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Background: SARS-CoV-2 infection poses tremendous challenge to the healthcare system of nations across the globe.Healthcare workers (HCWs) are crucial to the ongoing response to the SARS-CoV-2 pandemic. During the course of their work, they are exposed to hazards that place them at the risk of infection. Serological testing for SARS-CoV-2 among healthcare workers, which form a high risk group helps in identifying the burden of hidden infection in an institutional setting. The present study aims to investigate the seroprevalence of IgG antibodies against SARS-CoV-2 among HCWs during 1stand 2ndwave.Material & Methods:A prospective study was conducted at Viral Research and Diagnostic Laboratory, Government Medical College, Amritsar during JuneJuly2020 (1stwave)and April May 2021(2nd wave). During this period, 184 blood samples were collected from healthcare workers from Government Medical College and Hospital, Amritsar. Serum was separated and used for detection of Anti-SARS-CoV-2 IgG antibodies by ELISA technique.Results:Out of the 184 samples, 79 (42.9 %) were found to be seropositive. Higher seropositivity was seen i.e 60.8 % during the 2ndwave (April-May 2021 ) as compared to 25% during 1st wave. The increase in seroprevalence was observed in almost all categories of HCWs, Doctors 44.4% vz 13.04%, nurses 54.8 % vz 34.7 %, lab technicians 72% vz 30.4 % and housekeeping staff 72.2 % vz 21.7%. Also the unvaccinated HCWs showed higher seroprevalence during the second wave and 87.5 % of vaccinated HCWs had demonstrable IgG antibodies.Conclusions:High seropositivity was observed among healthcare workers due to their nature of work. Rise of seropositivity among unvaccinated HCWs during 2ndwave concludes that increase in seroprevalence was attributable to natural infection.The vaccine’s immunological response was also highlighted in the study.
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Background: The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge for healthcare systems worldwide. Earlier to SARS-CoV pandemic, coronaviruses were only thought to cause mild, self-limiting upper respiratory tract infections in humans. COVID 19 presents across a spectrum of symptoms. WHO recommends detection of unique sequences of virus RNA by Nucleic Acid Amplification Test (NAAT) such as real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). The aim of this cross sectional study was analysis and confirmation of Nasopharyngeal/oropharyngeal swab specimen by real-time reverse transcription polymerase chain reaction (RT-PCR).Material & Methods:This was a cross-sectional retrospective study that reviewed records of samples collected from June 2021 to March 2022. Nasopharyngeal/oropharyngeal swab specimen were collected from suspected COVID-19 subjects of various districts of Punjab and referred to Viral Research Diagnostic Laboratory [VRDL], Government Medical College [GMC], Amritsar for laboratory analysis and confirmation by real-time reverse transcription polymerase chain reaction (RT-PCR).Results:During the present study, a total of 11,27,005 samples were analyzed from June 2021 to March 2022 for SARS-CoV-2 detection by ICMR approved COVID-19 RT-PCR kits. Out of total 11,27,005 cases, 24,466 cases (2.17%) were found to be SARS-CoV-2 positive while 11,02,539 cases (97.83%) were SARS-CoV-2 negative.Conclusions:Ever since the COVID-19 global pandemic emerged, the developing countries are facing challenges regarding its diagnosis. Isolation of the infected person will eventually decrease the Reproduction number i.e Ro which will further interrupt the transmission cycle leading to decrease in community spread.
