochanteric and subtrochanteric femoral fractures in 25 patients treated by using PFN. Salvati and Wilson hip function scoring system and Kyle's criteria were used for follow up evaluation. At the end of 24 weeks follow up the Salvati and Wilson hip function was 32 (out of 40) in 88% of patients, the Kyle's criteria described the outcome as good or very good in 92% of patients and the level of function was similar to pre-injury level in 90% of patients. Distal locking difficulty was encountered in 3 cases. Difficulty in placement of neck screw was encountered in 4 cases. Secondary varus was noted in 3 cases and in 1 patient antirotational screw cut through was seen.However all fractures united well in all the patients.PFN was designed by AO/ASIF in 1996 for the treatment of peritrochanteric fractures.It combines the intrinsic advantages of the intramedullary nail and those of sliding screw is a valid and an important option in the treatment of pertrochanteric and subtrochanteric femoral fractures. It is a relatively easy procedure, a bio mechanically stable construct and a minimally invasive device; especially ideal in compromised elderly patients who are the majority population suffering from these type of fractures.With incorporation of single helical blade in place of two proximal screws in PFN, AO/ASIF has further enhanced the treatment modalities by devising PFNA (Proximal Femoral Nail Antirotation).

Properties of concrete containing ground granulated blast furnace slag [GGBFS] at elevated temperatures

Normal strength [NSC] and high-performance concretes [HPC] are being used extensively in the construction of structures that might be subjected to elevated temperatures. The behaviour of concrete structures at elevated temperatures is of significant importance in predicting the safety of structures in response to certain accidents or particular service conditions. This paper deals with the mechanical properties of concrete made with ground granulated blast furnace slag [GGBFS] subjected to temperatures up to 350[degree]C. For this purpose, normal concrete having com-pressive strength of 34 MPa was designed using GGBFS as partial replacement of cement. Cylindrical specimens [150x300 mm] were made and subjected to temperatures of 100, 200 and 350[degree]C. Measurements were taken for mass loss, compressive strength, splitting tensile strength, and modulus of elasticity. This investigation developed some important data on the properties of concrete exposed to elevated temperatures up to 350[degree]C.

Diversity of genotype and mode of spread of hepatitis C virus in northern India

Hepatitis C is caused by hepatitis C virus [HCV], which is classified into 6 genotypes. It leads to chronic hepatitis in 80% of the cases. Genotype of the virus helps in predicting response to antiviral therapy and also the duration of treatment. Therefore, it is important to know the prevalence of each genotype. Knowledge regarding the route of entry of HCV in the blood is also necessary to formulate a strategy to prevent its spread. One hundred and two newly diagnosed patients with chronic hepatitis C, having anti-HCV antibody-positive were included in the study. Their HCV RNA viral load and genotype were determined by Reverse Transcriptase PCR assay on Roche Cobas Ampliprep analyzer. Genotype 3 was commonly detected in 58.8% patients followed by genotype 1 in 20.6%. Twelve patients had genotype 4 [11.8%] and 9 had mixed infection with genotypes 3 and 4. Among these patients, 43.1% of patients had a history of multiple injection exposure. Blood transfusion received by 6.9% and 2.9% had donated blood. Only 1 patient had a history of drug abuse. The distribution of genotypes varies in different regions and therefore its knowledge is important, as it determines the response of the patient to the treatment. The use of autodisabled syringes, their proper disposal, following biomedical waste management guidelines, and organizing continued medical education and workshops will help in preventing the spread of HCV infection

The role of Gardnerella vaginalis in nonspecific vaginitis in intra uterine contraceptive device users.

Two Hundred Forty patients who had Intra Uterine Contraceptive Device (IUCD) and manifested of nonspecific vaginitis were investigated for the presence of G. vaginalis. Pure growth of this organism was obtained in 14(5.8%) cases while 116(48.3%) cases showed this organism in association with other organisms e.g. Esch. coli (11.7%), Klebsiella (9.2%), Candida (9.2%), Strept. faecalis (7.3%), Proteus species (5.8%) and Staph. albus (5%).