A prospective study evaluating the effect of a "Diagnostic Stewardship Care-Bundle" for automated blood culture diagnostics.

OBJECTIVES: We prospectively implemented a diagnostic stewardship care-bundle checklist, 'Sepsis-48 DSB', with the aim of reducing intervening duration of key steps of automated blood culture diagnostics (aBCD). METHODS: Sepsis-48 DSB was implemented for automated blood culture bottles (BCBs) received from adult intensive care units (AICUs) during the intervention period (P2; July 2020-June 2021) and intervening durations were compared with those during the retrospective, pre-intervention period (P1; March-June 2020). During both periods, provisional blood culture reports (pBCR) were issued wherein direct microbial identification (dID) was performed in BCBs with Gram-negatives by directly inoculating conventional biochemical tests and direct antimicrobial susceptibility testing (dAST) using EUCAST RAST method. The results were compared with the standard of care (SoC) method (i.e. full incubation followed by identification and AST by VITEKⓇ-2 Compact). RESULTS: During P2, significant reductions in loading time (LT; median: 63.5 vs. 32 minutes, P < 0.001), time to dID+dAST performance (TTD; 186 vs. 115 minutes, P = 0.0018) and an increase in compliance to bundle targets (LT ≤45: 44% vs. 66%, P = 0.006 and TTD ≤120: 34% vs. 51.7%, P = 0.03) were observed. Using dID+dAST method, results were read 694 minutes earlier than SoC method. Of 176 pBCR, 165 (94%) were concordant with SoC in microbial identification of species. Categorical agreement for any drug-bug combination was 92.7% (1079/1164) and corresponding major, very major, and minor error rates were 8.8% (19/216), 4.9% (45/921), and 1.8% (21/1164), respectively. CONCLUSION: The 'diagnostic stewardship care-bundle' strategy was successfully implemented with considerable diagnostic accuracy leading to significant reductions in duration of targeted steps of aBCD.

A prospective study evaluating the effect of a 'Diagnostic Stewardship Care-Bundle' for automated blood culture diagnostics.

OBJECTIVES: We prospectively implemented a diagnostic stewardship care-bundle checklist, 'Sepsis-48 DSB', with the aim of reducing intervening duration of key steps of automated blood culture diagnostics (aBCD). METHODS: Sepsis-48 DSB was implemented for automated blood culture bottles (BCBs) received from adult intensive care units (AICUs) during the intervention period (P2; July 2020-June 2021) and intervening durations were compared with those during the retrospective, pre-intervention period (P1; March-June 2020). During both periods, provisional blood culture reports (pBCR) were issued wherein direct microbial identification (dID) was performed in BCBs with Gram-negatives by directly inoculating conventional biochemical tests and direct antimicrobial susceptibility testing (dAST) using EUCAST RAST method. The results were compared with the standard of care (SoC) method (i.e. full incubation followed by identification and AST by VITEKⓇ-2 Compact). RESULTS: During P2, significant reductions in loading time (LT) [median: 63.5 vs. 32 minutes, P < 0.001], time to dID+dAST performance (TTD) [186 vs. 115 minutes, P = 0.0018] and an increase in compliance to bundle targets [LT ≤45: 44% vs. 66%, P = 0.006 and TTD ≤120: 34% vs. 51.7%, P = 0.03] were observed. Using dID+dAST method, results were read 694 minutes earlier than SoC method. Of 176 pBCR, 165 (94%) were concordant with SoC in microbial identification of species. Categorical agreement for any drug-bug combination was 92.7% (1079/1164) and corresponding major, very major, and minor error rates were 8.8% (19/216), 4.9% (45/921), and 1.8% (21/1164), respectively. CONCLUSION: The 'diagnostic stewardship care-bundle' strategy was successfully implemented with considerable diagnostic accuracy leading to significant reductions in duration of targeted steps of aBCD.

Mumps Antibody Titer in MMR-Vaccinated and Vaccine Naïve Children at a Public Hospital in Delhi.

OBJECTIVE: To compare the mumps antibody titers in Measles-Mumps-Rubella (MMR)-vaccinated and vaccine naive children. METHODS: This cross-sectional study was conducted at a tertiary-care public hospital in Delhi from November, 2016 to April, 2018 among 78 healthy children (aged 16 month-12 years) attending the pediatric outpatient department. Serum IgG and IgM rubella antibodies were measured by ELISA for confirmation of MMR vaccination status. Qualitative determination of IgG mumps was done followed by quantitative determination in samples positive for IgG mumps antibodies. RESULTS: IgG mumps was present in 69.2% of study population, with seroprotective titers in 32% taking endpoint titer as 1:4. Among MMR vaccinated children, 41.1% were sero-protected and in MMR vaccine naïve children 9.1% were seroprotected for mumps. CONCLUSION: Single dose of MMR vaccine does not provide effective (>90%) sero-conversion required for successful herd immunity to prevent mumps outbreak.

Prevalence of cryptosporidiosis in symptomatic immunocompetent children and comparative evaluation of its diagnosis by Ziehl-Neelsen staining and antigen detection techniques.

BACKGROUND: Cryptosporidia is a major pathogen causing diarrhoea and with increasing morbidity and mortality. As persistent diarrhoea from intestinal cryptosporidiosis leads to increased susceptibility to recurrent diarrheal episodes further leading to chronic nutritional and cognitive sequelae or even death, diagnosis is important. Most of the studies done on Cryptosporidium worldwide have focused on immunocompromised patients which have led to a paucity of data on its prevalence among immunocompetent people. AIMS AND OBJECTIVES: Keeping these facts in mind the present study was aimed to estimate prevalence of cryptosporidiosis in immunocompetent children, and do a comparative evaluation of its detection by microscopy with antigen detection methods. MATERIAL AND METHODS: 80 immunocompetent children (40 OPD children presenting with diarrhea and 40 children hospitalized for diarrhea) upto age of 5 years were studies and their stool samples were compared by microscopy by mZN with copro-antigen detection methods (using rapid ICT and ELISA) for the diagnosis of Cryptosporidiosis. RESULTS: A Cryptosporidium prevalence rate of 22.5% was detected in the immunocompetent children upto 5 years of age. Microscopy remained the preferred method of diagnosis for Cryptosporidium being a more sensitive test and considering it's low cost in resource poor settings. Moderate agreement between mZN and ELISA in Cohen's kappa test shows that either of the tests can be used for diagnosis of Cryptosporidium from fecal sample. ELISA is time-saving method but ELISA and rapid antigen tests should not be used as the sole method of diagnosis. Keeping in view the ICT kit used in this study is species specific, and the species identification was not carried out in the present study, hence genus specific kits may be useful for diagnosis in such settings. CONCLUSION: Microscopy remains the preferred method of diagnosis for Cryptosporidium having good sensitivity and specificity and considering it's low cost in resource poor settings. ELISA is time-saving method but ELISA and rapid antigen tests should not be used as the sole method of diagnosis.