Ventilator associated pneumonia: unravelling prevalence risk factor and antibiotic usage

Background: Hospital acquired infections, are a leading cause of mortality and morbidity. Ventilator associated pneumonia, one of the hospital acquired illnesses. The purpose of this study was to evaluate the prevalence, risk factors, causative organism, and antibiotic usage for the treatment of ventilator-associated pneumonia. Methods: Between May 2022 and October 2022, 50 patients participated in an ambispective and observational study conducted across several ICU departments at Adichunchanagiri Hospital, BG Nagara, Karnataka. Reviewing and evaluating daily patient case sheets, laboratory results, and treatment charts of participants who were hospital inpatients provided pertinent data needed for the study. Volunteers were enrolled after taking consent from each of them, a suitably designed data collection form was used to collect all the necessary information. Microsoft Excel was used to enter the data. Version 28 of SPSS was used to analyze the data. Statistical significance was determined by using a P-value of less than 0.05. Results: The study included 50 patients and discovered a 60% prevalence of ventilator-associated pneumonia in the general community. Staphylococcus aureus accounted for 26.7% of all gram-positive bacteria, whereas Enterobacter and Klebsiella species accounted for 16.7%. Metronidazole was given in 64% of instances, with accidents being the most frequent risk factor (40%). Conclusions: Within the specified population, the incidence of ventilator-associated pneumonia is 60%, with Staphylococcus aureus identified as the most predominant bacterial pathogen. Metronidazole is the most frequently prescribed antibiotic, and accidents are the key risk factors that cause ventilator-associated pneumonia.

Prevalence, risk factors, causative organism and antibiotic susceptibility of catheter associated urinary tract infections

Background: The most common nosocomial infection is catheter-associated urinary tract infection (CAUTI), with a 3-7% daily risk of developing CAUTI in acute care settings. This study's goal was to identify the prevalence, risk factors, causative organism of CAUTI and understanding the organism's current antimicrobial agent sensitivity profile. Methods: Total 120 patients participated in a prospective and observational study conducted at Adichunchanagiri Hospital, Karnataka. Reviewing and evaluating patient case sheets, laboratory results, and treatment charts of participants who were hospital inpatients provided data needed for the study. Microsoft Excel was used to enter the data and version 28 of SPSS to analyze the data. Statistical significance was determined by using a P-value of less than 0.05. Results: It was discovered that 12.5% of HAI cases were linked to catheter use. The most prevalent microbial agent in the current investigation was E. coli (41.7%). According to the current study, women are more likely than men to get UTIs. An underlying medical condition was found to have a strong correlation with UTIs in the current investigation. For CAUTI, drug resistance to cefotaxime and tigecycline was noted. Conclusions: The study suggested that gender, age extremes, use of antibiotics, length of stay in intensive care unit, diabetes mellitus, immunosuppressive medication, and indwelling urinary devices are the major risk factors for CAUTI. E. coli was the most common microbiological agent in the current study. Therefore, to assist doctors in the treatment and management of CAUTIs, ongoing surveillance of antimicrobial resistance patterns is required.

Carbapenem-resistant enterobacteriaceae screening: A core infection control measure for critical care unit in India?

Background: Infection/colonization due to carbapenem-resistant enterobacteriaceae (CRE) are emerging as an important challenge, particularly in high risk patients due to widespread use of Carbapenems. Therefore, preventing both CRE infections and their transmission has become an important infection control objective. Aims and Objective: Determine the proportion of asymptomatic carriers of CRE among patients admitted to our critical care unit (CCU) from the community and other health care facilities. Enumerate risk factors and guide implementation of infection control interventions. Methods: This prospective surveillance study was done in a 24 bed CCU of a tertiary care hospital, at Chennai, India between August2017 through December 2017. Patients were screened based on a composed questionnaire framed from Centers for Diseases Control and Prevention CRE tool-kit. Two rectal swabs were collected from each patient. They were processed in microbiology laboratory. Results: A total of 102 patients were included. CRE colonization were identified in 8 (7.8%) of the total samples. Among 8 CRE colonized patients 3 (37.5%) patients developed systemic infection. Patients who were exposed to high end antibiotic and past history of surgery had significant association with CRE colonization of (P = 0.0029) and (P = 0.0167) respectively. Conclusion: Overall CRE colonization rates among our CCU patients were found to be low. Risk factors associated with CRE colonization were high end antibiotic exposure and surgery in past 90 days. Hence rectal screening should be a risk factor朾ased active surveillance. Association of systemic infection among CRE colonizers was more significant. This study led us to modify our infection control practices in CCU.

Immunogenicity study of Haemophilus influenzae type B conjugate vaccine in Indian infants.

OBJECTIVE: To assess the immunogenicity in Indian infants to Haemophilus influenzae b oligosaccharide conjugate vaccine (HbOC). DESIGN: Prospective multicenter study. SETTING: Pediatric Out Patient Department of general hospitals in Pune and Mumbai. SUBJECTS: 124 full term healthy infants brought for routine DPT/OPV immunization. METHODS: Infants were administered 3 doses of 0.5 ml of HbOC, on the same day as their DPT/OPV immunization, injected intramuscularly on the limb opposite to that where DPT vaccine was administered. Data on local reactions and general symptoms was collected for three days after every dose. The children had their blood collected for assay of anti PRP (polyribosil ribitol phosphate) antibody titers, along with the first injection and one month after the third injection. One hundred and three infants completed the study protocol with two blood collections. RESULTS: The initial geometric mean titers (GMT) of 0.124 mcg/ml rose by 37 times to 4.552 mcg/ml. Ninety eight children (95.1%) had a final titer of > or = 0.15 mcg/ml, the minimum level associated with protection, and 77 children (74.8%) had a final level of > or = 1.0 mcg/ml, a level associated with long term protection. CONCLUSION: HbOC is immunogenic in Indian infants when used as per the locally recommended DPT/OPV immunization schedule.

Physiological dead space & arterial to end-tidal CO2 difference under controlled normocapnic ventilation in young anaesthetised subjects.

Physiological dead space and its components were determined in 27 young, otherwise healthy anaesthetised individuals before start of surgery. A squarewave inspiratory flow pattern and an end inspiratory pause (25 and 10% of cycle time respectively) were used at a respiratory rate of around 16 bpm with minute ventilation adjusted to maintain normocapnia. The physiological dead space was found to be 2.23 ml/kg with anatomical dead space forming 110.66 +/- 27.55 ml out of 125.55 +/- 27.06 ml. While VD alv was positively correlated to pause pressure, VD ant was correlated to age, weight, and body surface area. Mean arterial end tidal carbon dioxide difference was quite low (0.24 +/- 0.44 kPa).

Management of pain in pain clinic (review of 1348 cases).

Our series have shown that psychotherapy and physiotherapy when incorporated with specific therapy, produced a much better relief from pain and that the functional return of ability of the affected part was quicker.