Healthcare-associated blood stream infections: An evaluation of blood culture as indicator

Background: A nosocomial infection or healthcare-associated illness that develops in patients after they are admitted to the hospital but was not present or incubating at the time of admission is referred to as a hospital acquired infection. In patients with severe viral and fungal infections today, it is one of the most prevalent and life-threatening consequences. Blood culture is one of the most important diagnostic tools for the diagnosis of hospital acquired infections. It can also help in providing a clinical as well as an etiological diagnosis. Aims and Objectives: The aim of the study is early detection of blood stream infections along with its antibiotic susceptibility pattern. Materials and Methods: All samples were obtained and processed using conventional microbiological techniques, and an antibiotic sensitivity test was carried out in accordance with CLSI recommendations. Results: Total 160 samples were processed, out of which 54 (34%) samples were positive. Out of 54 positive blood sample, maximum samples were from NICU (28) 52%, followed by causality (10) 18%, PICU (4) 7%, HDU (2) 3%, intensive careunit (4) 7%, surgery (6) 11%, and overall males contributed to higher positivity rate. Total nine different organisms were isolated, out of which Gram negative bacilli were comprised 40 (74%), Gram positive cocci 8 (14%) and Candida were 6 (11%). Among Gram-negative bacilli of most common species were Klebsiella pneumonia (30%), Acinetobacter baumanii (18%), Pseudomonas aeruginosa (11%), Burkhoderia cepacia (11%), and Serratia fonticola (3%). The most prevalent isolated species of gram-positive cocci were Staphylococcus aureus (11%), Coagulase negative S. aureus (3%), and Enterococcus faecalis (3%). Conclusion: This study on blood culture gives insight to magnitude of hospital acquired infections in our set up. Again result of antibiotic susceptibility tests gives overview of drug resistance problem at our set up. This may help in antibiotic stewardship program.

A Comparative Evaluation Of Dexamethasone As An Adjunct To Bupivacaine And Levobupivacaine For Supraclavicular Brachial Plexus Block Using Peripheral Nerve Stimulator

Background:Dexamethasone appears to be effective in prolonging the duration of analgesia from supraclavicular brachial block using levobupivacaine or Bupivacaine. Long acting local anaesthetic, Bupivacaine is associated with cardiac and central nervous system toxicity which prompted the researchers to develop new local anaesthetic agent with a profile similar to bupivacaine but avoiding the toxic effects. Therefore, the aim of the present study is to test the hypothesis that adding dexamethasone significantly prolongs the duration of analgesia for levobupivacaine and bupivacaine and the magnitude of the effect differs among the two local anaesthetics. Methods: A prospective, randomized study was undertaken at JN Medical College. 120 patients posted for upper limb surgeries under Supraclavicular Brachial Plexus Block were assigned into four groups, each containing 30 patients. Group I received 25 ml Bupivacaine 0.5% and 2ml NS. Group II received 25 ml of Bupivacaine 0.5% and 2ml dexamethasone(8mg) .Group III received 25 ml of Levobupivacaine 0.5% and 2ml NS. Group IV received 25 ml of Levobupivacaine 0.5% and2ml dexamethasone (8mg). Results:Dexamethasone significantly prolonged the duration of analgesia of both levobupivacaine and bupivacaine. Conclusion:Dexamethasone prolongs analgesia in supraclavicular blocks using either levobupivacaine or bupivacaine. Considering the less cardiotoxic profile of levo-bupivacaine it should be preferred over bupivacaine.

Ruptured Hepatocellular Carcinoma in a Child with Budd-Chiari Syndrome.

Background: Hepatocellular carcinoma is an uncommon complication described in patients with Budd-Chiari syndrome. Case characteristics: A 12-year-old boy with Budd-Chiari syndrome, who was earlier treated with Transjugular intrahepatic porto-systemic shunt (TIPS), presented with acute onset hemoperitoneum and hypotension. Outcome: It was diagnosed to be a case of ruptured hepatocellular carcinoma. Message: Successful TIPS may not prevent the development of hepatocellular carcinoma, and children with Budd Chiari syndrome should be monitored for the same.

A Rare Presentation of Osler-Weber-Rendu Disease as Severe Anemia.

Hereditary hemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu disease is a rare fibrovascular dysplasia that makes vascular walls vulnerable to trauma and rupture causing skin and mucosal bleeding. It is of autosomal dominant inheritance characterized by recurrent epistaxis and telangiectasia on the face, hands and oral cavity; visceral arteriovenous malformations (AVMs) and positive family history. Epistaxis is often the foremost manifestation. It is associated with AVMs in several organs. There are possible hematologic, neurologic, pulmonary, dermatologic and gastrointestinal complications. Treatment is supportive and helps prevent complications. We report herein a patient with this syndrome who came to Medicine Unit first at our hospital.