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1.
Epidemiol Infect ; 152: e81, 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38736415

RESUMO

Nosocomial outbreak of varicella zoster virus (VZV) has been reported when susceptible individuals encounter a case of chicken pox or shingles. A suspected VZV outbreak was investigated in a 50-bedded in-patient facility of Physical Medicine and Rehabilitation in a tertiary care multispecialty hospital. A 30-year-old female patient admitted with Pott's spine was clinically diagnosed with chicken pox on 31 December 2022. The following week, four more cases were identified in the same ward. All cases were diagnosed as laboratory-confirmed varicella zoster infection by PCR. Primary case was a housekeeping staff who was clinically diagnosed with chicken pox 3 weeks prior (9 December 2022). He returned to work on eighth day of infection (17 December 2022) after apparent clinical recovery but before the lesions had crusted over. Thirty-one HCWs were identified as contacts a and three had no evidence of immunity. Two of these susceptible HCWs had onset of chickenpox shortly after first dose of VZV vaccination was inoculated. All cases recovered after treatment with no reported complications. VZV infection is highly contagious in healthcare settings with susceptible populations. Prompt identification of cases and implementation of infection prevention and control measures like patient isolation and vaccination are essential for the containment of outbreaks.


Assuntos
Infecção Hospitalar , Surtos de Doenças , Herpesvirus Humano 3 , Centros de Atenção Terciária , Humanos , Adulto , Feminino , Índia/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/virologia , Herpesvirus Humano 3/isolamento & purificação , Masculino , Varicela/epidemiologia , Assistência de Longa Duração , Infecção pelo Vírus da Varicela-Zoster/epidemiologia
2.
Eur J Clin Microbiol Infect Dis ; 43(4): 767-775, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38372832

RESUMO

OBJECTIVE: The aim of the study was to determine the resistance profile of linezolid-resistant Enterococcus faecium (LREfm) and to investigate risk factors and outcomes associated with LREfm infections. MATERIAL AND METHODS: A prospective case-control study was undertaken (2019 to 2022) and included 202 patients with LREfm infections (cases) and 200 controls with LSEfm infections. Clinical data was prospectively collected and analysed for risk factors and outcomes. Antimicrobial susceptibility was performed, and resistance profile was studied using WHOnet. RESULTS: Risk factors associated with LREfm infection were site of infection UTI (OR 5.87, 95% CI 2.59-13.29, p ≤ 0.001), prior use of carbapenem (OR 2.85 95% CI 1.62-5.02, p ≤ 0.001) and linezolid (OR 10.13, 95% CI 4.13-24.82, p ≤ 0.001), use of central line (OR 5.54, 95% CI 2.35-13.09, p ≤ 0.001), urinary catheter (OR 0.29, 95% CI 0.12-0.70, p ≤ 0.001) and ventilation (OR 14.87, 95% CI 7.86-28.11, p ≤ 0.007). The hospital stay 8-14 days (< 0.001) prior to infection and the mortality rate (p = 0.003) were also significantly high among patients with LREfm infections. Linezolid and vancomycin resistance coexisted; further, MDR, XDR and PDR phenotypes were significantly higher among LREfm. CONCLUSION: This study provided insight into epidemiology of MDR LREfm in a setting where linezolid use is high. The main drivers of infections with LREfm are multiple, including use of carbapenems and linezolid. Invasive procedures and increased hospital stay facilitate spread through breach in infection control practises. As therapeutic options are limited, ongoing surveillance of LREfm and VRE is critical to guide appropriate use of linezolid and infection control policies.


Assuntos
Enterococcus faecium , Infecções por Bactérias Gram-Positivas , Humanos , Linezolida/farmacologia , Linezolida/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Enterococcus faecium/genética , Estudos de Casos e Controles , Centros de Atenção Terciária , Enterococcus , Carbapenêmicos/uso terapêutico , Fatores de Risco , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia
3.
J Infect Dev Ctries ; 14(2): 214-222, 2020 02 29.
Artigo em Inglês | MEDLINE | ID: mdl-32146457

