Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda

Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.

Survey on the Quality of Life in Patients with Bronchial Asthma in an Outpatient Clinic in Malaysia.

Introduction: Bronchial asthma is one of the common diseases encountered by the physicians which leads to morbidity and mortality. Therefore it is important to know the quality of life in these patients. So that necessary measures can be taken to improve it. Objectives: To assess the quality of life in patients with bronchial asthma. Methodology: This was a cross sectional study conducted at a private clinic in Malaysia. Data was collected from 40 asthmatic patients. They were administered the mini asthma quality of life questionnaire developed by Professor Elizabeth Juniper. The Questionnaire tests four domains which includes symptoms, activity limitation, emotional function and environmental stimuli. The mean scores of 1-3.9, 4-4.9 and ≥ 5 indicated severe, moderate, mild limitations in the quality of life respectively. The data was analyzed using SPSS software (Statistical package for the social sciences). Results: The mean age of the patients was 32.7±15 yrs. We found that 70% of the patients were females. 60% of the patients had severe impairment in the quality of life. In the symptoms, emotional function and environmental stimuli domains 70%, 65% and 75% of the patients respectively had severe impairment in the quality of life, whereas in the activity domain it was only 27.5%. Conclusion: We conclude that most of the patients had severe impairment in the quality of life. It was seen that there was least impairment in the activity domain. Larger studies with more sample size is required to strengthen our findings.

Fulminant hepatic failure for herpes simplex virus.

Although exceedingly rare, fulminant hepatic failure in immunocompetent patients can develop with primary or recurrent infection due to herpes simplex virus. The diagnosis is frequently obscured by the absence of mucocutaneous involvement. Elevated transaminases with leucopenia and a relatively low bilirubin level may provide clues to the diagnosis. Here a female patient, 43 years, presented with the complaints of increasing jaundice, anorexia, nausea, vomiting for one week duration. She had hepatomegaly. Investigations revealed markedly raised transaminases and coagulopathy. Herpes simplex virus IGM (by ELISA) was positive. The immunocompetent woman was treated with acyclovir but the result was fatal.