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Background: COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. After a December 2019 outbreak in China, the World Health Organization identified SARS-CoV-2 as a new type of coronavirus. Currently, WHO recommends detection of unique sequences of virus RNA by rRT-PCR. ICMR also recommends use of CBNAAT using Cepheid Xpert Xpress SARS-CoV2. The aim of this study is to determine the prevalence of SARS-CoV-2 detected through CBNAAT.Material & Methods:This retrospective study was conducted from July 2020 to December 2021 at VRDL, GMC, Amritsar. The study group consisted of all the patients presenting with symptoms of Influenza Like Illness (ILI) and Severe Acute Respiratory Illness (SARI) who presented to hospital. The data was collected and subjected to statistical analysis.Results:During the present study, a total of 1,259 samples were analyzed for SARS-CoV-2 by CBNAAT from July 2020 to December 2021. Out of total 1,259 cases which were included in the study, 327 cases (25.97%) were found to be SARS-CoV-2 positive while 870 cases (69.10%) were SARS-CoV-2 negative and 62 cases were found to be inconclusive. 62 inconclusive samples were further tested by RT-PCR. Out of which, 15 were RT-PCR positive and 47 were RT-PCR negative.Conclusions:The COVID-19 pandemic has put forward unprecedented challenge to the public health system across countries to prepare themselves for this current crisis which included isolation, contact tracing, quarantine and enforcement of a nation wide lockdown starting 25th March, 2020.
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Background: Severe acute respiratory illness due to SARS-CoV-2 represents great global public health concern. The spectrum of disease ranges from mild to life-threatening. Surveillance of hospitalized patients with severe acute respiratory infections (SARI) is an important public health tool used to identify etiologies to understand the disease, track changes in circulating viruses and as an alert mechanism for potential pandemic viruses. We aim to find out the rate of SARS-CoV-2 positivity in SARI cases and further study the epidemiological and clinical characteristics of patients.Material & Methods:A Prospective study was conducted on 200 Severe Acute Respiratory Illness patients admitted at tertiary care hospital. The clinical, demographic, epidemiological, risk factors / co-morbidities of all the patients were recorded. Oropharyngeal and nasopharyngeal samples were collected and tested for SARS-CoV-2 by real time reverse transcriptase (RT-PCR) test.Results:Out of 200 SARI patients, 51 (25.5%) were tested positive for SARS-CoV-2. Maximum cases (54.90%) were in the age group of 41-60 years; males were infected predominantly (52.94%). The most common symptoms of presentation were fever (100%), cough (86.27%), dyspnoea (82.35%) and sore throat (56.86%). Comorbidities associated with COVID-19 were Hypertension (56.86%), Diabetes Mellitus (33.33%), Chronic Obstructive Pulmonary Disease (13.72%) and Coronary Artery disease (9.8%). More than 30% of the patients were admitted in ICU and 9.80% received mechanical ventilation.Conclusions:Evaluation of clinical and epidemiological profiles of SARI patients can help in understanding and managing the outbreak more efficiently. Close monitoring and quarantine will be required to prevent extensive transmission within the community.
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Background: Staphylococcus is notorious for its ability to become resistant to antibiotics. MRSA emerged as nosocomial pathogen in the early 1960. Methicillin Resistant Staphylococcus aureus are implicated in serious infections and nosocomial infection outbreaks, thus limiting the treating options to very few agents such as vancomycin and teicoplanin. Vancomycin has been regarded as the first line drug for the treatment for MRSA but its irrational use lead to emergence of vancomycin resistance. The Aim was to determine the prevalence and resistance of MRSA ,VRSA,VISA isolates from various clinical samples in a tertiary care hospital.Material & Methods:This present prospective study was done in the Microbiology department of Government Medical College. The study was conducted for a period of one and half year i.e from January 2019 to June 2020. All the samples (pus, urine, blood, body fluids, sputum etc) were processed as per standard protocols.Results:Out of 26,471 samples, 6578(24.85%) were found to be culture positive. 1583 isolates were identified as Staphylococcus aureus. Among them 1278(80.7%) were MRSA, 21(1.3%) were VISA and 8(0.5%) were VRSA. Maximum number of MRSA isolates were obtained from orthopaedics ward (22.7%) and Intensive Care Unit and most of them were isolated from pus(45%) followed by blood (19.09%)samples. Among them highest resistance were observed against azithromycin (85.6%), followed by ciprofloxacin (63.5%) and least resistance to rifampicin and doxycycline. Majority of the VISA and VRSA strains were isolated from ICU followed by orthopaedics, surgery. Most of them were isolated from pus followed by blood and urine specimen and most were found to be multidrug resistant while they retained their sensitivity to Linezolid and Teicoplanin.Conclusions:As there is high prevalence of MRSA isolates so the treatment options are limited to vancomycin. Overuse of vancomycin can lead to emergence of VRSA strains. So the need for rational use in the infection-control practices to prevent transmission of MRSA as well as VISA strains. Strict implementation of hand hygiene, decolonization of MRSA carriers,and education of healthcare team will be quite helpful.
