ABSTRACT
Background: Peripherally inserted central catheter (PICC) have become essential for a safe and reliable long term venous access in all neonatal intensive care units (NICU) for providing long term intravenous fluids and medications. However, they associated with central line blood stream infections (CRBSI) infections and it is postulated that this risk is more on during their removal but the true incidence is not known. The objective was to evaluate the incidence and identify risk factors associated with CRBSI following the PICC removal in preterm neonates.Methods: This was a retrospective cohort study was done on <37 weeks premature neonates. Data included patient particulars, location of PICC placement, days of PICC, antibiotics and TPN through PICC, infections noted during or within 48 hours of PICC removal.Results: A total of 238 PICC removals in 215 neonates were analysed which did not show a significant difference in the prevalence of CRBSI within 48 hours of PICC removal. However, there was an increase in odds for sepsis following PICC removal in less than 29 weeks gestation and if it was not used for antibiotic infusion for more than 48 hours preceding its removal.Conclusions: This study does not support the use of prophylactic antibiotics during PICC removal in neonates as there was no increase in the incidence of CRBSI following PICC removal. However, they may have a role in very low gestation age, low birth weight infants who have not recently received antibiotics prior to PICC removal.
ABSTRACT
High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE) are two dreaded altitude emergencies which can independently lead to complications. Two cases of suspected comorbid HACE and HAPE were managed at 5800 m/19000 ft in Karakoram Himalayas. Altitude acclimatization, purported to prevent high altitude illness, may not be protective. Comorbid HACE and HAPE at extreme altitude may present atypically necessitating high index of suspicion and prompt clinical decision making in challenging situations. One man HAPE bag/PHC is an excellent temporary measure in cases of delayed descent/evacuation. Due attention to extreme altitude emergencies is required in view of increased recreational, scientific and military activities at extreme altitude.
ABSTRACT
Objective: Renal transplantation is frequently complicated by bacterial infections in the scenario of immunosuppression, altered metabolism and interventions resulting in prolonged morbidity. Subdued clinical presentation, antimicrobial resistance and toxicity question the outcome of transplantation. This retrospective study conducted at tertiary care apex transplant centre highlights colonization, clinical infection and antimicrobial resistance patterns in Renal Transplant Recipients (RTR). Materials and methods: Infection and antimicrobial resistance patterns in 130 RTR were studied. Clinico-demographic and transplant parameters were noted. Infection screening in the post transplant period along with antimicrobial susceptibility were used to analyze data in a post transplant time frame. Results and discussion: Culture positivity timeline was dominated by post surgical infections in the first week post transplant. Urinary infections followed by blood stream infections were noted. Infection profile included simultaneous polymicrobial, prolonged and widespread infections. Multi-resistant organisms producing beta lactamases and extended spectrum beta lactamases were isolated. Conclusion: Transplant recipients remain prone to bacterial infections with multi-resistant organisms which may persist due to immunosuppression, altered metabolism and toxicity, and contribute to nosocomial hazard. Infection control may be targeted at avoidance of donor derived infections, surgical complications, epidemiologic exposures, strengthening antimicrobial prophylaxis and anti-infection engineering. Antimicrobial stewardship, outbreak and epidemic preparedness should be ensured.
ABSTRACT
Background & objectives: Extended-Spectrum Beta-Lactamases (ESBLs) is an important resistance mechanism in Enterobacteriaceae infections. Lack of standard guidelines from Clinical Laboratory Standards Institute (CLSI) for Amp C beta-lactamase detection poses a problem. This study was undertaken to detect ESBLs by phenotypic tests and Amp C beta-lactamase by inhibitor based method. Material and Methods: 200 consecutive non-repetitive isolates of E.coli, Klebsiella and Proteus from clinical samples were screened for ESBLs as per CLSI guidelines and confirmed by PCDT, DDST and E-tests (AB Biodisk, Biomerieux). Amp C beta lactamases were screened by cefoxitin resistance and confirmed by inhibitor (Cloxacillin) based method. Simultaneous occurrence of Amp C and ESBLs was detected by combined disk test (Neo-Sensitabs and Diatabs). Descriptive and Kappa statistics were used. Results: Out of 200 isolates studied, 131 were initially screened as ESBL producers and later 114 (57%) were confirmed by phenotypic methods. E-Test was found most sensitive phenotypic test as compared to PCDT and DDST. 13 strains resistant to cefoxitin (30μg) were found to be pure Amp C producers. Combined disk test detected 36 to be ESBL and Amp C co-producers. Surprisingly, six isolates found sensitive to cefoxitin disk were confirmed as Amp C producers by cloxacillin disk inhibition test. Conclusion: 57% ESBLs and 27.5% Amp C producers were isolated from nosocomial pathogens showing significant resistance to 3rd generation cephalosporins. Phenotypic confirmation by E-test, PCDT & DDST were useful for ESBL identification and for detection of Amp C, cloxacillin was found to be an effective inhibitor.