ABSTRACT
Context: Ventilator-associated pneumonia is the second most common complication among all types of nosocomial infections. Mechanical ventilation predisposes to formation of a biofilm which worsens the prognosis because of increased multidrug resistant isolates implicated in formation of biofilm. Aim of the Study: The study was conducted to find out the relationship between duration of mechanical ventilation, biofilm formation, and antibiotic resistance among VAPpathogens. Study Design and Methods: A descriptive analytical study of 150 clinically suspected VAPpatients was done. Patients were divided into Group I and II based on intubation duration for 1–5 days and more than 6 days, respectively. Endotracheal aspirate was collected from clinically diagnosed cases and processed as per standard microbiological techniques. Bacterial counts ? 106 CFU/ mLfor quantitative cultures were considered significant. Biofilm production was detected by tissue culture plate method. Multivariate analysis was done to find out the association of the various factors. Results: Klebsiella pneumoniae was the predominant bacteria isolated followed by Acinetobacterbaumannii. Among Gram negative bacteria 66.8% were ?-lactamase producers. In biofilm production by tissue culture method, Group I patients, 72.4% of the isolates showed either strong / moderate biofilm formation and in Group II patients, 92.3% of the isolates showed either strong / moderate biofilm formation. Multivariate analysis revealed that bacteria isolated from VAPoccurring after 5 days of mechanical ventilation among prior antibiotic-treated patients were resistant to all the antibiotics tested. Conclusion: Bacterial aetiology, prolonged intubation, biofilm formation, and drug resistance have ramification on outcome of VAP. Hence removal of ET tube in regular intervals should be considered with a proper choice of antimicrobial treatment or using ETtube coated with drugs/ biomaterials that discourage biofilm formation may be explored.
ABSTRACT
The co-circulation of multiple dengue virus serotypes has been reported in many parts of the world, including India; however, concurrent infection with more than one serotype of dengue virus in the same individual is rarely documented. An outbreak of dengue hemorrhagic fever/dengue shock syndrome [DHF/DSS] occurred in and around Davangere, Karnataka, from June 2011-March 2012. This is the first report from India with a high percentage of concurrent infections with different dengue virus serotypes circulating during one outbreak. Acute phase sera from patients were tested for the presence of dengue virus RNA by RT-PCR. Of the 72 samples tested for dengue virus RNA, 42 [58.3%] were positive. All four dengue virus serotypes were found to be co-circulating in this outbreak, and DENV-2 was the predominant serotype. In addition, concurrent infection with more than one dengue virus serotype was identified in 18 [42.9%] dengue virus-positive samples. Our study showed that serotype DEN-2 was dominant in the positive dengue virus-infected samples; the other serotype present was DEN-3. This is the first report of concurrent infections with different dengue virus serotypes in this part of the world
Subject(s)
Humans , Female , Male , Coinfection , Dengue , Dengue Virus/classificationABSTRACT
It has been shown that inhalation of carbonaceous particulate matter may impair lung function in children. Using the carbon content of airway macrophages as a marker of individual expo-sure to particulate matter derived from fossil fuel, we sought direct evidence for this associa-tion. 300 children from puffed rice industrial areas and 300 children from population living in green zone were selected randomly. Airway macrophages were obtained from healthy children through sputum induction, and the grading of ultrafine carbon particles in airway macrophages was measured. Pulmonary function was also measured by spirometry. Pulmonary function tests showed that in industrial area 42.6% and 20.3% of children had moderate obstructive airway disease and restrictive airway disease, respectively. In the green zone area, 7% of children had obstructive airway disease and 6% had restrictive airway disease. Evaluation of airway macrophages for ultrafine carbon particles revealed that in industrial area there were ultrafine carbon particles of grade 2 in 23% of subjects and grade 3 in 8.33% of individuals with obstructive airway disease. In the green zone area, the rates were 1.67% and 0.7%, respectively. The study provides a first evidence of the strong association between air pollution and development of airway diseases. Carbon particles in the sputum can be used as a marker for air pollution