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Background: Coronavirus disease?19 (COVID?19), produced by the severe acute respiratory syndrome coronavirus 2 (SARS?CoV?2), has become a global pandemic, giving rise to a serious health threat globally. Many countries have seen a two?wave pattern in there reported cases during the period of pandemic. Similarly, our country has reported the first peak between March and October 2020 followed by the second peak between April and June 2021. Objectives: The objective of this study was conducted to describe the spatiotemporal patterns and early epidemiological features of COVID?19 cases from November 2020 to May 2021 in the central (Majha) region of Punjab state of India which was considered as the epicenter of the infection. Methods: The multiplexed real?time reverse transcription–polymerase chain reaction (RT?PCR) method was used to detect SARS?CoV?2, with co?amplification of specific target genes using real?time PCR kits. Results: During the second wave, test positivity rate for COVID?19 in our laboratory (the central region of Punjab) was recorded as 4.8%. The study revealed that an increased sustained proportion of COVID?19 incidence is present in young adult age group (20–39 years) with 8.65% positive rate followed by the older age group and least in young ones. It was observed that during the second wave, more symptomatic individuals are positive (10.26%) alongside it was also observed that male population (5.61%) was more prone to infection in comparison to females (3.78%). Whole?genome sequencing carried out on 120 random samples selected from all the districts of Majha region of Punjab state showed two prominent strains, namely alpha variant (95 cases) and delta variant (19 cases). Conclusion: A higher positivity rate in the second wave demonstrates the rapid spread of the new emerging virus variants and warrants the implementation of strict vaccination regimes and quarantine in the affected region.
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Introduction: Enterococci are indigenous flora of theintestinal tract, oral cavity & genitourinary tract of human.Over recent years, there is increased interest in Enterococcinot only because of their serious infections but becauseof their increasing resistance to many antimicrobials.Vancomycin being the only alternative available. But over thetime, there has been increase in Vancomycin Resistance whichhas spread globally. The aim of this study was to determinethe prevalence of Vancomycin Resistant Enterococci (VRE)isolated from various clinical specimens in a tertiary carehospital in North India.Material and methods: A cross-sectional study was conductedin the Department of Microbiology, Government MedicalCollege, Amritsar from July 1st, 2018 to June 30th, 2019. Allthe samples received were processed and identification ofEnterococci was made by using standard microbiologicaltechniques. Antimicrobial susceptibility was performed byKirby Bauer disc diffusion method as per CLSI guidelines.Results: Out of total clinical samples (11,098), 3,551 (31.9%)were found to be culture positive. Among the culture positive,91 (2.56%) isolates were identified as Enterococcus speciescomprising of 37 E.faecalis (41%) and 54 E.faecium (59%).Maximum number of Enterococci were isolated from urinesamples (54.92%) followed by pus & body fluids (38.02%) andblood (7.04%). 9.52% of E.faecium isolates were found to beresistant to vancomycin. All the strains were 100% susceptibleto Linezolid, Teicoplanin & Quinupristin-dalfopristin.Conclusion: Enterococci have become the major pathogenicbacteria that cause hospital-acquired infections due tomultiple-antimicrobial resistance. VRE has emerged asimportant nosocomial pathogen and pose serious threat topatients. Vancomycin should be cautiously used else wewould be left with very few therapeutic options.
