Insight into the Burden of Antimicrobial Resistance among Bacterial Pathogens Isolated from Patients Admitted in ICUs of a Tertiary Care Hospital in India.

Intensive care unit (ICU) patients are prone to develop infections by hospital prevalent organisms. The aim of the study was to determine the bacteriological profiles and their drug resistance pattern among different infections in ICU patients of a tertiary care hospital. The record-based retrospective data of culture reports of the patients admitted to all the ICUs of a tertiary care hospital during the period from January 2020 to May 2022 were analyzed. A total of 3,056 samples were obtained from 2308 patients. The infection rate among ICU patients was found to be 53.40%. Isolates belonged equally to males (50.86%) and females (49.14%). The most common culture-positive clinical specimen received was blood (39.08%) followed by respiratory samples (29.45%). Acinetobacter sp. (33.02%) was the most common organism isolated from various clinical specimens, followed by Klebsiella pneumoniae (20.89%), and Escherichia coli (13.8%). More than 80% of Acinetobacter species were found to be resistant to third-generation cephalosporins, aminoglycosides, and carbapenems, whereas minocycline (56.31% S) and colistin (100% S) were the most effective drugs. Klebsiella sp. was found to be more resistant than E.coli, and the least resistance was observed to be tetracycline (43.97%) and doxycycline (55.84%). Among Staphylococcus aureus, 82.78% of strains were methicillin-resistant (MRSA). Vancomycin-resistant Enterococci (VRE) sp. accounted for 16.67% of the isolates. Evidence-based knowledge regarding the local bacterial organisms and their antimicrobial resistance pattern is pivotal in deciding empirical drug therapy, ultimately leading to the management of antimicrobial resistance (AMR).

Familial Mediterranean Fever Complicated By Massive Cardiac Tamponade.

Familial Mediterranean fever (FMF) is a hereditary, autosomal recessive auto-inflammatory disorder characterized by recurrent attacks of fever and serositis. While arthritis, pleuritis, peritonitis, and pericarditis are common in FMF, large pericardial effusions with cardiac tamponade as a sequelae of FMF are considered rare.  We report a case of an 83-year-old female with a history of FMF who presented with chest pain. She was found to have acute pericarditis complicated by hemodynamically significant pericardial tamponade that was subsequently treated with an urgent pericardiocentesis followed by colchicine.

Candidemia: Changing dynamics from a tertiary care hospital in North India.

Background and Purpose: Routine identification of Candida species and knowledge of antibiotic susceptibility patterns can prevent diagnostic delays and help clinicians choose appropriate empirical therapies. This study aimed to identify and speciate Candida isolates from bloodstream infections and evaluate their epidemiological profile and antibiotic susceptibility pattern in a tertiary care hospital in North India. Materials and Methods: Blood samples were cultured in the Department of Microbiology of a tertiary care hospital from January 2019 to May 2021, and the samples which showed growth of Candida species (spp.) were included in this study. Candida isolates were initially characterized by conventional techniques. Further identification and antifungal susceptibility testing were performed using Vitek 2 compact automated system. Data analysis was performed using the SPSS software (Version 25.0). Results: Candida spp. were isolated from a total of 116 blood samples, 60.92% of which belonged to males. The majority (43.10%) of isolates were obtained from 0-1-month-old neonates, followed by infants (16.38%) and children in the age range of 1-17 years (16.38%). Only 6.89% of isolates were obtained from adults older than 18 years. Candida tropicalis (26.72%) was the most common species, followed by Candida pelliculosa (19.83%), Candida albicans (17.24%), Candida parapsilosis (14.66%), Candida famata (9.48%), and Candida krusei (9.48%). Other isolated species included Candida lusitaniae, Candida sphaerica, and Candida inconspicua. Out of 116 isolates, 101 isolates were subjected to Vitek 2 susceptibility testing. Overall, 21.78% (22/101) of Candida isolates were found to be resistant/intermediate. Among C. albicans isolates, resistance was observed only against voriconazole (20%) and fluconazole (5%); however, among non- albicans Candida species (NAC), resistance was observed against flucytosine (16.04%), followed by fluconazole (14.81%), voriconazole (3.70%), and caspofungin (3.70%). Conclusion: Non-albicans Candida spp. predominated over Candida albicans in causing bloodstream infections and were found to be more resistant to antifungals. Continuous surveillance is necessary to monitor changes in epidemiological and resistance patterns.

Gastrointestinal vaso-occlusive crisis in sickle cell disease.