RESUMO

INTRODUCTION: Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal pulmonary infection caused by Nocardia otitidiscaviarum in elderly patients. METHODOLOGY: Case 1: A 70-year old woman presented with fever and cough with expectoration for a month. On physical examination, she had tachypnea and inspiratory crepitations in bilateral basal regions. Case 2: A 74-year old man presented with productive cough with foul smelling expectoration, fever and shortness of breath for one week. On examination, he had tachypnea, bilateral wheezing and inspiratory crepitations. In both cases, sputum was sent to microbiology laboratory. On direct microscopy Gram-positive, finely branching filaments were observed which were acid fast with 1% sulphuric acid. Chalky white opaque wrinkled colonies with musty basement type odour were seen on blood agar. Both patients were treated empirically with trimethoprim-sulfamethoxazole for Nocardia infection after notification of microscopy findings however both expired on Day 2 and Day 5 of admission, respectively. Both isolates were susceptible to amikacin, linezolid, ciprofloxacin and gentamicin. They were resistant to trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanic acid, erythromycin, and imipenem. Based on biochemical identification and antimicrobial susceptibility pattern, the organism was identified as Nocardia otitidiscaviarum. The identification was confirmed using MALDI-TOF (Vitek MS, Biomerieux, France). CONCLUSION: Our report highlights the importance of early identification of Nocardia to species level to improve treatment outcomes especially in critically ill patients. Mass spectrometry can become an integral part of diagnostic algorithms for nocardiosis.


Assuntos
Farmacorresistência Bacteriana Múltipla , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Idoso , Antibacterianos/uso terapêutico , Quimioterapia Combinada , Evolução Fatal , Feminino , Humanos , Masculino , Nocardia/isolamento & purificação , Infecções Respiratórias/microbiologia , Sulfametoxazol/uso terapêutico , Trimetoprima/uso terapêutico
4.
J Microbiol Methods ; 166: 105731, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31629914

RESUMO

BACKGROUND: The mortality associated with lower respiratory tract infection is high. Indiscriminate use of antimicrobials leads to alteration of respiratory tract flora and development of multi-drug resistance. Rapid diagnostic tests to confirm infection can guide the clinicians about antimicrobial treatment. So the present study was planned to evaluate the role of direct gram stain examination as a rapid and simple test to help clinicians for appropriate patient management. METHODS: The present study was conducted on 1000 respiratory specimens which were processed using conventional microbiological techniques. Gram stain smear and culture results were compared statistically to assess the sensitivity, specificity, positive and negative predictive value. The agreement between gram stain smear examination and culture was calculated using kappa statistics. RESULTS: Potential pathogens were obtained from 28 of 209 deeply coughed out sputum samples (13.3%) and from 19 of 315 saliva mixed sputum samples (6%). Out of 473 tracheal aspirates, 115 (24.3%) had potential pathogens. The sensitivity for predicting infection was higher for good quality sputum samples (54%) as compared to poor quality sputum samples (37%). The gram stain and culture of tracheal samples had a good agreement for predicting infection whereas there was only moderate agreement for sputum sample. CONCLUSION: Gram stain smear examination from respiratory samples can be used to guide empiric antibiotic therapy pending final culture sensitivity results if the attending physicians ensure appropriate sample collection and transport. In absence of these supportive measures smear examination should not be relied upon for empiric treatment.


Assuntos
Bactérias/isolamento & purificação , Infecção Hospitalar/diagnóstico , Violeta Genciana , Fenazinas , Pneumonia Bacteriana/diagnóstico , Escarro/microbiologia , Coloração e Rotulagem/métodos , Adolescente , Adulto , Infecções Comunitárias Adquiridas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária , Adulto Jovem
5.
J Med Microbiol ; 67(4): 481-488, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29458558

