Central Venous Catheter-related Blood Stream Infections: Incidence, Risk Factors and Associated Pathogens in a University Hospital ICU

Central Venous Catheters (CVCs) are indispensable in current intensive care treatment; also pose a greater riskof device related infections in comparison to any other type of medical device and are major cause of morbidity,mortality and increased expense. A cross sectional prospective study of one year duration was conducted inthe tertiary care University Hospital ICU located in the rural region of Haryana, India, to determine the incidenceof the central venous catheter related bloodstream infection (CRBSI), rate of catheter colonization and toidentify the associated risk factors and the microbial spectrum of CRBSI along with the antimicrobial sensitivitypattern of microbial isolates. Sixty patients with central venous catheter inserted and admitted under ICUhaving signs and symptoms of septicaemia post 48 hours of central venous catheter insertion were included.The rate of CRBSI was assessed by paired quantitative blood culture method in the CVC and peripheral vein.The CRBSI incidence was 16.67% and catheter colonization was found to be 53.3%. Methicillin-resistantstaphylococcus aureus and Acinetobacter baumanni were the predominant isolates. A statistically significantassociation of duration of catheterization with CRBSI was found. It is concluded that CRBSI incidence ishigh, with significant association of prolonged duration of catheterization with CRBSI. By knowing the changingtrends of microbial flora, empirical therapy can be formulated for early and effective management of CRBSI.

​Assessment For Performance Of Middlebrook 7h9 With Oleic-Albumin-Dextrose-Catalase Culture Media For Isolation Of Mycobacterium Tuberculosis In Ziehl–Neelsen Smear-Positive Sputum Samples In Clinically Suspected Cases Of Tuberculosis

Introduction: Pulmonary tuberculosis (TB) is a second foremost cause of death from a communicable disease, after the HIV.Being communicable should be diagnosed at the earliest. Smear examination is preliminary step for the confirm diagnosis, butculture is still a gold standard method.Materials and Methods: The present study was carried out in the Department of Microbiology on a total of 600 smear sputumsamples from clinically suspected cases of pulmonary TB attending the outpatient and inpatient departments of MMIMSR,Mullana, Ambala, from December 2016 to June 2018. Specimens were subjected to ZN and LED staining before and afterdecontamination. After microscopy, specimens were subjected to culture on LJ and Middlebrook 7H9.Results: Mycobacterium tuberculosis was isolated in 23.33% of samples. 110 (78.57%) were detected by microscopy (ZN andLED), respectively. ZN smear positivity before and after decontamination was maximum in mucopurulent 78% and 76.63% andLED 73.63% and 72.03%. Culture positivity on Middlebrook 7H9 was 100% while 87.85% on LJ media. The rate of contaminationwas 5% and 7% on Middlebrook 7H9 and LJ media, respectively.Conclusions: Middlebrook media was superior to the conventional LJ medium in being rapid, easy to use and interpret, andsignificantly low time-to-growth detection and had lesser contamination rate because the liquid media contains growth supplementoleic-albumin–dextrose-catalase, provides additional nutrition.

Bacterial Isolates and their Antibiotic Sensitivity Pattern in Clinically Suspected Cases of Fever of Unknown Origin.

The present study was conducted on 100 suspected cases of fever of unknown origin to identify the prevalence of predominant bacterial microorganisms and their drug sensitivity pattern. The blood samples were subjected to conventional blood culture and BACTEC 9050 culture system. Out of 100 suspected cases, culture positivity was seen in 46% cases with 80.43% pathogenic bacterial isolates comprising of 54.05% gram positive and 45.94% gram negative isolates. Predominant gram positive isolates were coagulase negative Staphylococcus 35% followed by 30% Staphylococcus aureus with sensitivity to vancomycin (100%) and resistance to ampicillin, cloxacillin & cefalexin. Gram negative isolates were Salmonella typhi (29.41%) followed by E coli (17.64%) showing sensitivity to piperacillin/tazobactum and cefoperazone/sulbactum (90%) each and resistance to amoxicillin. BACTEC 9050 was observed to be sensitive(100%) as compared to conventional blood culture(67.56%) for cultural isolation of pathogenic organisms in clinical specimens.

Extended-spectrum β-lactamase and AmpC β-lactamase Production among Gram-negative Bacilli Isolates Obtained from Urinary Tract Infections and Wound Infections.

Extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases continue to be a major problem in healthcare settings. Due to the scarcity of information regarding the antibiotic susceptibility patterns particularly from urinary tract infections (UTIs) and wound infections, the current study was carried out to assist the clinicians to prescribe appropriate antibiotics against gram-negative clinical isolates. In the current study, urine (n = 620) and pus (n = 228) samples were collected from different sites (at various clinical departments) and subjected to direct microscopic examination, culture and antibiotic susceptibility testing (AST). In the AST testings, the isolates that exhibited reduced zone of inhibition to one or more of the antibiotics such as cefotaxime (≤27 mm), ceftriaxone (≤25 mm), ceftazidime (≤22 mm), cefpodoxime (≤17 mm) and aztreonam (≤27 mm) were considered as potential ESBL producers and the ESBL production was confirmed using phenotypic screening test (doubledisk synergy test) and phenotypic confirmatory test (combined-disk test). However, isolates showing resistance or decreased sensitivity to cefoxitin, cefotaxime, ceftriaxone, ceftazidime, cefpodoxime or aztreonam and sensitive to cefepime were considered as a screen positive AmpC producer and subjected to AmpC disk tests. The current study concluded that 72.41% and 21.76% of ESBL and AmpC producers were detected, respectively in our hospital. It was also observed that the double-disk synergy and combined-disk tests were equally effective for ESBL detection. Further, AmpC disk test is simple, easy to perform and interpret, requiring less expertise for the rapid detection of AmpC isolates.

Extrapulmonary Tuberculosis In M.M.I.M.S.R, Muallana Ambala: A Microbiological & Histopathological Study.

Clinical microbiological and histopathological confirmation plays a key role in the diagnosis of tuberculosis. The present study correlates Zeihl Nelson staining , Lowenstein Jensen culture media, Montoux test and histopathology in the diagnostic yield of extrapulmonary tuberculosis.Result of current study shows out of total 255 samples, 24 (9.4 %.) showed the presence of mycobacteria by either of the following methods: LJ culture media, ZN staining, histopathology and montoux test.