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Introduction: Staphylococcus species is an asymptomaticcolonizer which has exhibited increasing resistance to variousantimicrobial agents in the recent times. Although, theorganism was naturally susceptible to all the antimicrobialagents, it has acquired multi drug resistance via variousmechanisms. In view of rising prevalence antimicrobialresistance, this study was undertaken to study the prevalenceof methicillin resistance and the emergence of linezolidresistance amongst the Staphylococcal isolates obtained fromvarious clinical samples in a tertiary care hospital.Material and Methods: This study was conducted from July2017 to December 2018 in a tertiary care hospital. Clinicalspecimens were processed, and Staphylococcal isolateswere identified using standard microbiological techniques.Antimicrobial resistance pattern of all the Staphylococcalisolates was determined and interpreted as per the latest CLSIguidelines.Results: A total of 989 Staphylococcal isolates were obtainedamongst which 498 (49.44%) were found to be methicillinresistant. Highest antimicrobial resistance was observedto beta lactam antibiotics followed by azithromycin andfluoroquinolones. 26 (2.628%) strains of Staphylococcalspecies were found to be resistant to linezolid while theyretained sensitivity to Vancomycin.Conclusion: The emergence of drug resistance in variousmicroorganisms has been a cause of global concern. Risingtrend of resistance has been observed to methicillin andlinezolid especially in indoor patients of the Intensive careunits. This study highlights the high prevalence of Methicillinresistance in both Staphylococcus aureus and Coagulasenegative Staphylococcus species in a tertiary care hospital inAmritsar, India. Although, linezolid resistance is emerging at aslow pace, adequate measures must be undertaken to preservethe therapeutic armoury.
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Introduction: Bacterial resistance to antibiotics has beena recognized reality almost since the dawn of the antibioticera, but only within the past twenty years has the emergenceof dangerous, resistant strains occurred with a disturbingregularity. Objective: Prevalence of carbapenem resistantGram negative organisms in a tertiary care hospital of NorthIndia.Material and methods: Various clinical specimens collectedfrom indoor and OPD were processed. Identification of theGram negative organisms and carbapenem resistance wasdone by standard bacteriological techniques. All isolates weredetected for carbapenemase production by Carba NP test.Results: Out of 1670 samples, 935 (55.99%) were found to beculture positive of which 485 (51.87%) were Gram negativebacteria. The prevalence of carbapenemase producing Gramnegative bacteria was 58 (11.96%).Conclusion: Determing carbapenem resistance pattern andconfirmation of carbapenemase production can improviseupon the usage of antimicrobials which will further help inreducing the burden of antimicrobial resistance.
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Introduction: Antimicrobial resistance is a cause of globalconcern as resistance is emerging enormously in hospitaland community settings. The occurrence of resistance tocephalosporins due to production of Extended SpectrumBeta- Lactamases is known worldwide. Hence, this studywas undertaken to detect the prevalence and antimicrobialresistance pattern of ESBL-producing gram-negative bacteriaisolated from various clinical samples received from theindoor patients of a tertiary care hospital.Material and Methods: Clinical specimens received fromthe patients admitted in Guru Nanak Dev Hospital, Amritsarfrom January 1, 2018 to June 30, 2018 were included inthe study. The samples were processed based on standardmicrobiological techniques. ESBL screening and confirmationwere done based upon CLSI guidelines. Antimicrobialresistance pattern of ESBL producing gram negative bacteriawas determined.Result:- A total of 8147 samples were received out of which1061(13.02%) gram negative bacteria were isolated. 227(21.97%) of the gram negative isolates were positive onscreening and 107 (10.08%) were confirmed to be ESBLproducers phenotypically. Maximum antimicrobial resistancewas observed to ciprofloxacin and amikacin. All the isolateswere sensitive to sulbactam ceftriaxone and imipenem.Conclusion: The present study highlights the prevalenceof ESBL-producing gram negative bacterial isolates in atertiary care hospital in Amritsar, Punjab. Measures such asthe establishment of antimicrobial stewardship activities,monitoring surveillance and infection control programmes,emphasizing on effective hand hygiene practices together withcoherent antibiotic policies should be enforced in the hospitalsto arrest the spread of ESBLs