RESUMO

BACKGROUND: The emergence of resistance amongst commensal flora is a serious threat to the community. However, there is paucity of data regarding antibiotic resistance in commensals in the absence of antibiotic pressure. METHODS: Altogether, 100 vaginally delivered antibiotic naïve exclusively breastfed neonates were selected. Stool samples collected on day (D)1, D21 and D60 of birth were cultured. Enterobacteriaceae isolates were screened for nalidixic acid (NA) and ciprofloxacin susceptibility as per CLSI guidelines. In 28 randomly selected neonates, isolates (n=92) resistant to NA and ciprofloxacin were characterized for the presence of plasmid-mediated quinolone resistance (PMQR) genes (qnrA, qnrB and qnrS, qepAand aac(6')-Ib-cr) and mutations in the quinolone resistance determining region (QRDR) of gyrA and parC genes by specific primers and confirmed by sequencing. RESULTS: A total of 343 Enterobacteriaceae were isolated from 100 neonates. On D1, 58 % of neonates were colonized with at least one Enterobacteriaceae predominantly E. coli. Overall resistance to NA was 60 % but ciprofloxacin resistance increased significantly from 15 % (14/96) on D1 to 38 % (50/132) on D60 (P-value <0.001). The predominant mechanism of fluoroquinolone resistance was mutation in gyrA (n=49) with or without PMQR. PMQR carrying isolates increased more than fivefold from D1 to D60. CONCLUSION: A high level of fluoroquinolone resistance in gut flora of antibiotic naïve and exclusively breastfed neonates suggests a rampant rise of resistance in the community. The source of resistance genes on D1 is probably maternal flora acquired at birth. High load of PMQR genes in commensal flora are a potential source of spread to pathogenic organisms.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Enterobacteriaceae/efeitos dos fármacos , Fluoroquinolonas/farmacologia , Trato Gastrointestinal/microbiologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Enterobacteriaceae/classificação , Enterobacteriaceae/genética , Enterobacteriaceae/isolamento & purificação , Fezes/microbiologia , Feminino , Humanos , Índia , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Plasmídeos , Prevalência
6.
Int Med Case Rep J ; 10: 289-294, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28860870

RESUMO

BACKGROUND: Concurrent dengue and mixed malaria infections in a single patient present with overlapping clinical manifestations which pose a diagnostic challenge and management dilemma in areas of common endemicities. METHODS: We report a case of a young male who tested positive for both Plasmodium vivax and Plasmodium falciparum along with dengue infection. He showed signs of early treatment failure to artemisinin combination therapy (artesunate with sulfadoxine+pyrimethamine). Molecular analysis for the drug resistance genes viz: chloroquine resistance (pfcrt), multidrug resistance (pfmdr-1), sulfadoxine (pfdhps), pyrimethamine (pfdhfr), and artemisinin resistance (keltch 13) was performed. RESULTS: A rise in parasitemia from <2% to 5% was observed after 3 days of treatment. Mutations in pfcrt, pfmdr-1, pfdhfr, and pfdhps genes were detected as a possible cause of treatment failure. CONCLUSION: Increased severity, overlapping symptoms, and suspected resistance to treatment warrants a multidimensional diagnostic approach and diligent therapeutic monitoring.

7.
Indian J Med Microbiol ; 35(2): 296-298, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28681826

RESUMO

The health-care workers (HCWs) are at an occupational risk of exposure to blood-borne pathogens, mainly, HIV, hepatitis B virus (HBV) and hepatitis C virus. HBV is currently the only blood-borne virus for which a vaccine is available. All health-care institutions must encourage the HCWs to undergo screening for blood-borne pathogens.


Assuntos
Transfusão de Sangue , Patógenos Transmitidos pelo Sangue/isolamento & purificação , Pessoal de Saúde , Exposição Ocupacional , Comportamento de Redução do Risco , Hospitais Pediátricos , Humanos , Prevalência , Medição de Risco , Centros de Atenção Terciária
8.
Cytojournal ; 13: 17, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27563340

RESUMO

BACKGROUND: To evaluate and compare the role of Ziehl-Neelsen (ZN) staining and mycobacterial culture in diagnosis of tuberculous lymphadenitis. MATERIALS AND METHODS: A total of 56 fine needle aspirations (FNAs) from patients who were clinically suspected to have tuberculous lymphadenitis were included. Acid-fast Bacilli detection was attempted by ZN staining on smears as well as culture on Middlebrook 7H9 broth. Percentage positivity of both smears and culture was calculated. RESULTS: Of the 56 cases, 46 showed cytomorphological features consistent with tuberculosis (TB). The most common pattern was only necrosis in 37 cases followed by necrotizing granulomas in 13 cases. ZN-stained smears were positive in 40 cases while culture was positive in only 27 cases. The highest smear and culture positivity was noted in cases with only necrosis. In six cases, diagnosis of TB was made on culture alone since smear was negative in these cases. CONCLUSION: FNA is a reliable technique for early and accurate diagnosis of tuberculous lymphadenitis in many cases. Mycobacterial culture by newer rapid techniques can assist in bacillary detection in smear-negative cases and also allows for drug sensitivity testing. Hence, culture should be resorted to in such cases.

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