Aerococcus viridans Bacteremia: A Rare Case Report from India.

Aerococci are fastidious, gram-positive Streptococcus-like organisms widely distributed in the hospital environment. Aerococcus viridans is primarily an opportunistic pathogen. Very few cases of A. viridans bacteremia have been reported so far probably because of its misidentification as streptococci. Here we report an interesting case of A. viridans bacteremia. How to cite this article: Varshini K, Ganesan V, Charles J. Aerococcus viridans Bacteremia: A Rare Case Report from India. Indian J Crit Care Med 2022;26(1):127-128.

Device-Associated Hospital-Acquired Infections: Does Active Surveillance With Bundle Care Offer a Pathway to Minimize Them?

Background and objective The prevalence of hospital-acquired infections (HAIs) is underreported in developing nations due to a lack of systematic active surveillance. This study reports the burden of device-associated HAIs (DA-HAIs) based on two years of active surveillance with in situ bundle care in closed intensive care units (ICUs) of a tertiary care hospital. Materials and methods A prospective surveillance study was carried out in 140-bedded ICUs (2,100-bed hospital) of a tertiary care private medical college hospital. Daily active surveillance for catheter-associated urinary tract infection (CAUTI), ventilator-associated event (VAE), and central line-associated bloodstream infection (CLABSI) was done by trained infection control nurses (ICNs) along with quality champion nurses with HAI surveillance forms with bundle care auditing, which was attached to the case sheets of all patients on devices. The surveillance definitions of DA-HAIs were adapted from the Centers for Disease Control and Prevention (CDC)'s National Healthcare Safety Network (CDC-NHSN) 2017 surveillance criteria. Data were analyzed at the end of every month to generate the cumulative device-associated infection (DAI) rates and device utilization ratio (DUR). These data were compared with NHSN and International Nosocomial Infection Control Consortium (INICC) - India HAI rates and communicated to corresponding ICUs and also presented at the hospital infection control committee (HICC) meeting. Results The surveillance data were reported over 71,877 patient days during the study period. The DUR of urinary catheters, ventilator, and central line were 0.53, 0.16, and 0.22, respectively. CAUTI, VAE, and CLABSI rates were 0.97, 10.5, and 0.43 per 1,000 device days, respectively. Among 166 DA-HAIs reported, 182 pathogens were identified. Klebsiella pneumoniae was the most common organism isolated, accounting for 37.4% of all DA-HAI cases, followed by Acinetobacter baumanii (30.8%). Most of the Gram-negative organisms were carbapenem-resistant (153/175; 87.4%). Vancomycin resistance rate in Enterococcus was 28.5% (2/7). Conclusion DUR and CAUTI, VAE, CLABSI rates were less/on par with the benchmarks of INICC and CDC-NHSN in almost all ICUs of our tertiary care unit. Gram-negative pathogen with 87.4% carbapenem resistance worsened the scenario. Proper active surveillance with bundle care and training by ICNs made a significant difference in all DA-HAI rates, especially VAE, which decreased to 10.5 from 23.6 per 1,000 ventilator days. Sustained active surveillance of HAI and bundle care auditing by a trained infection prevention team with a stringent antibiotic policy are the need of the hour to combat DAIs.

Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India.

INTRODUCTION: Implementation of evidence-based infection control practices is the need of the hour for every institute to reduce the device-associated infections, which directly reflects the quality of care. As catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection, the study was planned to evaluate the impact of the catheter care bundle in reducing CAUTI incidence. MATERIAL AND METHODS: The prospective interventional study before and after the trial study was carried out in adult intensive care units over a period of 9 months (April-June 2017-pre-implementation phase; July-September 2017-training of healthcare worker and implementation of catheter care bundle; October-December 2017-post-implementation phase). Catheter-associated urinary tract infection rates pre- and post-implementation were expressed as incidence rates with Poisson confidence interval. RESULTS: Statistically significant reduction was found in the incidence of CAUTI (60%-from 10.7 to 4.5 per 1,000 catheter days). The key factors that contributed were significant reduction in device utilization ratio (from 0.71 to 0.56) and average catheter days per patient (from 4.8 to 3.7). This holistic approach has resulted in less incidence of CAUTI even among patients with risk factors and prolonged catheter days. Neuro ICU showed drastic improvement compared to other ICUs due to the poor baseline status of their care practices. CONCLUSION: Adherence to all elements of care bundle brought a significant decrease in CAUTI. Implementing care bundle and auditing the adherence to each element should be included as a part of routine hospital infection control committee (HICC) practices. CLINICAL SIGNIFICANCE: Hospital-acquired infection directly reflects on the quality care of the hospital. Bundle care is an "all or none" phenomenon. Adherence to each element will have some influence in reducing CAUTI in terms of reducing the device utilization ratio and average catheter days per patient. Auditing the care bundle adherence is having a positive influence on the outcome. HOW TO CITE THIS ARTICLE: Soundaram GVG, Sundaramurthy R, Jeyashree K, Ganesan V, Arunagiri R, Charles J. Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in the Intensive Care Units of a Tertiary Care Teaching Hospital in South India. Indian J Crit Care Med 2020;24(7):544-550.