Although rare, gastrointestinal vaso-occlusive crisis in sickle cell disease results in potentially life-threatening ischemia and death. Here we present a case of a 34-year-old patient with sickle cell disease who developed an acute pain crisis complicated by hypovolemia, hypoxia, and hypotension. The patient was treated with supportive measures. Diagnosis can be challenging and difficult to differentiate from usual pain crisis.

Peritoneal Carcinomatosis as an Initial Presentation of Gastrointestinal Stromal Tumor: A Case Report and Review of the Literature.

Gastrointestinal stromal tumors (GISTs) are a rare type of tumor with a high risk of malignant transformation. The majority of GISTs are asymptomatic. Surgical resection remains the mainstay of treatment given that GIST is resistant to traditional chemotherapy and radiotherapy. In the last two decades, the discovery of targeted therapy with tyrosine kinase inhibitor therapy (TKI) and widespread mutation analysis of tumors have transformed the treatment of GIST. We present a case of a patient in whom imaging findings were consistent with carcinomatous peritonitis concerning a gynecological malignancy but who was later found to have an unresectable GIST which locally regressed with TKI.

Nitrofurantoin Susceptibility Pattern in Gram-Negative Urinary Isolates: In Need of Increased Vigilance.

Nitrofurantoin is the first-line drug in the treatment of uncomplicated urinary tract infections (UTIs) and its use has increased exponentially in recent years. Objectives This study aims to determine the susceptibility pattern of nitrofurantoin in gram-negative urinary isolates and to evaluate their bacteriological and epidemiological profile along with co-existing resistance to other important urinary antimicrobials. Material and Methods This was a retrospective study conducted in a tertiary care hospital in New Delhi in which 500 gram-negative bacterial urinary isolates were evaluated. Records of antimicrobial susceptibility were reviewed from July to September 2019. Antimicrobial susceptibility was performed using the Kirby-Bauer disk diffusion method on Mueller Hinton agar and interpreted using CLSI 2019. Test for extended spectrum ß-lactamase (ESBL) producers was done using double disk approximation test. Statistical Analysis Data analysis was performed using the SPSS windows version 25.0 software. Results Out of total 500 isolates, 20.17% (94) isolates were resistant (R) to nitrofurantoin and 9.01% (42) were found to be intermediate (I). Highest resistance was seen in Klebsiella sp. (44.61%) and Escherichia coli (8.12%). About 28.82% of the I/R isolates were of the pediatrics age group and most of the isolates belonged to females (64.69%). High resistance was also seen against ampicillin (92.30%), cefazolin (88.46%), ceftazidime (73.0%), and fluoroquinolones (65.38%). Carbapenemase co-resistance was seen in 57.15% isolates whereas ESBL production was seen in 30.76% of E. coli and 12.06% of Klebsiella sp. Conclusion Increase in multidrug resistance uropathogens along with a near absence of novel oral antibiotics has led to increased consumption of nitrofurantoin since its resistance has increased.

Synthesis and Characterization of Nitrogen Doped Reduced Graphene Oxide (N-rGO) Supported PtCu Anode Catalysts for Direct Methanol Fuel Cell.

Incomplete methanol oxidation and rapid activity degradation of electro-catalysts are key barriers to successful commercialization of direct methanol fuel cell (DMFC). To address these problems, we report the synthesis of platinum-copper (PtCu) alloy nanoparticles supported on nitrogen doped reduced graphene oxide (N-rGO) as the anode catalyst for the efficient electro-oxidation of methanol. Catalysts with varying molar ratios of PtCu were fabricated using impregnation reduction method and their electrochemical performance was compared with the commercially available Pt/C (20 wt%) anode catalyst. The electro-catalytic activity of the synthesized PtCu (1:2)/N-rGO catalyst was found to be much higher to those that observed for Pt/N-rGO and Pt/C catalyst as revealed by cyclic voltammetry, electrochemical impedance spectroscopy and electron transfer measurements. The enhanced electrochemical activity of PtCu (1:2)/N-rGO catalyst is not only attributed to strong interfacial interaction between the nitrogen group of N-rGO and PtCu active metal phase but also to the altered electronic structure of Pt as a result of Cu alloying. This reduces the adsorption of CO and OH- species on Pt surface, thereby creating more Pt active sites for methanol electro-oxidation; thus faster kinetics is exhibited. These results indicate the potential application of PtCu/N-rGO catalyst as an anode material in a DMFC.