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.

Admission To Medical Colleges- Predictive Validity Of Selection Criteria.

Background & objective: Appropriate selection criteria for admission to medical college is a fundamental prerequisite where number of aspirants seeking admission to medical college has increased. The selection criteria used by medical colleges has been changing from time to time and not uniform all over India. Hence it is important to validate the selection criteria by observing performance of students during medical course. The study aims to find predictive value of entrance test & science score obtained at HSC level on the performance of medical students in I MBBS University Examination. Methods: The study included marks obtained in science subjects at HSC level, Entrance and I MBBS University examination for four consecutive batches(2009 to 2012). Correlation between all three variables was found using spearman rank correlation. Results: Performance in I MBBS examination showed no correlation with Entrance score but correlated significantly with science scores at HSC level (p<0.001). Also on Linear Regression Analysis, only HSC score showed strong positive correlation with First MBBS score(p<0.001). Interpretation & conclusion: This study indicates that Entrance test needs revision. Either the test should be modified or several selection tools like giving additional weightage to science score at HSC level should be combined, so as to select the optimum standard students.

Correlation between difficulty & discrimination indices of MCQs in formative exam in Physiology.

Introduction: Difficulty index (P) and discrimination index (D) are the parameters used to evaluate the standard of multiple choice questions (MCQs) in examination. Accordingly the standard of MCQs can be interpreted as excellent, acceptable or poor. This study was intended to find out the standard of MCQs in formative examination in Physiology. The study also intended to find out correlation between P and D. Materials and Methods: There were 240 MCQ items, taken from the past 4 year batches of 100 students and were analyzed for level of difficulty and discrimination index. The relationship between them for each test item was determined by Pearson correlation analysis using SPSS 11.5. Results: There was a wide distribution of item difficulty indices (8.57 to 95.71) and discrimination indices (-0.54 to 0.8).The mean difficulty index (P) was 52.53 + 20.59 and mean discrimination index was 0.30+ 0.18. On average, about 23% of the MCQ items were easy (P >70%), while about 15% were difficult (P <30%). The remaining 62% items were within acceptable range (30 to 70%). In all 4% of the items showed negative discrimination and 21% of the items exhibited poor discrimination. The remaining 75% of the items were in the range of acceptable to excellent discrimination. The discrimination index exhibited slight positive correlation with difficulty index (r = 0.191, P=0.003<0.01). The maximal discrimination (D=0.6-0.8) was observed with moderately easy/difficult items (P = 40% - 60%). Conclusion: The majority (75%) of the items was acceptable as far as difficulty and discriminative indices were concerned. Moderately easy/difficult items had maximal discriminative ability. Too easy and too difficult items gave poor discrimination index. Negative discrimination was observed in only 4% of the items indicating faulty items or incorrect keys.

Evaluation and comparison of interleukin-8 (IL-8) level in gingival crevicular fluid in health and severity of periodontal disease: A clinico-biochemical study.

Background: Cytokines play an important role in the pathology associated with chronic inflammatory diseases. Because of pro-inflammatory and neutrophil chemotactic properties, the cytokines like interleukins (IL) may play a significant role in the pathogenesis of periodontitis. The biological effects of IL-8 are relevant in this regard. Aim: This study was done to compare the level of this molecule in gingival crevicular fluid (GCF) from patients with adult periodontitis (experimental group) and from individuals with clinically healthy gingival (control group). Materials and Methods: GCF was collected from patients with adult periodontitis and clinically healthy gingival for 30 s using a Periopaper strip and the volume of the sample determined. Following elution of the fluid, assays for IL-8 were carried out by enzyme-linked immunosorbent assay (ELISA). The concentration of IL-8 was calculated in the original volume of GCF on each strip. Results: The level of IL-8 in the experimental group was significantly higher than in the control group ( P < 0.01). The clinical parameters were positively correlated to IL-8, suggesting that the GCF IL-8 exhibited dynamic changes upon severity of periodontal disease ( P < 0.05). Conclusion: These data suggest that level of IL-8 is associated with periodontal status. The level of IL-8 in GCF is valuable in detecting the inflammation of periodontal tissue.

Assessment of cardiovascular response to treadmill exercise in normal healthy Indian adolescents.