Seroprevalence of transfusion transmissible infections among blood donors by chemiluminescent assay in a tertiary care centre.

INTRODUCTION: Blood transfusion is a life saving measure, but also carries risk of transfusion transmitted infections (TTIs). In spite of improved donor screening, risk of transmission of TTIs still remains a major concern. Stringent screening of blood not only ensures safe supply of blood and blood products, but also gives us an idea about prevalence of TTIs among general population. METHODOLOGY: Blood donors (voluntary and replacement), fulfilling national and regional blood bank criteria, attended our blood bank, during Jan 2015-Dec 2016 (included). Retrospective data analysis was performed by a structured database. After obtaining informed consent, venous blood was collected and analysed for HBsAg, anti-HCV and Anti-HIV1 and 2 (Chemiluminescent assay -OrthoVitrosECi/ECiQ), Malaria (ICT-pf/pan-Alere) and Syphilis (RPR-Labcare Dignotics). RESULTS: A total of 9027 donors were screened; Males and females were 99.23% and 0.76% respectively with the mean age of 27.4 ± 2 years (19-58 years). Voluntary donors were 68.7%; replacement donors 31.3%. Voluntary donation increased by 3% in 2016 (69.7%) vs 2015 (67.1%). TTI prevalence was 1.12% (102/9027). Surprisingly prevalence was higher among voluntary donors, females and 21-30 years. Seroprevalence of HBV (0.42%), HIV (0.13%), and Malaria (0.01%), in our region was relatively inferior than other parts of country. Nonetheless, HCV (0.56%) infections were on the rise. No syphilis case was reported. Low seropositivity rate is believed to be attributed to improved counselling of blood donors, adherence to standard donor selection criteria and rational use of blood. CONCLUSION: Even though low prevalence, effective control strategies including stringent screening, implementation of more sensitive tests and health education are urgently needed to prevent those TTIs.

Evaluation of Ica Gene in Comparison with Phenotypic Methods for Detection of Biofilm Production by Coagulase Negative Staphylococci in a Tertiary Care Hospital.

BACKGROUND: Biofilm producing bacteria are responsible for several chronic infections and are difficult to treat as they show much greater resistance to antibiotics. The major virulence factor determining the pathogenicity of CoNS has now well defined and found to be biofilm production. OBJECTIVE: The study was conducted to isolate and characterize Coagulase Negative Staphylococci (CoNS) and their ability to form biofilms was evaluated by phenotypic and genotypic methods. MATERIALS AND METHODS: A total of 96 clinical isolates of CoNS were characterized and subjected to biofilm detection by tissue culture plate method (TCP), tube method (TM), congo red agar method (CRA) and PCR. RESULTS: Staphylococcus epidermidis was the most commonly isolated species 76(79.17%). The ica gene was present in 35 (36.45%) of CoNS isolates which were detected as biofilm producers by TCP. Biofilm producing isolates showed higher antibiotic resistance(72.1%). Majority of biofilm producers had strong association with medical device related infections. CONCLUSION: To compare PCR based dectection method for presence of ica genes with TCP, the test share the specific identification rates. The sensitivity and specificity of TCP method in detection of biofilm was high in comparison with TM and CRA. TCP can be recommended as a general screening test for biofilm detection.