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Background: Early diagnosis of urinary tract infections (UTIs) is essential to avoid inadequate or unnecessary empirical antibiotic therapy. In this study, we evaluate the coincidence rate between conventional method for the diagnosis of UTIs (plate cultures and identification based on biochemical characteristics) and a fast method based on Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). In recent years, proteomic techniques have achieved a relevant role in the identification of microorganisms in the field of clinical microbiology. MALDI-TOF MS has been suggested as a fast and reliable method for bacterial identification.Methods: Around 50 midstream urine samples submitted to Microbiology laboratory for Gram staining and bacterial culture were analyzed. Samples were microscopically tested, characterized, and identified using different media such as blood agar and Mac Conkey agar and by applying suitable biochemical tests. Urine specimens showing a significant bacteriuria on culture and single morphological type by Gram staining were then processed by MALDI-TOF MS.Results: Of 50 specimens, colony growth was observed in 43(86%) specimens, and 38(88.3%) specimens had growth of single-colony morphological type in culture. 32(84.2%) of them had colony counts of >105 colony forming units (CFUs)/ml. 7(14%) samples were negative in culture, and all of them were also negative by MALDI-TOF MS. Microorganism identifications in this group were coincident at the species level in 28(87.5%) specimens. The most frequent microorganism identified was Escherichia coli, followed by Klebsiella species and Acinetobacter baumanii. MALDI-TOF MS identified Providencia stuartii in 3 samples and Pseudomonas putida in 1 of them; which were not in accordance with the conventional method used for identification.Conclusions: Present study results show that MALDI-TOF MS allows bacterial identification from infected urine in a short time, with high accuracy, and especially when uncommon uropathogens are involved.
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Ludwig angina is a rapidly progressing submaxillary, submandibular, and sublingual necrotizing cellulitis of the floor of the mouth that can have lethal consequences due to airway obstruction Various aerobic and anaerobic microorganisms, and less often fungi, have been implicated to cause Ludwig angina, including oral flora such as Streptococci and Staphylococci. Early recognition and use of parenteral antibiotics can prevent mortality and morbidity. We report a case of 30 years old male who was admitted to hospital with chief complaints of neck swelling, toothache, dysphagia and difficulty in opening mouth. Blood counts showed leukocytosis with neutrophilia along with raised ESR. Pus was drained after incision in submental and submandibular space and was transported to Microbiology department for further processing. Gram staining of pus showed many pus cells, spirochetes and fusiform shaped bacilli.
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Background: Acinetobacter has gained importance as an emerging multi drug resistant nosocomial pathogen among non fermenting aerobic gram negative bacteria, especially in intensive care units. This organism is contributing to increased morbidity and mortality with strong propensity to colonize and disseminate among humans and environmental sources. Materials and Methods: A retrospective observational study was conducted from February 2013 to December 2013. Various clinical specimens received in microbiology laboratory from inpatients and outpatients were studied including their antimicrobial resistance pattern. A total of 111 Acinetobacter species isolates were included in the study. Associated risk factors were recorded from the clinical data which included demographic characteristics of the patient along with the indoor department, period of stay in ICU and hospital, presence of indwelling devices, antimicrobial therapy, surgical interventions, focal or generalized infections and underlying chronic morbid diseases. Results: In current study maximum number of Acinetobacter was from urine specimen (57.66%) followed by blood (25.23%). Among inpatients highest percentage of isolates was recovered from general surgical ward (26.88%) followed by intensive care units (24.73%). The number of MDR & XDR isolates recovered was 21(18.92%) & 11(10%) respectively. Imipenem, Meropenem and Doxycycline remained efficacious drugs against Acinetobacter infections with resistance rates of 18.02%, 30.63% and 36.94% respectively. The study revealed focal/generalized infections, indwelling devices, duration of stay in ICU & hospital, mechanical ventilation as significant risk factors in decreasing order for acquisition of MDR and XDR Acinetobacter but according to the statistical analysis only Diabetes mellitus was found to be significant (p value 0.019) whereas all other factors remained insignificant ( p value > 0.05). Conclusion: Prolonged usage of indwelling devices & medical equipments in critically ill patients along with longer duration of hospitalization can facilitate colonization and infection with Acinetobacter which is otherwise a low virulence pathogen. Strict compliance of disinfection policy and infection control programme with rational use of antibiotics especially carbapenems in Acinetobacter infections shall help in curtailing drug resistant strains from further dissemination.