The study aims to assess the cardiovascular response to treadmill exercise test in healthy Indian adolescents. A group of 50 healthy adolescents took part in the study. Cardiovascular response was assessed by using treadmill exercise test as per Bruce protocol. Pulse rate, blood pressure and ECG were recorded before, during and after undertaking the treadmill test. Mean age and body mass index (BMI) were 18.7±0.51 yrs. and 21.4±3.44 kg/m2 respectively. Karl Pearson Correlation analysis showed highly significant negative correlation between BMI and exercise time (r = –0.598, P<0.001) and between resting DBP and Exercise Time (r = –0.424, P<0.002). While BMI and DBP showed highly significant positive correlation (r = 0.463, P<0.001). During exercise pulse and SBP rose and DBP fell. SBP rose from mean 122 to 175 (rise by 53 mm of Hg) and DBP fell from mean 78 to 65 (fall by 13 mm of Hg). One min recovery pulse was 156 indicating 22% fall from target heart rate. All the parameters returned to near resting value at 6 min recovery. In 30% students DBP showed exaggerated response i.e. rise during exercise. These students had more BMI and higher resting DBP as compared to other students, which could be the reason for exaggerated response in these participants. In ECG there were no significant ST/T changes during exercise or recovery period. This study provides normal data for small sample of healthy Indian adolescents when subjected to treadmill exercise test.

Laboratory evaluation of Ssp I PCR assay for the detection of Wuchereria bancrofti infection in Culex quinquefasciatus.

BACKGROUND & OBJECTIVES: There is a need to delimit the areas of filariasis transmission in view of the Filariasis Elimination Programme launched in India. Infection rate in vectors is an important parameter in determining transmission and it is conventionally assessed by dissection and microscopy. A PCR assay based on Ssp I repeats of Wuchereria bancrofti has shown potential in the detection of infection in vectors. The aim of the present study was to evaluate the specificity and sensitivity of this assay on W. bancrofti and its vector, Culex quinquefasciatus, prevalent in India. METHODS: The DNA from pools of C. quinquefasciatus to which W. bancrofti microfilariae (mf) were added, was extracted by lysing with 0.1 M NaOH and 0.2 per cent sodium dodecyl sulphate (SDS), followed by silica absorption in the presence of guanidinium thiocyanate. The PCR assay of the DNA samples was carried out using NV-1 and NV-2 primers and the species specific SspI band was visualized on agarose gels stained with ethidium bromide. RESULTS: The Ssp I PCR assay was found to be highly species specific, as it did not detect the DNA of a closely related filarial parasite, Brugia malayi. The assay detected as little as 0.04 pg of W. bancrarofti DNA. Minimum number of parasite detectable in pools of mosquitoes was 1 mf. A pool size of 50 mosquitoes was found to be optimum for the PCR assay. INTERPRETATION & CONCLUSION: The Ssp I PCR assay was found to be highly specific and sensitive in detecting filarial parasite in pools of mosquitoes and therefore has potential application in rapid assessment of transmission of filariasis.

Long term follow-up of amebic liver abscess: clinical and ultrasound patterns of resolution.

A prospective study was undertaken to evaluate the clinical and sonographic patterns of resolution in amebic liver abscess (ALA). There were 146 patients of ALA attending the gastroenterology clinic of a tertiary care centre of whom 25 died. Of the remaining 121 patients, 107 were followed up for 20.9 +/- 11.4 months. 14 (11.3%) patients were lost to follow up before complete disappearance of the cavity. Complete disappearance of the cavity was seen in 84 (78.5%) and a reduction in volume to 50% at entry in 23 (21.5%). Abdominal pain, fever and hepatomegaly were the predominant forms of clinical presentation. On ultrasound, there were 121 cavities in 107 patients. The most frequent type of lesion was solitary, (96%) round cavity (80.4%) in the right lobe of liver (85%). Clinical and hematological parameters of resolution occurred rapidly (3.2 +/- 2.9 months). Sonographic resolution took much longer (9.6 +/- 6.8% months) in the 84 patients. The remaining 23 patients are on follow up. Three pattern of resolution were observed: Type I--where complete disappearance of the cavity occurred within 3 months (29.8%), Type II--where a gradual reduction and disappearance of the cavity occurred (64.3%) and Type III--where a rapid reduction till 25% of original cavity size remained and then a delayed resolution occurred (5.9%). There were no relapses in the patients on follow up. Factors that influenced healing time included the size of the abscess cavity at admission, hypoalbuminemia and anemia. The type of clinical presentation, nature of therapy, number or location of abscesses and time for clinical resolution did not influence the resolution time. None of the variables studied influenced the pattern of resolution. We conclude that rapid clinical resolution is common in patients with ALA. Sonographic resolution may be delayed and does not warrant additional or prolonged therapy.